Integrating community health workers into the formal health system to improve performance A qualitative study on the role of onsite supervision in the South African programme

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dc.contributor.author Tseng m
dc.contributor.author Grifiths f
dc.contributor.author De dadt j
dc.date.accessioned 2020-03-10T11:21:48Z
dc.date.available 2020-03-10T11:21:48Z
dc.date.issued 2019
dc.identifier.citation ISI en_ZA
dc.identifier.issn 2044-6055
dc.identifier.uri https://hdl.handle.net/10539/29082
dc.description.abstract Abstract Objectives To explore the role of on-site supervision in community health worker (CHW) programmes and CHW integration into the health system. We compared the functioning of CHW teams reporting to a clinic-based nurse with teams supervised by a community-based nurse. We also consider whether a junior nurse can provide adequate supervision, given the shortage of senior nurses. Design A case study approach to study six CHW teams with different configurations of supervision and location. We used a range of qualitative methods: observation of CHW and their supervisors (126 days), focus group discussions (12) and interviews (117). Setting South Africa where a national CHW programme is being implemented with on-site supervision. Participants CHWs, their supervisors, clinic managers and staff, district managers, key informants from the community and CHW clients. Results Effective supervisors supported CHWs through household visits, on-the-job training, debriefing, reviewing CHWs’ daily logs and assistance with compiling reports. CHWs led by senior nurses were motivated and performed a greater range of tasks; junior nurses in these teams could better fulfil their role. Clinic-based teams with senior supervisors were better integrated and more able to ensure continuity of care. In contrast, teams with only junior supervisors, or based in the community, had less engagement with clinic staff, and were less able to ensure necessary care for patients, resulting in lower levels of trust from clients. Conclusion Senior supervisors raised CHW skills, and successfully negotiated a place for CHWs in the health system. Collaboration with clinic staff reduced CHWs’ marginalisation and increased motivation. Despite being clinic-based, teams without senior supervisors had lower skill levels and were less integrated into the health system. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. en_ZA
dc.title Integrating community health workers into the formal health system to improve performance A qualitative study on the role of onsite supervision in the South African programme en_ZA
dc.type Article en_ZA
dc.journal.volume 9 en_ZA
dc.journal.title BMJ OPEN en_ZA
dc.description.librarian KM2020 en_ZA
dc.citation.doi 10.1136/BMJOPEN-2018-022186 en_ZA
dc.citation.epage 11
dc.citation.spage 1
dc.journal.link DOI: 10.1136/bmjopen-2018-022186 en_ZA
dc.journal.issue 2 en_ZA
dc.faculty Health Sciences en_ZA
dc.school School of Public Health en_ZA


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