empowerment and ownership: achecklist to sustain community health workers

Title PageEmpowerment and Ownership:A checklist to Sustain Community

Health Workers

Dr. Elvira BeracocheaMIDEGO, Inc.

[email protected]

Dr. Chidi UkanduMIDEGO-Nigeria

[email protected]

Opportunity in Nigeria

• Population: Est. 170 million• Physician Density: 0.4/1000 people• Nurses & Midwives Density: 1.6/1000 people• Community Health Workers Density: 0.1/1000

people• Life expectancy: 52 years• Infant Mortality Rate: 74/1000 live births• Maternal mortality: 630 deaths/100,000 live

births• Health system ranked 187 out of 191 countries

by WHO in 2000

Community Health Workers & Healthcare Systems

• The use of CHW has been identified as one strategy to address the growing shortage of health workers in low income countries

• Robust evidence exists that CHWs can undertake actions that lead to improved health outcomes

• Although they can implement effective interventions the quality of health services they provide is sometimes poor

• For CHWs to make an effective contribution they must be carefully selected and appropriately trained and supervised and linked to supporting facility and made to feel “proud of their contribution” to the community and competent

Creating Empowerment and Ownerrship

• Participate in the design, implementation and evaluation of the programs they implement

• Participate in the tracking of their own improvement and help them to account for their own achievements

Community Health Workers in Nigeria

• CHO• CHEW• CBHV• TBAs• CDIs• Home based HIV care givers• Ward and Village Development

Committees and Local Leaders

Country led development programme starting with 10 items

1. Hand washing2. Antenatal, delivery/Postnatal Care3. Use of bednets4. Exclusive breast feeding5. Appropriate nutrition6. Routine immunization7. Birth spacing and family planning8. Malaria prevention9. Diarrhea and ORS10. Smoking cessation

Empowering CHWs to take action using a simple tool: the checklist

• A simple list of tasks to achieve a defined quality objective

• Can be carried around by CHWs• Allows for consistency in delivery of care• Prevents “action paralysis” due to

overwhelming challenges• Participatory and requires minimal training• Can be deployed rapidly

Sample checklist for hand washing

1. Smile and greet “guest”2. Introduce yourself3. Explain to guest why hand washing is important – very powerful for

preventing diseases4. Ask if guest can easily get access to clean water and soap5. If no, explore possible sources for getting access to clean water

with guest6. If yes, now explain the process the guest shall take to start

implementing hand washing immediately7. Demonstrate correct hand washing8. Have guest repeat procedure,9. Have guest invite others in HH to wash hands10.Set another date to meet with guest to evaluate progress 11.Thank guest for his/her time

Steps to be Developed by the CHW

1. Find a source of clean water for washing near the bathroom and kitchen at home. At work, have a source of clean water near every patient examination area. If you do not have a faucet, use a plastic bottle or bucket with a ladle to save water

2. Find soap and a clean cloth or towel to dry your hands

3. Pour water on both hands

4. Use soap to form a good amount of foam and rub palms, back of hands and in between fingers while counting slowly up to 20.

5. Rinse both hands with water

6. Inspect your hands and the hand of children after washing to ensure hands are clean and whether you need cut nails if long or there is dirt underneath.

7. Repeat if not clean.

Measuring Effectiveness: The Weekly Scorecard

1. Number of children born

2. Number of children who are exclusively breastfed

3. Number of children with adequate weight for age

4. Number of pregnant women

5. Number of pregnant women who have at least had one ANC visit

6. Number of immunized children

7. Number of people diagnosed with Malaria

8. Number of cases of diarrhea

9. Number of people who smoke

Next Steps

• Raise U$100,000 to implement and evaluate the project

• Scale up the project into a statewide and national program

empowerment and ownership: achecklist to sustain community health workers

Health & Medicine