Association between supportive supervision and performance of community health workers in India: a longitudinal multi-level analysis

Abstract Introduction 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 c...

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Autores principales:	Lakshmi Gopalakrishnan, Nadia Diamond-Smith, Rasmi Avula, Purnima Menon, Lia Fernald, Dilys Walker, Sumeet Patil
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Anganwadi worker CHWs ICDS Integrated Child Development Services Supervision Nutrition Medicine (General) R5-920 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/356bc4697dc24e00ba80aaaed6e31604
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spelling	oai:doaj.org-article:356bc4697dc24e00ba80aaaed6e316042021-11-28T12:38:33ZAssociation between supportive supervision and performance of community health workers in India: a longitudinal multi-level analysis10.1186/s12960-021-00689-71478-4491https://doaj.org/article/356bc4697dc24e00ba80aaaed6e316042021-11-01T00:00:00Zhttps://doi.org/10.1186/s12960-021-00689-7https://doaj.org/toc/1478-4491Abstract Introduction 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. Objectives 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. Methods 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. Results 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. Conclusion 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 : Trial registration number: https://doi.org/10.1186/ISRCTN83902145Lakshmi GopalakrishnanNadia Diamond-SmithRasmi AvulaPurnima MenonLia FernaldDilys WalkerSumeet PatilBMCarticleAnganwadi workerCHWsICDSIntegrated Child Development ServicesSupervisionNutritionMedicine (General)R5-920Public aspects of medicineRA1-1270ENHuman Resources for Health, Vol 19, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Anganwadi worker CHWs ICDS Integrated Child Development Services Supervision Nutrition Medicine (General) R5-920 Public aspects of medicine RA1-1270
spellingShingle	Anganwadi worker CHWs ICDS Integrated Child Development Services Supervision Nutrition Medicine (General) R5-920 Public aspects of medicine RA1-1270 Lakshmi Gopalakrishnan Nadia Diamond-Smith Rasmi Avula Purnima Menon Lia Fernald Dilys Walker Sumeet Patil Association between supportive supervision and performance of community health workers in India: a longitudinal multi-level analysis
description	Abstract Introduction 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. Objectives 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. Methods 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. Results 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. Conclusion 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 : Trial registration number: https://doi.org/10.1186/ISRCTN83902145
format	article
author	Lakshmi Gopalakrishnan Nadia Diamond-Smith Rasmi Avula Purnima Menon Lia Fernald Dilys Walker Sumeet Patil
author_facet	Lakshmi Gopalakrishnan Nadia Diamond-Smith Rasmi Avula Purnima Menon Lia Fernald Dilys Walker Sumeet Patil
author_sort	Lakshmi Gopalakrishnan
title	Association between supportive supervision and performance of community health workers in India: a longitudinal multi-level analysis
title_short	Association between supportive supervision and performance of community health workers in India: a longitudinal multi-level analysis
title_full	Association between supportive supervision and performance of community health workers in India: a longitudinal multi-level analysis
title_fullStr	Association between supportive supervision and performance of community health workers in India: a longitudinal multi-level analysis
title_full_unstemmed	Association between supportive supervision and performance of community health workers in India: a longitudinal multi-level analysis
title_sort	association between supportive supervision and performance of community health workers in india: a longitudinal multi-level analysis
publisher	BMC
publishDate	2021
url	https://doaj.org/article/356bc4697dc24e00ba80aaaed6e31604
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_version_	1718407883443404800

Association between supportive supervision and performance of community health workers in India: a longitudinal multi-level analysis

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