Co-design, implementation and evaluation of a learning from excellence programme for community health workers in slums
Community health workers (CHWs) can deliver a variety of community-based health care services, and are particularly important in areas where the use of facility-based services is low relative to need, like rural areas or urban slums. However, there are concerns about the sustainability of CHW programmes as there are high rates of attrition and variation in the levels of performance between CHWs. To increase sustainability and effectiveness of CHW programmes, performance and retention should be improved, but doing so, particularly in low-resource settings, is complex.
The performance of CHWs is influenced by health system elements such as training, finance and technology, as well as the interests, power, values and norms of the CHWs, their managers and the community. Retention is affected by motivation, which is driven by intrinsic factors including individual’s work-related goals and self-efficacy and extrinsic factors such as incentives and recognition/ appreciation by managers, colleagues and/or the community.
One potential approach to improving performance and retention is ‘Learning from Excellence’ (LfE). This programme was implemented in 2015 in the UK and is spreading rapidly across hospitals and other settings, in the UK and beyond. It aims to provide a means to identify, appreciate, study and learn from episodes of excellence in front-line healthcare, and is grounded in the theory of positive psychology. The LfE programme intends to create positive learning experiences, enhance staff morale and improve patient care, and thus seems a propitious method for increasing performance and retention of CHWs.
The aim of this PhD is therefore to co-design, implement and evaluate a LfE programme for CHWs in slums in order to determine whether the method can increase performance and/or retention. The primary work for this PhD will be undertaken in one slum with an established CHW programme. However it is anticipated that, if effective, the LfE programme developed could subsequently be adapted and implemented elsewhere.
This PhD will be based in the NIHR Global Health Research Unit on Improving Health in Slums that is addressing health services in slums in 4 countries (Nigeria, Kenya, Pakistan, Bangladesh). The student will be embedded in an interdisciplinary, international team and have access to training programmes
This is a mixed-method project in which both qualitative and quantitative data will be collected.
The following activities will be undertaken in this project:
- A baseline measurement regarding the retention, motivation and performance of CHWs in slums will be performed. Data will be collected with the help of surveys and observations, using existing methods of performance assessment.
- Interactive workshops will be developed and organised to co-design the LfE programme.
- The co-designed LfE intervention will be implemented in the daily practice of the CHWs in slums.
- The co-designed LfE programme and its implementation will be evaluated with the help of surveys and focus group discussions with CHWs and their managers.
- The impact of the co-designed LfE programme on retention, motivation and performance of CHWs in slums will be evaluated. The baseline measurement will be repeated and outcomes will be compared in an uncontrolled before and after study design. A more robust study design, including data on a control group, will be undertaken if possible. Furthermore case studies will be undertaken, based on a realist evaluation methodology, to understand more about the mechanisms and context of LfE.