Support for volunteer caregivers and its influence on the quality of community home-based care in the Eastern Cape, South Africa

Community health workers' experiences of supervision in maternal and child health programmes in low- and middle-income countries: A qualitative evidence synthesis

Maternal and child health programmes often use Community Health Workers (CHWs) to help address poor access to health care, particularly in low- and middle-income countries (LMIC). Supervision has long been recognised as a critical ingredient of successful CHW programmes, yet it is often reported as either of poor quality or absent. There is little research on CHWs' own perception of supervision and to the best of our knowledge, there are no reviews synthesising the evidence of CHWs' experiences of supervision. This review identified and synthesised qualitative research evidence about the experiences and perceptions of supervision by CHWs in programmes targeting maternal and child health (MCH) in LMIC. Electronic searches were performed in the following databases: EMBASE, Medline, PsycINFO, ASSIA, ERIC and CINAHL. This review included studies during the period from 2000 to 2021. In total, 10,505 titles were screened for inclusion, of which 177 full-text articles were retrieved and assessed. Ultimately, 19 articles were included in this review. Data extraction was based on the thematic synthesis approach: coding the text of included studies line-by-line; developing descriptive themes; and generating analytical themes. Four themes emerged: (1) frequency of supervision, (2) type of supervision, (3) supervision and motivation and (4) supportive supervision. Careful consideration needs to be taken of the model of supervision used, as primary care facility-based supervisors (usually nurses), although skilled, may not have sufficient time to supervise. Employing supervisors whose sole responsibility is to supervise CHWs may be a good strategy to alleviate these issues. Sufficient time and resources need to be allocated to supervisors and they should be expected to perform regular in-the-field supervision. Involving some aspects of community oversight should also be considered. Supervisor skills and training and the long-term retention of trained supervisors also need to be an important area of focus.

"Life continues": Patient, health care and community care workers perspectives on self-administered treatment for rifampicin-resistant tuberculosis in Khayelitsha, South Africa

Background

Self-administered treatment (SAT), a differentiated model of care for rifampicin-resistant tuberculosis (RR-TB), might address adherence challenges faced by patients and health care systems. This study explored patient, health-care worker (HCW) and community care worker (CCW) perspectives on a SAT pilot programme in South Africa, in which patients were given medication to take at home with the optional support of a CCW.

Methods

We conducted a mixed-methods study from July 2016-June 2017. The quantitative component included semi-structured questionnaires with patients, HCWs and CCWs; the qualitative component involved in-depth interviews with patients enrolled in the pilot programme. Interviews were conducted in isiXhosa, translated, transcribed and manually coded.

Results

Overall, 27 patients, 12 HCWs and 44 CCWs were enrolled in the quantitative component; nine patients were also interviewed. Of the 27 patients who completed semi-structured questionnaires, 22 were HIV-infected and 17 received a monthly supply of RR TB treatment. Most HCWs and CCWs (10 and 32, respectively) understood the pilot programme; approximately half (n = 14) of the patients could not correctly describe the pilot programme. Overall, 11 and 41 HCWs and CCWs reported that the pilot programme promoted treatment adherence. Additionally, 11 HCWs reported that the pilot programme relieved pressure on the clinic. Key qualitative findings highlighted the importance of a support person and how the flexibility of SAT enabled integration of treatment into their daily routines and reduced time spent in clinics. The pilot programme was also perceived to allow patients more autonomy and made it easier for them to manage side-effects.

Conclusion

The SAT pilot programme was acceptable from the perspective of patients, HCWs and CCWs and should be considered as a differentiated model of care for RR-TB, particularly in settings with high burdens of HIV, in order to ease management of treatment for patients and health-care providers.