Background: Supportive supervision is a key determinant of service quality and provider performance, and is particularly pertinent to low-resources settings where supervisors are pivotal to the performance of health workers. To strengthen the human resource management (HRM) function at district and health facility level we implemented the Support, Train and Empower Managers (STEM) project to increase the capacity of managers to support and supervise their staff in Tanzania.Methods: This study used a mixed-methods design, utilising data from health facilities to assess changes in practice and employing focus group discussions to explore perceptions of supervisors 12 months following implementation of STEM in three regions of Tanzania. The present study focused on the perceptions of supervisors on the implementation of supportive HRM processes and how these influenced the supervision practice.

No abstract

BackgroundA systematic and structured approach to the support and supervision of health workers can strengthen the human resource management function at the district and health facility levels and may help address the current crisis in human resources for health in sub-Saharan Africa by improving health workers’ motivation and retention.MethodsA supportive supervision programme including (a) a workshop, (b) intensive training and (c) action learning sets was designed to improve human resource management in districts and health facilities in Tanzania. We conducted a randomised experimental design to evaluate the impact of the intervention. Data on the same measures were collected pre and post the intervention in order to identify any changes that occurred (between baseline and end of project) in the capacity of supervisors in intervention a + b and intervention a + b + c to support and supervise their staff. These were compared to supervisors in a control group in each of Tanga, Iringa and Tabora regions (n = 9). A quantitative survey of 95 and 108 supervisors and 196 and 187 health workers sampled at baseline and end-line, respectively, also contained open-ended responses which were analysed separately.ResultsSupervisors assessed their own competency levels pre- and post-intervention. End-line samples generally scored higher compared to the corresponding baseline in both intervention groups for competence activities. Significant differences between baseline and end-line were observed in the total scores on ‘maintaining high levels of performance’, ‘dealing with performance problems’, ‘counselling a troubled employee’ and ‘time management’ in intervention a + b. In contrast, for intervention a + b + c, a significant difference in distribution of scores was only found on ‘counselling a troubled employee’, although the end-line mean scores were higher than their corresponding baseline mean scores in all cases. Similar trends to those in the supervisors’ reports are seen in health workers data in terms of more efficient supervision processes, although the increases are not as marked.ConclusionA number of different indicators were measured to assess the impact of the supportive supervision intervention on the a + b and a + b + c intervention sites. The average frequency of supervision visits and the supervisors’ competency levels across the facilities increased in both intervention types. This would suggest that the intervention proved effective in raising awareness of the importance of supervision and this understanding led to action in the form of more supportive supervision.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-017-0225-0) contains supplementary material, which is available to authorized users.

Context: This article aims to highlight challenges and adaptations made by local health officials in Tanzania in working to contain and manage COVID-19. Methods: The study takes an inductive approach, drawing on the reported experiences of 40 officials at different levels of government across four purposefully selected regions in July 2020. Interviewees were asked about the guidance they received to contain COVID-19, the source of that guidance, their challenges and successes in implementing the guidance, and if and how they adapted the guidance to their particular setting. Findings: The interviews depict considerable challenges, including a lack of supplies and resources; enforcing physical distancing, contact tracing and surveillance; and dealing with fear and stigma. At the same time, they also provide evidence of innovation and adaptation among street-level bureaucrats. Respondents overwhelmingly praise the President, whose limited national response is seen as helpful to reduce fear and stigma. Conclusions: Other scholars have highlighted the potential dangers of street-level discretion if local officials may “make policy” in ways that contradict their agencies’ stated goals. In contrast, our study suggests benefits of autonomy at the street level—particularly in contexts where the central state is relatively weak and/or acting against the public interest.

Every state copes with the question of which level of government should bear responsibility for social services such as health care and education. Tanzania is no exception. The current government infrastructure of Tanzania is based on the principle of Decentralization by Devolution (DbyD) and can be seen as a reaction to previous structures based on centralized de-concentration. This article reviews the decentralization as designed in the DbyD policy and its application in planning decisions by assessing the involvement of local communities in decision making, based on a case study in two primary facilities. The conclusion is that even though policy states a strong decentralized government, in reality central preferences dominate the decision-making. Wishes expressed in local plans are ignored in the planning procedure. The article identifies the factors that contribute to this central influence and concludes with reviewing the value of decentralization policy in Tanzania and other developing countries.