Supervision of community health workers in Mozambique: a qualitative study of factors influencing motivation and programme implementation

Authors: Sozinho Daniel Ndima, Mohsin Sidat, Celso Give, Hermen Ormel, Maryse Catelijne Kok and Miriam Taegtmeyer

Numerous countries around the world have established community health programmes as a means to expanding access to health services among vulnerable populations, and these programmes are considered a vital component of reaching the health-related Millennium Development Goals. With the shift towards the sustainable development goals and emphasis within these on equitable universal health coverage, there is an increasing need to understand how best to implement community health worker (CHW) programmes. CHWs, in Mozambique called Agentes Polivalentes Elementares (APEs), are an important component of health service provision in rural communities in Mozambique. There is a scarcity of literature regarding APEs in Mozambique, despite the APE programme having been established over three decades ago and having a clear impact on population health. The initial APE programme (developed in 1978) faced challenges which resulted in the interruption of programme implementation in the mid-1990s. Primary concerns were that the APEs felt abandoned, due to almost non-existent supervision and a progressive decrease in support from the National Health Service, although many continued to receive drug and supply kits.