Table 2 WBOT supportive supervision framework
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 |