Mali’s 360° Supervision Scale-Up: National Rollout of Evidence-Based CHW Performance Management

We call upon Community Health Workers to be more than health care providers. We expect them to be leaders. We expect them to make history. To stop deaths from malaria, to transform health outcomes for expecting mothers, to stop disease outbreaks in their tracks. We expect them to achieve these feats in settings of extreme poverty, often distant from their health system teammates, those who would support and supervise them. And yet while we expect more of CHWs, CHWs often receive far less training and supervision support than other providers.

Health systems overcome these challenges by design. We can enable CHWs to maximize their impact and leadership through the way we design their training and the supervision structures that support them. To solve for the core challenges CHWs face, Muso and our government partners designed and built 360° Supervision, a performance management system to support and evaluate a CHW from all angles.

Several strategies Muso has tested with the Malian government are now being implemented nationally through Mali’s historic health system reform. The reform focuses on redesigning community and health center-level care for Mali’s 18 million people. Muso’s 360° Supervision model will lead the pack. Our government partners committed to scale this dedicated supervision strategy in September 2018 on the strength of evidence from a Randomized Controlled Trial they jointly conducted with Muso and our academic partners. This study found that frequent and quality coaching for Community Health Workers can be critically important for improving CHW performance and quality of care. Based on this RCT’s findings, the Malian Ministry of Health decided to scale the supervision strategy nationally, building an operational plan and mobilizing partners to support financing and implementation. The vote to adopt dedicated supervision as national policy represents tremendous progress towards supporting all of Mali’s CHWs to provide high-quality, integrated care that contributes to measurable improvements in maternal and child health. Given this early commitment to supporting CHWs with evidence-based strategies, 360° Supervision will serve as a quality assurance backbone for the rest of the strategies within Mali’s national health system reform, driving quality, quantity, and speed of health care provided by CHWs across the country.

Now, the work begins. The government of Mali has asked Muso to provide technical support as it embarks upon designing and delivering historic change. In order to support the government to operationalize its strategic vision of dedicated supervision and other important reform commitments at national scale, Muso is building a dedicated technical assistance (TA) team to steward integration of evidence-based community health strategies in policy and practice. 360° Supervision scale-up—quality control through performance management—will act as an integral puzzle piece of the national community health system, and Muso is rapidly mobilizing to support the government as it rallies around this commitment. With financing from the Global Fund, the government plans to recruit, train, deploy, and hire CHW Supervisors at the national level, who will in turn support CHWs to care for patients across the country. These dedicated CHW Supervisors are intended to support every CHW working in Mali. Muso’s TA team will closely advise the government as it builds towards this goal, accompanying implementation and financing to drive impact for patients.

Muso’s new technical assistance team will support governments, implementers, funders, and norm-setting bodies to uptake methods that we have tested, in pursuit of our common goals of universal health coverage, maternal health, and child survival. In addition to their immediate accompaniment within Mali, our TA team will proactively steward leveraged impact through global actors, supporting them to deliver on global commitments for tens of millions of patients cared for by CHWs across the world.

 

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