Original Research

Scorecard metrics for assessing the extent of integration of community health worker programmes into national health systems

Lucia M. Mupara, John J.O. Mogaka, William R. Brieger, Joyce M. Tsoka-Gwegweni
African Journal of Primary Health Care & Family Medicine | Vol 13, No 1 | a2691 | DOI: https://doi.org/10.4102/phcfm.v13i1.2691 | © 2021 Lucia Mungapeyi Mupara, John Jules O. Mogaka, William Robert Brieger, Joyce Mahlako Tsoka-Gwegweni | This work is licensed under CC Attribution 4.0
Submitted: 23 July 2020 | Published: 26 November 2021

About the author(s)

Lucia M. Mupara, Department of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
John J.O. Mogaka, Department of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
William R. Brieger, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
Joyce M. Tsoka-Gwegweni, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa

Abstract

Background: The effectiveness of community health workers (CHWs) in delivering community-based preventive services is often curtailed by inadequate or complete lack of integration of the CHW programmes into national health systems. Although literature has defined the context and guidelines for integrating CHW programmes into health systems, indicators to quantitatively assess the extent of integration are inadequately addressed.

Aim: This article presents an integration scale – CHW Programme Integration Scorecard Metrics (CHWP-ISM) – for measuring the extent of CHW programme integration into national health systems.

Setting: Literature review and policy documents were focused on sub-Saharan Africa, while interview participants were drawn from six African countries.

Methods: A deductive–inductive approach to item and measurement scale development was employed. Information obtained from a combination of diverse literature sources, subject matter expert (SME) interviews and documentary abstraction from publicly available policy documents advised item generation for the proposed CHWP-ISM. The study qualitatively captured the sectoral CHW integration, thematically analysed the data and culminated in the quantitative integration metrics.

Results: Analysis of the responses from six SMEs and abstraction from policy documents resulted in the compilation of metrics with a total of 100 indicators for the CHWP-ISM scale that could be used to assess the level of CHW programmes integration into national health systems. The indicators were categorised along the six World Health Organization’s (WHO) health systems building blocks. Subject matter expert responses corresponded well with abstracted results from the 18 country CHW programmes, indicating content validity.

Conclusion: The proposed scorecard metrics can be used to quantitatively rate the extent of CHW programmes integration into health systems, in an attempt to strengthen health systems to improve health outcomes.


Keywords

CHW programmes; integration conceptual framework; health system measurement; integration metrics; sub-Saharan Africa

Metrics

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Crossref Citations

1. Community Health Worker programmes’ integration into national health systems: Scoping review
Lucia M. Mupara, John J.O. Mogaka, William R. Brieger, Joyce M. Tsoka-Gwegweni
African Journal of Primary Health Care & Family Medicine  vol: 14  issue: 1  year: 2022  
doi: 10.4102/phcfm.v14i1.3204