Keynote speech given by Maryse Kok at the Kampala Symposium on Community Health Workers.

1. Optimizing the benefits of their unique position between
communities and the health sector
PERFORMANCE OF COMMUNITY HEALTH
WORKERS
Maryse Kok, PhD

2. Performance of Community Health Workers
CommunityHealth Sector
CHW
!?!

3. Health systems are
complex, social
institutions
Source: Sheikh et al. (2011)

4. An example
from Malawi

6. Influencers of
Community Health
Worker performance
“Hardware”
• Supervision structure
• Training
• Supplies
“Software”
• Relationships
• Trust
• Power
Source: 1mCHW campaign

7. Mechanisms related to trusting or weak relationships
• Feelings of self-fulfillment
• Feelings of being supported
• Perception that CHWs serve in
their interest
• Recognition
• Respect
• Credibility
Feelings of connectedness and serving the same goals
Feelings of familiarity and free discussion
Misunderstandings related to lack of communication
• Disrespect
• Doubts about CHWs’
competencies
• Feelings of disconnectedness
• Feelings of unfamiliarity
• Feelings of not being
supported
• Lack of confidence in upper
level
• Perceptions of dishonesty and
unfairness to upper level
• Fear for lack of confidentiality
• Doubts about CHWs’
competencies
• Perceptions of dishonesty
(towards CHW)
• Perception that CHWs do not
serve in their interest
• Confused or disappointed
feelings
Health sector CHW Community

8. Broader context
‘In a context where...’
Programme context
‘and…,’
Mechanism Outcome
‘,leading to…’
Community participation
is promoted by the
government
CHWs are recruited from their
area of origin and/or selected
with involvement of the
community, and thus share
the same socio-cultural
attributes as their clients
Communities and CHWs feel
connected to and familiar with
each other and communities
feel that the CHWs serve in their
interest Trusting
relationships
between CHWs
and their
communities
There is a history and
value of volunteerism
Volunteering is an official
element of the CHW
programme
CHWs and volunteers feel
connected and serving the same
goals through their teamwork
There is a history and
value of traditional
leadership
Traditional leaders are
involved in the CHW
programme
Communities have more respect
for and credibility towards CHWs
Source: Kok et al. (2016)

9. Broader
context
Programme context
‘and…,’
Mechanism Outcome
‘,leading to…’
Constrained
human
resources for
health
Tasks shifted to CHWs and supplies
are available
Enhanced respect for and recognition
of CHWs; CHWs have increased
feelings of self-fulfilment
Trusting relationships
between CHWs and
their communities
Tasks shifted to CHWs and supplies
lacking and/or roles and
responsibilities of CHWs are unclear
to communities
CHWs feel stressed because of being
unable to fulfil communities’
expectations and communities feel
disappointed and/or confused
Weak relationships
between CHWs and
their communities
Tasks shifted to CHWs and
programmes have clear professional
support structures
CHWs and health professional feel
connected and serving the same
goals through their teamwork
Trusting relationships
between CHWs and
actors in the health
sector
Tasks shifted to CHWs, but roles and
responsibilities of CHWs are unclear
to health professionals and/or clear
professional support structures for
CHWs are lacking
CHWs feel disrespected by health
professionals and health
professionals doubt about CHWs’
competence
Weak relationships
between CHWs and
actors in the health
sector
Source: Kok et al. (2016)

10. Gender

11. Training and
Supervision
Source: supervision curriculum REACHOUT

12. Performance of Community Health Workers
CommunityHealth Sector
CHW
!?!

13. Realities of intermediate position
"Neither does the health services system hold our hand, nor do they
leave our hand“ (ASHA India)
“We would like it very much if officials from the ministry of health visit
us and listen to our concerns as some problems cannot be solved by our
coordinators.” (VHT Uganda)
Source: HIFA

14. Discussion &
recommendations “Hardware”
“Software”
Optimal
performance
Maryse.kok@kit.nl
Twitter:
@marysekok