The effect of a roving nurse mentor on household coverage and quality of care provided by community health worker teams in South Africa: a longitudinal study with a before, after and 6 months post design
Abstract Objective Community health workers (CHW) are undertaking more complex tasks as part of the move towards universal health coverage in many low- and middle-income settings. They are expected to provide promotive and preventative care, make referrals to the local clinic, and follow up on non-a...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-02-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-09093-4 |
| _version_ | 1797865168567271424 |
|---|---|
| author | Jane Goudge Olukemi Babalola Hlologelo Malatji Jonathan Levin Margaret Thorogood Frances Griffiths |
| author_facet | Jane Goudge Olukemi Babalola Hlologelo Malatji Jonathan Levin Margaret Thorogood Frances Griffiths |
| author_sort | Jane Goudge |
| collection | DOAJ |
| description | Abstract Objective Community health workers (CHW) are undertaking more complex tasks as part of the move towards universal health coverage in many low- and middle-income settings. They are expected to provide promotive and preventative care, make referrals to the local clinic, and follow up on non-attendees for a range of health conditions. CHW programmes can improve access to care for vulnerable communities, but many such programmes struggle due to inadequate supervision, low levels of CHW literacy, and the marginalized status of CHW in the health system. In this paper, we assess the effect of a roving nurse mentor on the coverage and quality of care of the CHW service in two vulnerable communities in South Africa. Participants CHW, their supervisors, household members. Intervention Roving professional nurse mentor to build skills of supervisors and CHW teams. Methods Three household surveys to assess household coverage of the CHW service (baseline, end of the intervention, and 6 months after end of intervention); structured observations of CHW working in households to assess quality of care. Results The intervention led to a sustained 50% increase in the number of households visited by a CHW in the last year. While the proportion of appropriate health messages given to household members by CHW remained constant at approximately 50%, CHW performed a greater range of more complex tasks. They were more likely to visit new households to assess health needs and register the household in the programme, to provide care to pregnant women, children and people who had withdrawn from care. CHW were more likely to discuss with clients the barriers they were facing in accessing care and take notes during a visit. Conclusion A nurse mentor can have a significant effect both on the quantity and quality of CHW work, allowing them to achieve their potential despite their marginalised status in the health system and their limited prior educational achievement. Supportive supervision is important in enabling the benefit of having a health cadre embedded in marginalised communities to be realised. |
| first_indexed | 2024-04-09T23:03:35Z |
| format | Article |
| id | doaj.art-08b9f28d5ef84692b2a5311942cd7ec3 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-09T23:03:35Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-08b9f28d5ef84692b2a5311942cd7ec32023-03-22T10:47:39ZengBMCBMC Health Services Research1472-69632023-02-0123111110.1186/s12913-023-09093-4The effect of a roving nurse mentor on household coverage and quality of care provided by community health worker teams in South Africa: a longitudinal study with a before, after and 6 months post designJane Goudge0Olukemi Babalola1Hlologelo Malatji2Jonathan Levin3Margaret Thorogood4Frances Griffiths5Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the WitwatersrandSchool of Public Health, Faculty of Health Sciences, University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the WitwatersrandAbstract Objective Community health workers (CHW) are undertaking more complex tasks as part of the move towards universal health coverage in many low- and middle-income settings. They are expected to provide promotive and preventative care, make referrals to the local clinic, and follow up on non-attendees for a range of health conditions. CHW programmes can improve access to care for vulnerable communities, but many such programmes struggle due to inadequate supervision, low levels of CHW literacy, and the marginalized status of CHW in the health system. In this paper, we assess the effect of a roving nurse mentor on the coverage and quality of care of the CHW service in two vulnerable communities in South Africa. Participants CHW, their supervisors, household members. Intervention Roving professional nurse mentor to build skills of supervisors and CHW teams. Methods Three household surveys to assess household coverage of the CHW service (baseline, end of the intervention, and 6 months after end of intervention); structured observations of CHW working in households to assess quality of care. Results The intervention led to a sustained 50% increase in the number of households visited by a CHW in the last year. While the proportion of appropriate health messages given to household members by CHW remained constant at approximately 50%, CHW performed a greater range of more complex tasks. They were more likely to visit new households to assess health needs and register the household in the programme, to provide care to pregnant women, children and people who had withdrawn from care. CHW were more likely to discuss with clients the barriers they were facing in accessing care and take notes during a visit. Conclusion A nurse mentor can have a significant effect both on the quantity and quality of CHW work, allowing them to achieve their potential despite their marginalised status in the health system and their limited prior educational achievement. Supportive supervision is important in enabling the benefit of having a health cadre embedded in marginalised communities to be realised.https://doi.org/10.1186/s12913-023-09093-4Community health workersSouth AfricaInterventionSupportive supervision |
| spellingShingle | Jane Goudge Olukemi Babalola Hlologelo Malatji Jonathan Levin Margaret Thorogood Frances Griffiths The effect of a roving nurse mentor on household coverage and quality of care provided by community health worker teams in South Africa: a longitudinal study with a before, after and 6 months post design BMC Health Services Research Community health workers South Africa Intervention Supportive supervision |
| title | The effect of a roving nurse mentor on household coverage and quality of care provided by community health worker teams in South Africa: a longitudinal study with a before, after and 6 months post design |
| title_full | The effect of a roving nurse mentor on household coverage and quality of care provided by community health worker teams in South Africa: a longitudinal study with a before, after and 6 months post design |
| title_fullStr | The effect of a roving nurse mentor on household coverage and quality of care provided by community health worker teams in South Africa: a longitudinal study with a before, after and 6 months post design |
| title_full_unstemmed | The effect of a roving nurse mentor on household coverage and quality of care provided by community health worker teams in South Africa: a longitudinal study with a before, after and 6 months post design |
| title_short | The effect of a roving nurse mentor on household coverage and quality of care provided by community health worker teams in South Africa: a longitudinal study with a before, after and 6 months post design |
| title_sort | effect of a roving nurse mentor on household coverage and quality of care provided by community health worker teams in south africa a longitudinal study with a before after and 6 months post design |
| topic | Community health workers South Africa Intervention Supportive supervision |
| url | https://doi.org/10.1186/s12913-023-09093-4 |
| work_keys_str_mv | AT janegoudge theeffectofarovingnursementoronhouseholdcoverageandqualityofcareprovidedbycommunityhealthworkerteamsinsouthafricaalongitudinalstudywithabeforeafterand6monthspostdesign AT olukemibabalola theeffectofarovingnursementoronhouseholdcoverageandqualityofcareprovidedbycommunityhealthworkerteamsinsouthafricaalongitudinalstudywithabeforeafterand6monthspostdesign AT hlologelomalatji theeffectofarovingnursementoronhouseholdcoverageandqualityofcareprovidedbycommunityhealthworkerteamsinsouthafricaalongitudinalstudywithabeforeafterand6monthspostdesign AT jonathanlevin theeffectofarovingnursementoronhouseholdcoverageandqualityofcareprovidedbycommunityhealthworkerteamsinsouthafricaalongitudinalstudywithabeforeafterand6monthspostdesign AT margaretthorogood theeffectofarovingnursementoronhouseholdcoverageandqualityofcareprovidedbycommunityhealthworkerteamsinsouthafricaalongitudinalstudywithabeforeafterand6monthspostdesign AT francesgriffiths theeffectofarovingnursementoronhouseholdcoverageandqualityofcareprovidedbycommunityhealthworkerteamsinsouthafricaalongitudinalstudywithabeforeafterand6monthspostdesign AT janegoudge effectofarovingnursementoronhouseholdcoverageandqualityofcareprovidedbycommunityhealthworkerteamsinsouthafricaalongitudinalstudywithabeforeafterand6monthspostdesign AT olukemibabalola effectofarovingnursementoronhouseholdcoverageandqualityofcareprovidedbycommunityhealthworkerteamsinsouthafricaalongitudinalstudywithabeforeafterand6monthspostdesign AT hlologelomalatji effectofarovingnursementoronhouseholdcoverageandqualityofcareprovidedbycommunityhealthworkerteamsinsouthafricaalongitudinalstudywithabeforeafterand6monthspostdesign AT jonathanlevin effectofarovingnursementoronhouseholdcoverageandqualityofcareprovidedbycommunityhealthworkerteamsinsouthafricaalongitudinalstudywithabeforeafterand6monthspostdesign AT margaretthorogood effectofarovingnursementoronhouseholdcoverageandqualityofcareprovidedbycommunityhealthworkerteamsinsouthafricaalongitudinalstudywithabeforeafterand6monthspostdesign AT francesgriffiths effectofarovingnursementoronhouseholdcoverageandqualityofcareprovidedbycommunityhealthworkerteamsinsouthafricaalongitudinalstudywithabeforeafterand6monthspostdesign |