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: awittcoff@rescue.org