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Supervision of community peer counsellors for infant feeding in South Africa: an exploratory qualitative study.
Nordic Council of Ministers, Nordic School of Public Health NHV. Health Systems Research Unit, Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa .
Department of Women's and Children's Health, Uppsala University, Sweden .
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2010 (English)In: Human resources for health, ISSN 1478-4491, Vol. 8, 6- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Recent years have seen a re-emergence of community health worker (CHW) interventions, especially in relation to HIV care, and in increasing coverage of child health interventions. Such programmes can be particularly appealing in the face of human resource shortages and fragmented health systems. However, do we know enough about how these interventions function in order to support the investment? While research based on strong quantitative study designs such as randomised controlled trials increasingly document their impact, there has been less empirical analysis of the internal mechanisms through which CHW interventions succeed or fail. Qualitative process evaluations can help fill this gap.

METHODS: This qualitative paper reports on the experience of three CHW supervisors who were responsible for supporting infant feeding peer counsellors. The intervention took place in three diverse settings in South Africa. Each setting employed one CHW supervisor, each of whom was individually interviewed for this study. The study forms part of the process evaluation of a large-scale randomized controlled trial of infant feeding peer counselling support.

RESULTS: Our findings highlight the complexities of supervising and supporting CHWs. In order to facilitate effective infant feeding peer counselling, supervisors in this study had to move beyond mere technical management of the intervention to broader people management. While their capacity to achieve this was based on their own prior experience, it was enhanced through being supported themselves. In turn, resource limitations and concerns over safety and being in a rural setting were raised as some of the challenges to supervision. Adding to the complexity was the issue of HIV. Supervisors not only had to support CHWs in their attempts to offer peer counselling to mothers who were potentially HIV positive, but they also had to deal with supporting HIV-positive peer counsellors.

CONCLUSIONS: This study highlights the need to pay attention to the experiences of supervisors so as to better understand the components of supervision in the field. Such understanding can enhance future policy making, planning and implementation of peer community health worker programmes.

Place, publisher, year, edition, pages
2010. Vol. 8, 6- p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3739DOI: 10.1186/1478-4491-8-6PubMedID: 20353561OAI: oai:DiVA.org:norden-3739DiVA: diva2:786529
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2015-02-09Bibliographically approved
In thesis
1. Lay Health Worker Programmes as aPublic Health Approachin South Africa
Open this publication in new window or tab >>Lay Health Worker Programmes as aPublic Health Approachin South Africa
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim is to assess the appropriateness of Lay Health Worker (LHW)programmes as a public health intervention in South Africa by considering the effectivenessof LHW programmes across the world and the experience of LHW programmeimplementation and policy making in South Africa.

Methods: This thesis comprises 4 papers that explore the issue of LHWs: (I) A systematicreview of randomised controlled trials (RCTs) of LHW interventions in primary andcommunity health care for maternal and child health and the management of infectiousdiseases; (II) A study of the experiences of farm dwellers trained to be LHWs, as exploredthrough focus group discussions; (III) A study of three LHW supervisors who worked on anintervention to support infant feeding mothers, as explored through individual interviews;and (IV) A study of the process of LHW policy development from the perspective of 11 keyinformants who were individually interviewed.

Findings: LHWs were found to be effective in promoting breastfeeding and in improvingpulmonary TB cure rates (I). There was also some indication that LHWs could be effective inreducing child morbidity and child and neonatal mortality, and in increasing the likelihood ofcaregivers seeking care for childhood illness (I). The experience of LHWs and LHWsupervisors suggests that LHW programmes need adequate support and supervision,especially in protecting the LHWs themselves (II, III). The care and protection of LHWs wasconsidered by policy makers (IV), but policy redevelopment processes did not link the needto ensure that LHWs were not exploited to concerns about gender exploitation.

Conclusions: LHW interventions can be effective but implementing them in developingcountries such as South Africa needs to be approached with caution

Publisher
62 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2012:2
Keyword
Lay health workers, Lay Health worker programmes, public health, primary health care, gender, intervention effectiveness, intervention experience, policy making, programme supervision.
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3743 (URN)978-91-86739-30-0 (ISBN)
Public defence
2012-05-11, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (English)
Opponent
Supervisors
Available from: 2015-02-09 Created: 2015-02-05 Last updated: 2015-02-09Bibliographically approved

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