A recent study published in the Global Health Action journal has reviewed the literature relating to supervision of community health workers (CHWs) in low income countries. It was established that there is very little known about what makes adequate supervision and how different strategies influence CHW motivation, performance and retention. The study by Hill et al. aims to determine the impact of supervision and discuss implementation and feasibility issues through reviewing the relevant literature.
As CHWs become an increasingly common and important part of the health system in resource poor settings, it is vital to establish adequate supervision which is believed to improve performance and keep CHWs motivated. Despite being considered one of the most important components of any CHW programme, supervision remains a challenge and is often lacking in quality if it is implemented at all.
Supervision of CHWs in the last decade has focused increasingly on supportive and facilitative approaches, influenced by models being used for clinical supervision in high income countries. Supportive supervision is now considered best practice and includes strategies such as observations, performance monitoring, provider participation, problem solving and focused education. In practice, supportive supervision implementation varies greatly in content and there is little evidence to inform the design of effective supervision strategies. The literature review examined different supervision areas and components such as supervision frequency, supportive/facilitative supervision packages, peer, group and community supervision, self-assessment and checklists, quality assurance and problem solving as well as supervisor training.
The study found that there is only a very limited amount of data available on supervision and concluded that there is need for further research on strategies that have not been rigorously tested. Despite this, the review shows that there is a large variety of supervision approaches being implemented in different settings and that improving the quality of supervision has a greater impact on CHW motivation and performance than simply increasing its frequency. And while evaluation of all proposed supervision strategies was found to be weak, the study shows that supportive supervision packages, community monitoring and quality improvement/problem-solving approaches show the most promise.
Read the full literature review here
To find out more about Malaria Consortium’s work in CHW supervision and the implementation of innovative approaches for its improvement using mHealth and community involvement strategies, please visit the inSCALE website.