Supportive supervision for volunteers to deliver reproductive health education: a cluster randomized trial

Abstract

BackgroundCommunity Health Volunteers (CHVs) can be effective in improving pregnancy and newborn outcomes through community education. Inadequate supervision of CHVs, whether due to poor planning, irregular visits, or ineffective supervisory methods, is, however, recognized as a weakness in many programs. There has been little research on best practice supervisory or accompaniment models.MethodsFrom March 2014 to February 2015 a proof of concept study was conducted to compare training alone versus training and supportive supervision by paid CHWs (n = 4) on the effectiveness of CHVs (n = 82) to deliver education about pregnancy, newborn care, family planning and hygiene. The pair-matched cluster randomized trial was conducted in eight villages (four intervention and four control) in Budondo sub-county in Jinja, Uganda.ResultsIncreases in desired behaviors were seen in both the intervention and control arms over the study period. Both arms showed high retention rates of CHVs (95 %). At 1 year follow-up there was a significantly higher prevalence of installed and functioning tippy taps for hand washing (p < 0.002) in the intervention villages (47 %) than control villages (35 %). All outcome and process measures related to home-visits to homes with pregnant women and newborn babies favored the intervention villages. The CHVs in both groups implemented what they learnt and were role models in the community.ConclusionsA team of CHVs and CHWs can facilitate families accessing reproductive health care by addressing cultural norms and scientific misconceptions. Having a team of 2 CHWs to 40 CHVs enables close to community access to information, conversation and services. Supportive supervision involves creating a non-threatening, empowering environment in which both the CHV and the supervising CHW learn together and overcome obstacles that might otherwise demotivate the CHV. While the results seem promising for added value with supportive supervision for CHVs undertaking reproductive health activities, further research on a larger scale will be needed to substantiate the effect.

Community Health Volunteers in Primary Healthcare in Rural Uganda: Factors Influencing Performance

“…Individual, group, and program factors have each been shown to influence the performance of CHVs (1, 3, 5, 6, 8–15, 17–19, 25). Factors previously reported to result into improved performance include the female gender, regular supervision and provision of feedback, higher education, the availability of job aides and other tools, and feeling “connected” with the system (3, 5, 6, 9–11, 13, 14, 17, 18). …”

“…Implementation mechanisms in the country have varied and have been largely steered by government partners, including local and foreign non-governmental organizations, as government funding and resources have dwindled since inception (7). Some of the factors described to improve their performance include support from the community and health facilities, adequate work resources, regular feedback, and supervision (3, 6, 11, 13, 17, 18). Challenges have been attributed to lack of or low remuneration, lack of uniform and regular contact with supervisors, or lack of motivation, high workload, and inadequate skills (3, 12).…”

“…However, the findings have been heterogeneous and influenced by many factors (4, 8), including socio-demographic, political, economic, and workplace environments. Workload, attrition rates, gender roles, level of education, political commitment and employment status, job aides, and physical workplace environment have a significant influence on such workers’ performance (3–6, 9–15). Understanding the contextual factors and enablers that influence the performance of CHVs is relevant for many settings aiming to use them to achieve the SDGs.…”

Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda

“…Research on CHWs in other contexts has also supported innovations in CHW supervision going beyond their facility-based supervisors [27][28][29]. MANIFEST also found that non-monetary incentives such as T-shirts, certificates and musawo (doctor) status in the community motivated VHTs to continue working.…”

Use, adoption and effectiveness of tippy-tap handwashing station in promoting hand hygiene practices in a resource-limited setting: A systematic review

“…Based on MMAT, eight studies scored 100% [14][15][16][17][18][19][20][21]; ten studies scored 75% [22][23][24][25][26][27][28][29][30][31] and two studies scored 50% [6,32]. With an average MMAT score of 82.5% across the included studies, the studies are considered to be of high quality.…”