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Table 1 Operational definitions of measurement constructs in the Community Health Worker Performance Measurement Framework

From: A conceptual framework for measuring community health workforce performance within primary health care systems

 Indicator DomainDefinitions/explanationsReferences
 Inputs
1.PoliciesNational-level policies that support the development and deployment of CHW programs 
CHW selectionAge, education and other policy-supported requirements for being eligible to become a CHW are listed[5, 14]
CHW tasks/workloadDescription of the role and tasks to be performed by a CHW from the community, CHW and health systems perspectives[5, 18, 46, 47]
2.Governance/stakeholdersEngagement with the Ministry, agencies and other stakeholders to support the CHW program 
3.LogisticsProvisions, material and technological to support CHW functions. 
TransportationProvisions, either monetary (fare for busses) or physical (bicycle) for CHWs to physically access target population[5]
Commodities (including job aids)Required equipment, medicines and supplies to deliver services, as well as resources such as job aids to support the quality of services[5, 18, 46,47,48]
4.FundingLevel of government/donor and other stakeholder investments in CHW programs in country 
5.Information management systemsSupport for CHW to document home visits including community-based health information systems, report visit-related data to the health system and link it to an assessment of CHW performance[18]
 Programmatic processes
 Indicator domainsDefinition/explanationReferences
1.Supportive systemsStructural processes that influence CHW functions at various levels of the health system (facility/local/sub-national/national) 
A.Supervision and performance appraisalConsistent and continued support for problem solving, service delivery and skill development, including evaluation and supportive feedback on the work performed by the CHW in a set period[10, 14, 18, 46, 47]
B.Data useThe use of data by individuals at various levels of the health system to make decisions and improve operational processes 
2.CHW development  
A.RecruitmentHow and from where a community health worker is identified, selected, and assigned to a community[18]
B.TrainingTraining is provided to the CHW to prepare for his/her role in service delivery and ensure s/he has the necessary skills to provide safe and quality care.[5, 18, 46, 47]
C.IncentivesIncludes financial incentives such as salaries and bonuses, and non-financial incentives such as training, recognition, uniforms and other opportunities for advancement[5, 6, 14, 18, 47]
3.Support from community-based groupsRole that the community (any organization or group at the community level) plays in selection, supervision, offering incentives and providing feedback to the CHW[5, 18, 46, 47]
 Community health systems performance outputs—CHW level
 Indicator domainDefinition/explanationReferences
4.CHW competencyDegree to which CHW has the knowledge and skills necessary to carry out the assigned tasks 
A.CHW knowledgeDegree to which CHWs have theoretical knowledge of counseling, preventative and curative and other tasks they are responsible for[5, 6, 49]
B.Service deliveryQuantity of promotional, preventive and curative services CHWs provide to community members[6, 46]
C.Service qualityAdherence to standards and procedures (counseling, health promotion, treatment accuracy)[6]
D.Data reportingRegularity and completeness of CHW reports on the services they provide at the community level[50]
E.AbsenteeismFrequency with which CHWs do not carry out tasks[6]
5.CHW well-beingThe overall well-being of the CHW may be seen as a measure of effectiveness of the system that supports the CHW program 
A.MotivationAn individual’s degree of willingness to exert and maintain effort on assigned tasks; a CHW’s confidence, belief in his/her ability to produce a desired result[5, 6]
B.Job satisfactionDegree to which CHWs derive personal satisfaction from serving the community and providing services[5, 6]
C.Attrition/retentionThe rate at which practicing CHWs resign, retire or abandon their positions[6, 14]
 Community health systems performance outputs—community level
 Indicator domainDefinition/explanationReferences
6.Community accessDelivery of CH services in a timely manner within the client’s home/community OR clients’ physical/social access to CHW service[5, 6, 49, 51]
A.Use of servicesClients are routinely seeking and using promotional, preventive and curative services that CHWs offer[5, 6]
B.Knowledge of service availabilityClients’ ability to identify the location of CHWs and services they provide[6]
C.Referral/counter-referralThe acceptance and use of services provided at a health facility following referral by a CHW[5, 49]
7.Community-centered careCommunity involvement, experience, and perceptions of services provided by CHWs 
A.EmpowermentBoth individuals and communities participate actively in community health activities[49]
B.Experience of careClients’ experience of services delivered by CHWs, including respectful care, and clients’ perception of quality of care.[6]
C.Economic evaluationComparison of two or more possible courses of action, with respect to the costs, consequences, and/or benefits of each[52]
D.Credibility/trust of CHWDegree to which clients consider the services provided by CHWs to be credible and reliable[6]
  1. Bold entries are domain sections