CHWs (134) CHWs and mental health (3) Supervision of CHWs

6 July, 2019

Dear HIFA colleagues,

We have discussed the role of CHWs in providing mental health services. This paper looks specifically at methods of supervision of task-shared mental health care, with a focus on Africa. Citation and se;lected extracts below.

CITATION: Supervision of Task-Shared Mental Health Care in Low-Resource Settings: A Commentary on Programmatic Experience

Christopher G. Kemp, Inge Petersen, Arvin Bhana, Deepa Rao

Global Health: Science and Practice,2019

'Task-shared mental health care programs in low-resource settings often incorporate supervisory structures that would be difficult to implement at scale, and many rely on foreign specialist experts as supervisors. Future programs could leverage peer supervision, technology, competency assessments/fidelity checklists, and other tools. Mental health care specialists will require training, support, and incentives to supervise generalist care providers.'

'The relative effectiveness of different supervisory models for task-shared mental health services in low-resource settings remains understudied, although recent calls for research suggest that a change is imminent. Little is known about the range of supervisory models already developed and implemented as part of task-shared mental health care in low-resource settings. An exploration of these models would offer support to future programs as staff plan, design, and implement task-shared programs. Our objectives were to provide an overview of the literature on the supervision of frontline and mental health care workers in low-resource settings, to describe and draw lessons from the experiences of implementers of task-shared mental health services in these settings, and to offer evaluative commentary for consideration by future investigators and implementers.'


Supervision of frontline health care workers — including but not limited to those delivering mental health care — may take many forms. Most broadly, supervision refers to the cyclical process in which a senior professional or team sets expectations for the practice of health care workers at a lower level in the health system, observes and/or audits that practice, assesses whether it meets expectations, and provides guidance or takes corrective action.23 Supervisors employ a wide range of activities to carry out these functions, and health systems may focus on and prioritize some supervisory functions over others. Depending on that focus, models for supervision fall along a spectrum of 3 general categories: traditional supervision, supportive supervision, or mentorship...

One well-documented approach to task-shared mental health supervision—focused specifically on psychosocial treatments—is the apprenticeship model: a collection of training and layered supervision methods originating with researchers at Johns Hopkins University, named after the model used by many crafts and trades. It is distinguished by its inclusion of 3 types of individuals: counselors, supervisors, and trainers.47 Counselors may be any type of mental health service provider, including community members trained to deliver a psychosocial intervention, while supervisors are counselors with the expertise or skills necessary to support other counselors...

We interviewed 16 informants between October 2015 and January 2017. Most were researchers, and most worked in sub-Saharan Africa... Informant experiences reflected 5 broad themes: movement from research to scale-up; building capacity for supervision by specialists; social hierarchies and supportive supervision; technological opportunities; and allowing for context, fluidity, and heterogeneity. We describe each of these below...

Specialists need additional training in supervision and personnel management to manage teams of task-sharing mental health workers...


Supervision is an understudied but critical component of task-shared mental health programs in low-resource settings. As interventions move from development to implementation and scale-up, models for supervision that are feasible for dissemination are increasingly being developed. In the absence of adequate numbers of specialists to provide supervision, technological solutions like audio recording and WhatsApp groups supported by supervisor guides and fidelity checklists can help promote better quality supervision as well as contact with supervisees. Further research is necessary to evaluate models for supervision across different programs and contexts.


Best wishes, Neil

Coordinator, HIFA Project on Community Health Workers

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: