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Supervision of community peer counsellors for infant feeding in South Africa: an exploratory qualitative study
Open accessAbstract
BACKGROUND: Recent years have seen a re-emergence of community health worker (CHW) interventions, especially in relation to HIV care, and in increasing coverage of child health interventions. Such programmes can be particularly appealing in the face of human resource shortages and fragmented health systems. However, do we know enough about how these interventions function in order to support the investment? While research based on strong quantitative study designs such as randomised controlled trials increasingly document their impact, there has been less empirical analysis of the internal mechanisms through which CHW interventions succeed or fail. Qualitative process evaluations can help fill this gap. METHODS: This qualitative paper reports on the experience of three CHW supervisors who were responsible for supporting infant feeding peer counsellors. The intervention took place in three diverse settings in South Africa. Each setting employed one CHW supervisor, each of whom was individually interviewed for this study. The study forms part of the process evaluation of a large-scale randomized controlled trial of infant feeding peer counselling support. RESULTS: Our findings highlight the complexities of supervising and supporting CHWs. In order to facilitate effective infant feeding peer counselling, supervisors in this study had to move beyond mere technical management of the intervention to broader people management. While their capacity to achieve this was based on their own prior experience, it was enhanced through being supported themselves. In turn, resource limitations and concerns over safety and being in a rural setting were raised as some of the challenges to supervision. Adding to the complexity was the issue of HIV. Supervisors not only had to support CHWs in their attempts to offer peer counselling to mothers who were potentially HIV positive, but they also had to deal with supporting HIV-positive peer counsellors. CONCLUSIONS: This study highlights the need to pay attention to the experiences of supervisors so as to better understand the components of supervision in the field. Such understanding can enhance future policy making, planning and implementation of peer community health worker programmes.
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According to Daniels et al., the emotional support provided through supervision was particularly helpful in settings where lay workers had not previously worked outside of their own homes.
“According to Daniels et al., the emotional support provided through supervision was particularly helpful in settings where lay workers had not previously worked outside of their own homes [52].”
From Barefoot therapists: barriers and facilitators to delivering maternal mental health care through peer volunteers in Pakistan: a qualitative study (2016) · cites this paper as [52]
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Metadata
- Authors
- Daniels, K., Nor, B., Jackson, D., Ekström, E.-C., & Doherty, T.
- Affiliations
- South African Medical Research Council (ZA)
- Uppsala University (SE)
- University of the Western Cape (ZA)
- Corresponding author
- Daniels, Karen
- Venue
- Human Resources for Health
- Published
- 2010-03-30
- Volume
- 8
- Issue
- 1
- Pages
- 6-6
- ISSN
- 1478-4491 (ISSN-L)
- PMC
- PMC2867794
- OpenAlex
- W1996988234
- Cited by
- 41
- References
- 41
- Citations by year
- 2025: 1 · 2024: 2 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 2 · 2018: 5 · 2017: 1 · 2016: 3 · 2015: 4 · 2014: 8 · 2013: 3 · 2012: 1
- FWCI
- 3.99
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Human Resources for Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- European Commission
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- community health workers, peer counseling, infant feeding, supervision, personnel management, HIV, resource constraints, rural health, process evaluation, South Africa
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