Table 5 Summary findings on supervision for CHWs

Supervision appears to be effective in combination with other supports

• Supervision is critical to maintain quality and motivation [19, 23, 33, 35, 76, 132].

• In integrated community case management programs, supervision and on-site training of CHWs improved clinical practices, with providers showing increased knowledge, increased effectiveness in promoting care-seeking behaviors, or improved basic disease management [27].

• Frequent supervision and continuous training led to better CHW performance in certain settings, but the evidence is mixed [15].

Many unknowns and need more research

• There is some evidence of benefit for health care performance, but evidence quality is low [30] and follow-up is limited [29].

• Supervision and training were often mentioned as facilitating factors, but few studies have tested which approaches work best or how these were best implemented [15].

What might work?

• Supervision that focuses on supportive approaches, quality assurance and problem solving may be most effective at improving CHW performance (as opposed to more bureaucratic and punitive approaches) [15, 29, 31].

• Enhanced supervision of CHWs was only superior to routine supervision in two low quality-studies, which examined the effect of regular, supportive supervision and the use of checklists on workforce performance [30].

• Less-intensive supervision of CHWs in one study of low quality did not show any adverse effect on the quality of care or health workers attrition [30].

• Improving supervision quality has a greater impact than increasing frequency of supervision alone [31].