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Table 2 Table comparing the frequency distribution of the acceptability and feasibility of the policy options under consideration

From: Stakeholders’ perceptions of policy options to support the integration of community health workers in health systems

Policy options Acceptability Feasibility P value† Mean score for acceptability (n = 95) Mean score for feasibility (n = 92)
DNA (%) UA (%) DA (%) DNF (%) UF (%) DF (%)
1. Compared to other methods or no assessment at all, how acceptable is the use of this questionnaire to rate the acceptability by stakeholders of implementing CHW policy interventions? 4 41 54 10 33 57 0.24* 6.3 6.2
Selection, education and certification
2. Using essential and desirable attributes to select CHWs for pre-service training 0 16 84 3 12 85 0.17* 7.3 7.2
 (a) Adopting only CHWs who have completed a minimum of secondary education (relative to lower levels of literacy) 29 35 36 29 25 46 0.27 5.2 5.5
 (b) Selecting older candidates on the basis of age (relative to random age selection) 37 43 20 25 47 28 0.17 4.5 5.2
 (c) Selecting members of the target community (relative to selecting non-members) 5 28 67 9 20 71 0.36 6.9 7.0
3. Training of CHWs for a short period (could range from a number of days to 1 month relative to training for a longer period of 6 months to 3 years) 13 26 62 7 20 74 0.16 6.4 7.0
4. Having standardized educational curricula 8 22 71 9 20 72 0.92 6.8 7.0
 (a) Curricula addressing biological /medical (determinants, basic notions of human physiology, pharmacology, and diagnosis and treatment) 22 35 43 19 35 46 0.8 5.6 5.8
 (b) Curricula addressing household level preventive behaviours in relation to priority health conditions 1 7 91 1 11 88 0.71* 7.9 7.8
 (c) Curricula addressing education about social determinants of health 1 13 86 2 13 85 0.83* 7.6 7.6
 (d) Curricula addressing counselling and motivation skills (including communication skills) 1 7 92 1 9 90 0.87* 8.0 7.8
 (e) Curricula addressing scope of practice (attitude, when to refer patients, range of tasks, power relationships with the client, personal safety) 1 13 86 1 13 86 1* 7.9 7.8
 (f) Curricula should address CHW integration within the wider system (access to resources) 2 14 84 2 18 80 0.78* 7.7 7.5
5. Issuing a formal certification for CHWs who have undergone competency-based pre-service training 3 15 82 2 16 81 0.89* 7.6 7.6
Management and supervision
6. Strategic supervision support for CHWs 0 9 91 1 13 86 0.34* 8.2 7.8
 (a) Coaching of CHWs 0 11 89 4 12 84 0.12* 8.0 7.5
 (b) Use of task checklists 1 13 86 1 9 90 0.7* 7.9 7.8
 (c) Observation of CHWs at facility 7 21 73 5 20 75 0.93 7.1 7.2
 (d) Observation of CHWs at community and facility 2 12 86 2 11 87 0.98* 7.8 7.6
 (e) CHWs supervising CHWs 16 32 52 14 28 58 0.76 6.1 6.3
 (f) Higher cadre health workers supervising CHWs 3 11 86 2 17 81 0.48* 7.7 7.5
 (g) Trained supervisor 3 8 89 0 9 91 0.22* 7.9 7.8
 (h) Assessing CHWs by service delivery supervision only 29 40 31 15 27 58 < 0.01 5.2 6.3
 (i) Assessing CHWs by service delivery supervision and community feed-back 3 10 87 1 21 78 0.07* 7.6 7.4
7. Rewarding CHWs for their work 1 14 85 3 11 86 0.51* 7.9 7.6
 (a) Monetary incentives 5 29 66 13 24 63 0.17 7.2 6.7
 (b) Non-monetary incentives 8 19 73 7 19 75 0.95 7.2 7.1
 (c) Benchmarking full-time CHW salary to the government minimum wage of the locality 11 31 59 18 29 52 0.31 6.7 6.2
8. CHWs having a career ladder opportunity/ framework within the health and education systems 6 18 76 13 34 53 < 0.01 7.3 6.4
Integration in and support by health system and communities
9. CHWs having a formal contract within the health system 5 24 71 10 30 60 0.24 7.0 6.7
10. CHWs collecting and submitting data on their routine activities 1 3 96 1 11 88 0.12* 8.0 7.7
11. Community engagement strategies to support practicing CHWs (including village health committees and community health action planning activities) 1 7 92 0 13 87 0.27* 7.9 7.6
12. Proactive community mobilization by CHWs (identifying priority health and social problems, mobilizing local resources, engaging communities in participation of health service organization and delivery) 0 7 93 1 15 84 0.14* 8.0 7.5
13. Providing strategies to ensure adequate availability of commodities and consumable supplies in the context of practicing CHW programmes 1 11 88 1 16 83 0.61* 7.9 7.4
 (a) Ensuring inclusion of relevant commodities in the National Pharmaceutical Supply Plan or equivalent national supply chain plan 2 16 82 2 21 76 0.64* 7.9 7.3
 (b) Simplified stock management tools and visual job aids for CHWs that accommodate low literacy with minimum data points to facilitate recording of data and re-supply 1 9 90 1 15 84 0.43* 8.0 7.6
 (c) Use of mobile phone applications (mHealth) for reporting stock and other data 0 20 80 3 31 66 0.04* 7.4 7.0
 (d) Co-ordination, supervision and standardization of resupply procedures, checklists and incentives 1 11 88 1 20 79 0.22* 7.8 7.3
 (e) Products specifically designed for use by CHWs (presentation, strength, form and packaging) 4 19 77 5 25 69 0.53* 7.3 7.0
 (f) Use of social media to manage commodity distribution 9 52 39 10 49 41 0.89 6.0 6.0
  1. DNA definitely not acceptable, UA uncertain whether acceptable or not, DA definitely acceptable, DNF definitely not feasible, UF uncertain whether feasible or not, DF definitely feasible
  2. *These statistics should be interpreted with caution as at least one cell contained less than 5 observations
  3. †Chi-square comparing acceptability distribution with feasibility P value
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