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Community health extension workers’ training and supervision in Ethiopia: Exploring impact and implementation challenges for non-communicable disease service delivery

Training and supervision of health workers are critical components of any health system;thus, we assessed how they impact health extension workers’ (HEWs) role in non-communicable disease (NCD) service delivery in Ethiopia’s health extension program (HEP), using an in-depth qualitative study conduct...

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Autores principales: Tesema, Azeb Gebresilassie, Peiris, David, Abimbola, Seye, Ajisegiri, Whenayon S., Narasimhan, Padmanesan, Mulugeta, Afework, Joshi, Rohina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021836/
https://www.ncbi.nlm.nih.gov/pubmed/36962619
http://dx.doi.org/10.1371/journal.pgph.0001160
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author Tesema, Azeb Gebresilassie
Peiris, David
Abimbola, Seye
Ajisegiri, Whenayon S.
Narasimhan, Padmanesan
Mulugeta, Afework
Joshi, Rohina
author_facet Tesema, Azeb Gebresilassie
Peiris, David
Abimbola, Seye
Ajisegiri, Whenayon S.
Narasimhan, Padmanesan
Mulugeta, Afework
Joshi, Rohina
author_sort Tesema, Azeb Gebresilassie
collection PubMed
description Training and supervision of health workers are critical components of any health system;thus, we assessed how they impact health extension workers’ (HEWs) role in non-communicable disease (NCD) service delivery in Ethiopia’s health extension program (HEP), using an in-depth qualitative study conducted in 2019.The study covered two regions—the Tigray and the South Nations, Nationalities and Peoples Region (SNNPR)—and involved the Federal Ministry of Health. We conducted twenty-seven key informant interviews with federal and regional policymakers, district health officials, health centre representatives and HEWs.Participants highlighted substantial implementation challenges with training and supervision practices delivered via the HEP. Training for NCDs lacked breadth and depth. IT was described as inconsistently delivered with variable availability within and between regions;and when available, the quality was low with scant content specific to NCDs. HEP supervision was inconsistent and, rather than being supportive, mainly focused on finding faults in HEW work practices. Supervisors themselves had skill gaps in critical areas overall, and specifically concerning NCDs. HEWs’ performance appraisal encompassed too many indicators, leading to excessive complexity, which was burdensome to HEWs. This, negatively impacted HEW motivation and compromised service delivery. HEW involvement in non-HEP activities (such as promoting other government programs) often competed with their core mandates, thus affecting HEP service delivery.Efforts to address training and supervision constraints in Ethiopia’s HEP should focus on improving the quality of NCD training for HEWs and supervisors, shifting from authoritative to supportive supervision, simplifying performance appraisal and reducing competing attention from other programs.
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spelling pubmed-100218362023-03-17 Community health extension workers’ training and supervision in Ethiopia: Exploring impact and implementation challenges for non-communicable disease service delivery Tesema, Azeb Gebresilassie Peiris, David Abimbola, Seye Ajisegiri, Whenayon S. Narasimhan, Padmanesan Mulugeta, Afework Joshi, Rohina PLOS Glob Public Health Research Article Training and supervision of health workers are critical components of any health system;thus, we assessed how they impact health extension workers’ (HEWs) role in non-communicable disease (NCD) service delivery in Ethiopia’s health extension program (HEP), using an in-depth qualitative study conducted in 2019.The study covered two regions—the Tigray and the South Nations, Nationalities and Peoples Region (SNNPR)—and involved the Federal Ministry of Health. We conducted twenty-seven key informant interviews with federal and regional policymakers, district health officials, health centre representatives and HEWs.Participants highlighted substantial implementation challenges with training and supervision practices delivered via the HEP. Training for NCDs lacked breadth and depth. IT was described as inconsistently delivered with variable availability within and between regions;and when available, the quality was low with scant content specific to NCDs. HEP supervision was inconsistent and, rather than being supportive, mainly focused on finding faults in HEW work practices. Supervisors themselves had skill gaps in critical areas overall, and specifically concerning NCDs. HEWs’ performance appraisal encompassed too many indicators, leading to excessive complexity, which was burdensome to HEWs. This, negatively impacted HEW motivation and compromised service delivery. HEW involvement in non-HEP activities (such as promoting other government programs) often competed with their core mandates, thus affecting HEP service delivery.Efforts to address training and supervision constraints in Ethiopia’s HEP should focus on improving the quality of NCD training for HEWs and supervisors, shifting from authoritative to supportive supervision, simplifying performance appraisal and reducing competing attention from other programs. Public Library of Science 2022-11-09 /pmc/articles/PMC10021836/ /pubmed/36962619 http://dx.doi.org/10.1371/journal.pgph.0001160 Text en © 2022 Tesema et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Tesema, Azeb Gebresilassie
Peiris, David
Abimbola, Seye
Ajisegiri, Whenayon S.
Narasimhan, Padmanesan
Mulugeta, Afework
Joshi, Rohina
Community health extension workers’ training and supervision in Ethiopia: Exploring impact and implementation challenges for non-communicable disease service delivery
title Community health extension workers’ training and supervision in Ethiopia: Exploring impact and implementation challenges for non-communicable disease service delivery
title_full Community health extension workers’ training and supervision in Ethiopia: Exploring impact and implementation challenges for non-communicable disease service delivery
title_fullStr Community health extension workers’ training and supervision in Ethiopia: Exploring impact and implementation challenges for non-communicable disease service delivery
title_full_unstemmed Community health extension workers’ training and supervision in Ethiopia: Exploring impact and implementation challenges for non-communicable disease service delivery
title_short Community health extension workers’ training and supervision in Ethiopia: Exploring impact and implementation challenges for non-communicable disease service delivery
title_sort community health extension workers’ training and supervision in ethiopia: exploring impact and implementation challenges for non-communicable disease service delivery
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021836/
https://www.ncbi.nlm.nih.gov/pubmed/36962619
http://dx.doi.org/10.1371/journal.pgph.0001160
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