CHW supervision RCT shows improvement in productivity
Researchers at the University of Bamako, Harvard Medical School, the University of California San Francisco, and the Malian Ministry of Health partnered with Muso and Medic Mobile to test a CHW Dashboard and Muso’s 360° Supervision approach through a recently-published randomized controlled trial. The study, published in the Journal of Global Health, found:
1. Supervision with the CHW Performance Dashboard improved Community Health Worker productivity, increasing number of home visits per month without sacrificing quality of care 2. All CHWs receiving 360° Supervision, with or without the Dashboard, achieved large and statistically significant improvements in the quality, speed, and quantity of care they provided over the course of the nine-month study.
How 360° Supervision Works
Fatime is a Muso CHW working on the edge of the Sahara Desert, serving a village of 700 people 17 kilometers from a health center. After a 36-day training, she was deployed to care for her neighbors with the mandate to arrest maternal, newborn, and child deaths in her village for the first time in history. Fatime is the vanguard of Muso’s integrated Proactive Care model, caring for patients at their doorsteps. But she is not alone.
Fatime’s dedicated CHW Supervisor, Aissa, visits her at least one day per month for a 360° Supervision visit. Supported by the CHW Supervisor App, Aissa follows a four-step workflow to support Fatime’s work from multiple angles:
1. Group Supervision: First, Aissa convenes a group discussion with all of the 18 CHWs she supervises, including Fatime. She leads a discussion on the common challenges and potential solutions faced by the CHWs she supervises, reviews and reinforces key competencies and skills, coordinates stock monitoring and resupply for each CHW, and organizes the month’s individual monthly supervision sessions. Group supervision supports peer learning between CHWs as they share challenges faced and lessons learned with each other. Aissa coordinates at least 2 group visits per month.
2. Patient Feedback Audit: On the scheduled day of Fatime’s individual monthly supervision, Aissa visits patient homes on her own in Fatime’s catchment area, to collect patient satisfaction feedback and verify reporting.
3. CHW Shadowing:
Third, Aissa finds Fatime in the village to directly observe her while she makes door-to-door rounds, focusing on the elements that can best be evaluated in-person: how Fatime communicate with patients, how she places a thermometer, how she explain dosing, how she counts respiratory rate.
4. One on One Feedback: After they finish rounds together, Fatime and Aissa sit down together for 1:1 coaching. Together, they study the CHW Dashboard to see personalized analytics and visual displays of Fatime’s performance across three dimensions—quantity, speed, and quality. The Dashboard displays how many home visits Fatime did in the past month, the speed at which she reached her patients in the course of their illness, and the frequency of key quality errors. The CHW Dashboard compares quantity, speed, and quality of care Fatime provided last month to the highest performing CHW. On the basis of the patient satisfaction feedback, direct observation, and Dashboard, Fatime and Aissa together identify areas of strength to reinforce and areas requiring improvement. Some of these weaknesses relate to skills gaps that Fatime works on with her supervisor, while others are tied to systems-level challenges. Fatime and Aissa discuss potential systems solutions to help Fatime and the other CHWs on her team succeed.
360° CHW Supervision is a low-cost, scalable strategy, costing only $0.49 per person served per year, or $1.7 million per year to serve 3.5 million of Mali’s most vulnerable patients at national scale.
As dozens of countries work to deploy Community Health Workers nationally, the findings of the RCT published in the Journal of Global Health are particularly important. Many of these national efforts are not providing high quality or frequent supervision support for CHWs, and these efforts are at risk of failing. This study tested strategies that could help.