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Supervision of community peer counsellors for infant feeding in South Africa: an exploratory qualitative study
Health Systems Research Unit, Medical Research Council, South Africa.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell kvinno- & mödrahälsovård/Essén)
School of Public Health, University of the Western Cape, South Africa.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell kvinno- & mödrahälsovård/Essén)
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2010 (English)In: Human Resources for Health, ISSN 1478-4491, E-ISSN 1478-4491, Vol. 8, 6- p.Article in journal (Refereed) Published
Abstract [en]

Background: Recent years have seen a re-emergence of community health worker (CHW) interventions, especially in relation to HIV care, and in increasing coverage of child health interventions. Such programmes can be particularly appealing in the face of human resource shortages and fragmented health systems. However, do we know enough about how these interventions function in order to support the investment? While research based on strong quantitative study designs such as randomised controlled trials increasingly document their impact, there has been less empirical analysis of the internal mechanisms through which CHW interventions succeed or fail. Qualitative process evaluations can help fill this gap. Methods: This qualitative paper reports on the experience of three CHW supervisors who were responsible for supporting infant feeding peer counsellors. The intervention took place in three diverse settings in South Africa. Each setting employed one CHW supervisor, each of whom was individually interviewed for this study. The study forms part of the process evaluation of a large-scale randomized controlled trial of infant feeding peer counselling support. Results: Our findings highlight the complexities of supervising and supporting CHWs. In order to facilitate effective infant feeding peer counselling, supervisors in this study had to move beyond mere technical management of the intervention to broader people management. While their capacity to achieve this was based on their own prior experience, it was enhanced through being supported themselves. In turn, resource limitations and concerns over safety and being in a rural setting were raised as some of the challenges to supervision. Adding to the complexity was the issue of HIV. Supervisors not only had to support CHWs in their attempts to offer peer counselling to mothers who were potentially HIV positive, but they also had to deal with supporting HIV-positive peer counsellors. Conclusions: This study highlights the need to pay attention to the experiences of supervisors so as to better understand the components of supervision in the field. Such understanding can enhance future policy making, planning and implementation of peer community health worker programmes.

Place, publisher, year, edition, pages
2010. Vol. 8, 6- p.
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:uu:diva-133194DOI: 10.1186/1478-4491-8-6ISI: 000277618500001OAI: oai:DiVA.org:uu-133194DiVA: diva2:360320
Available from: 2010-11-02 Created: 2010-11-02 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Promotion of Exclusive Infant Feeding in South Africa: Community-Based Peer Counselling in high HIV Prevalent Area
Open this publication in new window or tab >>Promotion of Exclusive Infant Feeding in South Africa: Community-Based Peer Counselling in high HIV Prevalent Area
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Despite global efforts, exclusive breastfeeding is rarely practiced in South Africa where infants are at risk of diarrheal infections, malnutrition and HIV transmission. The present study was conceptualized within the context of a multi-country, cluster randomized community-based behavioural intervention known as PROMISE-EBF in South Africa, Burkina Faso, Zambia and Uganda (www.clinicaltrials.gov, no: NCT00397150). The aim of this thesis was to identify and describe contextual factors that are important for the effectiveness of community-based peer counselling with a special focus on the promotion of exclusive breast and formula feeding. This thesis identifies the paradoxes and discrepancies embedded in the notion of community-based “peer” counselling approach, especially in the South African context of poverty, HIV and social distrust. Peer counselling, while perceived useful, was associated with social distrust which might have resulted in reduced effectiveness of the intervention. The thesis further illustrates that, while there is strong support for breast feeding, there was a general openness for early introduction of commercial foods and liquids. Mothers’ perceptions on infant feeding and peer counselling varied substantially according to HIV-status and geographical area. Nevertheless, the infant feeding peer counselling approach neither modified the mothers’ perceptions on feeding nor its associated barriers. Thus, several important barriers to exclusive breastfeeding including the risk for HIV stigmatization still remain. The results of this thesis highlight the need to rethink current approaches to the promotion of exclusive breastfeeding. It further draws attention to the gap between theoretical assumptions inherent in health interventions and the actual dynamic processes and realties of women in low-income high HIV settings.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 72 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 619
Keyword
Promotion, Exclusive Breastfeeding, Formula Feeding, Peer Counselling, HIV, South Africa
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:uu:diva-133199 (URN)978-91-554-7939-8 (ISBN)
Public defence
2010-12-15, Universitetshuset, Sal IX, Biskopsgatan 3, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2010-11-24 Created: 2010-11-02 Last updated: 2011-01-13Bibliographically approved

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Nor, BarniEkström, Eva-CharlotteDoherty, Tanya

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