Supervision of community peer counsellors for infant feeding in South Africa: an exploratory qualitative study

Karen Daniels, Barni Nor, Debra Jackson, Eva-Charlotte Ekström, Tanya Doherty, Karen Daniels, Barni Nor, Debra Jackson, Eva-Charlotte Ekström, Tanya Doherty

Abstract

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.

References

    1. Lewin SA, Dick J, Pond P, Zwarenstein M, Aja G, van Wyk B, Bosch-Capblanch X, Patrick M. Lay health workers in primary and community health care. Cochrane Database Syst Rev. 2005. p. CD004015.
    1. Lehmann U, Sanders D. Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. Geneva: Evidence and Information for Policy, Department of Human Resources for Health, World Health Organisation; 2007.
    1. Ofosu-Amaah V. National experience in the use of community health workers. A review of current issues and problems. WHO Offset Publ. 1983;71:1–49.
    1. Schneider H, Hlophe H, van Rensburg D. Community health workers and the response to HIV/AIDS in South Africa: tensions and prospects. Health Policy Plan. 2008;23:179–187. doi: 10.1093/heapol/czn006.
    1. Curtale F, Siwakoti B, Lagrosa C, LaRaja M, Guerra R. Improving skills and utilization of community health volunteers in Nepal. Soc Sci Med. 1995;40:1117–1125. doi: 10.1016/0277-9536(94)00172-P.
    1. Gilson L, Walt G, Heggenhougen K, Owuor-Omondi L, Perera M, Ross D, Salazar L. National community health worker programs: how can they be strengthened? J Public Health Policy. 1989;10:518–532. doi: 10.2307/3342522.
    1. Haines A, Sanders D, Lehmann U, Rowe AK, Lawn JE, Jan S, Walker DG, Bhutta Z. Achieving child survival goals: potential contribution of community health workers. Lancet. 2007;369:2121–2131. doi: 10.1016/S0140-6736(07)60325-0.
    1. Global Strategy for Infant and Young Child Feeding. World Health Organization; 2003.
    1. Dyson L, Renfrew M, McFadden A, McCormick F, Herbet G, Thomas J. Promotion of breastfeeding initiation and duration: Evidence into practice briefing. National Institute for Health and Clinical Excellence; 2005.
    1. Clarke M. Towards cost-effective tuberculosis control in the Western Cape of South Africa: intervention study involving lay health workers on agricultural farms. Karolinska Institutet, Division of International Health (IHCAR) Department of Public Health Sciences; 2005.
    1. Heiby J. QAP Editorial: Quality Assurance and Supervision Systems. QA Brief: The Quality Assurance Project's Information Outlet. 1998;7:1–3.
    1. Stinson W, Malianga L, Marquez L, Madubuike C. Quality Supervision. QA Brief: The Quality Assurance Project's Information Outlet. 1998;7:4–6.
    1. Rowe SY, Kelly JM, Olewe MA, Kleinbaum DG, McGowan JE Jr, McFarland DA, Rochat R, Deming MS. Effect of multiple interventions on community health workers' adherence to clinical guidelines in Siaya district, Kenya. Trans R Soc Trop Med Hyg. 2007;101:188–202. doi: 10.1016/j.trstmh.2006.02.023.
    1. Doherty T, Chopra M, Nkonki L, Jackson D, Greiner T. Effect of the HIV epidemic on infant feeding in South Africa: "When they see me coming with the tins they laugh at me". Bull World Health Organ. 2006;84:90–96. doi: 10.2471/BLT.04.019448.
    1. Doherty T, Chopra M, Nkonki L, Jackson D, Persson LA. A longitudinal qualitative study of infant-feeding decision making and practices among HIV-positive women in South Africa. J Nutr. 2006;136:2421–2426.
    1. Doherty TM, McCoy D, Donohue S. Health system constraints to optimal coverage of the prevention of mother-to-child HIV transmission programme in South Africa: lessons from the implementation of the national pilot programme. Afr Health Sci. 2005;5:213–218.
    1. Coutsoudis A, Pillay K, Kuhn L, Spooner E, Tsai WY, Coovadia HM. Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: prospective cohort study from Durban, South Africa. AIDS. 2001;15:379–387. doi: 10.1097/00002030-200102160-00011.
    1. Dunn DT, Newell ML, Ades AE, Peckham CS. Risk of human immunodeficiency virus type 1 transmission through breastfeeding. Lancet. 1992;340:585–588. doi: 10.1016/0140-6736(92)92115-V.
    1. Iliff PJ, Piwoz EG, Tavengwa NV, Zunguza CD, Marinda ET, Nathoo KJ, Moulton LH, Ward BJ, Humphrey JH. Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS. 2005;19:699–708. doi: 10.1097/01.aids.0000166093.16446.c9.
    1. Coovadia HM, Rollins NC, Bland RM, Little K, Coutsoudis A, Bennish ML, Newell ML. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet. 2007;369:1107–1116. doi: 10.1016/S0140-6736(07)60283-9.
    1. Thior I, Lockman S, Smeaton LM, Shapiro RL, Wester C, Heymann SJ, Gilbert PB, Stevens L, Peter T, Kim S. Breastfeeding plus infant zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine for 1 month to reduce mother-to-child HIV transmission in Botswana: a randomized trial: the Mashi Study. JAMA. 2006;296:794–805. doi: 10.1001/jama.296.7.794.
    1. Agrasada GV, Gustafsson J, Kylberg E, Ewald U. Postnatal peer counselling on exclusive breastfeeding of low-birthweight infants: a randomized, controlled trial. Acta Paediatr. 2005;94:1109–1115. doi: 10.1080/08035250510025752.
    1. Coutinho SB, de Lira PI, de Carvalho Lima M, Ashworth A. Comparison of the effect of two systems for the promotion of exclusive breastfeeding. Lancet. 2005;366:1094–1100. doi: 10.1016/S0140-6736(05)67421-1.
    1. Haider R, Ashworth A, Kabir I, Huttly SR. Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial. Lancet. 2000;356:1643–1647. doi: 10.1016/S0140-6736(00)03159-7.
    1. Leite AJ, Puccini RF, Atalah AN, Alves Da Cunha AL, Machado MT. Effectiveness of home-based peer counselling to promote breastfeeding in the northeast of Brazil: a randomized clinical trial. Acta Paediatr. 2005;94:741–746. doi: 10.1080/08035250410023854.
    1. Morrow AL, Guerrero ML, Shults J, Calva JJ, Lutter C, Bravo J, Ruiz-Palacios G, Morrow RC, Butterfoss FD. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet. 1999;353:1226–1231. doi: 10.1016/S0140-6736(98)08037-4.
    1. Chopra M, Jackson D, Doherty T, Colvin M. Good Start Community-Based Intervention Study: Ethics Application. Medical Research Council, University of the Western Cape & Centre for AIDS Development Research and Evaluation; 2006.
    1. Tylleskär T, Chopra M, Diallo H, Doherty T, Ekström E-C, Engebretsen IM, Goga A, Jackson D, Kankasa C, Klungsøyr J. PROMISE Final Scientific Report:- Preliminary results from the multi-centre cluster-randomised behaviour intervention trial PROMISE EBF: exclusive breastfeeding promotion in Sub-Saharan Africa. University of Bergen; 2009.
    1. Chopra M, Doherty T, Jackson D, Ashworth A. Preventing HIV transmission to children: quality of counselling of mothers in South Africa. Acta Paediatr. 2005;94:357–363.
    1. Nor B, Zembe Y, Daniels K, Doherty T, Jackson D, Ahlberg BM, Ekstrom EC. "Peer but Not Peer": Considering the Context of Infant Feeding Peer Counseling in a High HIV Prevalence Area. J Hum Lact. 2009.
    1. Goga A. Personal Communication. 2009.
    1. Mind the gap: equity and trends in coverage of maternal, newborn, and child health services in 54 Countdown countries. Lancet. pp. 1259–1267.
    1. Lewin S. Bridging the equity gap in maternal and child health: lay health workers may help bridge equity gap in maternal and child health. BMJ. 2005;331:844. doi: 10.1136/bmj.331.7520.844-a.
    1. Cattaneo A. Promoting breast feeding in the community. BMJ. 2009;338:a2657. doi: 10.1136/bmj.a2657.
    1. Hoddinott P, Britten J, Prescott GJ, Tappin D, Ludbrook A, Godden DJ. Effectiveness of policy to provide breastfeeding groups (BIG) for pregnant and breastfeeding mothers in primary care: cluster randomised controlled trial. BMJ. 2009;338:a3026. doi: 10.1136/bmj.a3026.
    1. MacArthur C, Jolly K, Ingram L, Freemantle N, Dennis CL, Hamburger R, Brown J, Chambers J, Khan K. Antenatal peer support workers and initiation of breast feeding: cluster randomised controlled trial. BMJ. 2009;338:b131. doi: 10.1136/bmj.b131.
    1. Department of Health SA. Community Health Worker Policy Framework. Pretoria. 2005.
    1. Moran VH, Dykes F, Burt S, Shuck C. Breastfeeding support for adolescent mothers: similarities and differences in the approach of midwives and qualified breastfeeding supporters. Int Breastfeed J. 2006;1:23. doi: 10.1186/1746-4358-1-23.
    1. Sarafino EP. Health Psychology: Biospsychosocial Interactions. New York: John Wiley & Sons; 1994.
    1. Sarafino EP. Health Psychology: Biopsychosocial Interactions. 5. New York: John Wiley & Sons; 2005.
    1. Marais H. A plague of inequality. Mail &Guardian. 2006.
    1. Daly J, Willis K, Small R, Green J, Welch N, Kealy M, Hughes E. A hierarchy of evidence for assessing qualitative health research. J Clin Epidemiol. 2007;60:43–49. doi: 10.1016/j.jclinepi.2006.03.014.
    1. Green J, Thorogood N. Qualitative Methods for Health Research. London: Sage Publications; 2004.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner