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The formative research identified supervision and motivation of CHWs as a critical barrier to address, especially amongst those CHWs previously employed by other projects.
International stakeholders, selected for interviews based on their range of programme and research experience in diverse settings and continents, also identified supervision as a key intervention to improve the retention and motivation of CHWs [ 13].
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With the LQAS, we could not compare pre-expansion and endline supervision areas individually due to the change in methodology in identifying supervision areas between the 2 time periods.
In parallel to IRT rollout, A&T/partners provided (1) primary healthcare staff training for supervisors and health workers (to provide on-the-job training to HEWs and other FLWs); (2) training and provision of supportive supervision that includes IYCF; and (3) review meetings to provide additional training or refreshers based on knowledge gaps identified during supervision.
Exploratory studies have consistently identified quality supervision as a positive contributor to CHWs' job motivation, retention, and satisfaction (5, 11, 12); however, if done poorly, supervision can also contribute to CHW dissatisfaction (10).
d) Allocate more attention to dealing with problems identified during supervision and monitoring visits.
The participants in this study identified positive supervision and improved feedback from referral hospitals as two achievable measures to improve both moral and quality of health care delivery.
Exploratory studies have consistently identified quality supervision as a positive contributor to community health workers' job motivation, retention, and satisfaction (11).
All 10 junior medical officers identified that supervision via videoconference validated their practice and management of patients, giving them increased confidence in future medical management.
However, nine studies identified poor supervision as a cause of stressful relationships between HWs and their supervisors within the workplace and as demotivating [ 55, 57, 59, 63- 68].
Peaks in the size reference lane were identified under supervision and the linear model lm y∼log(x)) fitted to produce an electrophoretic distance (y) to nucleotide size (x) calibration curve.
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