Post authored by Beatrice Wasunna, Senior Researcher. The figure above shows Muso's 360° Supervision system to actively and regularly mentor Community Health Workers for improved performance.
Our research and model-building partner Muso has achieved some of the lowest child mortality rates in sub-Saharan Africa, and we’re excited to share the results of a study that Muso and the Medic team have been working on since 2013. There’s no secret to Muso’s approach: they invest in proactive search for people who need care, they equip community health workers to treat people at the doorstep, and they support rapid-access clinics for when referrals are necessary. You can read more about this model of care, which they call Proactive Community Case Management or ProCCM, in the British Medical Journal. None of this would work without integrated efforts to strengthen the health system as a whole, and one of the key ways they strengthen the health system is through great supervision.
Muso has implemented a four-pronged approach called 360º supervision (Figure 1). This model provides dedicated mentorship and supportive supervision to CHWs tailored to each CHW’s particular strengths and challenges. By equipping CHWs with mobile applications, their performance can be automatically recorded and displayed on program dashboards and a supervisor app. These dashboards were also designed to be easy to print out on paper. Medic Mobile worked with Muso to design a CHW Dashboard that provides precision feedback on the quantity, speed, and quality of care that each CHW provides. A key theme of our human-centered approach was the idea of using data to improve face-to-face supervision, rather than using analytics to replace supervisors.
To isolate the effect of the personalized performance dashboard used as a supervision tool, Muso, Medic, and the Malian Ministry of Health MoH undertook a randomized controlled trial (RCT) involving 148 CHWs conducting proactive case-finding home visits in Yirimadio, Mali. Of these 148 CHWS, 73 were randomly allocated to receive individual monthly supervision with CHW performance dashboard and an additional 75 received individual monthly supervision without the CHW performance dashboard.
CHW Performance Dashboard, English translation
The results of this RCT highlights a range of key findings. These include:
Pre-and post-intervention comparisons of the number of CHW homes visits, timeliness and quality of CHW care showed improvements in all three outcomes over the study period.
A 17% point increase was observed in children <5 years of age treated without protocol errors (quality) in the post-intervention (67%) when compared to the pre-intervention period (50%).
The quantity (544 vs. 504), timeliness (87% vs. 83%) and quality (71 vs. 63%) of CHWS in the intervention arm was better when compared to the control group.
When the analysis was restricted to the treatment group (CHWs who received individual monthly supervision with CHW Performance Dashboard) there was a significant increase in the average number of CHW home visits per month, by almost 40 visits (95% CI=3.56-76.3), without compromising the quality or timeliness of care.
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.
This study is just one of the many collaborations we’ve had underway as part of Medic Mobile’s research efforts. Medic Mobile’s COO Jacqueline Edwards, Impact Director Amanda Yembrick, and Research Lead Isaac Holeman were co-authors on the paper. We remain committed to continued partnership with Muso in designing and building innovations that advance Universal Health Coverage and help replicate the ProCCM model of care around the world.
To read the full publication click here
Figure 1: Muso Supervision Model