The SSGWEP collects and validates surveillance and performance data through regular documented supervision at all program levels.
Secondary sources used included surveys reports, policy documents, supervision and monitoring and evaluation reports as well as written conference papers.
In practice, as highlighted by many respondents and policy documents, supervision has been poor: "Poor supervision and support, particularly at the most peripheral levels, conditions the quality of services provided to this important level of health care, which often represents the first and only contact for those who seek health care" (Ministério da Saúde, 2014a, p. 77).
While skill retention was not systematically assessed, this was documented in supervision notes.
In some evaluations that have documented weak supervision in national CHW programmes, the CHWs do not even know who their supervisors are or what they can expect from them [ 37].
SS, which was the focal point of the package of interventions, was based on 1) introducing updated job descriptions with documented lines of supervision; 2) improving communication lines and skills; 3) introducing guidelines and tools for supervision, performance review, and monitoring; and 4) evidence-based action planning.
Child protection/safeguarding issues were defined as a documented care or supervision order recorded in the PMHT case notes or a documented referral made to the safeguarding lead due to professional concerns.
Prior to recruitment of patients, providers in the intervention arm received training on the recognition of depression, the delivery of the manualized intervention package, how to obtain and document support and supervision received from the GP using mobile phones.
One particular study documented that intense supervision led to high provider performance in systematic influenza and pneumococcal vaccination in a busy public emergency department setting despite initial resistance and extreme variation in individual performance [ 13].
Given the increasing use of CHWs to deliver health services and the documented role quality supervision can play in maintaining health worker and CHW performance (57, 58) and motivation (5, 11, 59– 61), identifying effective supervision strategies and addressing implementation issues could help improve CHW supervision and motivation, performance, and outcomes.
