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