The Role of Digital Tools in Supportive Supervision of Community Health Workers in Liberia

Abstract

A joint report published by the WHO and the World Bank estimates that over half of the world's population lacks access to complete coverage of essential health services due to multiple factors within the health systems and external factors outside the health system (WHO & World Bank, 2017). One factor contributing to inadequate health services coverage is the shortage and inequitable distribution of skilled health workers (Liu et al., 2017a). CHWs are a cadre of the health workforce that can fill the health workforce deficit (WHO, 2008a).

The doctoral project explored the role of the digital tools that LMH has developed and how effective they are in enhancing supportive supervision of community health workers in remote areas in Liberia. It sought to understand and explain the relationship between CHWs and their supervisors and how well the digital tools can support that relationship. Furthermore, it explored how digital tools have been leveraged for supervision, and their connection to the broader health system, using the system thinking framework (Arnold & Wade, 2015).

The project used a qualitative approach for data collection and analysis. The research began with a systematic literature review. This was followed by focus group discussions and semi-structured interviews to elicit information from relevant stakeholders on the role of technology in supportive supervision, supervision structure for CHAs, community health, and engagement strategies/approaches to strengthen practices at the community level.

The findings showed the promise of how digital tools can be used to monitor attendance via GPS, minimize treatment and reporting errors, and complement on-site coaching done by supervisors. While the benefits of mobile technology deployments continue to show promise, there is a need to be aware of everyday challenges faced with the introduction of the technology. Challenges such as digital literacy, malfunctioning of phones, damage to phones, and inadequate power supply to properly charge the phones all affect how effective the tool is during and after supervision. The findings also support that digital tool can complement in-person training and serve as a valuable resource for CHAs and their supervisors on and off the field when in an enabling environment.