5-SPICE: the application of an original framework for community health worker program design, quality improvement and research agenda setting

Abstract

Introduction

Despite decades of experience with community health workers (CHWs) in a wide variety of global health projects, there is no established conceptual framework that structures how implementers and researchers can understand, study and improve their respective programs based on lessons learned by other CHW programs.

Objective

To apply an original, non-linear framework and case study method, 5-SPICE, to multiple sister projects of a large, international non-governmental organization (NGO), and other CHW projects.

Design

Engaging a large group of implementers, researchers and the best available literature, the 5-SPICE framework was refined and then applied to a selection of CHW programs. Insights gleaned from the case study method were summarized in a tabular format named the ‘5×5-SPICE chart’. This format graphically lists the ways in which essential CHW program elements interact, both positively and negatively, in the implementation field.

Results

The 5×5-SPICE charts reveal a variety of insights that come from a more complex understanding of how essential CHW projects interact and influence each other in their unique context. Some have been well described in the literature previously, while others are exclusive to this article. An analysis of how best to compensate CHWs is also offered as an example of the type of insights that this method may yield.

Conclusions

The 5-SPICE framework is a novel instrument that can be used to guide discussions about CHW projects. Insights from this process can help guide quality improvement efforts, or be used as hypothesis that will form the basis of a program's research agenda. Recent experience with research protocols embedded into successfully implemented projects demonstrates how such hypothesis can be rigorously tested.

This paper is part of the thematic cluster Global Health Beyond 2015 - more papers from this cluster can be found at http://www.globalhealthaction.net

• community health workers
• quality improvement
• research
• conceptual framework
• case study

Acknowledgements

The authors thank PIH collaborators Michael Rich, Donna Barry, Joia Mukherjee, Arielle Tolman, Lindsay Palazuelos, Kevin Savage, Rosabelle Conover, and Annie Michaelis.