Supervision of community peer counsellors for infant feeding in South Africa: an exploratory qualitative study

biomed - Daniels Karen , Nor Barni , Jackson Debra , Ekström Eva-Charlotte , Doherty , Doherty Tanya

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10 pages

English

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Recent years have seen a re-emergence of community health worker (CHW) interventions, especially in relation to HIV care, and in increasing coverage of child health interventions. Such programmes can be particularly appealing in the face of human resource shortages and fragmented health systems. However, do we know enough about how these interventions function in order to support the investment? While research based on strong quantitative study designs such as randomised controlled trials increasingly document their impact, there has been less empirical analysis of the internal mechanisms through which CHW interventions succeed or fail. Qualitative process evaluations can help fill this gap. Methods This qualitative paper reports on the experience of three CHW supervisors who were responsible for supporting infant feeding peer counsellors. The intervention took place in three diverse settings in South Africa. Each setting employed one CHW supervisor, each of whom was individually interviewed for this study. The study forms part of the process evaluation of a large-scale randomized controlled trial of infant feeding peer counselling support. Results Our findings highlight the complexities of supervising and supporting CHWs. In order to facilitate effective infant feeding peer counselling, supervisors in this study had to move beyond mere technical management of the intervention to broader people management. While their capacity to achieve this was based on their own prior experience, it was enhanced through being supported themselves. In turn, resource limitations and concerns over safety and being in a rural setting were raised as some of the challenges to supervision. Adding to the complexity was the issue of HIV. Supervisors not only had to support CHWs in their attempts to offer peer counselling to mothers who were potentially HIV positive, but they also had to deal with supporting HIV-positive peer counsellors. Conclusions This study highlights the need to pay attention to the experiences of supervisors so as to better understand the components of supervision in the field. Such understanding can enhance future policy making, planning and implementation of peer community health worker programmes.

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Publié par	biomed
Publié le	01 janvier 2010
Nombre de lectures	10
Langue	English

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Danielset al.Human Resources for Health2010,8:6 http://www.human-resources-health.com/content/8/1/6

R E S E A R C HOpen Access Research Supervision of community peer counsellors for infant feeding in South Africa: an exploratory qualitative study

1,2 34 31,3,4 Karen Daniels*, Barni Nor, Debra Jackson, Eva-Charlotte Ekströmand Tanya Doherty

Introductionticular, they were strongly promoted in the years follow-Supervising community health workersing the International Conference on Primary Health Care Community or lay health workers have been defined asat Alma-Ata (1978) [3,4]. Then they were seen as a means "any health worker carrying out functions related toto improving primary health care in developing countries health care delivery; trained in some way in the context of[4-6] and reaching the goal of Health for All by the year the intervention, and having no formal professional or2000 [3]. The 1980s thus saw a flurry of such programmes paraprofessional certificate or degree in tertiary educa-[4-6], but subsequent failure to produce the expected out-tion" [1]. The concept of community health workerscomes led to a decline in enthusiasm for national com-(CHWs) has been around for at least 50 years [2]. In par-munity health worker programmes [4,7]. Recent years have however seen a re-emergence of such programmes [2], especially in relation to HIV care [4], and in increas-* Correspondence: karen.daniels@mrc.ac.za Health Systems Research Unit, Medical Research Council, South Africaing coverage of child health interventions [7]. In the face 1 Full list of author information is available at the end of the article © 2010 Daniels et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons BioMedCentral Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.