By Kingsley Chikaphupha, Ireen Namakhoma and Miriam Taegtmeyer
In REACHOUT we developed group supervision in response to findings from research with community health workers in six countries. They told us that they really needed and appreciated the supervisors but they all too often supervision was infrequent irregular and of a fault-finding approach. Supervisors told us they were rarely trained in how to do supervision, lacked funds for site visits and felt they lacked skills on how to support Community Health Workers (CHWs). When we looked at the literature we found that many studies report supervision to be an important factor to increase CHW performance, although details of how supervisors were trained and supported and how supervision was done were scarce.
We use group supervision to bring together a group of peer CHWs on a regular basis. Trained supervisors facilitate meetings that cover the three main functions of supervision: administration and reporting, refresher training and support. A typical session might include a round of feedback and reports based on the CHW work plans; a short topic of training and a facilitated group discussions on challenges and possible solutions. A supportive environment allows genuine issues to be discussed openly and peers to offer solutions. This cross learning strengths the whole group and improves relationships and motivation through building the team.
The next step for REACHOUT is to conduct research on the effectiveness, costs and impacts of group supervision. We have designed tools that track attendance at supervision and also follow up on referrals and other routine programme data. Through the development of an eleven point perceived supervision scale we are able to track how supported the CHWs feel by supervision and the approach that supervisors take in listening to their views and helping them to solve problems. This scale was developed and validated in conjunction with partners at the University of Dublin and we are excited to work more with them in REACHOUT as we move forward. We are also tracking the impact of supervision on the overall functioning of the CHW programme at district level and through engaging key district people are working to embed approaches to quality improvement in community health care.
We have developed a generic group supervision curriculum that can be adapted to other projects and we are aiming to publish the perceived supervision scale. We have also tried and tested a range of tools to track supervision. The key learning so far is that a supportive approach to supervision is as important as (or more important than) its frequency.
This project is funded by the European Union.