University of California Berkeley, Berkeley, USA.
University of California San Francisco, San Francisco, USA.
Hum Resour Health. 2021 Nov 27;19(1):145. doi: 10.1186/s12960-021-00689-7.
Community health workers (CHWs) deliver services at-scale to reduce maternal and child undernutrition, but often face inadequate support from the health system to perform their job well. Supportive supervision is a promising intervention that strengthens the health system and can enable CHWs to offer quality services.
We examined if greater intensity of supportive supervision as defined by monitoring visits to Anganwadi Centre, CHW-supervisor meetings, and training provided by supervisors to CHWs in the context of Integrated Child Services Development (ICDS), a national nutrition program in India, is associated with higher performance of CHWs. Per program guidelines, we develop the performance of CHWs measure by using an additive score of nutrition services delivered by CHWs. We also tested to see if supportive supervision is indirectly associated with CHW performance through CHW knowledge.
We used longitudinal survey data of CHWs from an impact evaluation of an at-scale technology intervention in Madhya Pradesh and Bihar. Since the inception of ICDS, CHWs have received supportive supervision from their supervisors to provide services in the communities they serve. Mixed-effects logistic regression models were used to test if higher intensity supportive supervision was associated with improved CHW performance. The model included district fixed effects and random intercepts for the sectors to which supervisors belong.
Among 809 CHWs, the baseline proportion of better performers was 45%. Compared to CHWs who received lower intensity of supportive supervision, CHWs who received greater intensity of supportive supervision had 70% higher odds (AOR 1.70, 95% CI 1.16, 2.49) of better performance after controlling for their baseline performance, CHW characteristics such as age, education, experience, caste, timely payment of salaries, Anganwadi Centre facility index, motivation, and population served in their catchment area. A test of mediation indicated that supportive supervision is associated indirectly with CHW performance through improvement in CHW knowledge.
Higher intensity of supportive supervision is associated with improved CHW performance directly and through knowledge of CHWs. Leveraging institutional mechanisms such as supportive supervision could be important in improving service delivery to reach beneficiaries and potentially better infant and young child feeding practices and nutritional outcomes.
Trial registration number: https://doi.org/10.1186/ISRCTN83902145.
社区卫生工作者（CHWs）大规模提供服务，以减少母婴营养不足，但他们往往面临卫生系统提供的支持不足，难以有效地开展工作。支持性监督是一种很有前途的干预措施，可以加强卫生系统，并使 CHWs 能够提供高质量的服务。
我们研究了在印度全国营养计划——综合儿童发展服务（ICDS）背景下，以监督探访安格安瓦迪中心、CHW-主管会议和主管为 CHWs 提供培训的频率来衡量的监督支持的强度是否与 CHWs 的工作表现有关。根据项目准则，我们通过使用 CHWs 提供的营养服务的附加分数来制定 CHWs 工作表现的衡量标准。我们还测试了支持性监督是否通过 CHW 知识与 CHW 工作表现间接相关。
我们使用了在 Madhya Pradesh 和 Bihar 进行的一项大规模技术干预的影响评估中 CHWs 的纵向调查数据。自 ICDS 成立以来，CHWs 一直从他们的主管那里获得支持性监督，以便在他们所服务的社区提供服务。使用混合效应逻辑回归模型来检验更高强度的支持性监督是否与 CHW 工作表现的改善有关。该模型包括区固定效应和主管所属部门的随机截距。
在 809 名 CHWs 中，基线表现较好的比例为 45%。与接受较低强度监督性支持的 CHWs 相比，接受更高强度监督性支持的 CHWs 在控制基线表现、CHW 特征（如年龄、教育、经验、种姓、按时支付工资、安格安瓦迪中心设施指数、激励和服务范围内的人口）后，表现更好的可能性要高出 70%（优势比 1.70，95%CI 1.16-2.49）。中介检验表明，支持性监督通过提高 CHW 知识与 CHW 工作表现间接相关。
更高强度的支持性监督与 CHW 工作表现的直接提高以及 CHW 知识的提高有关。利用支持性监督等机构机制可能对改善服务提供以惠及受益人并有可能改善婴儿和幼儿喂养做法和营养结果至关重要。
