A key element of USAID’s strategic approach to maternal and child health (MCH) is to increase by at least 100,000 the number of functional community health workers serving in USAID priority countries by 2013. At the request of the USAID MCH team, the Health Care Improvement (HCI) Project developed a tool that defines a set of key elements that are needed for community health worker programs to function effectively and measures how well programs meet these criteria.  These elements were defined based on a review of recent literature on CHW programs (see link below) and suggestions from expert reviewers. The CHW Program Assessment and Improvement Matrix (CHW AIM) tool examines 15 programmatic components that CHW programs should consider as important to successfully supporting CHWs.  These include: recruitment; the CHW role; initial training; continuing training; equipment and supplies; supervision; individual performance evaluation; incentives; community involvement; referral system; opportunity for advancement; documentation and information management; linkages to the health system; program performance evaluation: and community ownership. 

In applying the tool, each component is rated with a four-point scale ranging from non-functional to highly functional. In addition to assessing whether CHWs are part of functional programs, the tool includes lists of high impact, evidence-based interventions for MCH and HIV/TB services to guide assessment of which services the CHWs are currently performing.  

The instrument can be applied in a stakeholder meeting to assess the current status of a specific program and determine if the program as a whole is functional. Health workers within that program are then considered to be functional. In addition to helping determine whether a CHW program is functional, the tool also provides an action planning and resources guide to assist program managers in strengthening their community health worker programs.