An External Evaluation of the ICTPH Guide Program in Karambayam

By Rosemary Stafford, External Evaluator

I arrived in India in the early morning hours of July 5, 2011, with one task at hand: to evaluate the ICTPH Guide program. I had 4 months to do this job, and I had no time to waste.

Excited to put my evaluation experience to work in a new setting, I initiated the evaluation with energy, enthusiasm, and a plan. You can read a bit more about why I was conducting the evaluation in this previous post. But, in short, ICTPH’s Community Health Worker (CHW) model, the Sugha Vazhvu Guide program, needed to be revamped but it was not clear exactly how. That’s where I came in.

Before I could propose any changes, I had to understand the program. My first task was to take stock of the program’s history and evolution, to understand what it had (and had not) accomplished, and to hear how satisfied (or dissatisfied) program stakeholders were with the program. Then, I would need to determine ICTPH’s goals for the program moving forward and restructure the Guide model so that is better suited the organization’s needs. This was no small task, so I got started right away.

I spent my first few weeks on the job traveling to all the different Sugha Vazhvu RMHCs, talking with the ICPTH management staff, meeting the Guides, and attending their training classes. This was all in an effort to understand the ecosystem in which the Guide program operated.

After these few weeks of taking stock, I began one-on-one structured interviews with ICTPH senior leadership to probe further into issues I or the stakeholders had identified as needing to be addressed. I conducted these interviews in a variety of places, whether in an office at the Sugha Vazhvu headquarters or in a Guides’ home over tea. Among the chief issues discussed were the program’s management structure, the benefits/incentives offered, consequence management for the Guides, and communication between the Guides in the field and the RMHC physician. The questions ranged from “How suitable is the benefits package?” to “How would the Guide program ideally be managed and run?” to “Should you/the Guides wear uniforms in the field? Why or why not?” These one-on-one discussions with ICTPH and the Guides yielded rich information that informed my research and recommendations.

With the interviews complete and 7 weeks already gone by, I launched an extensive literature review on community health worker models around the world. I quickly learned there is no “one best way” to structure a CHW program. However, there are some key elements common to successful CHW programs. As outlined in USAID’s CHW Toolkit, those key elements include regular and consistent supervision, ongoing training opportunities for CHWs, clearly defined roles and job expectations, and consistent and fair incentives.

Combining the firsthand feedback from program stakeholders, an understanding of CHW literature, and ICTPH’s vision for the program moving forward, I devised a new structure for the Sugha Vazvhu Guide program. This included revising contract terms, changing the management structure, and redefining the Guides’ roles and responsibilities. ICTPH adopted the majority of my recommendations, and in my final months in Thanjavur, I was able to see the new Guide program structure rolled out and implemented. The report you find here is a detailed account of the entire evaluation process, from initial meetings with stakeholders to the detailed way forward for the Guide program in year 2. It’s a privilege to present it to you, the broader public health community, and I hope you will find it enriching to your work.

Read the complete report here.

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