Community Health Workers’ experiences of an intervention to provide them with increased support and supervision: a qualitative study of a home visiting model in rural South Africa

Abstract

Deploying Community Health Workers (CHWs) is a crucial strategy to improve health at a community level in low- and middle-income countries. While there is substantial evidence for CHW effectiveness, there is a need for more research on the mechanisms through which these programs work. Understanding CHWs experiences of how programmes function is important. This article examines CHW’s experiences of three key programmatic domains; training, logistical support and supervision. Data were gathered using through qualitative descriptive study drawing from semi-structured interviews. The study was embedded within a cluster randomized controlled trial, testing the effectiveness of an enhanced supervision package delivered to government-employed CHWs in the rural Eastern Cape, South Africa, on maternal and child health outcomes We conducted individual semi structured interviews with CHWs (n = 16) and two supervisors. Data were coded deductively and overall, three overarching areas and five sub-themes emerged from our interviews, the overarching teams were; 1) CHW knowledge and confidence increased through additional training, 2) CHW motivation and community acceptance improved because of added logistical support, and 3) CHW supervision led to improved sense of accountability, feelings of respect, and sense of being supported. Our findings highlight the importance of a functional support system within which CHWs can operate, in a context where most CHWs operate in isolation and without support. CHWs receiving supportive supervision reported positive impacts on their motivation and ability to carry out their work effectively. Clinicaltrials.gov, NCT02957799, 2016-11-08.