Performance Evaluation of Community Health Workers: Case Study in the Amazon of Peru
A shortage in human resources for health is a growing crisis that has led to an inability to provide adequate health services to impoverished populations. By “task-shifting”, health systems can delegate certain activities, such as health promotion and referral, to trained community members to help fill the human resource gap. An effective community health agent program can improve maternal and child health and overall effectiveness of rural health systems. Such a program is most effective when the community health agents receive supervision and evaluation of their performance. There is a shortage of literature that provides instruction and example on how to conduct a performance evaluation in the developing world to improve maternal and child health outcomes. The current study provides a case study of a performance evaluation in the Amazon region of Peru and how the findings can be used to make program adjustments. A set of instruments to measure the performance of CHWs was adapted from the literature and then implemented in the field. The instruments were used to measure the quality of home visits by the CHWs, their knowledge of the health topics, and structural activities. Three communities with an active CHW program in Loreto, Peru were chosen to receive the evaluation. All CHWs in the communities were evaluated. The scores from the evaluation were compared internally to identify strengths and weaknesses of the program and within the population of CHWs. The evaluation was completed on 52 home visits and 27 CHWs in three communities. The CHWs were found to be most effective at creating good relationships with caregivers and delivering health messages, and least effective at interacting with the child during the home visit and using material to deliver health messages. The evaluation instruments were well suited for the CHW program that utilizes home visits to teach about child health and development.
KeywordsHealth systems Community health Human resources for health Implementation science Child health
We give thanks to the Municipality of Indiana, Mazan, and Napo for coordinating the community health agent program and assisting in the coordination of the program evaluation. Special thanks to Natalia Rivadeneyra Villafuerte for providing advisory services regarding environmental issues and governmental policies.
CW conceived the study, gathered data, performed analysis, and wrote report. RA assisted in literature review, creation of survey instruments, gathered data, and wrote report. DMPV assisted in the literature review, creation of the instruments, and gathered data. All authors read and approved the final manuscript.
This research was supported by Elementos, Peru.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no competing interests.
Ethics Approval and Consent to Participate
The community health agents gave written consent to participate in the outreach program and consent to be involved in the performance evaluation. The investigators only observed the community health agents interact with the families, and so no written consent was requested from the families. The ethics committee from the Research and Institutional Ethics Committee of National Hospital San Bartolome (Hospital Nacional Docente Madre Niño San Bartolome) provided original approval for the community outreach program and child development evaluations and activities (approval Exp. N 00445-17).
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