Table 4

Impact of supervision and location on the determinants of CHW performance

Clinic-based with PN and ENHealth post with PN and ENClinic-based with EN only
Mentorship of EN and CHWGoodDepending on how busy the PN was seeing patients.
  • Junior ENs were not able to provide adequate training or supervision.

  • Little mentoring as facility manager was not engaged.

Relationship with clinicGoodPoorPoor
FilesWell managed by PNFiles at clinic were not managed by PN and EN; often lost and CHWs had to go and find them.Part of clinic filing system.
Effect on quality of service
  • More able to ensure that patients get care needs

  • Better relationship with community

  • Limited service at health post; patient had to travel to clinic for anything other than basic service.

  • Referrals were more difficult because of distance between health post from clinic.

  • CHWs shied away from difficult cases, knowing that they did not have the support.

  • Poorer relationship with community.

  • CHW, community health worker; EN, enrolled nurse; PN, professional nurse.