By Lynne Elliott (LSTM) and Veronica Mwania (LVCT Health)
Community Health Workers are the frontline staff that form a bridge between the people and the health systems that serve them. Often, they work for free with the households near them, identifying families who are grappling with ill health and advising and referring them to the services that can make a difference. Challenges in supervision of community health workers are a common problem all over the world, and Kenya is no exception.
The USAID SQALE program has been supporting community health workers to collect and analyse good quality data on maternal, new born and child health as part of a process of quality improvement in line with government policy. As part of this process the Bangladesh Community Health Unit are practicing supportive supervision after it was recognised that this was a weakness in the way that Community Health Volunteers (CHVs) were managed.
Supportive supervision is a purposeful move away from the supervision of Community Health Volunteers which is fault finding and erratic to one where the team work together as a group to find solutions to the challenges being faced in a regularised way. Southlands Community Unit visited Bangladesh in order to observe one of their supervision sessions with a view to implementing something similar.
During the meeting there was a recap of the types of supportive supervision provided (one-to-one, group and spot checks) and reasons for each. Issues discussed in the supervision meeting included: data collection and reporting; dealing with challenges such as including engaging community members who were reluctant to link with CHVs; creating rapport and building community trust; the lack of commodities for example for nutrition, water treatment, and deworming; and re-engaging CHVs who were not active. For example, they identified three CHVs who had not provided community reports and devised a plan to follow up and re-engage with them.
Improved supervision had been having an impact. CHVs from Bangladesh have been meeting in group supervisions which they felt allowed them to share ideas and discuss solutions. These meetings give them a clearer sense of how they are performing. “We know more clearly what we’re doing well and where we’re going wrong. The meeting was a good opportunity to share challenges” one volunteer explained.