1. Improving Community Health Worker performance by using a personalised feedback dashboard for supervision: a randomised controlled trial
- Author
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Boureima Plea, Kassoum Kayentao, Alexander Keita, Ari Johnson, Isaac Holeman, Salif Samaké, Jenny Liu, Caroline Whidden, Samba Diarra, Youssouf Keita, Amanda Yembrick, Djoumé Diakité, Scott Lee, Mama Coumaré, and Jacqueline Edwards
- Subjects
Program evaluation ,medicine.medical_specialty ,Clinical Trials and Supportive Activities ,030231 tropical medicine ,Dashboard (business) ,MEDLINE ,Mali ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Clinical Research ,law ,Humans ,Medicine ,030212 general & internal medicine ,Symptom onset ,Pediatric ,Community Health Workers ,Under-five ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Articles ,Health Services ,Quality Improvement ,Family medicine ,Community health ,Public Health and Health Services ,Employee Performance Appraisal ,Catchment area ,business ,Program Evaluation - Abstract
Background Countries across sub-Saharan Africa are scaling up Community Health Worker (CHW) programmes, yet there remains little high-quality research assessing strategies for CHW supervision and performance improvement. This randomised controlled trial aimed to determine the effect of a personalised performance dashboard used as a supervision tool on the quantity, speed, and quality of CHW care. Methods We conducted a randomised controlled trial in a large health catchment area in peri-urban Mali. One hundred forty-eight CHWs conducting proactive case-finding home visits were randomly allocated to receive individual monthly supervision with or without the CHW Performance Dashboard from January to June 2016. Randomisation was stratified by CHW supervisor, level of CHW experience, and CHW baseline performance for monthly quantity of care (number of household visits). With regression analysis, we used a difference-in-difference model to estimate the effect of the intervention on monthly quantity, timeliness (percentage of children under five treated within 24 hours of symptom onset), and quality (percentage of children under five treated without protocol error) of care over a six-month post-intervention period relative to a three-month pre-intervention period. Results Use of the Dashboard during monthly supervision significantly increased the mean number of home visits by 39.94 visits per month (95% CI = 3.56-76.3; P = 0.031). Estimated effects on secondary outcomes of timeliness and quality were positive but not statistically significant. Across both study arms, CHW quantity, timeliness, and quality of care significantly improved over the study period, during which time all CHWs received dedicated monthly supervision, although effects plateaued over time. Conclusions Our findings suggest that dedicated monthly supervision and personalised feedback using performance dashboards can increase CHW productivity. Further operational research is needed to understand how to sustain the performance improvements over time. Trial registration ClinicalTrials.gov (NCT03684551).
- Published
- 2018
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