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Improving community health worker performance through supportive supervision: a randomised controlled implementation trial in Pakistan
Author(s) -
Aftab Wafa,
Rabbani Fauziah,
Sangrasi Kashif,
Perveen Shagufta,
Zahidie Aysha,
Qazi Shamim Ahmed
Publication year - 2018
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.14282
Subject(s) - medicine , randomized controlled trial , physical therapy , nursing , family medicine , surgery
Aim To assess the effect of enhanced supportive supervision of lady health workers ( LHW s) by lady health supervisors on integrated community case management of childhood pneumonia and diarrhoea. Methods A total of thirty‐four supervisors were randomly assigned to intervention and comparison arms. The intervention included enhanced training of supervisors on supervisory skills and written feedback to LHW s by supervisors. The performance of both cadres was assessed three times. Household surveys judged caregiver practices. Results Intervention arm LHW s performed better than those in the comparison arm in assessing dehydration (92% [n = 25] vs 64% [n = 25]) and in classifying diarrhoea correctly (68% [n = 25] vs 40% [n = 25]). The two arms differed little in correct disease classification for pneumonia (44% [n = 25] vs 40% [n = 25]). Supervisory performance of intervention arm supervisors was better than that in the comparison arm in correcting the workers’ clinical examination skills (64% [n = 25] vs 40% [n = 25]) and more frequent feedback. In the household survey, only 18% (n = 2182) intervention and 23% (n = 2197) comparison arm caregivers considered LHW s capable of providing diarrhoea and pneumonia care. Commodities for integrated community case management were not regularly available to workers. Conclusion Supportive supervision can improve community case management performance. Support through refresher training, logistics and commodities is essential.