Table 5

Programme design features and supervisory strategies that worked

RecommendationRationale
Programme design
  • Attachment to primary healthcare clinic

Facilitate physical and operational integration into the health system.
  • Team up senior and junior supervisors

Build relations, guide community health workers (CHWs) to navigate through the community and system, pass down know-how to junior supervisors.
  • Setting guidelines as to how much time supervisors can spend assisting in the clinic

Help to acknowledge that the engagement is a two-way collaboration, in which there are benefits for everybody.
  • Strengthen HR management practices

Build trust, improve dialogue in the workplace, problem solving, supervision and culturally appropriate communication.
Supervisory strategies
  • Supervise home visits

Provide opportunities to strengthen CHWs’ knowledge and skills, demonstrate a strong backup for CHWs in the community, keep updated of community’s status.
  • Formal and on-the-job training

Impart knowledge and skills.
  • Regular debriefing/feedback

Individual and collective supervision, track performance, build up teamwork spirit.
  • Examine daily logs and registers

Ensure accurate documentation and subsequent reporting.
  • Direct CHWs to tasks, such as tracing defaulting patients, that explicitly assist the clinic

Ensure the clinic staff are able to see the benefits of having CHWs as part of the team.
  • Draw in clinic staff to work with and train CHWs

Improve the extent and quality of working relationships between clinic staff and CHWs, and allow CHWs to benefit from the clinic staff’s expertise.
  • Assist data collating and reporting

Ensure that CHW activities are accurately reported so that health system managers can see the benefits of the programme.
  • Administration and logistics

Resolve administrative matters, negotiate for better work conditions, ensure CHWs are adequately equipped to deliver service.