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In a few contexts, other gaps were reported such as irregular supervision, no job descriptions and no feedback to CHWs following evaluations.
Poor training, staff vacancies, and irregular supervision have been long-standing issues in India's nutrition program, which may explain the insignificant effects in our study.
Insufficient and irregular supervision negatively affects motivation, and programme managers found it difficult to measure performance and keep mid-level managers and CHWs accountable in their programmes.
However, some weaknesses, such as irregular supervision, shortage of IMCI-related drugs and equipments, and an inefficient referral system, were also identified (19).
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According to this study, the effectiveness of the Rwanda CHW system was hampered by an irregular system of supervision and trainings.
Supervisory visits - The supervision was irregular and less educative.
There was irregular and inadequate support supervision, and health staff appraisals were occasional.
The higher prevalence of TB in rural areas was attributed to poor performance of anti-tuberculosis services in rural areas due to various reasons such as a lack of awareness of the disease and of available services, difficult terrain resulting in irregular drug supply and poor supervision by programme officials [ 28].
His style was particularly visible when Mr. Karzai demanded that all Western forces leave Wardak Province after Afghan civilians were abused by irregular Afghan forces operating under Western supervision.
The key challenges identified were an overwhelming workload, irregular trainings, and lack of sufficient supervision.
In addition to the above constraints, most HSAs are untrained (19% of the sample) and supervision is inadequate and irregular.
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