Overcoming Scalability Challenges in CHW Programs_Allison Goldstein_10.14.11
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This document summarizes a project that integrated community volunteers and health extension workers in Ethiopia to increase the scale and sustainability of polio vaccination efforts. It describes how the project partnered with local organizations to train over 1,000 community volunteers across 54 districts. These volunteers conducted nearly 16,000 house-to-house visits annually to reach over 2 million children. The document compares the volunteers to health extension workers and describes how the project strengthened relationships between the two groups to improve supervision, motivation, and collaboration between volunteers and the formal healthcare system. Evaluation of the partnership found it extended vaccination services and coverage through the combined roles of volunteers and health workers.
Overcoming Scalability Challenges in CHW Programs_Allison Goldstein_10.14.11
- 1. Integrating Community Volunteers and Health Extension Workers to Increase Scalability and Sustainability of the Core Group Polio Project (CGPP) in EthiopiaBy: Allison Goldstein
- 3. Regions and Zones of Ethiopia
- 4. ContextEthiopian government’s health extension planHealth Extension Workers (HEWs)CGPP partners with local organizations to train community volunteers (CVs)CGPP has trained 1,162 active volunteers 54 districts across 7 regionsConduct 15,918 house-to-house visits Reach 2,039,905 children under 15 annually
- 5. Comparison of CVs with HEWsIlliterate or primary education
- 7. From inside the community
- 8. Employed part time, but expected to work full time
- 9. No salary
- 10. Mostly male
- 12. 1+ years of training
- 13. From outside the community
- 15. Supported by the government
- 16. FemaleCGPP Community Volunteers(Volunteer health workers)Health Extension Workers (Government Employed Professional Health Staff)Responsibilities include:Polio surveillance and immunization activities
- 17. Surveillance for other vaccine-preventable diseases
- 18. Community education on disease prevention and controlResponsibilities include:16 health packages (curative and preventative)
- 19. Polio surveillance and immunization activities
- 20. Community education on disease control and preventionInnovation: Restructure CV and HEW RelationshipStrengthen ties with government health systems
- 21. CVs report directly to HEWS, monthly meetings
- 22. HEWs motivate CVs with training and supervisionDistrict Health OfficeHEWs2 per villageCommunity15,918 HH visitsActiveCommunity Volunteers1,1627 PVOs/ 5 NGOs
- 23. EvaluationConducted qualitative evaluation of the project8 Focus Groups, 17 In-Depth Interviews
- 24. Extended Service Through CollaborationStrong partnership marked by mutual respect, understanding, and accountabilityRole of volunteer cannot be overlookedCVs critical for overburdened HEWs Link to communityAcceptance and legitimization of role Community members are more likely to seek out vaccination and other preventative health services (family planning services, pit latrines and smokeless hearths)Extended Coverage: sex, knowledge, area
- 25. Issues Addressed by CollaborationAddresses Attrition: CVs cited HEWs as the primary motivation that gets them through hard times“When we are desperate, the [HEWs] encourage us and convince us to continue with our voluntary services.” Strengthened relationship with community“Previously, some irresponsible members of the society used to scare off HEWs with their furious dogs. Now, when we started collaboration, let alone scaring them away the society welcomes them warmly.”Supervision of non-MOH volunteers
- 27. Volunteer Perspective“NGOs can also make contribution in awarding CVs and HEWs with outstanding performance. Such benevolent gestures would serve as a great moral boost paving the way for much better performance and more consolidated rapport between CVs and HEWs.” [4thgrade male, Humbo woreda, 4 years experience]
- 29. Volunteer Perspective“We sacrificed ourselves to protect our community from communicable diseases with the assistant of the government and other non government organization. This makes us proud.” [7th grade female, Humbo woreda, 3 years experience]
- 30. AcknowledgementsThanks to Dora Ward and Meg Lynch for their constant support, Cam Escofferey for helping develop my materials, and all the CORE staff who have helped me along the way
- 31. Questions?