motivating and empowering APEs represents a potential additional supportive mechanism but cannot address all of the identified issues without linkage to the formal health system and supervision structures as well as efforts to create supervision structures that are supportive and problem-solving rather than managerial and faultfinding. Tailored solutions would be required, as each district/community has its specific characteristics, and challenges are not always similar in all parts of the country. Furthermore, when supervision does take place, feedback and thus learning opportunities should be the focus so that both supervisor and APE can positively contribute to enhanced community health.