Abstract
BackgroundCommunity Health Volunteers (CHVs) can be effective in improving pregnancy and newborn outcomes through community education. Inadequate supervision of CHVs, whether due to poor planning, irregular visits, or ineffective supervisory methods, is, however, recognized as a weakness in many programs. There has been little research on best practice supervisory or accompaniment models.MethodsFrom March 2014 to February 2015 a proof of concept study was conducted to compare training alone versus training and supportive supervision by paid CHWs (n = 4) on the effectiveness of CHVs (n = 82) to deliver education about pregnancy, newborn care, family planning and hygiene. The pair-matched cluster randomized trial was conducted in eight villages (four intervention and four control) in Budondo sub-county in Jinja, Uganda.ResultsIncreases in desired behaviors were seen in both the intervention and control arms over the study period. Both arms showed high retention rates of CHVs (95 %). At 1 year follow-up there was a significantly higher prevalence of installed and functioning tippy taps for hand washing (p < 0.002) in the intervention villages (47 %) than control villages (35 %). All outcome and process measures related to home-visits to homes with pregnant women and newborn babies favored the intervention villages. The CHVs in both groups implemented what they learnt and were role models in the community.ConclusionsA team of CHVs and CHWs can facilitate families accessing reproductive health care by addressing cultural norms and scientific misconceptions. Having a team of 2 CHWs to 40 CHVs enables close to community access to information, conversation and services. Supportive supervision involves creating a non-threatening, empowering environment in which both the CHV and the supervising CHW learn together and overcome obstacles that might otherwise demotivate the CHV. While the results seem promising for added value with supportive supervision for CHVs undertaking reproductive health activities, further research on a larger scale will be needed to substantiate the effect.
Highlights
Community Health Volunteers (CHVs) can be effective in improving pregnancy and newborn outcomes through community education
Plain English Summary To address shortages in the health-care workforce some low- and middle-income countries have drawn on Community Health Volunteers (CHVs) to bridge gaps by offering preventative reproductive health care
Having a system of supportive supervision while desirable has often been of low priority and too costly for most programs
Summary
Community Health Volunteers (CHVs) can be effective in improving pregnancy and newborn outcomes through community education. The two full-time HEWs (or CHWs) serving a population of 5000, train and supervise model families during home visits and group sessions, over a 96-h period as part of their routine work which includes a number of clinical duties [2, 7,8,9]. Some of those trained become volunteers that engage other community members in community-based change to improve health outcomes [2, 3, 9]
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