| Summary: | Philosophiae Doctor - PhD === National community health worker (CHW) programmes are to an increasing
extent being implemented in health systems globally, mirrored in South Africa in the ward-based
outreach team (WBOT) strategy. In many countries, including South Africa, a major challenge
impacting the performance and sustainability of scaled-up CHW programmes is ensuring
adequate support from and supervision by the local health system. Supervisory systems, where
they exist, are usually corrective and hierarchical in nature, and implementation remains poor.
In the South African context, the absence of any guidance on CHW supportive supervision has
led to varied practices across the country. Improved approaches to supportive supervision are
considered critical for CHW programme performance. However, there is relatively little
understanding of how this can be done sustainably at scale, and effective CHW supervisory
models remain elusive. Research to date has mostly positioned supervision as a technical
process rather than a set of relationships, with the former testing specific interventions rather
than developing holistic approaches attuned to local contexts.
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