Setting standards for monitoring the performance of primary care personnel--outreach workers.

PIP: Personnel performance evaluation should be an integral part of the monitoring of a service program's efforts, particularly in those programs utilizing outreach workers, for the effectiveness of the program will initially depend on the success of such a service element. Variables need to be selected and criteria need to be established in order to operationalize the measurements to be used and to be able to evaluate performance. The contribution of outreach personnel performance to the effectiveness of a personal health service program is based on conditions stated in the following assumptions: 1) if the working capacity of the outreach workers is maintained at a satisfactory level, the service program will have the capacity to contact and follow-up a sufficient number of consumers, therefore increasing the probabilities that the service program will succeed in achieving its objective of a high degree of "population coverage;" if the outreach worker is sufficiently "convincing," the services offered will be accepted by the consumer; and 3) if the outreach worker complies with the standards, techniques, and procedures set forth by the program, the quality of services is ensured. Based on these assumptions, it seems reasonable to consider working capacity, and compliance with standards, techniques, and procedures as variables in evaluating and monitoring outreach personnel performance, provided that these variables can be operationalized for measurement. The opportunity to apply these concepts was provided during the recent efforts to evaluate a primary care program in Cali, Colombia. PRIMOPS (Spanish acronym for Research Program in Health Delivery Models) is a primary care Maternal and Child Health/Family Planning Program designed to contribute to the reduction of mortality, morbidity, and fertility of the "target" area. The mainstay of the PRIMOPS design are the 13 health promotoras recruited and selected from the community and trained according to the tasks they will perform. Using the information gathered through the record system and the supervision report, an effort to measure the performance of PRIMOPS promotoras was conducted. It was found that the variables of working capacity, convincing capacity, and compliance with standards, techniques, and procedures can be adapted to programs with features similar to those of the PRIMOPS program. Consequently, they should be taken into consideration as managerial tools in the efforts to assess and monitor personnel performance.^ieng