A systematic review of supportive supervision as a strategy to improve primary healthcare services in Sub‐Saharan Africa

Bailey, Claire; Blake, Carolyn; Schriver, Michael; Cubaka, Vincent Kalumire; Thomas, Tisa; Hilber, Adriane Martin

doi:10.1016/j.ijgo.2015.10.004

Cited by 133 publications

(174 citation statements)

References 28 publications

Supporting

Mentioning

155

Contrasting

Unclassified

Order By: Relevance

“…In Uganda, the health care system has long been characterized by poor health worker distribution, inadequate skills sets and skill mix, insufficient drugs and basic supplies, poor infection-control practices and overall weakness in the management of service points [8,9]. These have contributed to the persisting high levels of maternal and newborn deaths, estimated at 438 per 100,000 live births and 27 per 1000 live births, respectively.…”

Section: Introductionmentioning

confidence: 99%

“…Supportive supervision is an avenue used to monitor the quality of healthcare delivered by health workers who have limited training. In this way, it enhances the quality of services provided at the health facilities [9]. However, this support is not always provided in many developing countries [9].…”

Section: Introductionmentioning

confidence: 99%

“…However, this support is not always provided in many developing countries [9]. Moreover, those that conduct support supervisions frequently lack technical and managerial skills and may have no authority to resolve service delivery problems [9]. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of support supervision on maternal and newborn health services and practices in Rural Eastern Uganda

Kisakye

Kananura

Ekirapa-Kiracho

et al. 2017

Global Health Action

View full text Add to dashboard Cite

Background: Support supervision is one of the strategies used to check the quality of services provided at health facilities. From 2013 to 2015, Makerere University School of Public Health strengthened support supervision in the district of Kibuku, Kamuli and Pallisa in Eastern Uganda to improve the quality of maternal and newborn services. Objective: This article assesses quality improvements in maternal and newborn care services and practices during this period. Methods: District management teams were trained for two days on how to conduct the supportive supervision. Teams were then allocated particular facilities, which they consistently visited every quarter. During each visit, teams scored the performance of each facility based on checklists; feedback and corrective actions were implemented. Support supervision focused on maternal health services, newborn care services, human resources, laboratory services, availability of Information, education and communication materials and infrastructure. Support supervision reports and checklists from a total of 28 health facilities, each with at least three support supervision visits, were analyzed for this study and 20 key-informant interviews conducted. Results: There was noticeable improvement in maternal and newborn services. For instance, across the first, second and third quarters, availability of parenteral oxytocin increased from 57% to 75% and then to 82%. Removal of retained products increased from 14% to 50% to 54%, respectively. There was perceived improvement in the use of standards and guidelines for emergency obstetric care and quality of care provided. Qualitatively, three themes were identified that promote the success of supportive supervision: changes in the support supervision style, changes in the adherence to clinical standards and guidelines, and multi-stakeholder engagement. Conclusion: Support supervision helped district health managers to identify and address maternal and newborn service-delivery gaps. However, issues beyond the jurisdiction of district health managers and facility managers may require additional interventions beyond supportive supervision.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of support supervision on maternal and newborn health services and practices in Rural Eastern Uganda

Kisakye

Kananura

Ekirapa-Kiracho

et al. 2017

Global Health Action

View full text Add to dashboard Cite

show abstract

“…External supervision often focuses on management and administration more than on problem solving and feedback [6,7]. Yet, health policies across Africa describe support for providers’ professional development as a component of external supervision [7,10–12], sometimes referred to as supportive supervision [8,13]. External supervisors may thus have a dual role that relates to: (1) managerial quality control of performance; and (2) formative support of providers.…”

Section: Introductionmentioning

confidence: 99%

“…The applicability of these instruments in management-centred, external supervision contexts has not been unexplored. Questionnaire-based outcome measures applied in studies of external, supportive supervision in Africa are commonly non-validated [8]. …”

Section: Introductionmentioning

confidence: 99%

Development and validation of the ExPRESS instrument for primary health care providers’ evaluation of external supervision

Schriver

Cubaka

Vedsted

et al. 2018

Global Health Action

Self Cite

View full text Add to dashboard Cite

Background: External supervision of primary health care facilities to monitor and improve services is common in low-income countries. Currently there are no tools to measure the quality of support in external supervision in these countries. Aim: To develop a provider-reported instrument to assess the support delivered through external supervision in Rwanda and other countries. Methods: “External supervision: Provider Evaluation of Supervisor Support” (ExPRESS) was developed in 18 steps, primarily in Rwanda. Content validity was optimised using systematic search for related instruments, interviews, translations, and relevance assessments by international supervision experts as well as local experts in Nigeria, Kenya, Uganda and Rwanda. Construct validity and reliability were examined in two separate field tests, the first using exploratory factor analysis and a test–retest design, the second for confirmatory factor analysis. Results: We included 16 items in section A (‘The most recent experience with an external supervisor’), and 13 items in section B (‘The overall experience with external supervisors’). Item-content validity index was acceptable. In field test I, test–retest had acceptable kappa values and exploratory factor analysis suggested relevant factors in sections A and B used for model hypotheses. In field test II, models were tested by confirmatory factor analysis fitting a 4-factor model for section A, and a 3-factor model for section B. Conclusions: ExPRESS is a promising tool for evaluation of the quality of support of primary health care providers in external supervision of primary health care facilities in resource-constrained settings. ExPRESS may be used as specific feedback to external supervisors to help identify and address gaps in the supervision they provide. Further studies should determine optimal interpretation of scores and the number of respondents needed per supervisor to obtain precise results, as well as test the functionality of section B.

show abstract

Examining the organizational factors that affect health workers' attendance: Findings from southwestern Uganda

Mukasa¹,

Bahar

Ssewamala

et al. 2019

Health Planning & Management

View full text Add to dashboard Cite

Summary Sub-Saharan Africa experiences human resources crisis in the health sector. Specifically, Uganda faces significant shortages in health care workforce at all levels. However, there is limited literature on factors contributing to health care workforce absenteeism. This study aims to explore reasons for absenteeism among health workers in rural Uganda. Data were collected using a demographic questionnaire and focus groups. Eight focus groups were conducted with participants (n = 27) selected from 39 selected health centers. Four main themes emerged as the reasons for absenteeism among health workers. These included personal/family related challenges, distance or transportation issues, income specifically additional sources of income, and poor support/supervision. Barriers to active engagement at work were also identified, including loss of motivation, concerns at home, patient level issues, and lack of equipment. Recommendations were also elicited from the participants. These findings are critical in formulating and developing interventions to address absenteeism and low performance among health workers.

show abstract

A systematic review of supportive supervision as a strategy to improve primary healthcare services in Sub‐Saharan Africa

Abstract: Results highlight the lack of sound evidence on the effects of supportive supervision owing to limitations in research design and the complexity of evaluating such interventions. The approaches required a high level of external inputs, which challenge the sustainability of such models.

Cited by 133 publications

References 28 publications

Effect of support supervision on maternal and newborn health services and practices in Rural Eastern Uganda

Effect of support supervision on maternal and newborn health services and practices in Rural Eastern Uganda

Development and validation of the ExPRESS instrument for primary health care providers’ evaluation of external supervision

Examining the organizational factors that affect health workers' attendance: Findings from southwestern Uganda

Contact Info

Product

Resources

About