Identifying feasible and effective community health worker supervision strategies : experiences of providing and receiving supervision in a rural South African community health worker programme

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dc.contributor.advisorTomlinson, Marken_ZA
dc.contributor.advisorSkeen, Sarahen_ZA
dc.contributor.authorStansert Katzen, Sara Linneaen_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine.en_ZA
dc.date.accessioned2023-10-17T07:50:03Z
dc.date.accessioned2024-01-08T13:51:03Z
dc.date.available2023-10-17T07:50:03Z
dc.date.available2024-01-08T13:51:03Z
dc.date.issued2023-12
dc.descriptionThesis (PhD)--Stellenbosch University, 2023. en_ZA
dc.description.abstractENGLISH SUMMARY: Despite a global focus on reproductive, maternal and child health, maternal and child mortality and morbidity remain real concerns, particularly in low- and middle-income countries (LMICs). The demands on health systems in LMICs continue to escalate due to the high burden of disease and an increased demand for healthcare services, in combination with a shortage of healthcare personnel. Deploying community healthcare workers (CHWs) is an important strategy to bridge the gap in health care and to support the functioning of the healthcare system. While there is substantial evidence of the benefits of CHW programmes, there are concerns regarding the effectiveness of these programmes at scale. Programmatic factors, such as training, access to equipment and sufficient supervision systems, are critical for CHW programme success, yet often lacking or limited in practice – and therefore more focused research is needed. This thesis attempts to address this gap by reporting the results of a qualitative evidence synthesis (QES) and three individual articles presenting findings from qualitative research within the Eastern Cape Supervision Study (ECSS). The ECSS is a cluster randomised controlled trial testing an enhanced supervision and support package for CHWs. In the QES, I report on evidence on how CHWs working in maternal and child health interventions experience supervision. Publications published between 2000 and 2021 were included. In the first qualitative paper I report on qualitative data from interviews with CHWs (who were part of the ECSS study), but which took place during the initial phases of the intervention. This paper reports on their experiences of becoming and remaining CHWs. In the second qualitative paper, I report on qualitative evidence from CHWs in both the intervention and control groups of the ECSS. This paper focuses on how they experience their roles as CHWs, and how they experience supervision, specifically the enhanced supervision intervention. In the third qualitative paper I report on qualitative evidence from interviews with programme stakeholders (in this case supervisors, clinic personnel and programme managers). This paper focuses on their experiences of the CHW programme in general, and the ECSS intervention in particular. The results from these individual substudies highlight substantial shortfalls in the current government-implemented CHW programme in the study area. Limited training, lack of supervision and limited or no access to resources such as equipment and transport were the challenges identified. Four overarching contributions were identified through this work: 1) CHWs’ and stakeholders’ perspectives when developing and improving CHW programmes, 2) Interpersonal skills and relationships to enhance programme delivery, 3) Supportive health system and programmatic environments, and 4: Systems of supportive supervision.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: Ten spyte van ’n globale fokus op reproduktiewe-, moederlike en kindergesondheid, moederen kindersterftes en morbiditeit bly groot bronne van kommer, veral in lae- en middelinkomste lande (low- and middle-income countries (LMICs)). Die eise wat in LMICs aan gesondheidstelsels gemaak word, hou aan eskaleer as gevolg van die hoe siektelas en ’n verhoogde vraag na gesondheidsdienste, tesame met ’n tekort aan gesondheidsorgpersoneel. Die ontplooiing van gemeenskapsgesondheidsorgwerkers (GGG’s; community healthcare workers (CHWs)) is ’n belangrike strategie om die gaping in gesondheidsorg te oorbrug en om die funksionering van die gesondheidsorgstelsel te ondersteun. Terwel daar wesenlike bewyse is van die voordele van GGG-programme, is daar kommer oor die doeltreffendheid van hierdie programme op skaal. Programmatiese faktore, soos opleiding, toegang tot toerusting en voldoende toesigstelsels is van kritieke belang vir die sukses van GGGprogramme, tog ontbreek hulle of is hulle in die praktyk beperk. Dit is om hierdie rede dat meer gefokusde navorsing benodig word. Hierdie tesis poog om hierdie gaping te oorbrug deur verslae te voltooi oor die resultate van ’n sintese van kwalitatiewe bewyse (qualitative evidence synthesis (QES)) en drie individuele artikels wat die bevindings van kwalitatiewe navorsing binne die Oos-Kaapse Toesigstudie (Eastern Cape Supervision Study (ECSS)) bevat. Die ECSS is ’n trosverewekansigde beheerde proef (cluster randomised controlled trial) wat ’n verbeterde toesig- en ondersteuningspakket vir GGG’s toets. In die QES, rapporteer ek oor hoe GGG’s, wat in moeder- en kindergesondheidsingrypings werk, toesig ervaar. Artikels wat tussen 2000 en 2021 gepubliseer is, was ingesluit. In die eerste kwalitatiewe artikel rapporteer ek oor kwalitatiewe data vanaf onderhoude met GGG’s wat deel was van die ECSS-studie, maar voor die studie begin het. Hierdie artikel rapporteer hulle ervarings oor hoe hulle GGG’s word en bly. In die tweede kwalitatiewe artikel rapporteer ek oor kwalitatiewe bewyse vanaf GGG’s in beide die eksperimentele en kontrolegroepe van die ECSS. Hierdie artikel fokus op hoe hulle hulle rolle as GGG’s ervaar en hoe hulle toesig ervaar, veral in terme van die verbeterde toesig-ingryping. In die derde kwalitatiewe artikel, rapporteer ek oor kwalitatiewe bewyse wat ontstaan uit onderhoude met die belanghebbendes van die program (in hierdie geval die toesighouers, kliniekpersoneel en programbestuurders). Hierdie artikel fokus op hulle ervaringe van die GGG-program in die algemeen en veral die ECSS-ingryping. Die resultate van hierdie individuele sub-studies lig aansienlike tekortkominge in die huidige GGG-program in die studiegebied uit, wat huidiglik deur die regering geimplementeer is. Beperkte opleiding, ’n gebrek aan toesig en beperkte of geen toegang tot hulpbronne soos toerusting en vervoer was geidentifiseer. Vier oorhoofse bydraes is deur hierdie werk geidentifiseer: 1) GGG’s en belanghebbendes se perspektiewe deur die ontwikkeling en verbertering van GGG programme, 2) Interpersoonlike vaardighede en verhoudings om programverskaffing te verbeter, 3) Ondersteunende gesondheidstelsel en programomgewings, en 4) Stelsels van ondersteunde toesig.af_ZA
dc.description.versionDoctorate
dc.format.extentxx, 297 pages : illustrations, maps, includes annexures
dc.identifier.urihttps://scholar.sun.ac.za/handle/10019.1/128864
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch University
dc.rights.holderStellenbosch University
dc.subject.lcshmortality and morbidity -- South Africaen_ZA
dc.subject.lcshChildren -- Mortality -- South Africaen_ZA
dc.subject.lcshMaternal and infant welfare -- South Africaen_ZA
dc.subject.lcshCommunity health aides -- South Africa -- Supervision ofen_ZA
dc.subject.lcshMothers -- Mortality -- South Africaen_ZA
dc.subject.lcshRural health services -- South Africaen_ZA
dc.subject.nameUCTD
dc.titleIdentifying feasible and effective community health worker supervision strategies : experiences of providing and receiving supervision in a rural South African community health worker programmeen_ZA
dc.typeThesisen_ZA
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