A unique non-linear chw program framework for quality improvement

The non-governmental organization Partners In Health (PIH) has developed a unique non-linear community health worker (CHW) program framework that, in the Freirian tradition of awareness building through facilitated contemplation, assists CHW program teams in analysis and quality improvement. Just as in medicine, linear practice algorithms and guidelines can form the basis of service delivery but they must also be complemented by “the art” of integrating technical skill, judgment, and adaptability in the face of change and uncertainty. These skills are taught through many mechanisms, including mentorship, modeling and reflection. The PIH framework, called 5-SPICE, was developed to provide a similar experience for CHW program implementers by giving them a means to develop deeper understandings of how their programs function in their particular contexts. 5-SPICE is an acronym for five essential elements that, when present and positioned to function harmoniously together, contribute to a high-impact CHW system:

Supervision, Partners, Incentives, Choice, Education.

Utilizing the metaphor of Chinese cooking, the framework's goal is to find a balance among several key elements in order to make an ever-better final product. Through facilitated discussions, during which participants evaluate the relative strengths and weaknesses of available inputs and on-site realities, the framework can be used as a brainstorming and reflection exercise, or as an academic exercise to set a quality improvement or research agenda.

The presentation will describe PIH's experience in developing, piloting, and refining 5-SPICE for CHW program development and support.