Community Health Data Harmonization.

Village Reach

How harmonizing community health worker (CHW) data can drive quality improvement and cross-site learning

Rigorous research shows CHWs can safely and effectively deliver a wide range of primary health care services, as diverse as administering injectable contraceptives to providing diagnosis and treatment for pneumonia, malaria, and other infectious diseases. 

Yet, despite widespread acceptance that CHWs are an essential component of the healthcare workforce, the 2018 World Health Organization (WHO) Guideline on Health Policy and System Support to Optimize Community Health Worker Programmes revealed several big gaps in the evidence about which health system design best practices lead to quality care.

To address this concern, and advance our mission of making professional CHWs (proCHWs) the norm worldwide, we set up a data harmonization collaborative (the Collaborative) to help close critical evidence gaps about CHW program design and implementation.

Read the full paper on the Collaborative here.

Goals of the Collaborative

  • Enable new opportunities for cross-site learning.
  • Use positive and negative outlier analysis to identify potential quality improvement practices for testing and, if helpful, propagation.
  • Create a multi-country “brain trust,” a space to exchange knowledge and experiences, to reinforce data and health information systems across various sites, and, ultimately, to contribute to an aggregate view of what can be achieved through high-impact community health delivery worldwide.
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Community Health Impact Coalition

Deciding on Common Indicators

Recognizing that the first step in harmonizing data was to agree on common indicators to measure, our Collaborative conducted a series of focus groups and identified the following nine initial indicators.

1. Integrated Community Case-Management Speed (iCCM speed) – Percentage of children assessed, with a symptom of malaria, diarrhea, or pneumonia, within 24 hours of symptom onset.

2. Pregnancy Speed – Percentage of pregnancies registered in the first trimester.

3. Postnatal Care (PNC) Speed – Percentage of women with home delivery receiving 1st PNC visit within 48 hours of delivery.

4. Proactive Coverage – Percentage of households visited at least once per month (where the family was home.

5. U5 Coverage – Number of assessments of children under 5 years of age.

6. Contraceptive Coverage – Contraceptive prevalence rate.

7. Deliveries Coverage – Percentage of deliveries at a health facility.

8. Treatment Quality – Percentage of correct pre-referral treatment administered by CHW, when recommended.

9. Referrals Quality – Percentage of referral follow-ups with health facility visits confirmed.

Pooling and Utilizing the Data

Definitional alignment on indicators and reporting is now at nearly 100%.

Since 2019, members of the Collaborative have submitted data on their respective CHW programs for pooling and analysis. 

Early analysis revealed that most organizations only tracked coverage indicators, not quality indicators. And that initially, organizations had almost no indicators in common.

Through our collective and individual organizational efforts, definitional alignment on indicators and reporting is now at nearly 100%.

The Collaborative has since utilized collected data to publish a research paper detailing how CHWs were able to maintain speed and coverage of essential primary health services during the COVID-19 pandemic.

Project members are also currently utilizing data to examine the relationships between indicators (for example speed of pregnancy registration and percentage of women giving birth in a health institution), with a view to quality improvement through cross-site learning. 

Organizations in our Collaborative can now glean new insights from partners that perform well in certain areas, to determine whether certain approaches can be used to improve their own programs. 

Future Directions for the Data Harmonization Collaborative

Initial efforts were driven by staff from research, monitoring and evaluation, learning, and/or data teams. However, we quickly realized that engaging CHWs, CHW supervisors, and other programmatic colleagues is necessary to achieve the goals of the Collaborative.

CHWs, their supervisors, and program managers are now able to participate in all aspects of the Collaborative’s quality improvement sessions. We have also extended the initiative to include qualitative data sources, such as success stories from the frontlines of service delivery, interviews, and other forms of narrative accompaniment.

To push inclusivity, where the Collaborative intends to publish, we’ll also invite authorship contributions during the paper writing process in many languages and non-writing forms. 

Finally, the Collaborative recommits to ensuring scientific outputs are shared deliberately with national government partners in the countries from which these data are derived, via dissemination workshops or meetings, and with communities themselves.

A woman in a purple dress serving a drink into a cup while other people watch her
Community Health Impact Coalition