Table 2 Summary of illustrative challenges and potential responses, by strategy
Strategy | Illustrative challenge | Potential response |
|---|---|---|
1. Joint ownership and design of CHW programmes | Overcoming resistance from established interests | • Capitalize on health sector decentralization to build mutual respect and trust among CHWs and the many community and health system actors |
• Mobilize community and health system leaders accountable to the entire community | ||
• Establish explicit structures and processes for community and health system collaboration | ||
2. Collaborative supervision and constructive feedback | Engaging communities in the supervisory process and institutionalizing the approach | • Build a new model of collaborative supervision from the ground up that responds to local context and takes advantage of community and health system assets |
• Enlist health system supervisors as mentors of community counterparts through on-the-job training and learning by doing | ||
• Encourage and facilitate community reporting on CHW performance that engages health system supervisors in design and implementation | ||
• Explore the potential of relatively inexpensive mobile communication media, keeping in mind its limitations | ||
3. Balanced package of incentives | Identifying the proper mix and sources of financial and non-financial incentives | • Develop a menu of options with explicit statements of advantages and disadvantages of each |
• Test and modify different approaches to optimizing the impact of the complementary contributions of communities and health systems | ||
• Maximize the full potential of non-financial incentives originating in both communities and health systems | ||
4. Monitoring system | Resistance by health system to support continuous monitoring in the presence of a functioning HMIS | • Present monitoring system as an extension of HMIS, as a means of enhancing its utility by addressing its current limitations |
• Adopt a long view; build capacity through learning by doing; find incentives for data collection and use; leverage community and health system assets to support and sustain | ||
Adequate implementation and ensuring data quality | ||
• Judiciously stage and combine external periodic assessments with continuous data collection, learning, feedback and adjustment | ||
Overcoming preference for periodic surveys and external assessments/evaluations |