Survey of harmonization practices amongst key NGOs supporting CHW programming

The rapid scale-up of community health workers (CHW) is a global priority for achieving universal health coverage (UHC), in countries experiencing severe health workforce deficits. However, the grassroots origin of CHW programs has led to fragmented implementation by NGOs and donors, which can impede country ownership and efforts to fully unlock the potential of the CHW workforce. With the objective of the UHC goal in mind, efforts must be made to build resilient and responsive CHW systems – requiring policymakers, communities, health workers, NGOs, donors, advocates, and researchers to achieve collective action. In 2013 the Core Group developed the CHW Principles of Practice (CHW-PoP), setting a precedent for harmonized working practices by NGOs in support of a government-led multi-stakeholder framework. The Joint Commitment to Harmonized Partner Action for Community Health Workers and Frontline Health Workers released in 2014 was signed by many NGOs, donor agencies and governments. In preparation for the upcoming Health Systems Global in Vancouver, session on "Harmonization in Action"  World Vision has partnered with Core Group and Frontline Health Workers Coalition member NGOs to conduct a brief survey to assess progress towards implementing harmonized CHW programs, and explore barriers that may still exist in some contexts.
 
In this survey we invite you to respond on behalf of your organization to identify current practices and any share your reflections on ongoing barriers to harmonization you currently experience in the field. The survey will take approximately 30 minutes of your time to complete. Please note that results of the survey may be published. Thanks in advance for your kind participation!
Checklist derived from CHW “Principles of Practice” and Joint Commitment  for Harmonized Partner Action. In this framework harmonization is defined by a “three ones’ paradigm for harmonization of CHW and FLHW initiatives and interventions through one national strategy; one national authority; one monitoring and accountability structure”

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* 1. Contact Information

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* 2. Confirm: The answers provided are accurate to the best of my knowledge. I agree that WV can publish or use the information I have provided in this survey in a shared analysis and publication.

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* 3. Area of Operation (select all that apply)

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* 4. What activities does the organization implement related to CHW support? (Select all that apply)

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* 5. In how many countries does your organization support CHWs?

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i We adjusted the number you entered based on the slider’s scale.

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* 6. Do you have data on how many CHWs globally your organization is currently working with or supporting?

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* 7. If answered "No" to question 6 please provide approximately how many CHWs your organization currently supports.

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* 8. How do you promote country ownership and leadership regarding CHWs involved in your programs?

  Always Mostly  Sometimes Rarely or Never
Working with existing MOH-identified CHW cadres where possible rather than creating new ones
Being approved by the MOH and being subject to national guidelines/policies relevant to CHW programs
Reporting to the MOH and health authorities on a regular basis at national and sub-national levels
Engaging complementary communityvolunteer cadres and groups in a way that includes and supports nationally recognized or formalized CHW cadres
Only implementing activities outside MOH CHW policy, under research/ pilot conditions

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* 9. Our CHW initiatives strengthen local health systems through CHW programs that...

  Always Mostly  Sometimes Rarely or Never
Are not duplicative of, or competitive with national CHW MOH programs
Include measures to ensure referral centers are appropriately equipped, staffed, and functional, with mechanisms for integrating CHWs within service delivery strategies
Also include activities and resources allocated for relevant health and community systems strengthening (HSS and CSS) activities in a systems-based approach
Nurture direct reporting, management, and supervision by facility heads, community leaders, and local health authorities
Avoid depleting human resources from the public sector when hiring (applying WHO code of conduct)
Contribute to building capacity and motivation of the public sector workforce

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* 10. Our CHW initiatives build functional and accountable local supply chains that...

  Always Mostly  Sometimes Rarely or Never
Ensure necessary commodities are sustainably financed e.g. domestic, national insurance
Include a plan in place for continuing supply of commodities when the project ends
Use state-led medical supply chains for the distributing medicines to CHWs
Promote accountability and efficient functioning of the local public sector supply chain system (i.e. not parallel or direct provision of commodities)
Ensure that gifts-in-kind (GIK) contributions, e.g. pharmaceuticals, are of high quality, in line with the demand, and distributed through local supply chains to ensure supervision by health authorities

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* 11. Our CHW initiatives apply uniform incentives amongst partners that...

  Always Mostly  Sometimes Rarely or Never
Adhere to a national standard of incentives agreed to by MOH and/or harmonized amongst all implementing NGOs
Do not promote payment for services, or undercut public sector prices
When providing financial incentives, that MOH and community stakeholders have been engaged in developing a sustainability or transition plan at project closure or transition

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* 12. Our CHW initiatives...

  Always Mostly  Sometimes Rarely or Never
Ensure all CHWs engaged have completed any existing standardized MOH pre-service training prior to project-specific trainings
Deliver CHW trainings that are not duplicative of previous projects and are aligned with needs

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* 13. Our CHW initiatives ...

  Always Mostly  Sometimes Rarely or Never
Prioritize CHW supervision and budgeted for inclusion in all CHW programs
Include CHW supervision activities in the project are integrated into the supportive supervision and mentoring practices at facility and local government
Ensure data collection through CHWs is aligned with the national system, with effort to strengthen existing data mechanisms
Limit any additional data collection burden to research and pilot programs

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* 14. Our CHW initiatives address research and innovation in the following ways...

  Always Mostly  Sometimes Rarely or Never
Nurture country ownership from outset of research/pilot to ensure results are 'owned' by critical stakeholders, inclusive of co-development with country technology specialists
Ensure innovations consider sustainable financing feasible from the outset to achieve long-term scalability 
Design innovations for CHWs that either alleviate time or work burden from the CHW or improve service quality 
Innovations are always aligned to and determined by the country's priorities, rather than donor or NGO priorities from the outset
Innovations, technologies, and resources developed as a result of research by the NGO are made freely available to MOH and licensed under creative commons 

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* 15. Our CHW initiatives promote harmonized collaboration by...

  Always Mostly  Sometimes Rarely or Never
Actively promoting harmonization with donors and partners in contexts where you are working
Ensuring the harmonized framework is a key component of your advocacy strategy for human resources for health

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* 16. In your view, has harmonization of CHW initiatives amongst NGOs been achieved in the contexts where you are working? Please explain your answer

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* 17. What processes and changes have helped your organization to contribute to harmonized CHW programs?

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* 18. What barriers to harmonization of CHW initiatives amongst different stakeholders still exist where you are working?

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