Harnessing Expertise to Optimize Community Health.

How six innovative partners joined forces

In 2017, as the world entered a new cycle of global targets with the Sustainable Development Goals (SDGs), universal health coverage (health for all) and preparedness against future epidemics emerged as priorities for global health leaders.

At the time, on the background of a worsening global health workforce shortage and the deadliest Ebola epidemic in history, there was consensus that community-based primary healthcare has an important role to play in achieving these key health goals—but the path forward was far from clear.

The world knew community health workers (CHWs) worked. There was rigorous evidence they could effectively deliver all sorts of complex health tasks, resulting in improved outcomes in child mortality, HIV care management, TB control, and more. But the most recent evaluations of national-scale CHW programs remained unfavorable.

In response to the situation, the WHO committed to developing new guidelines on health policy and system support to optimize CHW programs. Sensing this as a pivotal moment to advance the professional CHW (proCHW) movement, six organizations – Partners in Health, Living Goods, Last Mile Health, Muso, Possible, and Integrate Health – came together to better understand the several operational questions about CHW program effectiveness and changed the community health landscape forever.

Radical Collaboration

The early CHIC members had a restlessness with the world and wanted to accelerate the adoption of high-impact community health systems design.

Those six organizations demonstrated that programs in which CHWs are salaried, skilled, supervised and supplied could dramatically reduce under-five child mortality in an astonishingly short timeframe. So the hunch was that radical collaboration could spread good design, driving those results faster. Following a two-year period of informal collaboration, they committed and made CHIC official in 2019.

Ari Johnson, and Madeleine Ballard seated in an auditorium with a sign before them that reads

Community Health Impact Coalition

Paving the Way Forward.

To address the gaps in knowledge around the key ingredients of successful CHW programs, the group convened to compare and contrast their operational approaches in the following areas:

Recruitment and accreditation
Tasks
Training
Supervision
Incentives
Integration
Reporting
Supply chain

Coalition members started a detailed process of assessing areas of alignment and variation between their organizations in these areas of focus.

A Community Health Worker checking the pressure of an older man while another man watches

Safari Doctors

Harnessing Operational Insights

Making proCHWs the norm.

Throughout the operation, over 100 program documents were assembled and reviewed.

The standard operating procedures of each organization were compared in a matrix, which was then re-read for accuracy by program managers from each organization. Areas of alignment or variation were noted, and any outliers were recorded and examined.

The outcome of the group’s efforts was a coherent set of eight best practices that reflected areas of alignment among effective CHW programs.

The Genesis of a Movement

The resulting report from the collaboration of group members, Practitioner Expertise to Optimize Community Health Systems, was a pivotal milestone in the professional CHW (proCHW) movement.

Not only was it instrumental in defining CHIC’s shared advocacy agenda and the birth of the Coalition, but CHIC ensured that seven of the eight best practices from the practitioner expertise report also went on to be enshrined in the inaugural 2018 WHO guideline on health policy and system support to optimize community health worker programs (WHO CHW guidelines).

The best practices continue to be the glue that holds CHIC together.

Download Practitioner Expertise