Dear CHIFA colleagues,
Timely treatment of acute diarrhoea and pneumonia in children is vitally important to reduce child mortality. This paper concludes: 'Supportive supervision including written feedback and frequent supervisor contact could improve the performance of community-based workers in managing diarrhea and pneumonia among children'. Citation, abstract and a comment from me below.
CITATION: Does supportive supervision intervention improve community health worker knowledge and practices for community management of childhood diarrhea and pneumonia? Lessons for scale-up from Nigraan and Nigraan Plus trials in Pakistan. Hum Resour Health. 2021 Aug 17;19(1):99. doi: 10.1186/s12960-021-00641-9.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8371843/
ABSTRACT:
Background: 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.
Methods: The 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.
Results: LHSs' 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).
Conclusion: Supportive 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'.
COMMENT (Neil): The numbers of CHWs who do not precribe correct treatment is alarming. In one diarrhoea group, only 12% prescribed the correct treatment. It would be interesting to learn more about this and the role of healthcare information resources during training and at point-of-care.
Best wishes, Neil
Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org
