Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
Zithulele Research Centre, Zithulele Hospital, Mqanduli, South Africa.
Health Soc Care Community. 2022 Nov;30(6):2170-2185. doi: 10.1111/hsc.13893. Epub 2022 Jul 19.
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.
妇幼保健项目通常使用社区卫生工作者（CHW）来帮助解决医疗服务获取困难的问题，尤其是在中低收入国家（LMIC）。监督长期以来一直被认为是 CHW 项目成功的关键组成部分，但它往往要么质量差，要么不存在。关于 CHW 对监督的自身看法的研究很少，据我们所知，没有综述综合 CHW 对监督体验的证据。这项综述确定并综合了针对中低收入国家母婴健康（MCH）目标的项目中 CHW 监督经验和看法的定性研究证据。在以下数据库中进行了电子检索：EMBASE、Medline、PsycINFO、ASSIA、ERIC 和 CINAHL。本综述包括 2000 年至 2021 年期间的研究。共筛选了 10505 个标题以纳入研究，其中检索并评估了 177 篇全文文章。最终，19 篇文章纳入了本综述。数据提取基于主题综合方法：逐行对纳入研究的文本进行编码；开发描述性主题；并生成分析性主题。有四个主题出现：（1）监督的频率，（2）监督的类型，（3）监督与激励，（4）支持性监督。需要仔细考虑所使用的监督模式，因为虽然基层医疗保健机构的监督者（通常是护士）技术熟练，但可能没有足够的时间进行监督。雇用专门负责监督 CHW 的监督者可能是缓解这些问题的好策略。需要为监督者分配足够的时间和资源，并且应该期望他们进行定期的实地监督。还应考虑一些社区监督的方面。监督者的技能和培训以及经过培训的监督者的长期保留也需要成为一个重要的关注领域。
