The Role of Supervision and Performance Management in Improvement of Community Health Services.

The Role of Supervision and Performance Management in Improvement of Community Health Services.

One of the benefits of digitization of community health is improved supervision of Community Health Workers (CHWs) and general performance management at all levels. Community Health Workers are an important resource in community health and a vital cog in the electronic Community Health Information System (eCHIS) wheel that is being implemented in Kenya. They are the front-line workers, the first line of attack and the first line of defense.  They are critical in health reporting and implementing interventions.

As of 2019, Kenya had a total of 86000 CHVs. They are supervised and supported by Community Health Extension Workers (CHEWs) and Community Health Assistants (CHAs) who are government employees. In the same period, there were 1569 CHEWs and CHAs. For effective delivery of community health services, health workers need a supervision and performance management protocol.

In Kisumu County where eCHIS is being implemented, Living Goods is supporting the county government in supervision and performance management by seconding supervisors, coaches and peer coaches to work side by side with the government CHEWs and CHAs. The Living Goods staff extend support to Sub-County focal persons, community health extension workers, community health assistants and community health workers by mentoring them on supervision, performance management and service delivery by use of digital tools.

“My major work is to ensure that the system works and achieves the goal at the end of the day, which is enhanced service delivery. I also ensure the CHWs, CHEWs, CHAs and sub-county focal persons own the process and the system so that at the end of our support, we don’t leave with the digital part of it, because the community health system was there but it was not digitized”, says Beatrice Otieno, Supervisor Coach in Nyakach sub-county.

Supervisor App from the supervisors’ point of view.

The mentorship and supervision seem to be bearing fruit. Risper Awiti is a community health assistant in charge of West Kabodho unit in Nyakach sub-county. She says through the mentorship and coaching she receives; she has been able to supervise her CHWs to a point where they can now achieve set targets. “We are able to achieve monthly targets like household visitation which is 85% and assessments of Under 5 whose target is 40 children. My CHWs are able to achieve that. We normally have a review meeting every Monday to review our weekly data to see where we need to improve for the next week. The peer coach also attends this meeting”, she says.  She supervises 10 CHWs, each with an average of 80 households.

CHW Jael Atieno (left) and CHA Risper Awiti at the home of Faith Achieng during a home visit.

eCHIS has improved supervision by streamlining supervision tasks and making them specific. It has also enhanced remote supervision compared to the previous non-digitized system. In Muhoroni sub-county, Thomas Owino, a CHEW, says that he relies on the data from his tablet to make many decisions, among them supervising CHVs to conduct a health education day once a month to educate the community around a health issue based on the indicators from the data collected and verified. For example, if there is an increase in diarrhea cases, they will conduct a health education day within the community unit to talk about diarrhea.

CHEW Thomas Owino verifies commodities in possession of CHV Neighter Achola.

His coach and mentor from Living Goods is Kennedy Akani. “I use data from my dashboard to support CHEWs and CHAs by identifying gaps that they are experiencing and gaps in community units in general. I then make targeted support to the specific CHEW or CHA in order to remedy the situation and together we come up with a timely decision that can improve performance,” he says. Akani has 31 CHEWs and CHAs under his coaching and mentorship.

With improved supervision of CHWs by government supervisors (CHEWs and CHAs), the delivery of health services in the community has improved. Through supervision and training, CHWs have been empowered to achieve set targets and this has enhanced their performance. The resultant effect is that the quality and delivery of health services as well as reporting in the community has improved. The support of digital tools and the electronic system has improved ownership of the system by CHWs and government workers. This means that the efficiency and reliability that comes with the digital system are here to stay. 

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