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. 2013 Apr 3:6:19658.
doi: 10.3402/gha.v6i0.19658.

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

Daniel Palazuelos  1 , Kyla Ellis, Dana DaEun Im, Matthew Peckarsky, Dan Schwarz, Didi Bertrand Farmer, Ranu Dhillon, Ari Johnson, Claudia Orihuela, Jill Hackett, Junior Bazile, Leslie Berman, Madeleine Ballard, Raj Panjabi, Ralph Ternier, Sam Slavin, Scott Lee, Steve Selinsky, Carole Diane Mitnick
Affiliations

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

Daniel Palazuelos et al. Glob Health Action. .

Abstract

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

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

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

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

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

Keywords: case study; community health workers; conceptual framework; quality improvement; research.

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Figures

Fig. 1
Fig. 1
The 5-SPICE framework graphically represented.
Fig.2
Fig.2
Partners In Health (PIH) CHW Project characteristics (from the ‘Rich grids’). (a) Number of CHWs vs. Years in operation for various PIH CHW projects. (b) Distribution of CHW package of service across PIH programs. (c) CHW selection and recruitment at PIH programs. (d) Patient load per CHW by PIH program. Note: Data for PIH-Mexico are not yet available due to ongoing changes in this new program's implementation.
Fig.2
Fig.2
Partners In Health (PIH) CHW Project characteristics (from the ‘Rich grids’). (a) Number of CHWs vs. Years in operation for various PIH CHW projects. (b) Distribution of CHW package of service across PIH programs. (c) CHW selection and recruitment at PIH programs. (d) Patient load per CHW by PIH program. Note: Data for PIH-Mexico are not yet available due to ongoing changes in this new program's implementation.
Chart 1
Chart 1
5×5 SPICE chart-positive interactions.
Chart 2
Chart 2
5×5 SPICE chart-negative interactions.
See this image and copyright information in PMC

References

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