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Table 2 Summary of illustrative challenges and potential responses, by strategy

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

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