Putting Tigers in CHWs Tanks_Wittcoff_5.3.12
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Transcript of Putting Tigers in CHWs Tanks_Wittcoff_5.3.12
WHAT KIND OF CARE ARE YOUR CHWS DELIVERING? CORE SPRING MEETING -MAY 2012
Introduction to IRC• For over 50 years, IRC has
provided health care to the most vulnerable and marginalized communities in over 40 countries
• IRC partners with ministries of health, village committees and health facility staffto build capacity in-country and create sustainable programs
IRC’s Community Case Management Program- Size
and Scale• 6 countries• 350 health facilities• 13,000 CHWs• Up to 92,000
treatments/month for fever, diarrhea and pneumonia
• 795,000 under five• 4,110,000 total
population
IRC’s CCM Program- Continued
• CHWs chosen by their communities
• Initial training lasts 5 to 7days
• CHWs provide case management for malaria,diarrhea and pneumonia
• Monthly supervision visitsconducted by peer supervisors
IRC’s CCM Program- Monitoring & Evaluation
• CHWs record information in patient and drug registers to document each case
• Routine data collected monthly from registers, supervision visits and health facilities and then entered into Excel database
CCM Data Flow
CHW Patient Register
Assessing Quality of Care (QoC) Delivered by Individual CHWs
QoC Methodology• Systematic random sampling
of CHWs from a list of those active in area(s) to be assessed
• Direct observation of CHWs at their home while managing a child
• Prepared case stories used by caregivers at the sites when an actual sick child not available
QoC Methodology
• Two simple cases with one condition:• Fever for 1 day• Diarrhea for 3 days
• One case with two conditions:• Cough and fever for 3 days
• Two referral cases:• Diarrhea for 3 weeks• Vomits everything
Assessing CHWs
• Easy-to-use tools to note if standards for skills were met by CHW during observation
• Standards for each skill based on the CHW training manual
• Skills often require accomplishment of several tasks to meet the standard
Skills Assessed
1. Welcoming2. Assessment of the sick child3. Referral decision4. Classification5. Treatment 6. Counseling
Assessment of the sick child
1. Asks the child’s age2. Asks whether the child
has fever, diarrhea and cough
3. Checks for danger signs
Referral decision
1. Takes the correct referral decision (all main danger signs must have be assessed for children not referred)
2. Gives pre-referral treatment if necessary
Treatment of the sick child
1. Prepares and gives the child the first dose
2. Gives the caregiver the correct treatment according to the child’s age
Others skills assessed
Assessment of pneumonia1. Uncovers the child’s
chest2. Counts respiratory
rates correctly3. Knows the cut-off
points
Example of QoC Tool
Multi-Country ResultsEthiopia, Uganda and South Sudan
Testing Counting BeadsUganda and South Sudan
• CHWs received a short explanation of how to use the beads
• CHWs were told NOT to count but move the beads after each breath of the child
• CHW’s hand at the sound of the timer had to be within ±3 beads of the gold standard
Counting Beads
• The QoC assessment provides insight into the individual performance of CHWs
• The QoC can help identify major gaps/weaknesses in CHW performance that may not be captured through monthly routine data
• Counting beads can help CHWs to correctly identify pneumonia cases
Key Messages
THANK YOU
For further questions please contact Alison Wittcoff: [email protected]