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SCOPE: Community Health Workers

Community Health Workers Increase Access to Health Services

World Relief’s support to community health workers (CHWs) reinforced health worker capacity and community-facility linkages by strengthening case-finding, referrals and community data integration efforts, and ensuring synergies with other community-based outreach efforts.

Through the USAID-funded SCOPE project, WR worked closely with Ministry of Health (MOH) stakeholders to strengthen the capacity of CHWs to deliver community-based family planning, maternal and newborn care, and prevention of common childhood illnesses. This work was informed by a rapid CHW functionality assessment conducted in each country in the first program year, the results of which helped SCOPE plan for targeted technical support to enhance CHWs’ capacity in each country. SCOPE also mapped out the referral systems (between community and facility) and how community-level data collection and information management was done.

SCOPE’s support for CHWs involved recruitment, capacity development in family planning/maternal child health according to national protocols and guidelines, and ongoing coaching and mentoring to ensure post-training skills and knowledge remained high. An additional facet of CHW work included support and training of CHW supervisors in order to strengthen supervisory capacity.

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.

Community Health Workers by Name

August 26, 2021 Kajiado, Kenya with World Relief Staff, visiting SFL work. Sean Sheridan photographs.

The role and scope of the CHW cadres vary according to ministry of health guidelines and partnership in each SCOPE RMNCH project country:

Research Study for SCOPE Health Promoter Training in South Sudan

The low-dose, high-frequency (LDHF) approach is a capacity-building method that consists of frequent interactive training with many opportunities to practice and receive immediate feedback through supervision, coaching, and mentoring. This contrasts the standard/traditional training method, which typically consists of a single, lengthy training with more passive learning approaches, such as reading or lecture, with limited time for practice and receiving feedback. Under the standard/traditional method, supervision is usually limited to data quality checks (rather than mentoring/coaching and reinforcement of knowledge and skills). Research on the LDHF method has shown success among facility-based health workers and clinical providers; however, very little research has been done on testing the LDHF approach among community-based health workers.

These literature gaps led to SCOPE conducting a quasi-experimental research study comparing the LDHF approach of training and supervising CHWs with the standard/traditional method of training and supervising CHWs in Ibba and Maridi, South Sudan. The study looked at CHWs’ (1) satisfaction and perception of their training, (2) knowledge and skills retention, and (3) application of skills. 108 CHWs were enrolled in the study: 54 in the comparison group, and 54 in the intervention group. The study was conducted in partnership with OPEN, a local NGO in South Sudan, and took place between February 2022 to August 2023.

The study found that LDHF/coaching and mentoring approach was associated with higher satisfaction rates, higher retention of knowledge and skills over time, and greater application of skills among CHWs trained and supervised under the LDHF approach. These findings were consistent with the literature that interactive methods like case-based learning and hands-on practice results in greater improvement and retention in knowledge, skills, and/or practice than do passive techniques such as lecture or reading. Targeted, repeated training opportunities are preferable to one-time training and led to increased knowledge retention and the use of new skills by CHWs. It is recommended that future research studies explore the implementation and feasibility of this approach to other fragile settings or remote, hard-to-reach areas that experience chronic staff shortages and gaps in health services at the community level.

Key Results

Below is a snapshot of the results of SCOPE’s work with community health workers across the four SCOPE countries:

Hear the stories of transformation through community health workers

SCOPE Health Promoters Support Vaccine Access in Hard-to-Reach Areas

Through the support of SCOPE Health Promoters in South Sudan, mothers in Rastigi Village are accessing vaccines for their children.

Community Health Volunteer Provides Critical Postpartum Care

SCOPE-supported community health volunteers in Kenya visit new mothers and babies to ensure they are healthy and thrive.

Community Health Workers Change Lives for Rural Families

SCOPE is working with health workers in Haiti to engage mothers in hard-to-reach communities to care for their children.

Stronger Community Impact as Community Health Workers Lead by Example

Junia Saint-Cyr is a SCOPE-supported community health worker in Haiti is leading by example as she applies the lessons she teaches her clients to her own life.

SCOPE Project Improving Care for the Newborn at Home

SCOPE-trained health surveillance assistants like Joel Malango are helping families receive community-based maternal and newborn care in Khongoni.

SCOPE Health Promoters Help Mothers and Babies Succeed

SCOPE Health Promoters like Phoebe are filling the gap between communities and health facilities in Ibba County, helping mothers and babies thrive.

SCOPE's Contributions to Community Development in Mapou

Ricie Barthelemy shares how SCOPE has helped facilitate regular medical follow-up for women and children in Mapou, helping to support healthier and well-fed families.

Chiefs and Health Surveillance Assistants Partner to Tackle Maternal Mortality

An increase in maternal deaths led local chiefs and Health Surveillance Assistants in Nkoola Traditional Authority to sound the alarm and create change in their community.

With Family Planning, I Can Take Control of My Life

SCOPE trained health workers help mother Jésulène Desruisseaux overcome the challenges of being a young single mother and plan for her family’s future.

Care Groups and Community Health Facility Partner Together to Increase Facility Delivery

SCOPE addresses child mortality and morbidity in Turkana Country through Care Groups and community health volunteers partnering to provide behavior change messaging for mothers.

Training CHWs to Provide Community-based Antenatal Care

SCOPE is training community health workers who are providing antenatal care and referrals for pregnant mothers in South Sudan.

Esther shares her experience working with community health workers during her antenatal care visits.

Community-facility Linkages Providing Lifesaving Support

SCOPE is saving lives by supporting community-facility linkages in hard-to-reach areas through health surveillance agents.

Accessing Care During Pregnancy

SCOPE Health Promoters help Mary understand the importance of health facilities and help her seek out antenatal and delivery care at a facility in her community.

Supporting Increases in Health Services Access

High-quality, accessible health services are essential for mothers, children and families to survive. SCOPE is helping to address this in South Sudan through SCOPE Health Promoters.

Family Planning Services: A Wonder in Traditional Authority Nyambi

SCOPE Malawi is working to address fear and stigma around family planning in Nyambi Traditional Authority.

Community Health Workers Engaging Local Communities

Louis shares her experience as a community health worker and mother working to help women of childbearing age and children in her community.

Better Decisions for a Happy Family

A community health worker's visit helps Marita Noel make better decisions about feeding her children and the importance of family planning.

Raising Family Health Awareness in Hard-to-Reach Community

SCOPE helps a community health worker make a difference in the lives of young mother Berline Joseph and her neighbors by connecting them with locally available medical resources.

Learn more about how we’re working to reduce maternal and child deaths

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