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Enhancing Performance of CHWs for resilient and responsive health systems: The role of supportive supervision

Malawi

The REACHOUT project is funded by the European Union

REACHOUT Consortium Meeting, Bangladesh June 12th 2016

• Community Health Workers (CHWs) are key to both resilient and responsive health systems.

• Health Surveillance Assistants (HSAs) in Malawi are the core cadre extending health services to communities

• Their performance is hindered by poor supervision, which tends to be irregular and unsupportive

Background

QI activities • Have trained supervisors• Monthly peer supervision• Group monthly meetings with HSAs

and their supervisors• Quarterly supervisors meetings • Performance appraisal and

recognition awards

QI tools• Programme assessment• Implementation tracking• Supervision checklist• Performance tools i.e. Work plan,

appraisal form, reporting form• Motivation questionnaire• Qualitative topic guides• Supervision and outcome measure

questionnaires

Nature of intervention

Frequency of supervision

• The peer and group supervision brought improvement in frequency and approach to supervision

“…REACH Trust identified a few HSAs who were trained in supervision and they are helping with supervision of blocks and we are seeing some changes in supervision. The supervision is becoming more frequent ” Male HSA, Salima

Findings

• Commitment and accountability - The new model of supervision has led to an improvement to work commitment and accountability

“We meet maybe 6 HSAs per block… This system is good because we are having ownership and becoming accountable to what we are doing unlike in the past… Male HSA, Mchinji

Reflections on findings

• Health system challenges hampering supervision and performance-

Despite the mentioned improvements after the introduction of the intervention, HSAs bemoaned lack of equipment and supplies as one major factor that affected their commitment to perform:

“Lack of equipment can cause people to think you are not managing your work properly, because you can only work effectively if you have all the equipment…It affects us because we do not do the work as it was supposed to be done, so it discourages us from doing our best, and the community becomes deprived of

some health services” Female HSA-Salima

Discussion and Conclusion

• Peer and group supervision is important for building resilient and responsive health systems in resource limited settings.

• Group supervision promoted a supportive environment to achieving planned activities through sharing of resources as well as augmenting manpower.

– The approaches are contributing towards promoting a more collective approach to work, with the potential to enhance both HSA motivation and performance

• However, for the supervision approach to have more impact, supervision needs to occur at all levels (including district) level and be embedded in broader district health systems strengthening approaches.

Discussion and Conclusion

• There is need to strengthen engagement of facility and district level supervisors to conduct supervision

• Resources continue to be major challenge in terms of prioritization of supervision

• Opportunities for sustainability and strengthening resilience of primary health care at national level are available:

– the Adoption by MoH of block (peer and group supervision) system approach in Malawi– MoH plans to formally train HSA supervisors

Lessons learnt

• Ownership and interest at district level is important and will ease embedding the approach into district health systems.

However this requires will and championship at district and community level to lead the process.Active leadership led to better implementation of the intervention