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

Human Resources for Health

Asha S George²  Abdullah H Baqui²  Peter Winch²  Japhet Killewo³  Helen Semu¹  Rose Mpembeni³  Joy J Chebet²  Isabelle Feldhaus²  Marissa Silverman²  Chelsea M Cooper⁴  Idda Mosha³  Amnesty E Lefevre²  Jennifer Applegate²  Timothy Roberton² 

[1] Ministry of Health and Social Welfare, 6 Samora Machel Avenue, Dar es Salaam, 11478, Tanzania;Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore 21205, MD, USA;Muhimbili University of Health and Allied Sciences, United Nations Road, Dar es Salaam, 65001, Tanzania;Jhpiego, 1615 Thames Street, Baltimore 21231, MD, USA

关键词: MNCH;    CHW;    newborn and child health;    Maternal;    Tanzania;    Village leaders;    Supportive supervision;    Supervision;    Community health workers;   

Others  :  1171513
DOI  :  10.1186/s12960-015-0010-x

 received in 2014-11-24, accepted in 2015-03-08,  发布年份 2015

【 摘 要 】

Background

Supervision 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.

Methods

Quantitative 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.

Results

CHWs 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.

Conclusions

Supervision 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.

【 授权许可】

   
2015 Roberton et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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