Supportive supervision and constructive relationships with healthcare workers support CHW performance: Use of a qualitative framework to evaluate CHW programming in Uganda
Abstract Background While evidence supports community health worker (CHW) capacity to improve maternal and newborn health in less-resourced countries, key implementation gaps remain. Tools for assessing CHW performance and evidence on what programmatic components affect performance are lacking. This...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-02-01
|
| Series: | Human Resources for Health |
| Online Access: | http://link.springer.com/article/10.1186/s12960-018-0272-1 |
| _version_ | 1811299103892570112 |
|---|---|
| author | Teralynn Ludwick Eleanor Turyakira Teddy Kyomuhangi Kimberly Manalili Sheila Robinson Jennifer L. Brenner |
| author_facet | Teralynn Ludwick Eleanor Turyakira Teddy Kyomuhangi Kimberly Manalili Sheila Robinson Jennifer L. Brenner |
| author_sort | Teralynn Ludwick |
| collection | DOAJ |
| description | Abstract Background While evidence supports community health worker (CHW) capacity to improve maternal and newborn health in less-resourced countries, key implementation gaps remain. Tools for assessing CHW performance and evidence on what programmatic components affect performance are lacking. This study developed and tested a qualitative evaluative framework and tool to assess CHW team performance in a district program in rural Uganda. Methods A new assessment framework was developed to collect and analyze qualitative evidence based on CHW perspectives on seven program components associated with effectiveness (selection; training; community embeddedness; peer support; supportive supervision; relationship with other healthcare workers; retention and incentive structures). Focus groups were conducted with four high/medium-performing CHW teams and four low-performing CHW teams selected through random, stratified sampling. Content analysis involved organizing focus group transcripts according to the seven program effectiveness components, and assigning scores to each component per focus group. Results Four components, ‘supportive supervision’, ‘good relationships with other healthcare workers’, ‘peer support’, and ‘retention and incentive structures’ received the lowest overall scores. Variances in scores between ‘high’/‘medium’- and ‘low’-performing CHW teams were largest for ‘supportive supervision’ and ‘good relationships with other healthcare workers.’ Our analysis suggests that in the Bushenyi intervention context, CHW team performance is highly correlated with the quality of supervision and relationships with other healthcare workers. CHWs identified key performance-related issues of absentee supervisors, referral system challenges, and lack of engagement/respect by health workers. Other less-correlated program components warrant further study and may have been impacted by relatively consistent program implementation within our limited study area. Conclusions Applying process-oriented measurement tools are needed to better understand CHW performance-related factors and build a supportive environment for CHW program effectiveness and sustainability. Findings from a qualitative, multi-component tool developed and applied in this study suggest that factors related to (1) supportive supervision and (2) relationships with other healthcare workers may be strongly associated with variances in performance outcomes within a program. Careful consideration of supervisory structure and health worker orientation during program implementation are among strategies proposed to increase CHW performance. |
| first_indexed | 2024-04-13T06:31:10Z |
| format | Article |
| id | doaj.art-9614f5c7c82c4837aeee0a4f5c62d848 |
| institution | Directory Open Access Journal |
| issn | 1478-4491 |
| language | English |
| last_indexed | 2024-04-13T06:31:10Z |
| publishDate | 2018-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Human Resources for Health |
| spelling | doaj.art-9614f5c7c82c4837aeee0a4f5c62d8482022-12-22T02:58:10ZengBMCHuman Resources for Health1478-44912018-02-011611810.1186/s12960-018-0272-1Supportive supervision and constructive relationships with healthcare workers support CHW performance: Use of a qualitative framework to evaluate CHW programming in UgandaTeralynn Ludwick0Eleanor Turyakira1Teddy Kyomuhangi2Kimberly Manalili3Sheila Robinson4Jennifer L. Brenner5School of Public Health, University of AlbertaDepartment of Community Health, Faculty of Medicine, Mbarara University of Science and TechnologyMaternal, Newborn, and Child Health Institute, Mbarara University of Science and TechnologyDepartment of Community Health Sciences, Cumming School of Medicine, University of CalgaryDepartment of Community Health Sciences, Cumming School of Medicine, University of CalgaryPediatrics, Cumming School of Medicine, University of CalgaryAbstract Background While evidence supports community health worker (CHW) capacity to improve maternal and newborn health in less-resourced countries, key implementation gaps remain. Tools for assessing CHW performance and evidence on what programmatic components affect performance are lacking. This study developed and tested a qualitative evaluative framework and tool to assess CHW team performance in a district program in rural Uganda. Methods A new assessment framework was developed to collect and analyze qualitative evidence based on CHW perspectives on seven program components associated with effectiveness (selection; training; community embeddedness; peer support; supportive supervision; relationship with other healthcare workers; retention and incentive structures). Focus groups were conducted with four high/medium-performing CHW teams and four low-performing CHW teams selected through random, stratified sampling. Content analysis involved organizing focus group transcripts according to the seven program effectiveness components, and assigning scores to each component per focus group. Results Four components, ‘supportive supervision’, ‘good relationships with other healthcare workers’, ‘peer support’, and ‘retention and incentive structures’ received the lowest overall scores. Variances in scores between ‘high’/‘medium’- and ‘low’-performing CHW teams were largest for ‘supportive supervision’ and ‘good relationships with other healthcare workers.’ Our analysis suggests that in the Bushenyi intervention context, CHW team performance is highly correlated with the quality of supervision and relationships with other healthcare workers. CHWs identified key performance-related issues of absentee supervisors, referral system challenges, and lack of engagement/respect by health workers. Other less-correlated program components warrant further study and may have been impacted by relatively consistent program implementation within our limited study area. Conclusions Applying process-oriented measurement tools are needed to better understand CHW performance-related factors and build a supportive environment for CHW program effectiveness and sustainability. Findings from a qualitative, multi-component tool developed and applied in this study suggest that factors related to (1) supportive supervision and (2) relationships with other healthcare workers may be strongly associated with variances in performance outcomes within a program. Careful consideration of supervisory structure and health worker orientation during program implementation are among strategies proposed to increase CHW performance.http://link.springer.com/article/10.1186/s12960-018-0272-1 |
| spellingShingle | Teralynn Ludwick Eleanor Turyakira Teddy Kyomuhangi Kimberly Manalili Sheila Robinson Jennifer L. Brenner Supportive supervision and constructive relationships with healthcare workers support CHW performance: Use of a qualitative framework to evaluate CHW programming in Uganda Human Resources for Health |
| title | Supportive supervision and constructive relationships with healthcare workers support CHW performance: Use of a qualitative framework to evaluate CHW programming in Uganda |
| title_full | Supportive supervision and constructive relationships with healthcare workers support CHW performance: Use of a qualitative framework to evaluate CHW programming in Uganda |
| title_fullStr | Supportive supervision and constructive relationships with healthcare workers support CHW performance: Use of a qualitative framework to evaluate CHW programming in Uganda |
| title_full_unstemmed | Supportive supervision and constructive relationships with healthcare workers support CHW performance: Use of a qualitative framework to evaluate CHW programming in Uganda |
| title_short | Supportive supervision and constructive relationships with healthcare workers support CHW performance: Use of a qualitative framework to evaluate CHW programming in Uganda |
| title_sort | supportive supervision and constructive relationships with healthcare workers support chw performance use of a qualitative framework to evaluate chw programming in uganda |
| url | http://link.springer.com/article/10.1186/s12960-018-0272-1 |
| work_keys_str_mv | AT teralynnludwick supportivesupervisionandconstructiverelationshipswithhealthcareworkerssupportchwperformanceuseofaqualitativeframeworktoevaluatechwprogramminginuganda AT eleanorturyakira supportivesupervisionandconstructiverelationshipswithhealthcareworkerssupportchwperformanceuseofaqualitativeframeworktoevaluatechwprogramminginuganda AT teddykyomuhangi supportivesupervisionandconstructiverelationshipswithhealthcareworkerssupportchwperformanceuseofaqualitativeframeworktoevaluatechwprogramminginuganda AT kimberlymanalili supportivesupervisionandconstructiverelationshipswithhealthcareworkerssupportchwperformanceuseofaqualitativeframeworktoevaluatechwprogramminginuganda AT sheilarobinson supportivesupervisionandconstructiverelationshipswithhealthcareworkerssupportchwperformanceuseofaqualitativeframeworktoevaluatechwprogramminginuganda AT jenniferlbrenner supportivesupervisionandconstructiverelationshipswithhealthcareworkerssupportchwperformanceuseofaqualitativeframeworktoevaluatechwprogramminginuganda |