Abstract
BackgroundLack of programmatic support and supervision is one of the underlying reasons of the poor performance of Pakistan’s Lady Health Worker Program (LHWP). This study describes the findings and potential for scale-up of a supportive supervision intervention in two districts of Pakistan for improving LHWs skills for integrated community case management (iCCM) of childhood diarrhea and pneumonia.MethodsThe intervention comprised an enhanced supervision training to lady health supervisors (LHSs) and written feedback to LHWs by LHSs, implemented in Districts Badin and Mirpur Khas (MPK). Clinical skills of LHWs and LHSs and supervision skills of LHSs were assessed before, during, and after the intervention using structured tools.ResultsLHSs’ practice of providing written feedback improved between pre- and mid-intervention assessments in both trials (0% to 88% in Badin and 25% to 75% in MPK) in the study arm. Similarly, supervisory performance of study arm LHSs was better than that in the comparison arm in reviewing the treatment suggested by workers’ (94% vs 13% in MPK and 94% vs 69% in Badin) during endline skills assessment in both trials. There were improvements in LHWs’ skills for iCCM of childhood diarrhea and pneumonia in both districts. In intervention arm, LHWs’ performance for correctly assessing for dehydration (28% to 92% in Badin and 74% to 96% in MPK), and measuring the respiratory rate correctly (12% to 44% in Badin and 46% to 79% in MPK) improved between baseline and endline assessments in both trials. Furthermore, study arm LHWs performed better than those in comparison arm in classifying diarrhea correctly during post-intervention skills assessment (68% vs 40% in Badin and 96% vs 83% in MPK).ConclusionSupportive supervision including written feedback and frequent supervisor contact could improve the performance of community-based workers in managing diarrhea and pneumonia among children. Positive lessons for provincial scale-up can be drawn.Trial registration Both trials are registered with the ‘Australian New Zealand Clinical Trials Registry’. Registration numbers: Nigraan Trial: ACTRN1261300126170; Nigraan Plus: ACTRN12617000309381.
Highlights
Lack of programmatic support and supervision is one of the underlying reasons of the poor performance of Pakistan’s Lady Health Worker Program (LHWP)
Diarrhea and pneumonia have a high prevalence among Pakistani children—incidence of diarrhea and acute respiratory infections is 19% and 14% according to Pakistan Demographic Health Survey (PDHS) [1]—and the two diseases are responsible for deaths of 90,000 under-five children every year [2]
Socio‐demographic characteristics In Mirpur Khas (MPK), the intervention arm lady health supervisors (LHSs) and lady health workers (LHWs)’ median age, education, median years of experience with LHWP, lives in house with under 5 years child, and median time to reach health facility were comparable with comparison arm LHSs and LHWs, respectively
Summary
Lack of programmatic support and supervision is one of the underlying reasons of the poor performance of Pakistan’s Lady Health Worker Program (LHWP). This study describes the findings and potential for scale-up of a supportive supervision intervention in two districts of Pakistan for improving LHWs skills for integrated community case management (iCCM) of childhood diarrhea and pneumonia. Improving access and utilization of these lifesaving interventions is crucial if Pakistan is to achieve its sustainable development goal (SDG) 3.2 targets to reduce neonatal mortality to at least 12 per 1000 live births and under-5 mortality to at least 25 per 1000 live births [4, 5]. Community-based interventions involving community health workers (CHWs) have been introduced in many countries to increase the access to services for deprived population for management of these illnesses [6, 7]. World Health Organization (WHO) and UNICEF recommend that integrated community case management (iCCM) of these diseases through CHWs is an effective way of increasing access to quality and affordable services
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