Table 3 Activities and agreement reported by the experts for the implementation of primary health care principles in Delphi rounds one and two
Principles | Activities | Level of agreement (%) |
|---|---|---|
UNIVERSAL HEALTH COVERAGE | Provision of basic maternal, newborn and child health services | 93.8 |
Medical care services for physical and mental health | 93.3 | |
Appropriate distribution of resources (Staff and material) | 87.5 | |
Defining the catchment area | 86.7 | |
Community sensitization | 86.7 | |
Transparent distribution of resources | 86.7 | |
Outreach services to remote areas | 81.3 | |
Evaluation of the program implementation | 69.2 | |
Annual [re]planning for implementation | 57.1 | |
Equity | Equity-based planning from the beginning | 100 |
Identification of groups that are discriminated against | 100 | |
Removing financial and geographic barriers to health care | 100 | |
Implementation focused on vulnerable sub-populations | 93.8 | |
Service packages are adapted to the particular needs of disadvantaged groups | 93.8 | |
Provision of services in hard to reach areas | 87.5 | |
Gender mainstreaming | 85.7 | |
Broadening of selection criteria of CHWs e.g. low literacy groups and women | 78.6 | |
Bottleneck analyses | 68.8 | |
Program cost discussion with the community representatives | 50 | |
Access | Identification of the causes of low demand and utilization | 100 |
Ensuring all community members can access the program | 100 | |
Distribution of CHWs across a population | 93.8 | |
Addressing privacy and confidentiality | 81.3 | |
Ensuring financial protection | 68.8 | |
Training and mentorship of CHWs | 56.3 | |
Remuneration arrangements for CHWs in case of emergency | 56.3 | |
Role clarity between the community, CHWs and supervisors/program | 50 | |
Comprehensiveness | Provision of preventive, curative, and rehabilitative services | 100 |
Linkages with higher level service providers | 87.5 | |
Needs assessment | 81.3 | |
Referral for and management of endemic illnesses | 80 | |
Skilled CHWs | 66.7 | |
Pro-active CHWs | 53.3 | |
COMMUNITY PARTICIPATION | Engaging traditional and other community leaders | 100 |
Ensuring feedback by the community [and acting on it] | 92.9 | |
Involving community members in supervision of the program activities | 87.5 | |
A practical monitoring system incorporating data from communities and the health system | 87.5 | |
Joint ownership and design of CHW programs | 81.3 | |
Availability of health data to the community | 80 | |
Community sensitization and awareness of the program activities | 75 | |
The integration of CHWs in health care decisions | 75 | |
A balanced package of incentives for CHWs, both financial and non-financial | 62.5 | |
INTERSECTORAL COORDINATION | Senior leadership of the program—accessible and flexible | 93.8 |
CHWs working with community development personal and government officials | 93.3 | |
Addressing needs of water, sanitation, food, housing, transport | 87.5 | |
Horizontal integration at the service delivery level | 87.5 | |
Involvement of multiple ministries/sectors | 81.3 | |
Collaboration in governance structures from local to national level | 80 | |
Partner mapping: to identify all partners who are implementing CHW related interventions | 66.7 | |
Vertical integration within the health systems | 46.7 | |
APPROPRIATENESS | Need-based and context specific program design and implementation | 93.3 |
Prioritization of technically sound and operationally manageable service packages with max health impact | 86.7 | |
Competent CHWs | 86.7 | |
Respectable CHWs | 80 | |
CHW program follows international ethical and human rights standards | 66.7 | |
Effectiveness | Monitoring to assess outputs with reference to the stated goals | 100 |
Review of health outcomes and from an equity lens | 93.3 | |
Consistent access to required training, supplies and supervision for CHWs | 86.7 | |
Monitoring and performance systems | 80 | |
Clear coordination | 71.4 | |
Achievement of the target of the specific programs | 66.7 | |
Cultural acceptability | Community involvement in the selection of the CHWs | 100 |
CHWs are in high demand, have access to all community members | 93.3 | |
Monitoring to make sure that people understand the messages shared by CHWs | 86.7 | |
Community ownership | 85.7 | |
Community working with CHWs to address needs and concerns in an acceptable way | 66.7 | |
Situation analysis of the target population | 64.3 | |
Relevance of the primary health care, MNCH and reproductive health services | 60 | |
Affordability | Financial assessment of chosen intervention to envision sustainability | 86.7 |
Assess if transport cost is a barrier and provide subsidy/transport | 86.7 | |
Assess the ability of the local community to pay | 80 | |
Identify the costs of alternate interventions | 78.6 | |
Assess if the full spectrum of treatment needed is affordable | 73.3 | |
Provision of a basic package of health services that are cost effective | 66.7 | |
Drugs dispensed free to all people irrespective of their ability to pay | 53.3 | |
Manageability | Adequate human resource | 92.9 |
Regular provision of a comprehensive package of services at a high standard of quality to all in need | 86.7 | |
Adequate supportive supervision and performance review | 85.7 | |
Continuous adjustment of the role of CHWs as the program evolves with respect to communities’ needs | 85.7 | |
A balanced package of financial and non-financial incentives for CHWs | 66.7 | |
Majority of people are provided the needed services at the cost they can afford | 66.7 |