Last week, I spent four days in the field visiting five different health facilities across the Central Region of Malawi. My organization was doing the first round of supervision since our new community health workers (CHWs) completed training two weeks ago, and it was interesting to see the fruits of the two week training. As I’m based in the monitoring and evaluation (M&E) section, my primary task was to assist in the evaluation of our six different tools that we ask CHWs to collect information on. This largely meant spending anywhere between five and 30 minutes looking through a few of the books and papers with colleagues, checking if all of the information written made sense, if all of the relevant questions were answered (such as: what is woman’s HIV status? Who, if anyone, has the woman disclosed to? How far along is the woman, or how old is her baby? Does she have other children, and know the status of those children?), if data was properly transferred from one book into a cumulative log, and if total numbers were added correctly to represent the number of women coming in each day. While it may seem simple enough to answer these questions, different sites revealed that it will take time for our CHWs to adjust.
Although no two days were alike, the most eventful day had the following schedule:
Regardless, the most exciting part was realizing that I've been able to witness a complete process since I’ve been here from my observation of the candidate interviews at a health clinic, to the training of new employees, to the observations of their first few weeks on the jobs. The challenges for these health workers – especially in regards to data collection and managing relationships at their respective hospitals – are many; but the rewards of seeing HIV positive women take ownership of the fate of their peers are equally as great.
Also posted at: http://scoutbanana.org/health-in-africa/from-the-field-supervising-new-community-health-workers/
Although no two days were alike, the most eventful day had the following schedule:
- 9:00 am: Started off early on a bumpy, dirt road to get to a health facility
10:45 – 10:50 am: Greeted the head person (often a nurse) of the health facility
10:50 – 11am: Met with the two to three CHWs at each site, and asking for their feedback on the experience thus far
11:00 – 12:30 pm: Completed the supervision checklist through surveying the CHWs
11:00 am – 12 pm: Critically evaluated the different data collection tools used (while other colleagues went through checklist), and providing feedbacks on areas for improvement as well as successes
12:00 – 12:30 pm: Finished discussion and providing overall comments
12:30 – 1:15 pm: Traveled back into town
1:15 – 2:00 pm: Ate a hearty lunch of maize-based nsima, rapeseed mixed with peanut flour, and chunks of beef in a tomato stew
2:00 – 3:00 pm: Traveled on a dirt road to the next health facility
3:00 – 3:10 pm: Arrived at new facility, met CHWs, and attempted to carve out a space to sit and discuss.
3:10 – 4:00 pm: Looked over data collection tools, while Manager went through checklist
4:00 – 4:15 pm: Provided overall feedback and comments
4:15 – 5:15 pm: Traveled back into town.
5:15 onward: Spent time looking for affordable but clean accommodation, ate dinner, and went to bed.
Regardless, the most exciting part was realizing that I've been able to witness a complete process since I’ve been here from my observation of the candidate interviews at a health clinic, to the training of new employees, to the observations of their first few weeks on the jobs. The challenges for these health workers – especially in regards to data collection and managing relationships at their respective hospitals – are many; but the rewards of seeing HIV positive women take ownership of the fate of their peers are equally as great.
Also posted at: http://scoutbanana.org/health-in-africa/from-the-field-supervising-new-community-health-workers/
Sounds eventful and busy! But it must be a great feeling to see the whole process in action! So happy for you! :)
ReplyDeleteJust had some questions for you regarding this post:
ReplyDelete"While it may seem simple enough to answer these questions, different sites revealed that it will take time for our CHWs to adjust."
- what are they adjusting to?
You mentioned you "Completed the supervision checklist through surveying the CHWs"
-- What ddi your supervision checklist involve?
You had also "Critically evaluated the different data collection tools used (while other colleagues went through checklist), and providing feedbacks on areas for improvement as well as successes"
--- what were the successes?
KB
Angela,
ReplyDeleteIt was an eventful week! Thanks so much for your continued enthusiasm.
KB,
Thanks so much for your questions. Let me answer them one by one:
1. What are [CHWs] adjusting to?
-Our CHWs have to get acclimated to their new job requirements, which include accurately and precisely answering a series of questions for each incoming client and consistently recording this information clearly in our various tools. I hesitate to just say that they need to “learn,” because I think that for some of them – particularly those who have schooled at the secondary level – some of what we request our skills that they have already developed or been exposed to.
2. What did your supervision checklist involve?
-Excellent question. We use a standard supervision checklist that contains several questions about CHWs’ understanding of the job responsibilities, relationship with staff at the health facility, monitoring and evaluation (which is the area that I focus on), logistics/basic requirements for the program (such as a space for the CHWs to meet with clients and securely store documents), and overall challenges at the health facility, among other things. I did not play a role in developing the supervision checklist but it has been used and adapted by staff over the past three years.
3. What were the successes?
- At one site, we only had very minor suggestions to give to the CHWs on improving their data entry. The CHW whose book I examined forgot to answer two questions and marked answers correctly but using a different symbol than we ask. This site was an overall success, and although we noted that their biggest challenge was a lack of clients due to a facility HIV test kit shortage, we left confident that as client flow increases, the books will continue to look good.
In general, although many CHWs demonstrated a lack of understanding of the data entry process, if I saw one entry that was almost entirely correct, I praised them for that and encouraged them to do all of the entries like that. Focusing on the positive is always great, so thanks for the reminder.
What is a fig tree a parasite of?
ReplyDeleteYou mentioned :
"--In particular, the language barrier was a major issue and so I spent much more time observing than participating (and having a colleague translate bits and pieces for me)."
How do you feel this affects your view of the ability of non native
speakers to work on pub. health initiatives in places where they communication is a language barrier?
I would like to think that that doesn't have to be the case...but your comment makes me re-think that stance and makes me understand better, the reason that NGOs sometimes insist on speaking the native language....But I don't want to be limited in public health only to places where I can speak the native language =(
kb
KB,
ReplyDeleteLet me start with the easy question. I learned (during my wildlife excursion – see “2 Fun Weekends in Malawi”) that a fig tree is a parasite in the sense that it attaches itself and feeds off of another tree. The consequence is that the original tree ceases to produce its own fruit and instead helps the fig tree. This is exactly the definition of a parasite: an organism that feeds off of a host organism, consequently harming the host.
As for your last question, this is a complicated issue...No, I don't think that a language barrier means that one cannot be effective in public health work. In fact, here in Malawi, major donors such as USAID have a significant number of non-native staff, most of whom don't speak the language. I have also had the opportunity to work in Kenya, Senegal, and Namibia and still felt that I was able to significantly contribute to HIV prevention, treatment, and care. And think of all of our professors at the Harvard School of Public Health and across the globe; how many are fluent in the languages of the different places that they have worked in?
That being said, there are definitely some roles that are better filled by people who can clearly and effectively communicate with one another. Being an effective CHW trainer among individuals with low literacy or education levels, for example, would require that you not only speak Chichewa or Timbuku (depending on the part of Malawi that you are in) but that you can teach and encourage others. This clearly wouldn’t be an ideal role for someone like you or me, without extensive language and cultural training.
The quote that you’ve selected just highlights one of the major frustrations that I’ve had since my time here: exclusion because of a language barrier. Whether on a site visit, or just during lunchtime talk or a car ride, my inability to comprehend and communicate in Chichewa is always present. If you can’t communicate with someone, it will affect his/her ability to trust you, which is crucial in being given job responsibilities (and particularly the type that I and my work partner have been given thus far).
I do believe my experience is unique as compared to some of my other friends working here due to other factors – my gender, my race, my nationality. Being a female in a patriarchal society is tough but when you add being dark-skinned and a non-native, you’ve given three additional reasons not to be easily accepted or integrated. And those don’t even take into account personality differences and typical office relations.
So, do I think you need to speak the language to work in public health? Absolutely not. Do I believe that you have to find your most effective role given your language skills and other factors such as your gender, race, nationality, or other publically open factors, and that it may not be the role you most want? Absolutely.
I am still working on this.