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Table 2 Illustrative indicators for community health worker performance measurement

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

Illustrative indicatorsIndicator relevance/use by:Suggested data sources**
Facility manager/QI teamDistrict managersRegional and national MOH
H: High data use M: Medium data use 
Domain 1: Supportive systems
 Sub-domain A: Supervision and performance appraisal
1.#/% of supervisors trained in management and supervision of CHWsHHMTraining logs
2.Ratio of CHWs to supervisorsHHMHRIS
3.#/% of supervisory visits that met the quality criterionHHMSpecial studies
4.Average # of visits per supervisor to monitor/support CHW activities in the last monthHHMSupervisor report/special studies
5.#/% of CHWs who received a supervisory visit in the last 1–3 months that includes review of reports and data collectedHHMCHW report
6.Average # of supervisory contacts (in-person visits, phone calls, text messages, etc.) per CHWHHMCHW report
 Sub-domain B: Data use
7.#/% of health workers (CHWs/supervisors/health facility staff) who have access to client data AND who report using the data to make decisions about their provision of servicesHHMSpecial studies (CHW survey)
8.#/% of national/sub-national/facility/community meetings in which data (from standardized reporting platforms etc.) are discussed/reviewedHHHRoutine meeting minutes
9.#/% of CHWs who have access to the client data they have collected (for follow-up) in the last 6 monthsHHMCHIS/HMIS
Domain 2: CHW development
 Sub-domain A: Recruitment
10.#/% of CHWs who have been selected in alignment with selection criteriaMHHHMIS/HRIS/training logs
11.# of CHWs who have been selected/recruitedHHHHRIS
12.#/% of target communities/populations that have an assigned CHWHHHHRIS
 Sub-domain B: Training
13.#/% of CHWs who have received initial trainingMHHHRIS/training logs
14.#/% of CHWs who have received follow-up training in the last 2 yearsMHHHRIS/training logs
15.#/% of CHWs who have completed the certification programMHHHRIS/training logs
 Sub-domain C: Incentives
16.#/% of CHWs who have received their stipend in the last monthMHHCHW report/supervisor report/special survey
17.#/% of CHWs who have received a specific non-financial incentiveMHHCHW report/supervisor report/special studies
Domain 3: Support from community-based groups
18.# of planning/review meetings held at the level of the local government to discuss CHW program performanceMHHMeeting minutes/special studies
Domain 4: CHW competency
 Sub-domain A: CHW knowledge
19.#/% of CHWs who have passed knowledge/competency tests (following training)HHHTraining/accreditation logs
20.#/% of CHWs who express that they feel confidence in their abilities to provide health educationHHHSpecial studies
21.#/% of CHWs who express confidence in their abilities to deliver basic healthcare servicesHHHSpecial studies
 Sub-domain B: Service delivery
22.Average # of home visits made by CHWs in the last month (indicator to be disaggregated by type of home visit—i.e., sick child visit, antenatal care)HHMCHW record/CHW report
 Sub-domain C: Service quality
23.#/% of CHWs who correctly identified the case/health problem (as per items in a checklist)HHHSpecial studies/supervisor report
24.#/% of CHWs who correctly addressed (treated) the identified health problem (as per items in a checklist)HHHSpecial studies/supervisor report
25.#/% of CHWs with all the key stock commodities in the last reporting periodHHHCHW report
26.Average time from onset of symptom to first contact with CHWHMMSpecial studies
 Sub-domain D: Data reporting
27.#/% of CHWs who submitted reports in the last monthHHMCHIS/HMIS/supervisor report
28.#/% of CHW reports submitted that were complete/did not have missing informationHHMCHIS/HMIS/supervisor report
 Sub-domain E: Absenteeism
29.#/% of CHWs who reported on their activities in the last monthHHHCHIS/HMIS
30.# of days CHW has performed at least one CHW responsibility in the last monthHHHSpecial studies/supervisor report
Domain 5: CHW well-being
 Sub-domain A: Motivation
31.Composite metricHHHSpecial studies
 Sub-domain B: Job satisfaction
32.#/% of CHWs who expressed satisfaction with the community support they receiveHHMSupervisor report/special studies
33.#/% of CHWs who expressed satisfaction with the support they receive from health facility staffHHMSupervisor report/special studies
 Sub-Domain C: Attrition/retention
34.In the last 3 months, #/% of CHWs who have reported on their activitiesHHHCHIS/HMIS
Domain 6: Community access
 Sub-domain A: Use of services
35.#/% of households who received at least one visit by a CHW in the last 3 monthsHHMSpecial studies
 Sub-domain B: Knowledge of service availability
36.#/% of community members that know the name of the community CHWsHHMSpecial studies
37.#/% of community members who can name at least 3 services that the CHW providesHHMSpecial studies
 Sub-domain C: Referral/counter-referral
38.% of individuals referred by CHW to the health facility per 100 clients seen (and subset by reasons for referral)HHHCHIS/HMIS/CHW record
39.#/% of clients that completed the referral at the health facility (referral completion)HHHCHIS/HMIS
40.#/% of referred clients seen at receiving service (health facility) that is seen back at referring service (CHW) with complete counter-referral information (counter-referral)HHHCHIS/HMIS
41.Average # of referrals made per CHW in the last monthHHHCHW report/CHW record
Domain 7: Community-centered care
 Sub-domain A: Empowerment
42.Composite metricMHHSpecial studies
 Sub-domain B: Experience of care
43.#/% of women/households who express satisfaction with services they received from the CHW in the last 3 monthsHHHSpecial studies/community scorecards
44.#/% of women who report that in their interaction with the CHW they felt humiliated or disrespected (scale 1–5)HHHSpecial studies/community scorecards
 Sub-domain D: Credibility/trust of CHW
45.#/% of women/clients who report they trust the health information provided by the CHWHHHSpecial studies/community scorecard
46.#/% of women/clients who report they trust the treatment services provided by the CHWHHHSpecial studies/community scorecard
  1. Measurement Consideration 8: Equity, Gender, and Accountability: Each of the above indicators may be disaggregated by one or more of the following characteristics to assess possible equity gaps or disparities: education, ethnicity, family type, health risk-level, immigration/migrant status, language, marital status, occupation, refugee/asylee status, religion, sex, social capital, tribe, village size, wealth
  2. Measurement Consideration 9: Economic Evaluation: While no extant routine or recommended indicators for measuring CHW program performance were identified, metrics for cost-related benefits of institutionalizing CHW programs and engaging communities are important to capture and require further exploration
  3. **Special studies may include cross-sectional, intermittent surveys of a sample of CHWs, supervisors and/or community members. In case of quality of care, a special study might include direct observation of the CHW during a client interaction
  4. HRIS Human Resource Information System: a national/sub-national HRH database or registry, either digital or paper-based (e.g., iHRIS), that manages health workforce information such as number of health workers (e.g., CHWs) recruited, trained, and on payroll
  5. CHIS/HMIS Community Health Information Systems/Health Management Information Systems
  6. CHW record: Routine records or community-based client registries maintained by CHW
  7. CHW report: Summative reports on the number of home visits and types of client seen, typically submitted on a pre-determined schedule by CHWs to their supervisors
  8. Supervisor report: Summative reports on activities of CHWs and other community-based logistics, routine submitted by supervisors to district or regional level administration
  9. Bold entries are domain and sub-domain sections