Human Resources for Health in Maternal, Neonatal and - HRH ...

The involvement of community groups and NGOs in health worker supervision has been
highlighted as a useful way forward in some contexts. In Papua New Guinea the issue of
VHV supervision and support at Aid Posts and community health posts may be better
achieved with NGOs, faith based organisations and international project staff such as those
from GAVI Alliance (Government of Papua New Guinea 2009). The findings of a study of
the performance of CHWs in Colombia indicated that feedback and rewards from the
community have a greater influence on work performance (defined as degree of perceived
goal attainment on job tasks) than do those stemming from the health system. The authors
suggest a health system participation model that would focus management support on the
worker-community interface rather than the worker-health service interface (Robinson 1990).
Participatory approaches to supervision have been found to be more constructive than a top
down model. A study in Zimbabwe that included the observation of nurse supervisors in
mobile community clinics indicated that a participatory approach to supervision that
incorporated problem solving and action planning would benefit nurses. In addition the study
recommended that supervision could be strengthened through training and job aides (Kim
2000). A practice known as educational outreach involving visits from trained individuals
who may be supervisors to health workers in their practice has been found to improve health
worker performance in Indonesia and Thailand (O‘Brien 2007). Bi annual supervisory visits
by mobile district health teams to VHV and TBAs in a project in Laos were used as an
opportunity for problem solving, professional development and promotion. This provided an
opportunity to combine on the job training with the delivery of clinical services (Perks 2006).
The importance of action planning and good relationships between community health
workers and supervisors is highlighted in a PRIME II project in Senegal. The final evaluation
of the two-year activity found that 89% of the 69 CBHWs sampled felt at ease with their
supervisors, 81% had a performance work plan (compared to none prior to the intervention),
and 94% stated that supervisory feedback had contributed to improved performance
(IntraHealth 2004).
A project in Mexico that piloted participatory supervision and self assessment for doctors
focusing on the improvement of their interpersonal communication (IPC) skills (Kim 2002)
may be transferrable to a community context where regular visits are difficult. In this project,
supervisors were assisted by job aids and engaged in a participatory manner with the doctors
being supervised. The doctors, who had received IPC training, periodically audio-taped and
self-assessed their own consultations as part of the intervention. The audio-taped assessments
may be useful in a community context where supervisory site visits may be affected by long
distances or geographical barriers. Resident health workers who may have low literacy skills
may find this approach helpful as a way of recording and reflecting on practice. Mobile
technology may also be useful in this context.
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