Improving Community Health Worker performance by using a personalised feedback dashboard for supervision: a randomised controlled trial

Caroline Whidden, Kassoum Kayentao, Jenny X Liu, Scott Lee, Youssouf Keita, Djoumé Diakité, Alexander Keita, Samba Diarra, Jacqueline Edwards, Amanda Yembrick, Isaac Holeman, Salif Samaké, Boureima Plea, Mama Coumaré, Ari D Johnson, Caroline Whidden, Kassoum Kayentao, Jenny X Liu, Scott Lee, Youssouf Keita, Djoumé Diakité, Alexander Keita, Samba Diarra, Jacqueline Edwards, Amanda Yembrick, Isaac Holeman, Salif Samaké, Boureima Plea, Mama Coumaré, Ari D Johnson

Abstract

Background: Countries across sub-Saharan Africa are scaling up Community Health Worker (CHW) programmes, yet there remains little high-quality research assessing strategies for CHW supervision and performance improvement. This randomised controlled trial aimed to determine the effect of a personalised performance dashboard used as a supervision tool on the quantity, speed, and quality of CHW care.

Methods: We conducted a randomised controlled trial in a large health catchment area in peri-urban Mali. One hundred forty-eight CHWs conducting proactive case-finding home visits were randomly allocated to receive individual monthly supervision with or without the CHW Performance Dashboard from January to June 2016. Randomisation was stratified by CHW supervisor, level of CHW experience, and CHW baseline performance for monthly quantity of care (number of household visits). With regression analysis, we used a difference-in-difference model to estimate the effect of the intervention on monthly quantity, timeliness (percentage of children under five treated within 24 hours of symptom onset), and quality (percentage of children under five treated without protocol error) of care over a six-month post-intervention period relative to a three-month pre-intervention period.

Results: Use of the Dashboard during monthly supervision significantly increased the mean number of home visits by 39.94 visits per month (95% CI = 3.56-76.3; P = 0.031). Estimated effects on secondary outcomes of timeliness and quality were positive but not statistically significant. Across both study arms, CHW quantity, timeliness, and quality of care significantly improved over the study period, during which time all CHWs received dedicated monthly supervision, although effects plateaued over time.

Conclusions: Our findings suggest that dedicated monthly supervision and personalised feedback using performance dashboards can increase CHW productivity. Further operational research is needed to understand how to sustain the performance improvements over time.

Trial registration: ClinicalTrials.gov (NCT03684551).

Conflict of interest statement

Competing interests: CW, KK, YK, DD, AK, and AJ declare grants from Child Relief International Foundation; KK declares grants from USAID Development Innovation Ventures. The authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare no other conflicts of interest.

Figures

Figure 1
Figure 1
CONSORT diagram.
Figure 2
Figure 2
Timeline of the intervention and related research activities.
Figure 3
Figure 3
360 Supervision strategy.
Figure 4
Figure 4
CHW Performance Dashboard, English translation.
Figure 5
Figure 5
Mean quantity (left), timeliness (middle), and quality (right) performance trends during pre- (left of dotted line) and post-intervention (right of dotted line) periods for CHWs in the control and intervention arms.

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Source: PubMed

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