Community Health Committees (CHCs) and

Health Facility Management Committees (HFMCs)

Program Functionality Assessment

A Toolkit for Improving CHC and HFMC Programs
 Community Health Committees (CHCs) and
Health Facility Management Committees (HFMCs):

Program Functionality Assessment:

A Toolkit for Improving CHC and HFMC Programs

January 2017
 Community and Health Facility Management Committees: Program Functionality Assessment
_____________________________________________________________________________

Acknowledgements
This document was developed by Michele Gaudrault of World Vision International, and Karen LeBan,
Lauren Crigler and Paul Freeman, independent consultants and members of the CORE Group.

The authors would like to thank participants of the CORE Group Global Health Practitioners Fall
Conference 2015 for the valuable reactions and feedback provided during and after that event. Particular
thanks go to Minal Rahimtoola and Camille Collins Lovell of Pathfinder International for their comments on
earlier drafts of this product and suggestions for improvements. Appreciation is also extended to René
Loewenson of Equinet (Regional Network for Equity in Health in East and Southern Africa) for sharing
relevant research and discussion papers. Finally, thanks to the Siaya Sub-County Health Management Team,
Kenya, and Lilian Chebon of World Vision Kenya for their support during field testing of this tool.

Photo Credits
Cover: © 2012 Janine Schooley; © 2006 Jane Brown, Courtesy of Photoshare; © 2017 Elie
Gardner/Intimedia; © 2003 Elizabeth Serlemitsos, Courtesy of Photoshare

Graphic Design
Holly Collins, CORE Group

Recommended Citation
Gaudrault M, LeBan K, Crigler L, Freeman P. Community Health Committees and Health Facility
Management Committees: Program Functionality Assessment Toolkit. 2016. CORE Group and World
Vision International, Washington D.C.

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Table of Contents
Abbreviations iv

Section I: Introduction
A. Background 1
B. Program Functionality Assessment Process 3
C. Structure of the Functionality Assessment 4

Section II: CHC/HFMC Program Functionality Steps and Instructions

A. Step 1: Pre-Workshop: Collect Documents and Adapt Tools to Program Context 6
B. Step 2: Assessment and Improvement Workshop 7

Appendix A: Document Review Guide and Checklist for CHC/HFMC Programs 10

Appendix B: CHC and HFMC Roles and Responsibilities Checklist

I. Community Health Committee (CHC) Roles and Responsibilities 12
II. Health Facility Management Committee (HFMC) Roles and Responsibilities 16

Appendix C: CHC and HFMC Assessment and Improvement Matrices

I. Community Health Committee (CHC): Assessment and Improvement Matrix 19
II. Health Facility Management Committee (HFMC): Assessment and Improvement Matrix 34

Appendix D: CHC/HFMC Validation Questionnaire 49

Appendix E: Score and Score Rationale Documentation Worksheet

I. Community Health Committees 53
II. Health Facility Management Committees 54

Appendix F: Action Plan Template 55

References 56

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Abbreviations

CHC Community Health Committee

CHW Community Health Worker
FGD Focus Group Discussion
HFMC Health Facility Management Committee
MoH Ministry of Health
NGO Non-Governmental Organization
WHO World Health Organization

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Section 1: Introduction

A. Background

The development of this tool originated from the CORE Group Fall 2014 Global Health Practitioners
Conference, in a session focusing on community support for Community Health Workers (CHWs). In
1989, WHO recommended that CHW programs have the support of a group composed of members of
the community with active links to the health sector. Such groups exist in many countries, known by
various names such as village health committees, community health committees and the like. In addition to
providing support to CHWs, these groups may perform other functions to include assessing and tracking
local health status and issues, mobilizing communities for action to address identified issues, and advocating
for improved health services. While the initial focus of the CORE Group session was to understand the
support that such groups can provide to CHWs, attention turned to consider the strength of the groups
themselves, and the support that they, too, require in order to perform successfully.

While many Ministry of Health (MoH) community health strategies around the world include community
health committees, the reality on the ground shows that these groups are often weak and poorly
supported. Literature and field experience suggest that before the strength of individual groups can be
considered, there are fundamental programmatic, structural and policy elements that must be in place in
order for the community health committee programs to function effectively. It was felt that ministries and
partners could benefit from a tool that listed and described these recommended programming
components, to use for assessment and programming improvements.

This tool has been developed to help Ministries of Health and supporting organizations to assess
community and health facility committee program functionality against 14 elements deemed essential for
program success; to review the scope of roles and responsibilities intended for the groups; to identify
existing program strengths, and to address those elements assessed as weak. Note that the tool is not
intended to assess individual community or health facility groups but rather to assess the functionality of the
program as a whole, in line with the understanding that the prerequisites must be in place first, before the
strength of the groups themselves can be considered.

Community Health Committees (CHCs) and Health Facility Management Committees

(HFMCs)

There is extensive literature advocating for, and in some cases providing evidence to support, the
importance of community participation as a means of improving community health outcomes. Ministries of
Health and governments have acknowledged this, developing community health strategies that include
varieties of community participation, to include processes of community mobilization, the work of CHWs,
and the functions of community health groups.

This tool focuses specifically on two types of representative health groups; the Community Health
Committee (CHC) and the Health Facility Management Committee (HFMC).

CHCs are typically embedded and located in the community and carry out their work there, are comprised
of membership almost exclusively from within the community, and may or may not have a strong formal
link with the health facility and the MoH at large. Their roles and responsibilities relate to identifying and
addressing health issues within the community, and supporting community health workers and/or other
volunteer health cadres. They may also be involved in actions of a social accountability nature; raising issues
regarding health service performance, although the intention (in community health strategies) is that they

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remain supported by MoH in any case; thereby distinguishing them from those groups that may occupy a
fully autonomous space and whose primary function is to hold duty bearers to account.

The Bamako Initiative, sponsored by UNICEF and WHO and adopted by African ministers of health in
1987, saw the emergence of village committees involved in health-facility management, with particular
success in West Africa. HFMCs now form part of community health strategies in many countries around
the world. HFMCs are by definition attached to local health facilities and formally linked with MoH, usually
include both community representatives and facility staff as members, and typically hold meetings and carry
out their work at the facility, with a potentially lesser presence in the community as compared to CHCs.
Roles and responsibilities relate more to facility management concerns, and the channeling of community
health concerns to facility staff, than to work in the community as such.

Individual countries may have one or both types of group. This tool may be used with either CHCs or
HFMCs. Two versions of the ‘Roles Checklist’ and ‘Assessment and Improvement Matrix’ are included; one
for each type of group. In many ways, the programmatic and structural elements required for success are
the same for CHCs and HFMCs, but there are enough differences between them to warrant the two
versions.

Users

In most cases, responsibility for mandating, designing, managing and supporting a CHC and/or HFMC
program lies – or should lie – with the Ministry of Health. As such, this tool is primarily aimed at
supporting ministries to assist them to assess and improve these programs. Nonetheless, it is recognized
that t is frequently the case that ministries work in partnership with non-governmental organizations
(NGOs) or other agencies to implement and manage the CHC/HFMC programs. The tool, as such, is
designed to be used by any implementing organization. Ideally, the exercise will be carried out by the
supporting organization together with the Ministry of Health, and ultimately taken on entirely by MoH.

Objectives of the Functionality Assessment Process

• Assess functionality and guide improvement in programs working with CHCs and/or HFMCs
• Develop action planning and best practices to assist in strengthening CHCs and/or HFMCs
• Identify the location of functional CHC and/or HFMC programs and geographic gaps in coverage

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B. Program Functionality Assessment Process

The functionality assessment exercise may be carried out at any time. In most cases, CHC and HFMC
programs are in existence and ongoing; rarely will it be the case that the functionality assessment will be
carried out at start-up of a new CHC/HFMC program (although it is recommended that it be carried out at
the start of any implementing partner’s support and involvement with a program). The functionality
assessment will be used by ministries of health and partner agencies to assess the current state of CHC and
HFMC programmatic and structural design and support elements at any point in time, with a view to
improving the necessary elements as needed.

The tool is meant as a guide to aid progress rather than a rigid prescription and so covers key concepts
relevant at this level of programmatic design and improvement, while recognizing that some adaptation to
local contexts may be needed1.

Facilitation: Although participatory in nature, the process should be led by an experienced facilitator. The
facilitator’s role is to guide the planning, implementation, and follow up of the assessment. He or she runs
the workshop and ensures active participation, consensus, completion of tools and responsive action plans.

Participants: The assessment should be carried out during a workshop with multiple stakeholders
knowledgeable about how the program is managed or supported and the geographic areas in which it
functions. Between 15 and 25 participants is recommended, and should include MoH staff at appropriate
levels, field managers, sub-national managers, CHC and/or HFMC members and their supervisors. The
process promotes the involvement of CHC and/or HFMC members, as their experience and voice adds to
a fair assessment.

Approach: The process is based on a guided self-assessment that allows a diverse group of participants to
score their own programs against a checklist of roles and responsibilities, and against a matrix of 14
programmatic components. Following the review, the participants use the results to develop action plans to
address areas assessed as weak.

The approach encourages rich discussions on actual, versus theoretical, impressions of CHC and/or HFMC
programs. It allows host governments to quickly and efficiently map and assess programs using a rating scale
based on literature support and good practice.

Limitations: The approach does not evaluate the strength of individual CHCs or HFMCs.

1 Description modeled after: Crigler L, Hill K, Furth R, Bjerregaard D. 2011. Community Health Worker Assessment and
Improvement Matrix (CHW AIM): A Toolkit for Improving Community Health Worker Programs and Services. Published by the
USAID Health Care Improvement Project. Bethesda, MD: University Research Co., LLC (URC).

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C. Structure of the Functionality Assessment

There are two tools for assessing the functionality of the CHC and/or HFMC program:

1. Checklist of Roles and Responsibilities (CHC and HFMC versions)

The checklist contains nine categories of roles for CHCs and HFMCs. Each role category contains a list
of possible responsibilities, distinguishing between those responsibilities that all groups should do at
minimum in order for the program to be considered functional (labeled ‘standard’ in the checklist), and
those that are considered context-specific or ‘optional’ (labeled ‘per context’ in the checklist).

Table 1: Roles of CHCs and HFMCs

Roles
1. Link community and health service providers
2. Network with health partners and stakeholders
3. Assess and monitor community health status
4. Mobilize community outreach and action
5. Address socio-cultural norms
6. Provide leadership and governance oversight of health services
7. Mobilize resources for health activities
8. Provide support to CHW program
9. Provide oversight and support to health facility

2. Assessment and Improvement Matrix (CHC and HFMC versions)

The assessment and improvement matrix is divided into 14 components, each with descriptions of
characteristics of functionality in the scoring ranges of 0-3. Figure 1 categorizes the 14 components into
four main topical areas, providing an overall Program Functionality Framework

Figure 1: CHC/HFMC Program Functionality Framework

High Level Support for Program Human Resource/Group Management

Strategic Description/Clarity of Program CHC/HFMC Formation
Budget for CHC/HFMC Program CHC/HFMC Member Recruitment/Selection
Country Ownership CHC/HFMC Roles, Organization, Structure

CHC/HFMC
Program
Functionality

Support to CHCs/HFMCs Operational Elements

Member Training and Capacity Building CHC/HFMC Support of Referral System
Supervision of CHC/HFMC Linkages to Broader Health System
Incentives for CHC/HFMC Members Communication & Information Mgmt
Wider Community Support/Involvement Program Performance Evaluation

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Programmatic Elements

The following 14 programmatic elements are considered essential pre-requisites for functional
CHC/HFMC programs.

Table 2: CHC/HFMC 14 Essential Programmatic Elements

1. Strategic Description and Clarity of CHC/HFMC Programming: Whether CHCs/HFMCs are
included in MoH community health strategy and their strategic intent is clearly described

2. CHC/HFMC Formation: How the CHCs/HFMCs are formed: what entity catalyzed and backs the
program, the existence of policies and procedures, and the degree of community awareness

3. CHC/HFMC Member Recruitment and Selection: How members are selected and recruited to the
CHCs/HFMCs

4. CHC/HFMC Roles, Organization and Structure: Clarity and effectiveness of CHC/HFMC

organization and structure with regard to roles, expectations, decision-making and procedures

5. CHC/HFMC Member Training and Capacity Building: Training and capacity building provided to
CHC/HFMC members to equip them with knowledge and skills to fulfill their roles

6. Budget for CHC/HFMC Programming: Funding available for CHC/HFMC activities, and processes for
fiscal management

7. Supervision of CHC/HFMC Members: The extent to which CHC/HFMC members receive supportive
supervision, and the incentive system for the supervisors

8. Incentives for CHC/HFMC Members: A balanced incentive package for CHC/HFMC members that is
standardized, well known, and results in member motivation

9. Wider Community Support and Involvement: The extent to which the wider community is aware of,
recognizes the value of and participates in the activities of the CHCs/HFMCs

10. CHC/HFMC Support of the Referral System: Processes for patient referrals and counter-referrals,
and the extent to which the CHCs/HFMCs play a role in supporting the processes

11. Communication and Information Management: How data flows to and from the health system and
how the CHCs/HFMCs make use of the data

12. Linkages to the Broader Health System: How CHCs/HFMCs are linked to the broader health system,
at higher administrative levels

13. Country Ownership: The extent to which the MoH has policies in place that legitimize CHCs/HFMCs
within the health system, and the types of MoH support to the groups

14. CHC/HFMC Program Performance Evaluation: General CHC/HFMC program evaluation against
targets, objectives and indicators carried out on a regular basis

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Section II: CHC/HFMC Program Functionality Steps and Instructions

Step 1: Pre-Workshop: Collect documents and adapt tools to program context

Collect program documents

Refer to the Document Review Guide and Checklist for CHC/HFMC Programs in Appendix A. Collect all
documentation describing the CHC and/or HFMC programs and review the documents to understand how
the program(s) function. If possible, speak to program managers and key MoH staff for deeper descriptive
understanding. Note in the comments section of the checklist any key programming features that support
or do not support good practice. Documents should be brought to the workshop as background and
evidence during participant discussions.

Align CHC/HFMC Roles and Responsibilities Checklist(s)

Refer to the appropriate checklist(s) in Appendix B. If the assessment will be dealing with CHC
programming, use the first checklist; with HFMC programming the second checklist; with both types of
committees both checklists.

The checklists contain eight broad categories of roles for each type of group. Within each role category is a
list of responsibilities, differentiated between core and specific-to-context. Prior to the workshop, and
based on the programming documentation collected and discussions with MoH and other key
implementers, determine which categories of roles form part of the committees’ work in your country.
Remove from the checklist(s) any role category that the committee(s) are not meant to perform, and print
final copies of the checklist(s). The final checklist(s) should contain only those role categories that are
within the purview of the committee(s) in the country, per MoH guidelines . For those role categories that
remain, do not delete any of the responsibilities. The analysis of whether or not the committees carry out
the responsibilities listed in the role categories will take place during the workshop.

Contextualize the CHC/HFMC Assessment and Improvement Matrix/Matrices

Refer to Appendix C for the CHC and HFMC Assessment and Improvement Matrices. Use one or both,
depending on the type(s) of committee(s) you are assessing. Share the matrix/matrices with the program
managers and key stakeholders. The matrices are based on good practice, but discussing them ahead of
time will raise awareness about their contents and usefulness for assessing and strengthening CHC/HFMC
programs. Determine if any changes are needed for the specific context. For example, you should change
the titles if the committees in the country where you are carrying out the assessment go by different
names; e.g. Village Health Committee, Health Center Advisory Board, etc.

Plan the Assessment Workshop

• Identify and invite participants, to include program staff, MoH representatives at various levels, CHC
and/or HFMC members, CHC and/or HFMC supervisors, and representatives of CHWs or other
volunteer cadres associated with the CHC and/or HFMC, if any
• Organize the field visit to take place either before or after the workshop; to carry out FGDs with
between 2-3 committees of each type being assessed
• Arrange all logistics for a one or two day assessment workshop; e.g. venue, refreshments, transport,
photocopies, etc.

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Step 2: Assessment and Improvement Workshop2

Introduce the Process

You may wish to develop a brief presentation to introduce the workshop goal and objectives, and provide
an overview of the Roles and Responsibilities Checklist and the Assessment and Improvement Matrix.

Explain that the CHC/HFMC program functionality assessment process is meant to ensure functionality of
CHC and/or HFMC programs by rating the program(s) against 14 good practice elements, and by
determining whether the CHCs and/or HFMCs are carrying out a full range of recommended
responsibilities based on their roles according to program and national guidelines. The assessment and
action planning process will help guide MoH and partners to improve on areas identified as weak.

The process is not meant to measure the performance or strength of individual CHCs and/or HFMCs.

You may also wish to lead a short session to discuss the challenges of supporting CHCs and/or HFMCs, as
this would lead nicely into analyzing the programmatic components that may or may not be in place to
support the committees. You could divide participants into small groups for brainstorming, followed by
report back and discussion in plenary, for example.

Carry out Analysis of CHC/HFMC Roles and Responsibilities

Distribute copies of the relevant Roles and Responsibilities Checklist(s), per the type of group(s) you are
assessing; e.g. CHC, HFMC or both. These should be the aligned, final copies of the checklist(s) that include
only the role categories that the committees are meant to be carrying out per the document review and
discussions regarding national guidelines that you carried out prior to the workshop. Have on hand the
documents you collected prior to the workshop; e.g. national guidelines describing the CHC and/or HFMC
programs and policies, etc.

Divide the participants into small groups and assign each group one or more role categories. (You may
have some groups reflecting on CHCs and others on HFMCs, if you are assessing both types of
committees.) Using their own knowledge and experience with CHCs and/or HFMCs, and referring to the
background documents, they should determine which of the responsibilities listed in the role categories are
meant to be carried out by the committees, and complete the checklist accordingly.

Return to plenary and consolidate the results on flip charts. Zero in on any responsibilities indicated as
‘core’ that the committees are not carrying out. Good practice recommends that for CHC/HFMC
programs to be considered functional, the committees should ideally be carrying out a minimum range of
core responsibilities – anything less than the core range is less than comprehensive and therefore less than
functional. Lead a discussion to determine if the participants agree that these core responsibilities should in
fact be considered ‘minimum standards’, and if there is a consensus for adding missing responsibilities into
the committees’ mandates.

If the participants (including the Ministry of Health) agree that there are gaps in the committees’ range of
responsibilities, the MoH may consider whether they will update guidelines to include new areas. Explain to

2
Workshop process modeled after: Crigler L, Hill K, Furth R, Bjerregaard D. 2011. Community Health Worker Assessment and
Improvement Matrix (CHW AIM): A Toolkit for Improving Community Health Worker Programs and Services. Published by the
USAID Health Care Improvement Project. Bethesda, MD: University Research Co., LLC (URC).

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participants that they will fill out an action plan later in the workshop, and the MoH may choose to include
actions related to the guidelines at that time.

Review the Validation Questionnaire, prepare for field visit

Ideally, the workshop will be organized such that the field visit to meet with CHCs and/or HFMCs takes
place prior to scoring the Assessment and Improvement Matrix/Matrices. By gathering information and views
directly from CHC/HFMC members the scoring will be a more accurate reflection of the status of
programming, than if the scoring were carried out by relying only on the information and views of the
workshop participants.

Distribute copies of Appendix D: the CHC/HFMC Validation Questionnaire. Note that the same
questionnaire can be used with either type of committee. Explain that the participants will use the
questionnaire as a guide for leading Focus Group Discussions (FGDs) with members of CHCs and/or
HFMCs. The questions aim to provide information around the 14 elements of the Assessment and
Improvement Matrices.

If you feel that the participants require explanation and practice carrying out FGDs you may build that into
the workshop. You will need to locate materials that will prepare you to lead a session on how to carry
out effective FGDs, and what to observe for when participants practice/simulate an FGD.

Carry out Field Visit: FGDs with CHC and/or HFMC members

You should aim to carry out a minimum of two FGDs with each type of committee you are assessing. (i.e.
two FGDs with CHCs, and/or two with HFMCs). The number of FGDs should be increased if the types of
groups or the characteristics of the settings and communities vary widely within the country, to ensure that
representative information is gathered from these various contexts. The number of committee members
participating in an FGD should not exceed 12, to enable good discussion by all. You will probably want to
split the workshop participants into groups; with each group carrying out perhaps two FGDs in one day of
field work. Ensure that all logistics are in place.

Following the field visit (either on the same day or the morning of the next day), the workshop participants
will come together and debrief; sharing the information they gathered from their respective FGDs.

Score the Assessment and Improvement Matrix/Matrices

Distribute copies of the relevant Assessment and Improvement Matrix/Matrices, per the type of group you are
assessing; e.g. CHC, HFMC or both. Distribute copies of Appendix E, the Score and Score Rationale
Documentation Worksheet.

Carry out the scoring process for the first element of the Assessment and Improvement Matrix (Strategic
Description and Clarity of CHC and/or HFMC Programming) in plenary. Read the description in the first
column. Have the participants silently read the descriptions for each level of functionality 0-3 and decide
how they would score their program, based on how the program matches the criteria under each level of
functionality. Note that there are no ‘half scores’ such as 2.5. They must score a full 0, 1, 2, or 3, and the
program must meet all the criteria to fit a particular score. Give the participants time to make their
assessments and then ask how many scored 0, 1, 2 or 3; write the numbers on a flip chart. Ask those
whose scores differ from the majority to justify their responses. Encourage discussion until consensus is
reached on a final score. Ask if there are any questions, clarify them and provide feedback.

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Explain that they will use the Score and Score Rationale Documentation Worksheet to document and justify
their scores. Explain that the remaining section of the matrix/matrices will be done in small groups.

Divide the participants into groups and assign matrix elements to each group. You may have some groups
assessing CHCs and some assessing HFMCs if you are working with both types of committees. Ensure that
the groups are evenly balanced in terms of the types of stakeholders represented (e.g. MoH staff,
implementing partner staff, CHC and/or HFMC members, etc.)

The groups should discuss and reach consensus on the score for each element assigned to them. They
should refer to the program documents provided by you, the information from the FGDs and their own
knowledge and experience with the committees to decide on the scores. They will record their scores and
justification on the worksheet. They should also begin to think of the types of actions that could be
recommended to improve the scores as necessary, and write their ideas in the corresponding column.

Once all groups have finished, return to plenary. Each small group will present their results, which should
be followed by plenary discussion to reach consensus on a final score. Allow ample time for discussion at
this stage – this is the heart of the functionality assessment process and deep discussion around the CHC
and/or HFMC programming should take place in order to grapple with the issues that are problematic, the
challenges that the programs are facing, and to think through the best ways of working through these and
bringing programming up to high levels of functionality. Record the final scores on a flip chart.

Alternative: As an alternative, the FGDs with the CHC and/or HFMC members may be carried out after
the scoring process. In this scenario, the participants will score during the workshop based on their
knowledge and experience with CHCs/HFMCs, and then use the FGDs as opportunities to validate and
perhaps adjust the scores taking into account the perspectives of the committee members. The advantage
of this alternative is that it provides an opportunity to clarify with the committees any issues that may have
surfaced during the workshop discussions. The FGD questionnaire should be reviewed before the field
exercise to identify the questions that refer to any such issues, so that the FGDs can focus in on those
questions specifically. Nonetheless, the participants should still plan to ask all the questions in the FGDs.
This will ensure that the scoring is not based on assumptions but, rather, on the actual views of all involved.
The CHC/HFMC members may also have input into actions to be included in the action plan, below.

Create an Action Plan

Distribute copies of Appendix F: Action Plan Framework, or have the participants write on flip charts. You
may break the participants into small groups again, or work in plenary. An action plan should be developed
in order to: (1) incorporate new responsibilities into the committee(s)’ scope of work, if required per the
Roles and Responsibilities Checklist assessment, and (2) improve any programmatic elements scoring less than
3. Ideally the workshop participants will include those decision-makers who can authorize changes and
authorize the actions needing to be taken. If decision-makers are not present then the actions can be
presented as recommendations, and followed up with decision-makers at a later stage.

Next Steps and Follow Up

Ensure that steps are agreed for bringing the action plan forward prior to closing the workshop. Hold a
follow-up meeting at a later date with MoH, program managers and some of the participants from the
workshop, to review the action plan and to discuss how to complete it. Share the final action plan with all
stakeholders for their knowledge and assistance. Discuss how the plan will be monitored. If more than one
location or organization has been involved, consider a meeting of representatives from all sites to
periodically share effective actions and discuss challenges and achievements.
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Appendices

Appendix A: Document Review Guide and Checklist for CHC/HFMC

Programs

Instructions3: This document should be completed in advance of the assessment workshop by the facilitator as part
of pre-workshop preparation. If possible, conduct interviews with program managers and supervisors to review
documentation and understand how the program functions and how the documentation might inform the workshop
assessment and scoring process. Note in the Comments section any key elements that support or do not support
good practice. Documents should be brought to the workshop as supporting evidence during participant discussions.

Review of CHC/HFMC Program Policies and Procedures

Membership and recruitment of CHCs/HFMCs

Does the program have written guidelines for the Yes____ Comments
membership of CHCs/HFMCs? No____

Does the program have written guidelines for how Yes____ Comments
CHC/HFMC members should be recruited? No____

CHC/HFMC organization and structure

Does the program have written guidelines for the Yes____ Comments
leadership structure of the CHC/HFMC? (i.e. No ____
Chairperson, etc.)
Roles of CHC/HFMC
Does the program have written guidelines describing Yes____ Comments
the roles of CHCs/HFMCs? No ____

Does the program have written guidelines specifying Yes____ Comments

the roles and relationships of CHCs/HFMCs vis-à-vis No____
CHWs?
CHC/HFMC member training and capacity building
Are there program records that track how many Yes____ Comments
CHCs/HFMCs/members have received training? No____

Are there written guidelines that specify what topics Yes ____ Comments
should be covered during training? No ____

According to the program, is there a specific time Yes____ Comments

period during which the CHC/HFMC should receive No ____
initial training?

3
Description modeled after: Crigler L, Hill K, Furth R, Bjerregaard D. 2011. Community Health Worker Assessment and
Improvement Matrix (CHW AIM): A Toolkit for Improving Community Health Worker Programs and Services. Published by the
USAID Health Care Improvement Project. Bethesda, MD: University Research Co., LLC (URC).

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Budget for CHC/HFMC programming

Is there an authorized budgetary line item in the Yes ____ Comments
health sector’s budget to financially support the No ____
CHC/HFMC program?
Are there guidelines that specify CHC/HFMC Yes ____ Comments
authority on revenue generated by the health No ____
facility?
Supervision of CHC/HFMC members
Are there guidelines that specify who should Yes ____ Comments
supervise the CHCs/HFMCs? No ____
Are there program guidelines that specify how often Yes ____ Comments
supervision visits take place? No ____

Are there written guidelines to determine what Yes ____ Comments

should take place during a supervision visit? No ____

Do supervision checklists or any other supervision Yes ____ Comments

tools exist to help guide supervision? No ____

Incentives
According to program documents, are any financial Yes ____ Comments
or non-financial incentives provided to No ____
CHCs/HFMCs by the program or the MoH?
Community support
Does program documentation specify the role that Yes ____ Comments
the community should play in supporting No ____
CHCs/HFMCs? (i.e. providing feedback, providing
incentives)
Information management
Does program documentation specify health Yes ____ Comments
information that CHCs/HFMCs should be accessing, No ____
analyzing and sharing?
Program performance evaluation
Is there a process for conducting performance Yes ____ Comments
evaluations of CHCs/HFMCs? No ____

Does the process include community feedback? Yes ____ Comments

No ____

Are CHC/HFMC activities evaluated based on Yes ____ Comments

program targets, objectives and indicators? No ____

Country ownership
Do national policies exist regarding the role of Yes ____ Comments
CHCs/HFMCs? No ____

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Appendix B: CHC and HFMC Roles and Responsibilities Checklists

I. Community Health Committee (CHC) Roles and Responsibilities

1. Link Community and Health Service Providers

CHC Responsibilities Recomm. √

Work closely with Health Facility Management Committee (HFMC) where these Standard
exist to improve access of the community to health services
Send representative(s) to health facility committee meetings or hold quarterly Standard
meetings with the HFMC
Report community health status and represent community needs to health service Standard
providers
Ensure that community needs are integrated in the health facility action plan Standard
Serve as conduit for grievances in relation to health service performance Per context
Facilitate feedback to community on operations and management of health facility Per context

II. Network with Health Partners and Stakeholders

CHC Responsibilities Recomm. √

Organize periodic community meetings with open participation, inviting all health Standard
stakeholders
Meet periodically with community health partners (NGOs, CBOs, etc.) Standard
Facilitate working together of existing community based health actors Standard

III. Assess and Monitor Community Health Status

CHC Responsibilities Recomm. √

Conduct ‘Participatory Learning & Action’ (PLA) activities in the community for Standard
health situation analysis
Identify vulnerable or high-risk groups, include in situation analysis Standard
Collect and analyze aggregated data from CHWs Standard
Monitor and report disease outbreaks Standard
Report community health status to health facility Standard
Create and maintain a ‘community health information board’ with relevant health Standard
information and updates
Collect and analyze secondary data/health statistics Per context
Conduct periodic Focus Group Discussions with select community groups (e.g. Per context
pregnant women, adolescents, etc.) to collect primary data
Conduct periodic Key Informant Interviews at health facilities and with other key Per context
health stakeholders
Conduct structured barrier analysis around health practices Per context
Collect household/community health behavioral data on periodic basis Per context
Investigate adverse health events Per context

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IV. Mobilize Community Outreach and Action

CHC Responsibilities Recomm. √

Develop Village Health Plans and share with community and health facility Standard
Improve community health literacy (e.g. organize health information campaigns, Standard
awareness raising etc.)
Mobilize community to participate in clinic outreach events Standard
Support home visitation programs, community-level support groups, peer group Standard
activities etc.
Report activities to community and health facility Standard
Network with other sectors and development stakeholders towards improving the Per context
health status of the community (Ministries of agriculture, education, etc.)
Plan environmental sanitation activities (clean-ups, stagnant water removal, etc.) Per context
Create and manage emergency transport fund Per context

V. Address Socio-Cultural Norms

CHC Responsibilities Recomm. √

Identify harmful cultural/social norms, bring attention to them, and plan activities to Standard
challenge them
Engage faith leaders to challenge harmful social/cultural norms Per context
Engage local politicians to challenge harmful social / cultural norms Per context
Engage media to report on actions to address harmful social / cultural norms Per context

VI. Provide Leadership and Governance Oversight of Health Services

CHC Responsibilities Recomm. √

Inform community of health rights Standard
Provide health facilities with community feedback on services Standard
Facilitate negotiations and help resolve stakeholder conflict Standard
Ensure health facility duty bearers are accountable to communities Per context
Visit health facilities to monitor health services Per context
Use visible community scorecards to track health service performance Per context

VII. Resource Mobilization

CHC Responsibilities Recomm. √

Facilitate resource mobilization for implementation of community work plan (Village Standard
Health Plan), ensuring accountability and transparency
Organize and manage community contributions for community health activities Per context

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VIII. Provide Support to CHW Program

Element of CHC Responsibilities Recomm. √

CHW program
CHW Mobilize community to review, contribute to recruitment Standard
Recruitment criteria
Map community groups to inform recruitment process Standard
Mobilize community participation in selection of new CHWs Standard
CHW Role Ensure community understands CHW role Standard
Define agreement (preferably in written form) on CHC’s role Standard
vis-à-vis CHWs
Ensure community is aware of processes for grievances Standard
Report to CHW supervisor when CHMS/community becomes Standard
aware of CHW infractions
CHW Training Orient CHC members on CHW training Per context
CHMS members visit trainings (make visible connections, Per context
reinforce value)
Enable community feedback on training curricula (priority topics, Per context
etc.)
Track trainings, attendance, equity in training opportunities Per context
Equipment & Monitor CHW stock control forms if relevant Standard
Supplies Alert supervisor of any suspected CHW misuse of stock Standard
CHW Meet periodically with CHWs to discuss concerns, address Standard
Supervision issues
Interact with CHW supervisor during visits to provide feedback Standard
and solve problems; invite community members to participate
CHW Individual Provide feedback on CHW performance Standard
Performance Solicit input from community on CHW performance Standard
Appraisal Ask CHW to provide feedback to CHC on its performance Standard
CHW Mobilize community to ensure CHWs receive locally Standard
Incentives appropriate recognition for good performance
Referral system Understand and support the referral system Standard
Establish community support for referrals e.g. emergency Per context
transport fund or identifying alternative transport
Opportunity for Recommend CHWs to health facility Per context
Advancement Recommend when new CHW position should be created or Per context
additional training is needed for CHWs. (e.g. scholarship, literacy
training)
Documentation, Understand the reporting forms that CHWs use Standard
Information Obtain aggregated data from CHW to present in community Standard
Management meetings
Carry out spot checks in community to ensure CHWs are doing Standard
the work claimed on reporting forms
Identify barriers to data collection and use and helps solve issues Standard
Linkages to Use CHW data to advocate for quality improvement in health Standard
health system services and timely CHW supplies
Ensure CHW is active, performing well, collecting accurate data Per context
Recognize CHWs for performance Per context

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IX. Provide Oversight and Support of Health Facility

HFMC Responsibilities Recomm. √

Support facility community outreach work Standard
Support facility communications with the public Standard
Contribute to preventive maintenance and security of the health facility Standard
infrastructure
Mobilize community to participate in development projects at health facility Standard

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II Health Facility Management Committee (HFMC) Roles and Responsibilities

1. Link Community and Health Service Providers

HFMC Responsibilities Recomm. √

Work closely with Community Health Committees (CHCs) where these exist to Standard
improve access of the community to health services
Report community health status and represent community needs to health service Standard
providers
Ensure that community needs are integrated in the health facility action plan Standard
Serve as conduit for grievances in relation to health service performance Standard
Facilitate feedback to community on operations and management of health facility Standard

II. Network with Health Partners and Stakeholders

HFMC Responsibilities Recomm. √

Organize periodic community meetings with open participation, inviting all health Standard
stakeholders, or participate in such meetings organized by CHCs
Meet periodically with community health partners (NGOs, CBOs, etc.) Per context
Facilitate working together of existing community based health actors Per context

III. Assess and Monitor Community Health Status

HFMC Responsibilities Recomm. √

Monitor and report disease outbreaks Standard
Report community health status to health facility Standard
Create and maintain a ‘facility health information board’ with relevant health Standard
information and updates
Conduct ‘Participatory Learning & Action’ (PLA) activities in the community for Per context
health situation analysis
Identify vulnerable or high-risk groups, include in situation analysis Per context
Collect and analyze aggregated data from CHWs Per context
Collect and analyze secondary data/health statistics Per context
Conduct periodic Focus Group Discussions with select community groups (e.g. Per context
pregnant women, adolescents, etc.) to collect primary data
Conduct periodic Key Informant Interviews at health facilities and with other key Per context
health stakeholders
Conduct structured barrier analysis around health practices Per context
Collect household/community health behavioral data on periodic basis Per context
Investigate adverse health events Per context

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IV. Mobilize Community Outreach and Action

HFMC Responsibilities Recomm. √

Develop Facility Health Plans and share with community and health facility Standard
Report activities to community and health facility Standard
Network with other sectors and development stakeholders towards improving the Standard
health status of the community (Ministries of agriculture, education, etc.)
Create and manage emergency transport fund Standard
Improve community health literacy (e.g. organize health information campaigns, Per context
awareness raising etc.)
Mobilize community to participate in clinic outreach events Per context
Support home visitation programs, community-level support groups, peer group Per context
activities etc.
Plan environmental sanitation activities (clean-ups, stagnant water removal, etc.) Per context

V. Address Socio-Cultural Norms

HFMC Responsibilities Recomm. √

Identify harmful cultural/social norms, bring attention to them, and plan activities to Per context
challenge them
Engage faith leaders to challenge harmful social/cultural norms Per context
Engage local politicians to challenge harmful social / cultural norms Per context
Engage media to report on actions to address harmful social / cultural norms Per context

VI. Provide Leadership and Governance Oversight of Health Services

HFMC Responsibilities Recomm. √

Inform community of health rights Standard
Provide health facilities with community feedback on services Standard
Facilitate negotiations and help resolve stakeholder conflict Standard
Ensure health facility duty bearers are accountable to communities Standard
Visit health facilities to monitor health services Standard
Use visible community scorecards to track health service performance Per context

VII. Resource Mobilization

HFMC Responsibilities Recomm. √

Facilitate resource mobilization for implementation of community work plan (Village Standard
Health Plan), ensuring accountability and transparency
Organize and manage community contributions for community health activities Standard

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VIII. Provide Support to CHW Program

Element of CHC Responsibilities Recomm. √

CHW program
Opportunity for Recommend when new CHW position should be created or Standard
Advancement additional training is needed
Documentation, Identify barriers to data collection and use and help solve issues Standard
Information
Management
Linkages to Recognize CHWs for performance Standard
Health System Use CHW data to advocate for quality improvement in health Standard
services and timely CHW supplies

IX. Provide Oversight and Support of Health Facility

HFMC Responsibilities Recomm. √

Oversee adherence and provision of Primary Health Care package at facility, Standard
including general norms and standards
Monitor and report the extent the health facility is meeting and achieving the health Standard
indicators and targets set for primary health care
Oversee and give community feedback on the operations, management and quality of Standard
services in facility
Identify community needs and ensure they are integrated into the health facility Standard
action plan
Monitor health facility budget and expenditure Standard
Monitor the extent to which facility addresses and resolves complaints submitted by Standard
the community
Facilitate access to facility information Standard
Consolidate, analyze, use and disseminate data Standard
Interpret government health policies to the communities Standard
Support facility community outreach work, including patient follow up at grassroots Standard
level
Support facility communications with the public Standard
Monitor procurement, storage and utilization of all facility goods and services in line Standard
with government regulations
Develop health facility plans and budget Standard
Contribute to preventive maintenance and security of the health facility Standard
infrastructure
Mobilize community contributions to community health fund Standard
Mobilize community to participate in development projects at health facility Standard

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Appendix C: CHC and HFMC Assessment and Improvement Matrices

I. Community Health Committee (CHC): Assessment and Improvement Matrix

1. Strategic Description and Clarity of Community Health Committee (CHC) Programming

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard
CHCs are included in MoH MOH is not involved in MoH is the recognized CHCs form part of MoH CHCs form part of MoH
community health strategy establishing or supporting institutional body policies, strategies policies, strategies and
and their strategic intent is CHCs. The CHCs may have convening the CHCs, but and/or action plans for action plans for community
clearly described been formed through NGO or the roles and functions of community health, and the health and the strategic intent,
other organizations, with no these groups are not strategic intent, roles and roles and functions of these
link to MoH formalized in policies or functions of these groups is groups is clearly described
strategies for community clearly described in in written documentation.
health written documentation The policy/strategy is
reviewed on a regular basis
and updated as needed

If strategy calls for both Where HFMCs are operational Where HFMCs are Where HFMCs are Where HFMCs are
HFMCs and CHCs, the alongside CHCs, the MoH is operational alongside operational alongside operational alongside CHCs,
strategic intent and not involved in establishing or CHCs, MoH is the CHCs, the existence of the existence of these two
functions of these two supporting the CHCs recognized institutional these two groups forms groups forms part of MoH
groups are clearly body convening these part of MoH policies or policies or strategies for
described and groups, but the strategies for community community health, and the
differentiated distinctions between health, but the distinction strategic intent and functions
the two types of groups between the two groups is of these two groups are
is not described in poorly understood in clearly described and
policies or strategies for practice differentiated
community health

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2. CHC Formation
Component Definition 0 1 2 3
Non-functional Minimal Functional Standard
How the CHCs are CHCs exist but meet Loose organization of Organized CHCs exist Organized CHCs exist that
formed: infrequently with no clear members meet ad-hoc to that meet on a regular meet on a regular basis and
objectives or direction discuss key issues within the basis and keep records of keep records of meetings
To what extent the CHC community but not on a meetings
members are organized, regular basis and no formal CHC members have a shared
and clear on the purpose, record is kept CHC members have an vision of what their healthy
mission and importance of idea of what a healthy community can look like in 3
the group’s work The CHC members have a community is, and agree or more years, why their work
vague idea of why their on their overall mission is important and can only be
group should exist and objectives, but are done by them not the MOH or
not put in writing. NGOs.

CHCs have written mission

and objectives

What entity catalyzed the MOH is not involved in MoH catalyzed the MoH catalyzed the MoH catalyzed the formation
program and backs and establishing or supporting formation of the CHCs, but formation of the CHCs of the CHCs and MoH
supports it; e.g. Ministry of CHCs. The CHCs may have MoH involvement with the and MoH - often in supports the groups through
Health (MoH), been formed through NGO groups in practice is limited partnership with NGOs – participation, guidance, and
independent NGO efforts, or other organizations, with provides some supervision supervision
etc, and whether or not no link to MoH and guidance
there are MoH policies,
procedures and to support
the formation and
continuance of the CHCs

The degree of community The wider community is Some community members Community members Community mobilization
awareness and unaware of the CHCs are aware of the informal are aware of intended including multiple
participation in CHC and/or the purpose of these organization, but the structure and purpose of communications prior to group
formation groups community was not CHCs, and participate in formation and recruitment of
consulted in CHC some, but not all of the new members ensures
formation. committee formation community fully aware of
process intended structure and
purpose of group

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3. CHC Member Recruitment and Selection

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

The processes by which No or only a few criteria Some criteria exist and Selection criteria are Selection criteria are defined
CHC members are exist and are not well are communicated but are defined and and communicated and call for
identified and selected, known or commonly applied general and/or do not communicated, but do not representation of gender,
including selection criteria, address specific issues such always specify ethnic/tribal and
community involvement in as gender representation of gender, disadvantaged groups
selection, and degree of ethnic/tribal and
representation (of various disadvantaged groups Selection criteria are
segments of the developed with broad
community) of CHC segment of the community.
members.
No efforts have been made Some community members Communications regarding CHC member recruitment is
Selection criteria should to engage/mobilize the are aware of the CHCs and recruitment for CHC intentionally
focus on: inclusiveness of community to participate in some position openings, but members reach most of communicated through
all subgroups in the CHC member recruitment. primarily through discussion the community through multiple communications prior
community and motivation The community is unaware or personal relationships regular community to group formation and
of members to do work when recruitment is taking communication channels recruitment of new members.
place. (e.g. through community
leaders)
Community is not involved in
The community plays no the recruitment of CHC Community is involved Community is involved in
role in recruitment members but may approve in recruitment of CHC recruitment of CHC
the final selection members; nominating and members; nominating and
voting for candidates voting for candidates, and
marginalized and key
subgroups have a real say in
recruitment

Most selection criteria All selection criteria (literacy,

(literacy, gender, sub- gender, sub-group
group representation, etc.) representation, etc.) are met
are met where possible where possible

There are no specifications Term limits on key members

on term limits or re- or re-election on performance
election of members basis

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4. CHC Roles, Organization and Structure

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard
Clarity and effectiveness of Roles of the CHCs are CHC members may have Roles of the CHCs are Roles of the CHCs are
CHC organization and not defined or documented some ideas about the roles clearly defined and clearly defined and
structure with regard to of the group, but these are documented but not documented and are
roles, expectations, not documented communicated to community communicated to community
frequency, decision-making members or MOH members and MOH
and procedures
The roles of the various The CHCs may have defined The roles of the various The roles of the various
members of the CHC (e.g. the roles of the various CHC members and the CHC members and the
leaders, etc.) are not defined members and an groups’ organizational groups’ organizational
or documented organizational structure structure (e.g. leadership structure (e.g. leadership
(e.g. leadership positions positions, etc.) are clearly positions, etc.) are clearly
etc.) for themselves, but defined and documented but defined and documented, and
these are not documented not communicated to are communicated to
community members or community members and
MoH MoH

Expectations of the Expectations (e.g. time Expectations (e.g. time Expectations (e.g. time
committee are not defined commitment, frequency of commitment, frequency of commitment, frequency of
or documented meetings) and tasks are meetings) and are discussed meetings) and tasks are
discussed in CHCs but are and specific in CHCs but discussed and specific and
not specific or have not been shared communicated to the
documented, or shared with community MOH, the community,
with community members involved organizations and
the committees themselves
The CHCs’ decision-
The decision-making making authority with The CHCs’ decision-
authority of the CHCs with regard to health services is making authority with
regard to health services is clearly established within the regard to health services is
not established, is unclear or CHCs but not clearly established and
is contested communicated (others not communicated so that others
aware) are aware
Process for updating and
No process exists for discussing roles, expectations
updating and discussing and tasks is in place
roles, expectations and tasks

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5. CHC Member Training and Capacity Building

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard
Training provided to the CHC No or minimal Minimal training is A training plan exists within A training plan exists within
members to equip them with the training is provided but is not the local health system for the local health system and
knowledge and skills required to provided to the systematic or new committee members and regular training to the plan
fulfill their roles CHC members OR according to a training generally takes place for all CHC members takes
curriculum or a training . place.
The entity responsible for providing Minimal initial plan; OR Content of training includes
the training (MoH, clinic staff, NGO training is provided at minimum enabling CHCs to Initial training in all
partners). Whether or not the (e.g. one workshop) A training plan exists understand their roles, and necessary content (listed in
training program is institutionalized that does not within the local health basic skills needed to carry column 2), and ongoing
within the MoH adequately prepare system but is not them out, to include training for skill
the CHCs to fulfil implemented regularly. community health maintenance, new skills,
Details of the training: the existence their functions Occasional training is situation analysis, use of new organizational
of a practical, , systematic training offered to some data for decision making, development and health
plan to include initial and ongoing members through ad community mobilization literacy strengthening
training; relevant and sufficient hoc workshops and CHW/volunteer
content vis-a-vis the CHCs’ roles and support Some training is conducted in
responsibilities, the community itself, with
Where committees are linked community participating, as
The extent to which the training with CHWs, training providers of feedback and peer
system is responsive to the fact that includes basic information in co-trainers especially per
the CHCs are made up of members the specific CHW areas (e.g. senior workers.
with different levels of intelligence MNCH, HIV, etc.)
and formal education. With Training develops committee
members skills matched to the tasks as part of wider system that
they are motivated to and can can address many health needs
perform, all members are important locally and knows how and
to fulfil the range of health activities where to go to for help for
that need to be performed and The MoH takes responsibility new or uncommon problems.
should be encouraged so the CHCs for CHC training but often
can function as a whole. The MoH has no The MoH is the entity requests assistance from The training of CHCs is fully
responsibility for nominally responsible NGOs/other partners (e.g. institutionalized within the
training the CHCs for CHC training, but training partially MoH and carried out by
rely on NGOs/other institutionalized w/in MoH) MoH/clinic staff, with
partners (training not NGOs/partners playing only a
institutionalized in MoH) supportive role as needed

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6. Budget for CHC Programming

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

The extent to which CHCs CHCs have no budget or CHCs have no budget but CHCs have an annual CHCs have the legal
have the legal mandate and funding to perform or receive one-off funding budget from MoH and mandate and
authority to develop an annual support community activities from MOH to tackle a consistent funding to authority to develop an
budget and manage revenue that improve health specific health issue enable the CHCs and/or annual budget and
from the government, user fees communities to take small, manage revenue from the
from clinics, or donations from doable action to support government, and
the community to support CHWs, and other health donations from the
community health activities focused activities community including
local businesses to
The extent to which processes support community
are in place for fiscal health activities
management and the CHCs go
through annual audit / CHCs are able to submit
verification processes proposals for funding to
other potential funding
sources

Processes are in place for Processes are in place for

financial management financial management
and CHCs go through
annual audit /
verification processes

The CHCs have

developed the
attitude that many
activities can be done
well with local resources
and without having to
seek further finances.
Therefore local solutions
are examined first before
outside funding is sought.

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7. Supervision of CHC Members

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

The extent to which CHC There is no supervision of The MoH has a formal The MOH has policies in The MOH has policies
members receive support and the CHCs; neither through supervisory relationship place that describe regular in place that describe
supervision from the MOH MoH nor other with the CHCs, or other supervision processes to regular supervision
and/or through other mechanisms OR supervisory mechanisms provide support, coaching processes to provide
mechanisms (such as are occasionally used and problem solving to support, coaching and
committee peer Health staff are meant to CHCs OR problem solving to CHCs
supervision/support, or supervise the CHCs but, as AND
supervision by partner NGOs an added responsibility, the An alternative
or other appropriate direct and indirect costs of supervision mechanism is An alternative
stakeholders) that enable the doing so are too high and/or in place supervision
CHCs to reach their objectives they do not have the mechanisms is in
and fulfill their mission. logistical means and so the place
supervision responsibility
Frequency and purpose of goes unfulfilled
supervisory contacts, and
action and documentation There are no supervisory Occasional supervisory Regular, at least 3 monthly Regular, at least 3
resulting from the contacts contacts with the CHCs. contacts to discuss data, supervisory contacts monthly supervisory
goals and activities and using tools to discuss goals, contacts using tools to
provide input, but not data and current challenges. discuss goals, data and
based on a review of Supervision takes place at current challenges.
data, goals and health facility or other Supervision takes place in
objectives. central location rather than the community
in the community

Little or no ongoing on- Supervision includes Progressive CHC

the-job training as part of assessment of skills and member
the supervision process on-the-job training development and on
the job training planned,
monitored evaluated, and
documented with local
community leaders &
wider community

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Incentives for supervisors: the There are no incentives or Supervisor(s) receive no Some unstandardized An agreed package of
extent to which the supervisors forms of recognition for the incentives package, financial non-financial incentives non-financial
of the CHCs are compensated supervisors of the CHCs or non-financial but are offered to the incentives is provided
for costs of supervisory work Supervisors of the CHCs are appreciation from the supervisors of the CHCs to supervisors of the
and provided with not compensated for time or CHCs is considered a CHCs and is in line with
opportunities for continuing expenses in order to reward general expectations
education for further career perform their supervisory placed on supervisors
development. role
Supervisors of the CHCs are Financial support is provided Financial support is
not compensated for time or to the supervisors of the provided to the
expenses in order to CHCs to offset the direct supervisors of the CHCs
perform their supervisory costs of the supervisory to offset the direct
role work costs of the supervisory
work

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8. Incentives for CHC members

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard
The types of incentives CHC program is completely No incentives package, Some non-financial An agreed package of
received by CHC members volunteer; no financial or financial or non-financial, is incentives are offered to non-financial incentives
non-financial incentives provided by the program but CHC members such as such as training, recognition,
Financial: support to offset are provided recognition from the training, recognition, certification, etc. is provided
direct costs of participation community is considered a certification, but these are to CHC members and is in
reward not standardized and line with expectations placed
Non-financial: include such uniform within defined on members.
considerations as training, geographic areas, and may
certification, recognition, not be commensurate to The incentives package is
community tokens of expectations placed on known by all, and is
appreciation, ceremonies, etc. members uniform within a defined
geographic area (e.g.
The extent to which the district, etc.)
incentive system is
standardized, well-known, and Community offers Community offers
results in CHC member appropriate forms of appropriate forms of
motivation recognition and reward recognition and reward

The extent to which incentives No financial support is Financial support is Financial support is Financial support is
provided are appropriate to the provided to offset the provided to offset the provided to offset the provided to offset the
training, level of effort and time direct costs of participation direct costs of participation direct costs of participation direct costs of participation
commitment that a CHC (e.g. transport to (e.g. transport to (e.g. transport to (e.g. transport to
member needs to input to do trainings/reimbursement) trainings/reimbursement) trainings/reimbursement) trainings/reimbursement)
their work satisfactorily.
CHC members may feel that There is mixed feeling CHC members may feel that CHC members generally feel
the direct and indirect costs among CHC members in intangible benefits such as that the tangible
of participation exceed the terms of the costs/benefits pride, esteem in the incentives and intangible
benefits, and attrition of participation, and community, visible benefits (pride, esteem,
rates may be high inconsistency in member community improvements, value of the work)
participation, with some social opportunities etc. outweigh the costs of
drop-outs outweigh the direct and participation and are
indirect costs of motivated to serve on the
participation and thus are committee
willing to remain on the
committee

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9. Wider Community Support and Involvement

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard
The extent to which the The wider community Some community members The role that the wider Community plays an active
wider community is plays no role in ongoing understand the role that community plays in joining the role in all support areas for
aware of and recognizes support to CHCs they can play in supporting the CHCs, participating in CHC- the CHCs, such as providing
the value of the CHCs. CHCs led activities and supporting input in defining the CHC’s
CHWs is well-understood role, providing feedback,
The extent to which the participating in CHC-led
wider community community activities, and helps
recognizes its own role in to establish the legitimacy of
supporting the CHCs, and the CHCs in the community
participates in their
activities and initiatives Members of the wider The wider community is Community members actively The wider community
community do not see a sometimes involved with participate in meetings and understands the value of, and is
benefit to participating in the CHCs (campaigns, activities led by the CHCs active in participating in CHC-
CHC activities education) and some people led activities.
in the community recognize
the CHCs as a resource
There is intentional effort to
There is no involvement Social/political hierarchies in include the most The community leaders are
or attempt to reach the the community and the vulnerable/ marginalized in supportive advocates of
most vulnerable and influence and interests of the CHC and in community equal participation of the
marginalized in CHC elite mean that the most activities, and levels of socio- most vulnerable and
initiatives vulnerable and cultural/elite resistance to this marginalized
marginalized may be are low
poorly represented or
excluded from CHC and Community members share
community activities concerns about community The CHCs are recognized
health with the CHCs and and appreciated for being a
actively seek their involvement vehicle for the community to
in addressing the concerns raise concerns, and for
providing service to the
community

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 Community and Health Facility Management Committees: Program Functionality Assessment
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10. CHC Support of the Referral System

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard
Processes for patient referrals No referral system is in The community, the CHCs The community, the CHCs The community, the CHCs
and counter-referrals, from place OR and CHWs/ health and CHWs/ health and CHWs/ health
CHW to clinic and back, and volunteers know where volunteers know where volunteers know where
the extent to which the CHCs A referral system exists but referral facility is but have referral facility is and referral facility is and usually
play a role in supporting the is rarely used, and the no formal referral usually have the means have the means for
process; through information, CHCs play no role in process/logistics, forms to transport clients transport and have a
tracking, logistics, emergency supporting it functional logistics plan
transport provisions or other for emergencies
(transport, funds)

No logistics planning in The CHCs do not have The CHCs have processes The CHCs manage
place by the community for any role in supporting the in place to support the emergency transport
emergency referrals referral system CHW with referral funds
assistance when needed

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11. Communication and Information Management

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard
The extent to which data flows The CHCs have no access Community health data There is a process for There is a process for
to the health system and back. to publicly available health that does not identify documentation and documentation and
The extent to which CHCs data and do not collect any individuals is publicly information flow of health regular two way
make use of data and data from CHWs available at the data between health information flow of health
information to identify key community level. CHCs facilities, CHWs and CHCs data between health
health issues for action and to may access the data on facilities, CHWs and CHCs.
advocate for health service request from health facility This data is stored in such a
improvement or from CHWs way that it is readily
accessible to members of the
public.
The CHCs do not use
health data to guide The CHCs review The CHCs review The CHCs review
action to address health community health data with community health data with community health data with
issues and disease CHWs and take some CHWs, and use the data CHWs, and use the data
epidemiology action to address the key to verify/ascertain equity to verify equity in health
health issues and disease in health services, to services to address key
epidemiology address key issues and health issues, and disease
disease epidemiology and to epidemiology, to improve
improve health services. health services, and report
back to stakeholders
The CHCs have no access
to or mechanism for The CHCs have no access Mechanisms are in place Health service
tracking health service to or mechanism for for CHCs to track health performance is openly
performance data tracking health service service performance and the accessible. The flow of
performance data CHCs sometimes collect information –health facility
and make use of this to CHC to community - is
information such that the performance of
the health facility and CHWs
CHC and community rights can be accessed.
CHWs and health workers and standards for
are not formally CHWs and health workers performance of CHW duties CHCs and community know
accountable to the are not formally and service provision are their rights and
community accountable to the recorded and available to standards of CHW duties
community community members. and service provision.

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12. Linkages to the Health System

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

How the CHCs and Links to health, local MoH and other MoH and other CHCs are linked to the
communities are linked to the government, and other stakeholders recognize stakeholders provide larger health system and
larger health system. ministerial systems are contribution of CHCs to some support to the local government, with a
weak or non-existent; overall health system but fundamental mechanics of supporting management culture
Health system is made up of CHCs work in isolation provide little or no the CHCs. that encourages transparency
government, regions, districts, support and openness between the
municipalities and individual health facility, CHCs, CHWs,
health facilities that provide community.
resources, finances and
management to deliver health
services to the population CHCs organizational CHCs organizational goals
goals and yearly plans and yearly plans are
are integrated into MOH integrated into MOH yearly
yearly plans, though not plans, and regularly
closely monitored or monitored or supported.
supported.

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13. Country Ownership

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

The extent to which the The CHCs have no The CHCs have The MOH or other The MOH or other
Ministry of Health (MoH) has: relationship with the relationships with the ministries have policies in ministries have policies
MOH or other ministries MOH, health facility or place that integrate and that integrate and include
Integrated and included the and receive no support. local government, and include CHCs in health CHCs in health system
CHCs in health systems provide input, but are not system planning and planning and budgeting
planning (e.g. policies are in part of a legal or budgeting processes. processes, and provide them
place) regulatory system. with logistical and
financial support to
Budgeted for financial support sustain them

Provided logistical support (e.g. CHCs have legal

supervision, training) to sustain frameworks and are
CHC programs at the district, registered as community
regional and/or national level based organizations.

CHCs are organized as an

association with a
representation system for
providing input to the
government at district level
and above.

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14. CHC Program Performance Evaluation

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

The extent to which program No regular evaluation of Yearly evaluation Yearly evaluation Yearly evaluation
evaluation of CHC program performance conducted of CHCs’ conducted of CHCs’ conducted of CHCs’
performance against targets, related to CHCs’ mission activities but does not activities that assesses activities that assesses
objectives, and indicators is and objectives assess achievements CHC achievements in CHC achievements in
carried out by the CHC against program relation to program relation to program
supervisors indicators and outcomes indicators and targets indicators and targets

No feedback provided to Feedback is provided to Feedback is provided to

Whether or not evaluations CHC members on how they CHC members but this may CHC members in relation to
take place annually to input into are performing relative to be informal and ad-hoc program indicators and
the operational plans for the program indicators and targets
next year and the development targets
and revision of strategic plans
The CHC program is The CHC program is
reaching at least 50% of its reaching at least 75% of its
targets targets

The yearly evaluations are

included as a responsibility
in the job descriptions of
relevant supervising health
workers and managers

The assessment includes

input from community
members regarding their
level of satisfaction with the
achievements of the CHCs

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Community and Health Facility Committees: Program Functionality Assessment
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II. Health Facility Management Committee (HFMC): Assessment and Improvement Matrix

1. Strategic Description and Clarity of Health Facility Management Committee (HFMC) Programming
Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

HFMCs are included in MoH MOH is not involved in MoH is the recognized HFMCs form part of HFMCs form part of MoH
community health strategy and establishing or supporting institutional body MoH policies, strategies policies, strategies and
their strategic intent is clearly HFMCs. The HFMCs may convening the HFMCs, but and/or action plans for action plans for community
described have been formed through the roles and functions of community health, and the health and the strategic intent,
NGO or other these groups are not strategic intent, roles and roles and functions of these
organizations, with no link formalized in policies or functions of these groups is groups is clearly described
to MoH strategies for community clearly described in in written documentation.
health written documentation The policy/strategy is
reviewed on a regular basis
and updated as needed

If strategy calls for both HFMCs Where CHCs are Where CHCs are Where CHCs are Where CHCs are operational
and CHCs, the strategic intent operational alongside operational alongside operational alongside alongside HFMCs, the
and functions of these two HFMCs, the MoH is not HFMCs, MoH is the HFMCs, the existence of existence of these two groups
groups are clearly described involved in establishing or recognized institutional these two groups forms forms part of MoH policies or
and differentiated supporting the CHCs body convening these part of MoH policies or strategies for community
groups, but the strategies for community health, and the strategic intent
distinctions between health, but the distinction and functions of these two
the two types of groups between the two groups is groups are clearly described
is not described in poorly understood in and differentiated
policies or strategies for practice
community health

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2. HFMC Formation
Component Definition 0 1 2 3
Non-functional Minimal Functional Standard
To what extent the HFMC HFMCs exist but meet Loose organization of Organized HFMCs exist Organized HFMCs exist
members are organized, and infrequently with no clear members meet ad-hoc to that meet on a regular that meet on a regular
clear on the purpose, objectives or direction discuss key issues within basis and keep records of basis and keep records of
mission and importance of the community and facility meetings meetings
the group’s work but not on a regular basis
and no formal record is
kept

The HFMC members have HFMCs agree on their HFMC members have a
a vague idea of why their overall mission and shared vision of what
group should exist objectives, but these are their healthy
not put in writing. community can look like
in 3 or more years, why
their work is important and
can only be done by them
not the MOH or NGOs.
HFMCs have written
mission and objectives

What entity catalyzed the MOH is not involved in MoH catalyzed the MoH catalyzed the MoH catalyzed the
program and backs and establishing or supporting formation of the HFMCs, formation of the HFMCs formation of the HFMCs
supports it; e.g. Ministry of HFMCs. The HFMCs may have but MoH involvement with and MoH - often in and MoH supports the
Health (MoH), independent been formed through NGO or the groups in practice is partnership with NGOs – groups through
NGO efforts, etc, other organizations, with no limited provides some supervision participation, guidance, and
link to MoH and guidance supervision

The degree of community The wider community is Some community members Community members Community mobilization
awareness and participation unaware of the HFMCs are aware of HFMCs but are aware of intended including multiple
in HFMC formation and/or the purpose of this the community was not structure and purpose of communications prior to
groups consulted in HFMC HFMCs, and participate in group formation and
formation. some, but not all of the recruitment of new
committee formation members ensures
processes community fully aware
of intended structure and
purpose of HFMCs

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3. HFMC Member Recruitment and Selection

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

The processes by which No or only a few Some criteria exist and are Selection criteria are Selection criteria are defined
HFMC members are criteria exist and are communicated but are defined and communicated, and communicated and call for
identified and selected, not well known or general and/or do not address but do not always specify representation of gender,
including selection commonly applied specific issues such as gender representation of gender, ethnic/tribal and
criteria, community ethnic/tribal and disadvantaged groups
involvement in selection, disadvantaged groups
and degree of Selection criteria are developed
representation (of various with broad segment of the
segments of the community.
community) of HFMC
members. Health facility staff are Criteria for health facility staff Criteria for health facility staff Criteria for health facility staff as
members of the HFMC as members of the HFMC as members of the HFMC members of the HFMC are clear
The selection and roles of and often dominate the specify which health staff ensure that their roles are and specify that if health staff
health facility staff as group to the detriment should play which roles, but balanced against the roles of hold a leadership position in the
members of the HFMC of community interests no mechanisms exist to guard community members so that HFMC, then other leadership
against unhealthy power the community members have positions must be held by
dynamics between health staff equal voice in the HFMC community members, in order to
and community members ensure balance of power

The community plays Community is not involved in Community is involved in Community is involved in
no role in recruitment the recruitment of HFMC recruitment of HFMC recruitment of HFMC
members but may approve members; nominating and members; nominating and voting
the final selection voting for candidates for candidates, and
marginalized and key
subgroups have a real say in
recruitment

Most selection criteria All selection criteria (literacy,

(literacy, gender, sub-group gender, sub-group
representation, etc.) are met representation, etc.) are met
where possible where possible

There are no specifications on Term limits on key members

term limits or re-election of or re-election on performance
members basis

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4. HFMC Member Roles, Organization and Structure

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

Clarity and effectiveness Roles of the HFMCs HFMC members may have Roles of the HFMCs are Roles of the HFMCs are
of HFMC organization are not defined or some ideas about the clearly defined and documented clearly defined and documented
and structure with regard documented roles of the group, but but not communicated to and are communicated to
to roles, expectations, these are not documented community members community members
frequency, decision-
making and procedures The roles of the The HFMCs may have The roles of the various The roles of the various
various members of defined the roles of the HFMC members and the HFMC members and the
the HFMCs (e.g. various members and an groups’ organizational groups’ organizational
leaders, etc.) are not organizational structure (e.g. leadership structure (e.g. leadership
defined or documented structure (e.g. leadership positions, etc.) are clearly positions, etc.) are clearly defined
positions etc.) for defined and documented but not and documented, and are
themselves, but these are communicated to community communicated to community
not documented members members

Expectations of the Expectations (e.g. time Expectations (e.g. time Expectations (e.g. time
HFMC members are commitment, frequency of commitment, frequency of commitment, frequency of
not defined or meetings) and tasks are meetings) and are discussed and meetings) and are discussed and
documented discussed but are not specific but have not been specific and communicated to
specific or shared with community the community, involved
documented, or shared members organizations and the HFMCs
with community themselves

The decision-making The HFMCs’ decision-making The HFMCs’ decision-making

authority of the HFMCs authority with regard to health authority with regard to health
with regard to health services is clearly established services is clearly established and
services is not established, within the HFMCs but not communicated so that others are
is unclear or is contested communicated (others not aware
aware)

No process exists for Process for updating and

updating and discussing roles, discussing roles, expectations and
expectations and tasks tasks is in place

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5. HFMC Member Training and Capacity Building

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

Training provided to the HFMC No or minimal Minimal training is A training plan exists A training plan exists
members to equip them with the training is provided to provided but is not within the local health within the local health
knowledge and skills required to the HFMC members systematic or according system for new committee system and regular
fulfill their roles OR to a curriculum or a members and training training to the plan for all
training plan; OR generally takes place . HFMC members takes
The entity responsible for providing Minimal initial training place.
the training (MoH, clinic staff, NGO is provided (e.g. one A training plan exists Content of training
partners). Whether or not the workshop) that does within the local health includes at minimum
training program is institutionalized not adequately prepare system but is not enabling HFMCs to Initial training in all
within the MoH the HFMCs to fulfil implemented regularly. understand their roles, and necessary content and
their functions Occasional training is basic skills needed to carry ongoing training for
Details of the training: the existence offered to some members them out skill maintenance, new
of a practical, through ad hoc skills, new organizational
systematic training plan to include workshops development and health
initial and ongoing training; relevant literacy strengthening
and sufficient content vis-a-vis the
HFMCs’ roles and responsibilities, Training develops
and effectiveness of training committee as part of
methodologies. wider system that can
address many health needs
The extent to which the training locally and knows how and
system is responsive to the fact that where to go to for help for
the HFMCs are made up of members new or uncommon
with different levels of intelligence The MoH takes problems.
and formal education. With responsibility for HFMC
members skills matched to the tasks The MoH has no The MoH is the entity training but often requests The training of HFMCs is
they are motivated to and can responsibility for nominally responsible for assistance from fully institutionalized within
perform, all members are important training the HFMCs HFMC training, but rely NGOs/other partners (e.g. the MoH and carried out by
to fulfil the range of health activities on NGOs/other partners training partially MoH/clinic staff, with
that need to be performed and (e.g. training not institutionalized w/in MoH) NGOs/partners playing only
should be encouraged so the HFMCs institutionalized in MoH) a supportive role as needed
can function as a whole

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6. Budget for HFMC Programming

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

The extent to which the The HFMCs have no The HFMCs have no The HFMCs have an The HFMCs have the legal
HFMCs have the legal mandate budget or funding to budget but may receive annual budget from mandate and authority to
and authority to develop an perform or support one-off funding from MoH and consistent develop an annual budget
annual budget and manage community or facility- MOH to tackle a specific funding to enable the and manage revenue from the
revenue from the government, level activities that health issue HFMCs and/or community government, the health facility
user fees from clinics, or improve health to take small, doable and/or donations from the
donations from the community health focused activities community including local
to support facility and businesses to support
community health activities community or facility-levvel
health activities
The extent to which processes
are in place for fiscal HFMCs are able to submit
management and the HFMCs proposals for funding to other
go through annual audit / potential funding sources
verification processes Processes are in place for
financial management Processes are in place for
financial management and
the HFMCs go through an
annual audit / verification
processes

The HFMCs have developed

the attitude that many
activities can be done well with
local resources and without
having to seek further finances.
Therefore local solutions are
examined first before outside
funding is sought.

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Community and Health Facility Committees: Program Functionality Assessment
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7. Supervision of HFMC Members

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

The mechanism by which There is no supervision of A formal mechanism A formal mechanism The MOH has policies in
HFMCs are supervised. the HFMCs; neither through exists for supervision of exists for supervision of place that describe regular
This is especially MoH nor other HFMCs, through a local HFMCs, through a local supervision processes for
important for those mechanisms OR government council, MoH at government council, MoH at HFMCs, reporting to a local
HFMCs managing or higher administrative levels higher administrative levels government council, MoH at
overseeing facility funds An identified mechanism (e.g. district, national), or (e.g. district, national), or higher administrative levels (e.g.
or budgets exists for supervision of the other appropriate mechanism, other appropriate district, national), or other
HFMCs; either by a local occasionally mechanism, regularly appropriate mechanism, and
council or higher-level MoH the supervisory mechanism
staff (e.g. district, national) operates regularly and
but, as an added responsibility effectively
for those involved, the direct
and indirect costs of doing so
are too high and/or they do
not have the logistical means
and so the supervision
responsibility goes
unfulfilled

Frequency and purpose of There are no supervisory Occasional supervisory Regular, at least 3 monthly Regular, at least 3 monthly
supervisory contacts, and contacts with the HFMCs. contacts to discuss data, supervisory contacts using supervisory contacts using
action and documentation goals and activities and tools to discuss goals, data tools to discuss goals, data and
resulting from the provide input, but not based and current challenges. current challenges.
contacts on a review of data, goals
and objectives.
Supervision includes review Supervision includes rigorous
of HFMCs’ use of funds, if financial control of the
applicable HFMCs’ use of funds, if
applicable

Little or no ongoing on- Supervision includes Progressive HFMC

the-job training as part of the assessment of skills and member development and
supervision process on-the-job training on the job training planned,
monitored evaluated, and
There are no incentives or documented

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Community and Health Facility Committees: Program Functionality Assessment
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Incentives for supervisors: forms of recognition for the Supervisor(s) receive no Some unstandardized An agreed package of non-
the extent to which the supervisors of the HFMCs incentives package, financial non-financial incentives financial incentives is
supervisors of the HFMCs Supervisors of the HFMCs are or non-financial but are offered to the provided to supervisors of the
are compensated for not compensated for time or appreciation from the supervisors of the HFMCs HFMCs and is in line with
costs of supervisory work expenses in order to perform HFMCs is considered a general expectations placed on
their supervisory role reward supervisors

Supervisors of the HFMCs are Financial support is provided Financial support is provided to
not compensated for time or to the supervisors of the the supervisors of the HFMCs
expenses in order to perform HFMCs to offset the direct to offset the direct costs of
their supervisory role costs of the supervisory the supervisory work
work

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Community and Health Facility Committees: Program Functionality Assessment
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8. Incentives for HFMC members

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

The types of incentives HFMC program is No incentives package, Some non-financial An agreed package of
received by HFMC completely volunteer; no financial or non-financial, is incentives are offered to non-financial incentives
members financial or non-financial provided by the program but HFMC members such as such as training, recognition,
incentives are provided recognition from the training, recognition, certification, etc. is provided
community is considered a certification, but these are not to HFMC members and is in
Financial: support to offset reward standardized and uniform line with expectations placed
direct costs of within defined geographic areas, on members.
participation and may not be commensurate
to expectations placed on The incentives package is
Non-financial: include such members known by all, and is
considerations as training, uniform within a defined
certification, recognition, geographic area (e.g.
community tokens of district, etc.)
appreciation, ceremonies,
etc. Community offers Community offers
appropriate forms of appropriate forms of
The extent to which the recognition and reward recognition and reward
incentive system is
standardized, well-known, No financial support is Financial support is Financial support is provided Financial support is
and results in HFMC provided to offset the direct provided to offset the direct to offset the direct costs of provided to offset the
member motivation costs of participation (e.g. costs of participation (e.g. participation (e.g. transport to direct costs of participation
transport to trainings/ transport to trainings/ trainings/reimbursement) (e.g. transport to
The extent to which reimbursement) reimbursement) trainings/reimbursement)
incentives provided are
appropriate to the training, HFMC members may feel There is mixed feeling among HFMC members may feel that HFMC members generally
level of effort and time that the direct and indirect HFMC members in terms of intangible benefits such as feel that the tangible
commitment that a HFMC costs of participation the costs/benefits of pride, esteem in the incentives and intangible
member needs to input to exceed the benefits, and participation, and community, visible community benefits (pride, esteem,
do their work attrition rates may be high inconsistency in member improvements, social value of the work)
satisfactorily. participation, with some opportunities etc. outweigh outweigh the costs of
drop-outs the direct and indirect costs of participation and are
participation and thus are motivated to serve on the
willing to remain on the committees
committees

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9. Wider Community Support and Involvement

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard
The extent to which the wider The wider community plays Some community members The role that the wider Community plays an
community is aware of and no role in ongoing understand the role that community plays in joining active role in all support
recognizes the value of the support to HFMCs they can play in supporting the HFMCs, and areas for the HFMCs, such
HFMCs. the HFMCs participating in HFMC-led as providing input in defining
activities is well- the HFMCs’ role, providing
The extent to which the wider understood feedback, participating in
community recognizes its own HFMC-led community
role in supporting the HFMCs, activities, and helps to
and participates in its activities establish the legitimacy of
and initiatives, as required the HFMCs in the
community

There is no involvement Social/political hierarchies in There is intentional effort The community leaders are
or attempt to reach the the community and the to include the most supportive advocates of
most vulnerable and influence and interests of the vulnerable/ marginalized equal participation of the
marginalized in HFMC elite mean that the most in the HFMCs’ activities, and most vulnerable and
initiatives vulnerable and levels of socio-cultural/elite marginalized in HFMCs’
marginalized may be resistance to this are low activities
excluded from the HFMCs’
activities

Community members share

concerns about community The HFMCs are
health with the HFMCs and recognized and
actively seek their appreciated for being a
involvement in addressing vehicle for the community to
the concerns raise concerns, and for
providing service to the
community

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10. HFMC Support of the Referral System

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

Processes for patient referrals No referral system is in The community, the HFMCs The community, the HFMCs The community, the HFMCs
and counter-referrals, from place OR and CHWs/ health and CHWs/ health and CHWs/ health
CHW to clinic and back, and volunteers know where volunteers know where volunteers know where
the extent to which the A referral system exists but referral facility is but have referral facility is and referral facility is and usually
HFMCs play a role in is rarely used, and the no formal referral usually have the means have the means for
supporting the process; HFMCs play no role in process/logistics, forms to transport clients transport and have a
through information, tracking, supporting it functional logistics plan
logistics, emergency transport for emergencies
provisions or other (transport, funds)

No logistics planning in The HFMCs do not have The HFMCs have a process The HFMCs manage
place by the community for any role in supporting the in place to support the emergency transport
emergency referrals referral system CHW with referral funds
assistance when needed

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Community and Health Facility Committees: Program Functionality Assessment
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11. Communication and Information Management

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

The extent to which data flows The HFMCs have no access Community or facility There is a process for There is a process for
to the health system and back. to publicly available health health data that does not documentation and documentation and
The extent to which the data and do not collect any identify individuals is information flow of health regular two way
HFMCs make use of data and data publicly available at the data between health facilities information flow of health
information to identify key community level. HFMCs and HFMCs data between health facilities
health issues for may access the data on and HFMCs. This data is
communication and to request from health facility stored in such a way that it
advocate for health service is readily accessible to
improvement members of the public.

Extent to which HFMCs The HFMCs do not use The HFMCs review The HFMCs review facility The HFMCs review facility
support the government and health data to guide community or facility health health data use the data to health data, and use the
the facility in communications action to address health data and take some action communicate key issues data to communicate
with the public issues and disease to address the key health and disease epidemiology key health issues, and disease
epidemiology issues and disease with the public and to epidemiology with the public,
epidemiology improve health outcomes. to improve health outcomes
and report back to key
stakeholders
Mechanisms are in place
The HFMCs have no access The HFMCs have no access for HFMCs to track health Health service
to or mechanism for to or mechanism for service performance and the performance is openly
tracking health service tracking health service HFMCs sometimes collect accessible. The flow of
performance data performance data and make use of this information –health facility
information to HCMC to community - is
such that the performance of
the health facility can be
accessed.
Rights and standards for
Health workers are not Health workers are not performance and service HFMCs and community
formally accountable to formally accountable to provision are recorded and know their rights and
the community the community available to community standards of service
members. provision.

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12. Linkages to the Broader Health System

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

How the HFMCs and Links to broader health HFMCs are linked to the HFMCs are linked to HFMCs are linked to the
communities are linked to the system, local government, local health facility district-level health broader health system at
larger health system. and other ministry and only, with no links to the management teams and district level and to local
community systems are broader health system at receive some support from government, with a supporting
Health system is made up of weak or non-existent; higher administrative levels them management culture that
government, regions, districts, HFMCs work in isolation encourages transparency and
municipalities and individual openness between the health
health facilities that provide facility, CHCs, CHWs,
resources, finances and community.
management to deliver health
services to the population .
HFMCs’ organizational HFMCs’ organizational goals
goals and yearly plans and yearly plans are
are integrated into MOH integrated into MOH yearly
yearly plans, though not plans, and regularly
closely monitored or monitored or supported.
supported.
.

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13. Country Ownership

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

The extent to which the The HFMCs have no legal The HFMCs have linkages The MOH or other The MOH or other
Ministry of Health (MoH) has: or formalized with the MOH, or local ministries have policies in ministries have policies
relationship with the government beyond their place that integrate and that integrate and include
Integrated the HFMCs in health MOH or other ministries work at local health include HFMCs in health HFMCs in health system
systems planning (e.g. policies beyond their work at local facilities, and provide input , system planning and planning and budgeting
are in place) health faclities, and receives but are not part of a legal budgeting processes. processes, and provide them
no support. or regulatory system. with logistical and
Budgeted for financial support financial support to
sustain them
Provided logistical support (e.g.
supervision, training) to sustain HFMCs have legal
HFMC programs at the district, frameworks and are
regional and/or national level registered as community
based organizations.

HFMCs are organized as

an association with a
representation system for
providing input to the
government at district level
and above.

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14. HFMC Program Performance Evaluation

Component Definition 0 1 2 3
Non-functional Minimal Functional Standard

HFMC Program No regular evaluation of Yearly evaluation Yearly evaluation Yearly evaluation
Performance Evaluation program performance conducted of HFMCs’ conducted of HFMCs’ conducted of HFMCs’
related to HFMCs’ mission activities but does not activities that assesses activities that assesses
The extent to which program and objectives assess achievements HFMC achievements in HFMC achievements in
evaluation of HFMC against program relation to program relation to program
performance against targets, indicators and outcomes indicators and targets indicators and targets
objectives, and indicators is
carried out by the HFMC No feedback provided to Feedback is provided to Feedback is provided to
supervisors HFMC members on how HFMC members but this HFMC members in relation
they are performing relative may be informal and ad-hoc to program indicators and
to program indicators and targets
Whether or not evaluations targets
take place annually to input into
the operational plans for the The HFMC program is The HFMC program is
next year and the development reaching at least 50% of its reaching at least 75% of its
and revision of strategic plans targets targets

The yearly evaluations are

included as a responsibility
in the job descriptions of
relevant supervising health
workers and managers

The assessment includes

input from community
members regarding their
level of satisfaction with the
achievements of the HFMCs

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Appendix D: CHC/HFMC Validation Questionnaire

Instructions: Use this document either before or after the assessment workshop to verify the scoring established by
workshop participants. Try to visit 2-3 committees that did not participate in the workshop (or 4-6 if you are
assessing both CHCs and HFMCs; 2-3 of each type of group) and hold focus group discussions with committee
members, using the questions in this questionnaire as a guide. The number of committee members participating in a
FGD should not exceed 12 to enable good discussion by all. Following the FGDs, compare responses with the
workshop scores and the action plan to determine if any changes are needed. If the FGDs are conducted prior to the
assessment, use the information as a guide during the discussion. If the FGDs take place after the assessment, discuss
the changes with those who participated in the assessment.

No. Question Responses

1 How long have you worked as
Community Health Committee (or
Health Facility Committee) members?
2 How many members does this
committee have? How many
men/women?
4 Please describe how you were recruited

5 The members of the committee

represent which community structures,
groups and stakeholders?
(Circle all that apply and/or write the
corresponding numbers in the space)

1. Health facility staff

2. Community leaders
3. CHWs
4. Traditional healers
5. Traditional birth attendants
6. Church/faith leaders
7. Youth
8. Disabled
9. NGO/CBO
10. Women’s groups
11. Other (explain)
6 How is the committee structured? What
are the leadership positions?

7 How does the committee decide which

members will hold the leadership
positions?

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No. Question Responses

8 Please describe the key tasks for which
the committee is responsible

9 How well does the community

understand the objectives and roles of
the committee? Explain
10 How well do you think what you do as a
committee meets the expectations of
the community? Of the health facility?
Explain
11 How often do you meet together as a
committee?
12 Do you keep written records of
committee meetings?

13 Please describe the initial training you

received to prepare you for your role as
a committee? When did the training
take place, how long did it last, and what
topics were covered?

14 Please describe any additional training

(refresher/ongoing training) you have
received to help you fulfill your role as a
committee

15 Do you have the supplies and materials

you need to provide the services you
are expected to deliver? Explain
16 Do you have any funds to carry out
your activities?

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No. Question Responses

If yes, where do the funds come from?

If yes, describe any training you have

received on financial management

17 Who supervises this committee?

18 How often do you meet with your

supervisor?

19 What does your supervisor do when

he/she meets or visits you?

20 Does the community you work in

provide you with any of the following?
(Circle all that apply and/or write the
corresponding numbers in the space)
1. Feedback
2. Support (financial/gifts in kind)
3. Formal recognition/appreciation
4. Guidance on your work
5. Other (explain)
21 How active would you say the
community is in participating in activities
and meetings that you lead?

22 How active would you say the more

vulnerable members of the community
are in participating in activities and
meetings that you lead?
23 What is the procedure for referring
patients/clients to the health facility?

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No. Question Responses

24 Please describe the transportation
systems available to get clients to
referral facilities

25 What role, if any, does the committee

play in the referral process?

26 Please describe any sources of health

data and information that you receive
and review

27 How does the committee use health

data and information?

28 How often do you meet with health

facility staff?
29 What is the purpose of these meetings,
and what takes place during the
meetings?

30 Have you received an evaluation of your

work in the last 12 months?

If yes:
• Who evaluated you?
• How were you evaluated?
• What was evaluated?
31 What are your biggest challenges as a
committee?

32 What changes are needed to help you

do your job better?

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____________________________________________________________________________________________________________________

Appendix E: Score and Score Rationale Documentation Worksheet

I: Community Health Committees

Instructions: This worksheet is for participants to note their scores and the evidence or rationale they have for choosing the score. Participants should note
in the action column any interventions that can help the program move forward towards better practice. Scores can be revised (*) only if field visits or other
information provides evidence that supports a different score from that agreed in the workshop.

Component Workshop Validated Rationale Action Items Comments

Score Score*
1. Strategic Description and
Clarity of CHC Programming
2. CHC Formation

3. CHC Member Recruitment

and Selection
4. CHC Member Roles,
Organization and Structure
5. CHC Member Training and
Capacity Building
6. Budget for CHC Programming

7. Supervision of CHC Members

8. Incentives for CHC Members

9. Wider community support

and involvement
10. CHC Support of the Referral
System
11. Communication and
Information Management
12. Linkages to the Broader
Health System
13. Country Ownership

14. CHC Program Performance

Evaluation
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____________________________________________________________________________________________________________________

II: Health Facility Management Committees

Instructions: This worksheet is for participants to note their scores and the evidence or rationale they have for choosing the score. Participants should note
in the action column any interventions that can help the program move forward towards better practice. Scores can be revised (*) only if field visits or other
information provides evidence that supports a different score from that agreed in the workshop.

Component Workshop Validated Rationale Action Items Comments

Score Score*
1. Strategic Description and
Clarity of HFMC Programming
2. HFMC Formation

3. HFMC Member Recruitment

and Selection
4. HFMC Member Roles,
Organization and Structure
5. HFMC Member Training and
Capacity Building
6. Budget for HFMC
Programming
7. Supervision of HFMC
Members
8. Incentives for HFMC
Members
9. Wider community support
and involvement
10. HFMC Support of the Referral
System
11. Communication and
Information Management
12. Linkages to the Broader
Health System
13. Country Ownership

14. HFMC Program Performance

Evaluation

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Community and Health Facility Management Committees: Program Functionality Assessment
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Appendix F: Action Plan Template

Instructions: Copy as many pages of this template as needed and use to create an action plan for improving the functionality of the CHC and/or HFMC
program(s)

Program Issue Improvement Person(s) Resources Timeframe Indicator

Element Activity Responsible Needed

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