Historically, PIH’s CHWs have been directly supervised by clinical staff, usually a doctor or nurse involved in the care of HIV or TB patients. As our programs have grown, we have increasingly recognized a need for more formal supervision structures that take advantage of the experience and skills of more senior CHWs. Recently, we have introduced the role of Accompagnateur Leader at several of the program sites.

CHW leaders

Most often, the leader is an existing CHW who has been chosen based on the high quality of his/her work, leadership qualities and standing in the community. The length of time the CHW has been working as an accompagnateur and his/her level of education are also factors.

The number of CHWs supervised by each CHW leader varies. In the PIH program in Rwanda, a CHW leader supervises between 15 and 25 CHWs (Accompagnateur leader duties and weekly report), while in the PIH program in Haiti a CHW leader may oversee up to 50 CHWs.

Roles and responsibilities

The primary responsibility of the CHW leader is to ensure that the CHWs are visiting their patients daily, administering medications correctly, and vigilantly monitoring patient health. The leader also helps the clinical team by answering patients’ questions, joining the team on patient visits, and identifying problems between CHWs and patients. See examples of supervision at Zanmi Lasante, Haiti and at Inshuti Mu Buzima, Rwanda.

Another point of supervision is at the pharmacy, which CHWs visit regularly to pick up medications for their patients. Pharmacy logs and interactions with the pharmacist are important points of supervision.

The CHW leader and other members of the health center identify problems between CHWs and patients through unannounced visits to patients’ homes. When a conflict does arise, the CHW is called to the health center to discuss the situation.

CHW leaders meet regularly with health center staff to exchange information and discuss common issues. CHWs meet monthly with health center staff for ongoing training and to discuss any problems or concerns.