Towards a Global Impact: New Institutional Tools for CHW Programs

Muso’s work is to implement and test a strong proactive health system that removes barriers to care for communities in Mali, but we know that the results we’ve seen should not remain limited to these communities, or even this region. Muso advocates for our proven approaches to be integrated into policy recommendations and implemented in practice at national and global scale. As our research has gained momentum, we’ve joined with organizations who share our mission and vision for universal access to health care with Community Health Workers on the front lines. For the past two years, Muso has collaborated with high-impact peer organizations in the Community Health Impact Coalition (CHIC), which launched officially this year. Through the Coalition’s allied efforts, Muso’s implementation research helped craft two indispensable new tools that were released last fall.

At the Global Conference on Primary Health Care in Astana, Kazakhstan in October 2018, the World Health Organization announced the launch of their Guideline on Health Policy and System Support to Optimize Community Health Worker Programs, targeted at the national Ministries of Health and international partners who are implementing community case management. The WHO drew on years of research as well as numerous expert voices. Among them was Muso’s CEO, Dr. Ari Johnson, who served as a member of the External Review Group for the guideline development process, alongside leadership from CHIC members Last Mile Health and Living Goods.

Thanks in part to Muso’s participation in the process, the guideline reflects several key elements of the Proactive Care model: CHWs who are continuously trained, integrated into strong health systems, part of data feedback loops, and paid salaries commensurate with their hours and job demands, rather than reliant on performance-based incentives. While the document does suggest that CHWs receive supervision, it falls short of recommending the dedicated supervision that Muso has seen reinforce our CHWs’ performance and quality of care. You can learn more about Muso’s dedicated 360° Supervision approach here.

Muso also played a role in the development of the Updated Program Functionality Matrix, launched in December 2018. The tool builds off of USAID’s Community Health Worker Assessment and Improvement Matrix, developed in 2011. The Matrix can be used to evaluate CHW programs, both those run by small NGOs and those operating at national scale, against 10 key components needed for functioning and high-impact programs, including training, incentives, data, community involvement, and linkages to health systems. CHIC, as a collective, was a contributing author to the updated tool, along with influential global actors Initiatives Inc, UNICEF, and USAID.

As with the WHO Guideline, this Matrix emphasizes the need for high-quality, well-designed CHW programs that recruit from local communities, offer ongoing training and paths to advancement, pay workers at competitive salary levels, use and share data, and are integrated into larger health systems—all elements of Proactive Care that Muso has tested with the Malian government over the past decade. We hope to build off the Matrix’s discouragement of point-of-care fees and strive for CHW-led health systems that are financially accessible to all patients from door-step to referral facilities. Most of all, Muso is enthusiastic to see the inclusion of these evidence-based principles in a document that will be used by global decision makers to strengthen existing community health programs.

Muso’s theory of change begins with the proactive health care our team provides across nine sites in Mali, builds off embedded research designed to test our strategies, and grows through technical assistance to Mali’s Ministry of Health and other policymaking and implementing partners around the world. The publication of these two tools, both highlighting key elements of the Proactive Care model we’ve designed and tested in Mali, mark the next stage of our impact: one where change in policy and practice for CHW programs occurs at a global scale, and universal health care is truly within reach.

 

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