Association between supportive supervision and performance of community health workers in India: a longitudinal multi-level analysis

Human Resources for Health

Rasmi Avula¹  Purnima Menon¹  Sumeet Patil²  Lia Fernald³  Lakshmi Gopalakrishnan³  Nadia Diamond-Smith⁴  Dilys Walker⁴ 

[1] International Food Policy Research Institute, Washington, DC, USA;NEERMAN, Center for Causal Research and Impact Evaluation, Mumbai, India;University of California Berkeley, Berkeley, USA;University of California San Francisco, San Francisco, USA;

关键词: Anganwadi worker;    CHWs;    ICDS;    Integrated Child Development Services;    Supervision;    Nutrition;    Madhya Pradesh;    Bihar;    Supervisor;    Health system;   

DOI  :  10.1186/s12960-021-00689-7

来源: Springer

【 摘 要 】

IntroductionCommunity health workers (CHWs) deliver services at-scale to reduce maternal and child undernutrition, but often face inadequate support from the health system to perform their job well. Supportive supervision is a promising intervention that strengthens the health system and can enable CHWs to offer quality services.ObjectivesWe examined if greater intensity of supportive supervision as defined by monitoring visits to Anganwadi Centre, CHW-supervisor meetings, and training provided by supervisors to CHWs in the context of Integrated Child Services Development (ICDS), a national nutrition program in India, is associated with higher performance of CHWs. Per program guidelines, we develop the performance of CHWs measure by using an additive score of nutrition services delivered by CHWs. We also tested to see if supportive supervision is indirectly associated with CHW performance through CHW knowledge.MethodsWe used longitudinal survey data of CHWs from an impact evaluation of an at-scale technology intervention in Madhya Pradesh and Bihar. Since the inception of ICDS, CHWs have received supportive supervision from their supervisors to provide services in the communities they serve. Mixed-effects logistic regression models were used to test if higher intensity supportive supervision was associated with improved CHW performance. The model included district fixed effects and random intercepts for the sectors to which supervisors belong.ResultsAmong 809 CHWs, the baseline proportion of better performers was 45%. Compared to CHWs who received lower intensity of supportive supervision, CHWs who received greater intensity of supportive supervision had 70% higher odds (AOR 1.70, 95% CI 1.16, 2.49) of better performance after controlling for their baseline performance, CHW characteristics such as age, education, experience, caste, timely payment of salaries, Anganwadi Centre facility index, motivation, and population served in their catchment area. A test of mediation indicated that supportive supervision is associated indirectly with CHW performance through improvement in CHW knowledge.ConclusionHigher intensity of supportive supervision is associated with improved CHW performance directly and through knowledge of CHWs. Leveraging institutional mechanisms such as supportive supervision could be important in improving service delivery to reach beneficiaries and potentially better infant and young child feeding practices and nutritional outcomes.Trial registration : Trial registration number: https://doi.org/10.1186/ISRCTN83902145

【 授权许可】

CC BY