Cargando…
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...
Autores principales: | , , , , , , |
---|---|
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 |
_version_ | 1783399627675926528 |
---|---|
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. |
format | Online Article Text |
id | pubmed-6398712 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT tsengyuhwei integratingcommunityhealthworkersintotheformalhealthsystemtoimproveperformanceaqualitativestudyontheroleofonsitesupervisioninthesouthafricanprogramme AT griffithsfrances integratingcommunityhealthworkersintotheformalhealthsystemtoimproveperformanceaqualitativestudyontheroleofonsitesupervisioninthesouthafricanprogramme AT dekadtjulia integratingcommunityhealthworkersintotheformalhealthsystemtoimproveperformanceaqualitativestudyontheroleofonsitesupervisioninthesouthafricanprogramme AT nxumalononhlanhla integratingcommunityhealthworkersintotheformalhealthsystemtoimproveperformanceaqualitativestudyontheroleofonsitesupervisioninthesouthafricanprogramme AT rwafateurai integratingcommunityhealthworkersintotheformalhealthsystemtoimproveperformanceaqualitativestudyontheroleofonsitesupervisioninthesouthafricanprogramme AT malatjihlologelo integratingcommunityhealthworkersintotheformalhealthsystemtoimproveperformanceaqualitativestudyontheroleofonsitesupervisioninthesouthafricanprogramme AT goudgejane integratingcommunityhealthworkersintotheformalhealthsystemtoimproveperformanceaqualitativestudyontheroleofonsitesupervisioninthesouthafricanprogramme |