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Integrating community health workers into the formal health system to improve performance: a qualitative study on the role of on-site supervision in the South African programme

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 junio...

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Autores principales: Tseng, Yu-hwei, Griffiths, Frances, de Kadt, Julia, Nxumalo, Nonhlanhla, Rwafa, Teurai, Malatji, Hlologelo, Goudge, Jane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398712/
https://www.ncbi.nlm.nih.gov/pubmed/30819698
http://dx.doi.org/10.1136/bmjopen-2018-022186
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author Tseng, Yu-hwei
Griffiths, Frances
de Kadt, Julia
Nxumalo, Nonhlanhla
Rwafa, Teurai
Malatji, Hlologelo
Goudge, Jane
author_facet Tseng, Yu-hwei
Griffiths, Frances
de Kadt, Julia
Nxumalo, Nonhlanhla
Rwafa, Teurai
Malatji, Hlologelo
Goudge, Jane
author_sort Tseng, Yu-hwei
collection PubMed
description 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.
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spelling pubmed-63987122019-03-20 Integrating community health workers into the formal health system to improve performance: a qualitative study on the role of on-site supervision in the South African programme Tseng, Yu-hwei Griffiths, Frances de Kadt, Julia Nxumalo, Nonhlanhla Rwafa, Teurai Malatji, Hlologelo Goudge, Jane BMJ Open Health Services Research 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. BMJ Publishing Group 2019-02-27 /pmc/articles/PMC6398712/ /pubmed/30819698 http://dx.doi.org/10.1136/bmjopen-2018-022186 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. 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/.
spellingShingle Health Services Research
Tseng, Yu-hwei
Griffiths, Frances
de Kadt, Julia
Nxumalo, Nonhlanhla
Rwafa, Teurai
Malatji, Hlologelo
Goudge, Jane
Integrating community health workers into the formal health system to improve performance: a qualitative study on the role of on-site supervision in the South African programme
title Integrating community health workers into the formal health system to improve performance: a qualitative study on the role of on-site supervision in the South African programme
title_full Integrating community health workers into the formal health system to improve performance: a qualitative study on the role of on-site supervision in the South African programme
title_fullStr Integrating community health workers into the formal health system to improve performance: a qualitative study on the role of on-site supervision in the South African programme
title_full_unstemmed Integrating community health workers into the formal health system to improve performance: a qualitative study on the role of on-site supervision in the South African programme
title_short Integrating community health workers into the formal health system to improve performance: a qualitative study on the role of on-site supervision in the South African programme
title_sort integrating community health workers into the formal health system to improve performance: a qualitative study on the role of on-site supervision in the south african programme
topic Health Services Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398712/
https://www.ncbi.nlm.nih.gov/pubmed/30819698
http://dx.doi.org/10.1136/bmjopen-2018-022186
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