SCOPE: Community Health Workers
Community Health Workers Increase Access to Health Services
SCOPE works with community health workers (CHWs) to link communities with health actors and facilities, with the aim of reducing preventable maternal and child mortality and morbidity. SCOPE’s support of CHWs reinforces community-facility linkages by strengthening case-finding, referrals, community data integration efforts, and ensuring synergies with other community-based outreach efforts made by local ministries of health and non-governmental organizations. SCOPE trains, equips, supports, and mentors CHWs in the delivery of community-based family planning, maternal and newborn care, and prevention of common childhood illnesses.
A Capacity-Building Approach to Community Health Worker Training
Building on World Relief’s years of experience working with CHWs and existing USAID investments, SCOPE launched CHW activities by working closely with each country’s ministry of health to train, equip, support, and mentor community health workers. This work was informed by a rapid CHW functionality assessment conducted as part of the start-up and landscape mapping activities in the project’s first year. This assessment consisted of document review, key informant interviews, and engagement with national and sub-national stakeholders, including individual USAID Missions. By assessing the CHW program in each country, SCOPE learned about CHW recruitment practices, the role/scope of the CHW cadre, and the equipment and supplies needed for the CHW (based on their scope per ministry of health policy). SCOPE also learned about supervision modalities, other implementing partner efforts on CHW capacity development, and incentives that may affect health worker motivation. Lastly, SCOPE mapped out the local referral systems (between community and facility) and how documentation and information management were done. This process also informed our training approach and the in-country stakeholder relationships critical to the CHW programs’ sustainability beyond SCOPE’s time on the ground.
To ensure that CHWs retain their knowledge and skills after they have completed their training, SCOPE also trains and supports CHW supervisors. Each CHW supervisor line-manages an appropriate number of CHWs to ensure the proper supervisor-to-health-worker ratio within each country, usually about ten CHWs working out of five health care facilities (an average of two CHWs per facility). The individual CHW’s learning needs and their behavior change opportunities at the household level are usually considered and factored into mentoring sessions. Technical content is centered on information CHWs’ “need to know,” allowing for hands-on learning, followed by continuous practice with feedback and coaching.
Research Study for SCOPE Health Promoter Training in South Sudan
In South Sudan, SCOPE has been conducting a research study on the low-dose, high-frequency (LDHF) approach to building capacity among community health workers (called SCOPE Health Promoters (SHPs). The literature shows that this method has produced successful results among facility-based health workers in other countries. However, to date, there is no published literature testing this training methodology amongst CHWs, especially in fragile contexts such as South Sudan. Therefore, SCOPE has developed a research study comparing the LDHF training and supervising project-specific community health workers (SHPs) to the standard method of training and supervising SHPs in Ibba and Maridi. The study, which has received research ethics approval in South Sudan and the US, follows a quasi-experimental design utilizing quantitative and qualitative data methods. Study groups include a comparison group (SHPs trained and supervised under the standard approach) and an intervention group (SHPs trained and supervised under the LDHF). Both groups are being trained in the ministry of health curriculum that covers FP, MCH and general health topics. Data collection is underway and is expected to be completed in December 2023.
Despite the challenges from COVID and region-specific political and environmental factors, SCOPE’s work with CHWs in Haiti, Kenya, Malawi, and South Sudan has demonstrated progress in increasing access to services and in working to reduce preventable maternal and child mortality and morbidity. As of June 2022, the SCOPE’s work with community health workers has brought the following results in the four SCOPE countries: