Impacts of Supervising Community Health Workers in South Sudan to Deliver Integrated Community Case Management Services for Newborns and Children

Improving and maintaining the clinical skills of frontline health workers over time is critical for strengthening health systems and providing adequate care to mothers, newborns, and children—supervision is widely recognized as a key to improving health worker performance. In Warrap State, South Sudan, a 13-month study was undertaken to describe and assess a supervision model for illiterate community health workers (CHWs). CHWs were trained, supervised, and studied to assess correct use of newborn and child health record forms; identification, classification, treatment and referral of disease. After the supervision period, 87% of CHWs were accredited as competent to deliver Integrated Community Case Management plus essential newborn care services (iCCM Plus), with 95% of registration forms completed; 7% of discrepancy between classification of illness and drug administration, and all drugs accounted for with complete stocks.  A total of 2,552 children under age five were seen by CHWs, with a mean of 196 child visits per month. The overall referral initiation rate to primary health care unit found was 73%, with 92% referral completion rate. Program results showed CHWs to be effective in improving coverage of key MNCH practices, assessing mothers and children, and initiating treatment for malaria and diarrhea. Results indicate that a supervision process to monitor, improve and maintain clinical skill performance by CHWs within a community case management strategy, is an important element of program design and implementation to obtain health outcomes, especially among community-based approaches where treatment with drugs is included and in fragile state context.