The status of Ghanaian community health workers’ supervision and service delivery: descriptive analyses from the 2017 Performance Monitoring and Accountability 2020 survey

Schwarz, Dan; Kim, June-Ho; Ratcliffe, Hannah L.; Bell, Griffith; Awoonor-Williams, John Koku; Nimako, Belinda Afriyie; Otupiri, Easmon; Lipsitz, Stuart R.; Hirschhorn, Lisa R.; Bitton, Asaf

doi:10.12688/gatesopenres.12979.2

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…On this topic, the evidence is mixed. In a study from Ghana, the type of supervisor (i.e., community health officers, public health nurses, midwives, health assistants, and physician assistants) and type of facility (i.e., community health post, health centre, or hospital) to which the CHW was linked had no impact on the frequency of supervision, though the quality of supervision was not assessed [ 42 ]. Meanwhile, a qualitative study in South Africa concluded that supervision by senior nurses in facilities promoted better integration with the facility teams compared to supervision by a junior nurse [ 43 ].…”

Section: Resultsmentioning

confidence: 99%

Community health workers at the dawn of a new era: 7. Recent advances in supervision

Westgate

Musoke

Crigler³

et al. 2021

Health Res Policy Sys

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Background Supervision is essential for optimizing performance and motivation of community health workers (CHWs). This paper, the seventh in our series, “Community health workers at the dawn of a new era”, supplements the existing evidence on CHW supervision in low- and middle-income countries by reviewing what supervision approaches are employed in specific contexts, identifying potential facilitators of CHW supervision including mobile health (mHealth) interventions, and noting challenges of supervision including the relationship between supervision and other CHW programme elements. Methods For this exploratory research study on CHW supervision, we reviewed the supervisory interventions described in a compendium of 29 case studies of large-scale CHW programmes, performed an electronic search of multiple databases to identify articles related to CHW supervision published between 15 June 2017 and 1 December 2020, and from those articles followed additional references that appeared to be relevant for our results. Results We reviewed 55 case studies, academic articles, and grey literature resources as part of this exploratory research. A variety of supervision approaches have been adapted over time, which we grouped into five categories: external supervision, community supervision, group supervision, peer supervision, and dedicated supervision. These approaches are frequently used in combination. Digital (mHealth) technologies are being explored as potential facilitators of CHW supervision in both small- and large-scale programmes; however, evidence of their effectiveness remains limited to date. Inadequate support for supervisors is a major challenge, particularly given the numerous and varied roles they are expected to fulfil, spanning administrative, clinical, and supportive activities. Supervisors can help CHWs acquire other critical elements needed from the health system for them to perform more effectively: incentives to foster motivation, clarity of roles and tasks, adequate tools and supplies, appropriate knowledge and skills, and a safe work environment. Conclusion In the absence of a universal “best approach” for CHW supervision, our recommendation is that countries and programmes prioritize homegrown evolution over time to suit the local context. In some cases, this may involve scaling up novel approaches that have proven effective at small scale or testing approaches that have worked in other countries.

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Section: Resultsmentioning

confidence: 99%

Community health workers at the dawn of a new era: 7. Recent advances in supervision

Westgate

Musoke

Crigler³

et al. 2021

Health Res Policy Sys

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“…[16][17][18][19][20] In Ghana, for example, despite NCDs not being part of the formal programme, CHWs reported working on NCDs in nine out of 10 regions. 21 To date, there are very few examples of evaluations of polyvalent CHW programmes that incorporate multiple conditions in their care provision model. 3…”

Section: Key Questionsmentioning

confidence: 99%

A household-based community health worker programme for non-communicable disease, malnutrition, tuberculosis, HIV and maternal health: a stepped-wedge cluster randomised controlled trial in Neno District, Malawi

Wroe

Nhlema²,

Dunbar

et al. 2021

BMJ Glob Health

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BackgroundCommunity health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expanding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).MethodsWe conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20–40 households for monthly (or more frequent) visits.FindingsThe intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (−0.8 percentage points (pp) (95% credible interval: −2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: −0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (−0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (−0.6 per 1000 (95% CI −2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges.InterpretationCHW programmes can be successfully expanded to more comprehensively address health needs in a population, although programmes should be carefully tailored to CHW and health system capacity.

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“…In addition to varying definitions and framing of supervision, several studies have noted challenges with how it is implemented. Not only is there a lack of evidence on what 'good supervision' for CHWs entails (Assegaai & Schneider, 2019), but there is also variability in supervisory interactions across different geographical contexts and programmes, resulting in a lack of consistency or development of best practices (Schwarz et al, 2019). As a result, there is a need for studies to explore how supervision for CHWs is positioned, its purpose and ways to support effective delivery (Agarwal et al, 2019;Nkomazana et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Exploring supervision for volunteer community health workers in Mukono District, Uganda: An exploratory mixed-methods study

O’Donovan

Namanda²,

Hamala³

2021

Global Public Health

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Community Health Worker (CHW) supervision is an under-researched area. This mixed-methods study engaged key stakeholders involved in CHW supervision in Mukono District, Uganda including CHWs (n = 14), District Health Office officials (n = 5), NGO programme managers (n = 3) and facility-based health staff (n = 3). Our study aimed to explore how supervision is currently conceptualised and delivered in this setting, the desired qualities of a potential supervisor, as well as the challenges regarding supervision and potential solutions to address these. To understand these concepts, we conducted structured surveys and individual interviews. Survey data were analysed in SPSS using descriptive statistics. Interview transcripts were thematically analysed in NVivo using conventional content analysis. This study revealed current CHW supervision in this context is fragmented. Supervision is perceived both as a means of motivating CHWs and facilitating ongoing training, as well as a way of holding CHWs accountable for their work. Stakeholders identified technical knowledge and expertise, strong interpersonal skills and cultural awareness as desirable qualities for a supervisor. Challenges surrounding supervision included a shortage of funding, a lack of guidelines on supervision, and infrequent supervision. To address these challenges, stakeholders proposed the need for increased funding, creating clearer job descriptions for supervisors, and in-person supervisory meetings.

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The status of Ghanaian community health workers’ supervision and service delivery: descriptive analyses from the 2017 Performance Monitoring and Accountability 2020 survey

Abstract: Community-based services are a critical component of

Cited by 7 publications

References 8 publications

Community health workers at the dawn of a new era: 7. Recent advances in supervision

Community health workers at the dawn of a new era: 7. Recent advances in supervision

A household-based community health worker programme for non-communicable disease, malnutrition, tuberculosis, HIV and maternal health: a stepped-wedge cluster randomised controlled trial in Neno District, Malawi

Exploring supervision for volunteer community health workers in Mukono District, Uganda: An exploratory mixed-methods study

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