A randomised controlled trial to investigate effects of enhanced supervision on primary eye care services at health centres in Kenya, Malawi and Tanzania

Kalua, Khumbo; Gichangi, Michael; Barassa, Ernest; Eliah, Edson; Lewallen, Susan; Courtright, Paul

doi:10.1186/1472-6963-14-s1-s6

Cited by 20 publications

(28 citation statements)

References 18 publications

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“…The evidence from the qualitative interviews also suggest that the four day training conducted in this setting was more effective in raising awareness of eye health than imparting skills in clinical management. This finding is consistent with evidence from earlier research in Tanzania and other settings in Africa, which showed that no more than two thirds of PHWs trained in PEC could identify cataract in pictures [ 12 ] and the PHWs’ ability and willingness to measure visual acuity, remove foreign bodies or accurately differentiate the causes of a red eye did not change after training [ 22 ]. Whether the knowledge and skills acquired during training will be translated into action in the long term will depend on overcoming the multiple barriers to this process [ 23 ].…”

Section: Discussionsupporting

confidence: 90%

Mixed methods evaluation of a primary eye care training programme for primary health workers in Morogoro Tanzania

et al. 2016

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BackgroundThere are 285 million people with visual impairment (VI) worldwide including 39 million who are blind; 15 % of those with VI live in Africa, and around 80 % of VI is preventable or treatable with the right equipment, information and skills. The scarcity of human resources for eye health, particularly in Sub-Saharan Africa, is a key challenge towards achieving this goal. Therefore training primary health workers (PHW) in providing eye-care services has been seen by some authors as a way to improve access to eye-care services in remote communities. However, the package of interventions which could be effectively delivered for eye-care at the primary-care level or the set of skills and competencies that PHWs need has not yet been delineated. The aim of the study was to evaluate the effectiveness of a four day training programme of PHWs in primary eye-care conducted in Morogoro, Tanzania in 2010/2011.MethodsA mixed methods study using pre- and immediate post-training knowledge assessment of 60 trainees, and in-depth face to face interviews with 20 PHWs and 8 service managers 2 to 3 years after the training.ResultsPre-and immediate post-training assessments indicated improvement in health worker knowledge about eye-care in the short term. Qualitative investigations 2 to 3 years after the training showed that although staff could make the correct management decisions when presented with eye-health problems, they often could not make a correct diagnosis. PHWs and managers reported satisfaction with the content of the training but some of the less well qualified staff found it overwhelming. Theoretical teaching was appreciated by most participants but almost all suggested increasing the time spent on acquiring skills. The training manual was accepted by many and some improvements were recommended. All interviewed PHWs were keen to improve their skills and knowledge. Acquired skills and knowledge were used for identification, referral of patients and for eye-health promotion.ConclusionThe training program in Morogoro was considered by PHWs as broadly successful and satisfying in terms of content, methods and duration of training. However, any future programme needs to be considered within the context of strengthening wider health systems.

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Section: Discussionsupporting

confidence: 90%

Mixed methods evaluation of a primary eye care training programme for primary health workers in Morogoro Tanzania

et al. 2016

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“…Qualitative findings from a systematic review of lay health worker programmes suggest that supervisors often lack supervisory skills and face constraints due to time and transportation [ 20 ]. A randomized control trial of an enhanced supervision programme for eye care in three sub-Saharan African countries, including Tanzania, found only modest improvements in the skills and knowledge of health workers receiving enhanced supervision, with authors concluding that the lack of programme impact may be linked to poor health system functioning and high staff turnover [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Initial experiences and innovations in supervising community health workers for maternal, newborn, and child health in Morogoro region, Tanzania

et al. 2015

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BackgroundSupervision is meant to improve the performance and motivation of community health workers (CHWs). However, most evidence on supervision relates to facility health workers. The Integrated Maternal, Newborn, and Child Health (MNCH) Program in Morogoro region, Tanzania, implemented a CHW pilot with a cascade supervision model where facility health workers were trained in supportive supervision for volunteer CHWs, supported by regional and district staff, and with village leaders to further support CHWs. We examine the initial experiences of CHWs, their supervisors, and village leaders to understand the strengths and challenges of such a supervision model for CHWs.MethodsQuantitative and qualitative data were collected concurrently from CHWs, supervisors, and village leaders. A survey was administered to 228 (96%) of the CHWs in the Integrated MNCH Program and semi-structured interviews were conducted with 15 CHWs, 8 supervisors, and 15 village leaders purposefully sampled to represent different actor perspectives from health centre catchment villages in Morogoro region. Descriptive statistics analysed the frequency and content of CHW supervision, while thematic content analysis explored CHW, supervisor, and village leader experiences with CHW supervision.ResultsCHWs meet with their facility-based supervisors an average of 1.2 times per month. CHWs value supervision and appreciate the sense of legitimacy that arises when supervisors visit them in their village. Village leaders and district staff are engaged and committed to supporting CHWs. Despite these successes, facility-based supervisors visit CHWs in their village an average of only once every 2.8 months, CHWs and supervisors still see supervision primarily as an opportunity to check reports, and meetings with district staff are infrequent and not well scheduled.ConclusionsSupervision of CHWs could be strengthened by streamlining supervision protocols to focus less on report checking and more on problem solving and skills development. Facility health workers, while important for technical oversight, may not be the best mentors for certain tasks such as community relationship-building. We suggest further exploring CHW supervision innovations, such as an enhanced role for community actors, who may be more suitable to support CHWs engaged primarily in health promotion than scarce and over-worked facility health workers.

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“…This approach allowed the study team to identify recurring themes and describe the salient issues that emerged from the data. NVivo 10 Software was used to store and analyse the data [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

Integration of eye health into primary care services in Tanzania: a qualitative investigation of experiences in two districts

Jolley

Mafwiri

Hunter

et al. 2017

BMC Health Serv Res

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BackgroundVisual impairment is a public health problem in sub-Saharan Africa, affecting nearly 5% of the population. Efforts to combat avoidable causes have been hampered by weak health systems and little evidence exists to suggest what interventions may be effective to improve the situation. Despite this, there are calls to promote some specific interventions, one of which being the closer integration of eye health services into health systems, often focusing on training primary health workers to deliver basic eye health services. This study seeks to understand how eye health services are delivered by primary health workers who have received training and what constraints remain to effective service provision.MethodsThis was a qualitative investigation into the experiences of 20 primary health workers trained in primary eye care and eight key informants working within specialist eye health services or regional and district health management positions in two districts in Tanzania.ResultsDespite feeling confident in their own eye care skills, most primary health workers felt constrained in the services they could provide to their communities by insufficient resources needed for diagnosis and treatment, and by lack of systematic supportive supervision to their work. Specialist ophthalmic staff were aware of this issue, although for the most part they felt it was not within their capacity to remedy and that it fell within the remit of general health managers. Many participants discussed the low support to eye health from the national government, evidenced through the lack of dedicated funding to the area and traditional reliance on outside funds including international charities.ConclusionsAlthough training of primary health workers is useful, it is recognised that is not sufficient to address the burden of eye health disease present in rural communities in Tanzania. It is likely that broader engagement with the general health system, and most likely with the private sector, will be necessary to improve the coverage of eye health care to remote and poor communities such as those in Morogoro. Further investment is needed to develop innovative approaches to delivering eye health services, including preventative, curative and rehabilitative services.

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A randomised controlled trial to investigate effects of enhanced supervision on primary eye care services at health centres in Kenya, Malawi and Tanzania

Cited by 20 publications

References 18 publications

Mixed methods evaluation of a primary eye care training programme for primary health workers in Morogoro Tanzania

Mixed methods evaluation of a primary eye care training programme for primary health workers in Morogoro Tanzania

Initial experiences and innovations in supervising community health workers for maternal, newborn, and child health in Morogoro region, Tanzania

Integration of eye health into primary care services in Tanzania: a qualitative investigation of experiences in two districts

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