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Table 1 Key definitions

From: Strategic partnering to improve community health worker programming and performance: features of a community-health system integrated approach

Keywords Definition
Community health worker A health worker who receives limited standardized training outside the formal nursing or medical curricula to deliver a range of basic health, promotional, educational and mobilization services and has a defined role within the community system and larger health system. This label applies to a heterogeneous cadre of frontline health workers operating in a diverse set of countries and contexts. For example, in some countries, a CHW may be a full-time, paid employee of the government, while in other countries, he or she may be an unpaid, full- or part-time volunteer supported by an NGO. Both types of CHW may be present in the same country.
Health system All people, institutions, resources and activities whose purpose is to promote, restore and/or maintain health [93]. The health system includes NGOs working in concert with the public and private sectors to provide services and achieve these goals.
Community A social group comprising both kin and non-kin social networks that share a sense of connectedness – through shared values, common interests and/or adherence to norms of reciprocity – and which perceives itself as distinct in some respect from the larger society in which it resides [95]. Potential sources of support for CHWs in the community include both public sector and civil society entities, such as village or neighbourhood health committees, religious leaders and faith-based organizations, social support associations, community-based organizations, multi-sectoral organizations, political and governance groups and women leaders.
CHW support Quality CHW programming comprises a wide range of support activities that explicitly target CHWs and are undertaken by a range of actors in the health system and the community. We have subsumed these support activities, for both the health system and the community, under three common rubrics: technical support, social support and incentives. Technical support includes efforts to design well-functioning CHW programmes that deliver, through sound implementation and management, high impact, evidence-based interventions, monitor adequacy of implementation and evaluate effectiveness. Social support includes fostering partnerships, strengthening linkages with various health and community system actors and entities that can support CHWs in their efforts and providing opportunities for CHWs to interact and support one another. Incentives encompass non-financial, in-kind and financial inducements (including salaries) that are commonly used to motivate CHWs to enhance and sustain their performance.
CHW performance We define CHW performance in relation to the specific roles and responsibilities of CHWs in a given context in three ways: outputs, outcomes and impact. Outputs are proximate measures of performance that occur at the level of the individual CHW. Some are indirect measures, such as cognitive/psycho-motor (for example, knowledge and skills acquisition) or affective (for example, self-efficacy/self-esteem, confidence or personal satisfaction) CHW-level changes, while others are direct behavioural measures that occur at the interface of CHWs and clients, such as absenteeism, the quantity and quality of service delivery, responsiveness to clients and productivity. Attrition and advancement are measures of CHW developmental changes over time. Outcomes are intermediate measures, defined as CHW-attributable changes that occur among individual clients (for example, healthcare-seeking behaviour or health-promoting behaviour in the home), as well as effects on communities and health systems (for example, changes in social cohesion or cost savings to the health system, respectively). Impact refers to more distal measures, defined as CHW-attributable changes in health (for example, morbidity and mortality) at the population level.