An Evaluation of a Peer Supervision Pilot Project among Community Health Workers in Rural Uganda

Abstract BackgroundThe World Health Organization recommends use of community health workers (CHWs) as a strategy to address the growing shortage of health workers. High-quality, regular supervision can help CHWs reach their full potential. Living Goods operates a community health program in 19 districts of Uganda. In the standard supervision model for the program, CHWs are supervised by a full time Community Health Supervisor (CHS) who reviews performance, coaches and mentors the CHWs. Whereas this model has proven to be effective, it is very expensive. Evidence indicates that peer supervision can be a substitute for standard supervision. In this paper, we describe our experience and program outcomes while implementing a peer supervision model among 211 CHWs in Mayuge district between January and December 2019.Objectives1. To describe the peer supervision model used. 2. To compare health services delivery outcomes. 3. To compare costs of delivery of the two supervision models.MethodsInternal organization records from January to December 2019 were reviewed. Focus group discussions and in-depth interviews with 29 CHWs were also conducted. Qualitative analysis was conducted using thematic content analysis while quantitative data was summarized to generate averages, percentages and graphs.FindingsCHWs under the peer supervision model performed better than those under the standard supervision model against all key performance indicators (KPIs). The total cost to maintain the peer supervision model for 1 year was $176 per CHW vs $273 among CHWs under the standard supervision model. Peer supervision thus resulted in an overall saving of 36% of direct operations costs. There was lower attrition among CHWs under peer supervision vs non-peers (10% vs 17%). Strengths of peer supervision included: improved CHW teamwork and motivation, optimization of supervisor time, as well as reduced program costs.ConclusionsPeer supervision is a feasible and more affordable model of supervising CHWs.