Table 6 Supervision methods

Monitoring of CHWs reports

Report checking, registration of quality assurance, or data validation by supervisors.

The supervisor gathered CHWs once per month, and each CHW would present their report to the group [35].

Observing CHWs day-to day activities

- Supervisors accompanied CHWs during household visits [17, 22, 29, 31, 47, 48]

- CHWs were gathered in the village [34]

- Remote supervision through digital communication or by phone [64]

- CHWs made routine visits to health facilities to work under trained professionals [11]

- Supervisors and CHWs would discuss obstacles and opportunities of their work.

- Site visits were also a method of leveraging CHWs capacities. This included face-to-face meetings to refresh the subjects given during pre-service training [17], or routine spot checks to assess CHWs performance to plan which would be used to plan future work [29, 48].

- CHWs in Bangladesh received a monthly check-in with the supervisors, through digital communication of at least once a month, and additional offline meetings if needed [64].

- A study using randomised controlled trials (RCT) in India reported that supervisors conducted the supervision activities remotely. An approximately five-minute call on a weekly basis discussed the feedback on CHWs target, work improvement, and technical problems faced by the CHWs. The reported outcomes included case activities and performance for duration in counselling by CHWs [38].

Supportive supervision

- Through this method, CHWs felt encouraged and valued [57, 71], and felt equal or at the same level as their supervisor [24].

- Supportive supervision was found to be meaningful during challenging and dynamic contexts, such as COVID-19 pandemic [64, 71].

- However, the supervision delivery method affected the supervision outcome. Trials in four countries showed a significant increase in CHWs motivation after supportive supervision through monthly group meetings [57].

- In a country where monthly group supervision was combined with biweekly peer supervision and self-assessment, CHWs showed significant improvement in their organisational commitment, work mindfulness, and confidence.

- The expected downsides of this supportive supervision method is the complexity of preparing the supervisors to perform well. This included specialised training of mental health support [71], dedicated time allocation [24], and prequalification as graduate- or postgraduate-degree holder [66].