Progress in Scaling Dedicated Supervision for 8,200 Frontline Healthcare Providers

Routine, structured, and systemized supervision is a proven pillar of effective Community Health Worker (CHW) care delivery. Yet in many settings, supervision remains inconsistent and under-resourced, limiting CHWs’ ability to deliver reliable, high-quality care to the communities they serve.

Photo of CHW supervisor Sylvestre and a CHW, taken in Adzopé.

Over the past year, with support from Muso, the Ivorian Ministry of Health has moved from piloting to scaling a national model of dedicated CHW supervision. This significant health system reform is strengthening the quality and reliability of community-based care nationwide and now reaches 8,200 CHWs serving 6.3 million people.

As Muso worked to support the development of the supervision strategy, a situational analysis revealed several structural gaps limiting the effectiveness of community health services nationwide: weak and inconsistent CHW supervision and coaching across all levels of the health system; limited technical capacity of District Management Teams to supervise both facility- and community-based providers; insufficient transportation for district-level coordinators to reach remote communities; and gaps in the reporting and use of community-level data at primary health care facilities. 

In response to these findings – and drawing on  evidence and sustained advocacy from Muso and other partners – the Ministry of Health formally adopted an Enhanced Supervision strategy.

In 2024, Muso’s embedded technical assistance experts began supporting the Ivorian government to operationalize dedicated supervision, initially launching the model in six districts. By October 2024, implementation had expanded to 14 districts. In 2025, the Ministry added 39 more, bringing the total to 53 of Côte d’Ivoire’s 113 health districts within a single year - reaching 8,200 CHWs. This rapid expansion represents a major step in translating national policy into practice at scale. 

Supervision reforms have been accompanied by the parallel scale-up of the Community Health Toolkit (CHT), the digital platform that has supported care delivery, real-time data collection, and performance monitoring in Muso sites since our launch of direct service delivery in the country in late 2022. The CHT is now in use in close to 50% of the country, significantly expanding the availability and quality of community-level data and strengthening decision-making from the community to the national level. 

An independent analysis using both quantitative and qualitative methods assessed the strategy’s effects on CHW and supervisor practices, service quality, data quality, community perceptions, and the feasibility of sustained implementation. 

Key findings from the assessment  include: 

Data and decision-making: 100% of supervisors and 98% of CHWs were trained on the CHT. Most supervisors (94%) reported that the tool supports clinical decision-making and reduces calculation errors, while 88% cited automatic data aggregation as a major improvement. 

Service quality: Communities unanimously rated CHW performance as excellent across five dimensions – listening, counseling, care, punctuality, and follow-up. 

Access to care and health impact: Over 70% of households indicated that CHW home visits are useful for managing childhood illness, and more than 90% reported increased use of health services. 

Professionalization of CHWs: Supervision contributed to improved skills, more consistent practices, reduced errors, and greater recognition of CHWs as trusted health providers.

Next Steps 

As Côte d’Ivoire continues to scale dedicated supervision nationwide, the focus will be on consolidating gains, addressing implementation bottlenecks (such as challenges with internet connectivity), and ensuring sustainable financing and workforce models. 

The pilot demonstrates that when supervision is structured, adequately resourced, and paired with digital tools, it can significantly improve both service quality and system accountability. 

For Muso, this progress reflects years of evidence generation and policy engagement, and shows how sustained technical partnership can help move proven models from pilots to national adoption, transforming community health systems at scale.