Monitoring and Evaluation of Community Health Programmes

Monitoring and evaluation is an integral part of each phase of the project life cycle of community-based health programmes. It is essential to define measurable milestones in the project plan. Continuous and periodic monitoring helps to establish to what extent the programmes have achieved the set goals and targets. Upon completion of the project, a final evaluation is carried out to measure the outcome of the project in terms of predetermined targets and articulate the accomplished goals. In the recent days, many health and development organisations have been using logical framework analysis. The logical framework approach (LFA) is a management tool mainly used in the design, monitoring and evaluation of health and development programmes. LFA was first developed by USAID during the 1970s but now it is widely used by bilateral and multilateral development agencies and most recently by NGOs as well. It provides clear, concise and systematic information about a project. The framework helps in connecting all the project components including goal, purpose, outputs/results, inputs/activities and indicators, in one framework, presenting the relationship between them and leading to the achievement of the anticipated project outcomes. Please refer the link below as for an example of a guideline for preparing a logical framework developed by AusAid.

An evaluation framework for community health programmes developed by the Center for the Advancement of Community Based Public Health is found to be useful tool for the evaluation of community health programmes (see link below). The evaluation framework emphasizes programme evaluation as a practical and ongoing process that involves various stakeholders including programme staff, community members, partners, clients, donors and evaluation experts. The framework consists of six steps namely, engage stakeholders, describe the programme, focus the evaluation design, gather and analyze evidence, justify conclusions and ensure use, and share lessons learned.

Tearfund UK has developed a Capacity Self-Assessment (CASA), a tool to assess an overall impression of an organisation, identify the stage of its development and provide insight into its current and potential impact. A pilot study of this tool was carried out involving partner organisations from Cambodia, Haiti and UK. This is a quality assessment tool, which is found beneficial to help organisations to improve their standard of service and their overall results. Further, this tool helps to identify both positive and negative aspects of organisations so that organisations are aware of their strengths to be retained and weaknesses to be improved. The CASA tool is divided into three assessment modules: International Organisation, External Linkages and Projects. Please refer to the link given below for the full version of CASA manual.

References & Links:

• http://www.ausaid.gov.au/ausguide/pdf/ausguideline3.3.pdf
• http://www.cdc.gov/eval/evalcbph.pdf
• http://tilz.tearfund.org/webdocs/Tilz/Roots/English/CASA/CASA_E-%20full%20document.pdf

Community Health Workers

The global policy of primary health care support was initiated with Alma Ata Declaration in 1978. Since then primary health care and community health programmes have become synonymous. Community health workers (CHWs) play a significant role in the delivery of primary healthcare in the resource-poor countries. World Health Organisation (WHO) recognises that CHWs are providing services in remote and inaccessible parts of the world. There are programmes run by various national and international agencies to build the capacity of CHWs. However, Low and Ithindi (2003) claim that such programmes have been criticised either as being inappropriate and ineffective or as having problematic relationships between partners.

The role of CHWs has become very important due to the shortage of qualified health professionals, particularly in resource-poor countries. Hence, they have become prominent players in bridging the health care gap. Their role and activities are enormously diverse across countries, programmes and scope. CHWs are making valuable contribution to primary health care services and overall community development. However, some challenges exist on the selection, nurturing and remuneration aspects of CHWs. Further, a key challenge lies in setting up vision and systems, and institutionalising and mobilising community participation (see link below).

A DFID funded research programme called ‘The Consortium for Research on Equitable Health Systems’ has carried out a research study on ‘community health workers: a review of concepts, practice and policy concerns’ (see link below). This study suggests that CHWs have evolved with community-based health care programmes. However, the concepts and practices of CHWs differ across countries, conditioned by their aspirations and economic capacity. Seven critical factors have been identified. These are gender; selection of CHWs; nature of employment, career prospects and incentives; educational status; population and service coverage; training; and feedback, monitoring mechanisms and community participation that influence the overall performance of CHWS.

Low and Ithindi (2003) identify a set of steps and roles and responsibilities of partners involved in utilization of CHWs. Those steps include:

·        Strategic direction – steering committee representation

·        Preparatory phase – selection of the pilot constituency, needs assessment, development of the CHW job description, selection of the CHWs, CHW training

·        Operational phase – provision of the kit box, uniforms and shoes, operational work planning, visiting households and other tasks, supervision and support, reporting to the steering committee, monitoring

·        Evaluation – outcomes, efficiency and effectiveness

Further, they claim that three major types of problems can prevent programmes functioning. These are: lack of commitment by the partners, poor management and the limited scope of the partnership. These problems exclude the community from involvement in decision making and result in the top-down orientation of the programme.

References & Links:

• Low, A. and Ithindi, T. (2003). Adding value and equity to primary healthcare through partnership working to establish a viable community health workers' programme in Namibia. Critical Public Health. 13(4):331-346
• http://www.who.int/hrh/documents/community_health_workers.pdf
• http://www.crehs.lshtm.ac.uk/Community_health_workers_prasad.pdf