Accompanimeter 1.0: creation and initial field testing of a tool to assess the extent to which the principles and building blocks of accompaniment are present in community health worker programs

ABSTRACT

Background: The strategic incorporation of community health workers (CHWs) into health system strengthening efforts is recognized as a critical and high-value approach for meeting the Sustainable Development Goals established by the United Nations in 2015. How to best build CHW programs, however, is prone to a wide variety of opinions and philosophies, many of which are often externally imposed. Partners in Health (PIH) is a non-governmental organization that pioneered an approach to healthcare system strengthening, called accompaniment, in which CHWs play a key role. Learning from PIH is a critical first step in replicating the organization’s achievements beyond PIH. As such, PIH has developed a tool, referred to as the ‘Accompanimeter 1.0,’ that serves to evaluate existing CHW programs and guide adjustments in programming.

Objective: To provide a standardized approach for defining, assessing, and implementing accompaniment in CHW programs using a tool called the Accompanimeter 1.0.

Methods: Development of this tool included three stages: (1) desk review of literature relevant to the work of CHWs globally, (2) discussions among colleagues and initial field testing, (3) feedback from colleagues who are experts in community health and in the principles of accompaniment.

Results: Three core principles of accompaniment in a CHW program were identified: professionalization, CHWs as bridges to institutional strength, and community proximity. These core principles direct five thematic areas that are found in successful CHW programs: Partnering (co-creating engagement with a continuous and intersectoral dialogue to improve the program); Choosing (identifying the right people for the right job); Educating (building CHWs´ capacity); Incentivizing (enabling CHWs to perform their work without financial sacrifice); Supervising (mentoring CHWs for personal growth).

Conclusions: The Accompanimeter 1.0 can serve as a helpful tool for CHW program implementation and policy decisions that maximize system-side inputs, community engagement, and support for individuals with medical issues.

KEYWORDS:

• Community health workers
• quality improvement
• the Accompanimeter 1.0
• Partners In Health
• primary health care

Responsible Editor Stig Wall, Umeå University, Sweden

Responsible Editor Stig Wall, Umeå University, Sweden

Acknowledgements

We thank all the participants in this study: Kenneth Maes, Steve Reifenberg, Archie Ayeh, Joia Mukherjee, Michelle Morse, Sheila Davis, Annie Michaelis, Cynthia Maltbie, Pierre Paul, Anatole Manzi, Hugo Flores, Emily Wroe, Camilla Giuliani, Eberhart Portocarrero, Miriam Santibañez, Rodrigo Bazua, Zulema Garcia, Francisco Rodriguez-Garza, Camila Giugliani, Kevin Fiori and the multiple CHW managers, implementers, CHWs and community members in Rio de Janeiro, Brazil and Chiapas, Mexico.

Disclosure statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure and declare: the research was conducted without support from any organization for the submitted work.

Ethics and consent

The creation of the tool was an exercise undertaken by the authors and the participants in the acknowledgements; no human subjects were involved. The tool’s initial field testing was approved by the Institutional Review Board of the Instituto Tecnológico y de Estudios Superiores de Monterrey (México), the Johns Hopkins Bloomberg School of Public Health, and the Superintendence of Primary Health Care of the Municipal Health Department of Rio de Janeiro (SMS-RJ, Brazil). All participants’ information presented in this manuscript is anonymized.

Paper context

CHWs programs have received greater attention with the advent of the SDGs. Our paper provides a guide for designing CHW programs around the values of an approach called ‘accompaniment,’ and supplies critical feedback around the essential elements that drive impact at community and health system levels. The Accompanimeter 1.0 tool can help programs achieve better health outcomes with a focus on equity, enhance stakeholder participation in the program, and more effectively pursue and use resources.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was funded by a scholarship awarded to HC from the Johns Hopkins Bloomberg School of Public Health.

Notes on contributors

Hector Carrasco

Hector Carrasco, Harriet Napier, David Giber, Stephanie Kang, Mercedes Aguerrebere, Matthew Hing, Vinicius Siqueira, Mariana Montaño, Henry Perry and Daniel Palazuelos. HC is the principal investigator, and is responsible for the original conceptualization, oversight of the study and critical review of the manuscript. HC, and DP led the design of the study. HP and HN contributed to study design. HN, DG, DP and HC created the data collection tools. HC, HN, MA, VS, MM and DG led data collection. VS, HC, and MM transcribed the interviews and focus groups performed on the field. DG, SK, MH, MA and HP oversaw the data collection process and ensured data quality. All authors participated in the drafting and revision of the manuscript, as well as interpretation of the results. The lead author affirms the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as planned and registered have been explained.