Community Health workers (Volunteers)

PIPNU’s perspective, endorsing each of the 8 best practices outlined in the Community Health Coalition’s (CHIC) 2017 Report:

Best Practice 1: Community-Led Design

PIPNu wholeheartedly endorses community-led design, recognizing that meaningful community engagement drives effective health solutions. Our organization has established community advisory boards, comprising local leaders and stakeholders, to inform program design and ensure cultural relevance.

Best Practice 2: Integrated, Multisectoral Approaches

PIPNu supports integrating healthcare with social services, education, and economic empowerment. We collaborate with local schools, community centers, and businesses to provide comprehensive support, addressing social determinants of health.

Best Practice 3: Context-Specific Interventions

PIPNu acknowledges the importance of tailoring interventions to unique community contexts. Our researchers conduct thorough community assessments to inform evidence-based, culturally sensitive program design.

Best Practice 4: Strengthening Community Health Worker (CHW) Capacity

PIPNu believes in empowering CHWs as critical health system stakeholders. We provide training, mentorship, and supportive supervision to CHWs, enhancing their skills and effectiveness.

Best Practice 5: Data-Driven Decision-Making

PIPNu supports data-informed decision-making, leveraging data to optimize program impact. Our monitoring and evaluation team collects and analyzes data to identify areas for improvement and inform program adjustments.

Best Practice 6: Community Engagement and Participation

PIPNu prioritizes community engagement, recognizing community ownership as vital to sustainable health solutions. We facilitate community forums, focus groups, and town hall meetings to ensure community voices shape program direction.

Best Practice 7: Policy and Advocacy

PIPNu endorses policy and advocacy efforts to address systemic barriers. Our advocacy team works with community leaders, policymakers, and stakeholders to advance health equity through policy reforms.

Best Practice 8: Collaborative Partnerships and LearninG

PIPNu values collaborative learning and partnerships, recognizing the strength of collective action. We engage in knowledge-sharing networks, participate in joint research initiatives, and partner with organizations sharing our commitment to community health.

Frequency of Household Visits:

PIPNu’s Community Health Workers (CHWs) visit each household at least 4 times a month, ensuring proactive disease surveillance and timely interventions.

Factors Considered in CHW Recruitment and Distribution:

To ensure effective coverage and impact:

1. Geography: CHWs are recruited from and assigned to specific communities within the Central Region of Kampala, considering local knowledge and accessibility.

2. Population density: CHW workload is adjusted according to population density, ensuring manageable caseloads.

3. Service delivery needs: CHWs are allocated based on community health priorities, such as high prevalence of specific diseases or vulnerability.

4. Language and cultural competence: CHWs are matched with communities sharing similar language and cultural backgrounds.

5. Accessibility and mobility: CHWs are equipped with bicycles or mobile phones to facilitate travel and communication.

CHW Recruitment Criteria:

1. Residency in the assigned community

2. Basic literacy and numeracy skills

3. Community leadership or volunteer experience

4. Ability to ride a bicycle (for rural areas)

5. Strong communication and interpersonal skills

6. Completion of PIPNU’s CHW training program

Household Visit Protocol:

During visits, CHWs:

1. Conduct health assessments and screenings

2. Provide health education and counseling

3. Distribute health-related materials (e.g., mosquito nets, family planning resources)

4. Identify and report suspected cases of diseases

5. Complete household review forms for monitoring and evaluation

Household Review Forms:

CHWs use standardized forms to collect data on:

1. Household demographics

2. Health status and risks

3. Service utilization and referrals

4. Health education and counseling provided

Data Management and Utilization:

Collected data informs:

1. Program planning and adaptation

2. Community health profiles

3. CHW performance evaluation

4. Advocacy for resource allocation

Training Structure for Community Health Workers (CHWs):

PIPNu ensures continuous training and capacity building for CHWs through:

Initial Training (Pre-Service)

1. Comprehensive 5-day training on community health, child and maternal health, and disease management.

2. Focus on post-neonatal discharge and management of preterm babies at home.

3. Includes theoretical and practical sessions

Modular In-Service Training

1. Quarterly 2-day refresher training on specialized topics (e.g., nutrition, family planning).

2. Skill-building workshops (e.g., CPR, first aid).

3. Case study discussions and peer-to-peer learning.

Mentorship and Coaching

1. Experienced CHWs mentor new recruits.

2. Regular check-ins and feedback sessions.

3. On-site coaching and supportive supervision.

Continuing Medical Education (CME)

1. Mandatory 10-hour CME per quarter.

2. Topics aligned with community health priorities.

3. Collaborations with medical institutions and experts.

Training Delivery Methods

1. Classroom sessions.

2. On-site training.

3. Mobile health (mHealth) training apps.

4. Peer-to-peer training.

Training Content

1. Maternal and child health.

2. Disease management (e.g., malaria, pneumonia).

3. Nutrition and family planning.

4. Community health assessment and referral.

5. First aid and emergency response.

Assessment and Evaluation

1. Pre- and post-training assessments.

2. Quarterly performance evaluations.

3. Continuous monitoring and feedback.

Partnerships and Collaborations

1. Local hospitals and health institutions.

2. Ministry of Health.

3. International organizations (e.g., WHO, UNICEF)

PIPNu’s Community Health Worker (CHW) Supervision and Support Structure

Supervision:

– Administrative Officers (AOs) and Senior Community Health Workers (SCHWs)

– Bi-weekly check-ins, quarterly home visits, and 1-on-1 coaching every 3 months

Supervisor Tasks:

– Monitor performance

– Assess patient experience

– Provide feedback and coaching

– Conduct joint home visits

– Facilitate training and capacity building

Digital Tracking:

– Google Forms for CHWs to report home visits and services

Benefits:

– Enhanced CHW performance and confidence

– Improved patient satisfaction and outcomes

– Timely addressing of challenges and concerns

– Continuous skill-building and capacity development

Additional Support:

– Peer support groups

– Quarterly team-building activities

– Recognition and incentive programs

PIPNu’s CHW Incentivization Structure

Financial Incentives:

– Transport reimbursement (no monetary compensation)

Non-Monetary Incentives:

– Personal fulfillment

– Skill development

– Community recognition

– Peer support

Motivation Factors:

– Shared experience (CHWs are parents of preterm babies)

– Empowerment

– Flexibility

Retention Strategies:

– Appreciation events

– Ongoing training

– Feedback mechanisms

– Community engagement

Our Community Health Workers (CHWs) are integrated into Uganda’s national health system through the Ministry of Health’s clinical protocols for managing small and very sick babies. This ensures our CHWs provide standardized, high-quality care aligned with national health guidelines ¹.

Integration with Healthcare Facilities

Our CHWs work closely with healthcare facilities, particularly in eastern Uganda, where they collaborate with hospitals and higher-level health centers offering comprehensive maternal and newborn care. These facilities have implemented the World Health Organization’s Service Availability and Readiness Assessment tool to evaluate their readiness to manage maternal and neonatal conditions ².

Clinical Protocols and GuidelinesThe Ministry of Health’s clinical protocols guide our CHWs in managing conditions such as neonatal infection, hypoglycemia, and jaundice. For instance, they follow specific guidelines for antibiotic treatment and dosage for neonatal infections, ensuring consistency with national standards ³.

Capacity Building and Support

To enhance their skills, our CHWs receive training and support from healthcare professionals, focusing on essential newborn care, resuscitation, and preterm care. This capacity building enables them to provide quality services, addressing the needs of high-risk newborn babies

PIPNu’s Data Management and Feedback Loops

Performance Indicators:

1. Home visits conducted

2. Timely interventions for preterm babies

3. Neonatal mortality rate

4. CHW knowledge and skills

5. Patient satisfaction

Data Collection:

1. Digital tools (ODK)

2. Paper-based forms

Data Reporting:

1. District Health Information System (DHIS2)

2. National Health Management Information System (NHMIS)

3. Monthly/quarterly reports

Data Utilization:

1. Program planning

2. CHW training

3. Quality improvement

4. Policy advocacy

Expertise in Community Health Worker (CHW) Programs:

PIPNu possesses comprehensive expertise in CHW programs, particularly in Uganda’s context. Our organization has developed and implemented effective strategies in the following areas:

1. CHW Selection:

– Developed a rigorous recruitment process focusing on community engagement, leadership, and basic literacy skills.

– Partnered with local leaders to identify suitable candidates.

2. Training:

– Designed and delivered comprehensive training programs for CHWs, covering:

    – Maternal and newborn health

    – Child health

    – Disease management

    – Community health assessment

– Collaborated with Ministry of Health experts to ensure alignment with national guidelines.

3. Supervision:

– Established a mentorship program pairing experienced CHWs with new recruits.

– Implemented regular check-ins, coaching, and performance evaluations.

4. Remuneration:

– Developed a transport reimbursement system for CHWs.

– Explored alternative incentives, such as community recognition and skill-building opportunities.

5. Health System/Community Integration:

– Fostered strong relationships with local healthcare facilities and district health officials.

– Ensured CHW integration into Uganda’s national health system through data reporting and collaboration.

6. Monitoring & Evaluation:

– Developed and implemented robust monitoring and evaluation frameworks.

– Tracked key performance indicators (KPIs) to assess program effectiveness.

7. Supply Chain:

– Established partnerships with local pharmacies and suppliers to ensure access to essential medicines and equipment.

– Implemented logistics management systems for efficient supply chain operations.