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Table 2 WBOT supportive supervision framework

From: Developing a district level supportive supervision framework for community health workers through co-production in South Africa

Theme Constraints Strategies
Development of CHWs Formal training
- Limited trainers for CHWs
- Non-prioritisation of CHW training (Province)
In-service training
- Shortage of team leaders
- Poor supervision from PHC facility workers
- Lack of support from programme (HIV, MNCH, etc) managers
- In-service training must be done regularly by team leader (TL), facility manager, and peers
- Human resource development should come with the schedule for training of CHWs on new guidelines and policies
- Absorb existing CHWs into the health system
Allocation of roles - Vacant posts
- Severe shortage in key positions
- Lack of supervision guidelines for the programme
- Appoint a fully functional WBOT (including TLs, CHWs, environmental health practitioners, data capturers, health promoters)
- Develop supervisory tools for managers
- Appoint PHC facility manager
- Re-orientation of managers on the programme – in general role clarification
- Training of CHWs
- Training of newly recruited CHWs
- Debriefing/early identification of burnout and act on it
Leadership - Non-responsiveness of management to requests
- Lack of resources
- Lack of understanding of roles by managers
- Lack of commitment by managers to the programme
- Lack of capacity building
- Consistent implementation of the policies
- Continuous support and interaction
- Provision of resources e.g. working tools for TLs, CHWs uniform, name tags
- Commitment, selflessness, passion
- Good communication, confidentiality, equality
- Training and development
Resources - Shortage of team leaders and other relevant health workers
- No transport for WBOT
- Poor integration of WBOT into the health system, fragmentation
- Limited space for administration work (office, stationery, medical supplies)
- Lack of supplies (stationery, medical supplies)
- Create, fund and fill posts
- Procure facility-based transport
- Dedicated management structure for WBOT to be standardised
- There must be a schedule for quarterly in-service training for CHWs TLs
- Develop a framework for supervision