Association between supportive supervision and performance of community health workers in India: A longitudinal multi-level analysis
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...
| Autores principales: | , , , , , , |
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| Formato: | Journal Article |
| Lenguaje: | Inglés |
| Publicado: |
BMC
2021
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| Materias: | |
| Acceso en línea: | https://hdl.handle.net/10568/142630 |
| _version_ | 1855531568237379584 |
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| author | Gopalakrishnan, Lakshmi Diamond-Smith, Nadia Avula, Rasmi Menon, Purnima Fernald, Lia Walker, Dilys Patil, Sumeet |
| author_browse | Avula, Rasmi Diamond-Smith, Nadia Fernald, Lia Gopalakrishnan, Lakshmi Menon, Purnima Patil, Sumeet Walker, Dilys |
| author_facet | Gopalakrishnan, Lakshmi Diamond-Smith, Nadia Avula, Rasmi Menon, Purnima Fernald, Lia Walker, Dilys Patil, Sumeet |
| author_sort | Gopalakrishnan, Lakshmi |
| collection | Repository of Agricultural Research Outputs (CGSpace) |
| description | 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. |
| format | Journal Article |
| id | CGSpace142630 |
| institution | CGIAR Consortium |
| language | Inglés |
| publishDate | 2021 |
| publishDateRange | 2021 |
| publishDateSort | 2021 |
| publisher | BMC |
| publisherStr | BMC |
| record_format | dspace |
| spelling | CGSpace1426302024-10-25T07:59:38Z Association between supportive supervision and performance of community health workers in India: A longitudinal multi-level analysis Gopalakrishnan, Lakshmi Diamond-Smith, Nadia Avula, Rasmi Menon, Purnima Fernald, Lia Walker, Dilys Patil, Sumeet child development health training nutrition health care communities 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. 2021-11-27 2024-05-22T12:10:46Z 2024-05-22T12:10:46Z Journal Article https://hdl.handle.net/10568/142630 en Open Access BMC Gopalakrishnan, Lakshmi; Diamond-Smith, Nadia; Avula, Rasmi; Menon, Purnima; Fernald, Lia; Walker, Dilys; and Patil, Sumeet. 2021. Association between supportive supervision and performance of community health workers in India: A longitudinal multi-level analysis. Human Resources for Health 19: 145. https://doi.org/10.1186/s12960-021-00689-7 |
| spellingShingle | child development health training nutrition health care communities Gopalakrishnan, Lakshmi Diamond-Smith, Nadia Avula, Rasmi Menon, Purnima Fernald, Lia Walker, Dilys Patil, Sumeet Association between supportive supervision and performance of community health workers in India: A longitudinal multi-level analysis |
| title | 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_short | 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 |
| topic | child development health training nutrition health care communities |
| url | https://hdl.handle.net/10568/142630 |
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