In Niger, community health workers (RComs) are central to delivering primary health care. For years, however, supervision systems were fragmented, tools were inconsistent, and data was underused leading to ineffective decision making for PHC planning and execution. To address these gaps, the Building Integrated Readiness for Community Health (BIRCH) project, funded by the Global Fund and implemented with the Ministry of Health, is introducing unified, digitized, and quality-focused approaches to supervision.
Key Steps in the Journey
- Digitized supervision tools: For the first time, supervision checklists were redesigned, standardized, and digitized across all levels, from central to community. They now include scoring systems, action-planning templates, and client feedback forms.
- Field pre-test: A two-day mission in Kollo district validated the tools, prompting adjustments to improve usability and reliability.
- Quality Improvement (QI) framework: A comprehensive framework now guides governance, capacity building, data use, and community engagement.
- Cascade training: Supervisors and CSI managers in Diffa and Tahoua completed intensive training. According to training records, post-test scores rose by up to 20 percentage points.
Transformation in Action
A CSI supervisor in Tahoua shared that: “Before, supervision felt like an inspection. Now, it feels like problem-solving.” In Diffa, where insecurity limits mobility, RComs now meet in peer-learning sessions at health centres. These gatherings strengthen performance and solidarity among health workers working in fragile environments.
The BIRCH experience shows that quality is not a one-time event but a continuous practice. By integrating improvement into routine supervision, oversight is shifting from punitive checks to supportive learning. Dashboards and real-time data now enable supervisors to spot trends, address stockouts, and adjust case-management protocols quickly.
Challenges remain, including drug shortages and weaknesses in data systems. In response, BIRCH promotes flexibility—such as adaptive supervision in high-risk areas, rotating one-on-one sessions, and targeted mentoring where gaps persist.
Progress in Niger has been driven by strong partnership between field teams, Ministry of Health counterparts, and technical experts at Solina headquarters. Contributions, ranging from tool design and training support to troubleshooting field issues, have complemented local leadership and ensured alignment with national goals.
This collaborative model underscores Solina’s approach: evidence-based, locally adapted, and globally supported.
At the core of this transformation are CSI quality assurance leads. Trained to guide teams in root-cause analysis, SMART action planning, and continuous learning cycles, they are now enabling their peers to make quality improvement a shared, locally owned practice.
Looking Ahead
In the coming months, BIRCH will extend supportive supervision to 132 CSIs in Diffa and Tahoua. Planned activities include monthly Regional Coordination Committee meetings, joint supervision visits, and broader use of digital dashboards.
The BIRCH project demonstrates that when tools, training, and trust converge, community health systems can move from fragile to resilient, helping to ensure that communities across Niger receive the care they need.
