How to create more supportive supervision for primary healthcare: lessons from Ngamiland district of Botswana: co-operative inquiry group

Abstract

BackgroundSupportive supervision is a way to foster performance, productivity, motivation, and retention of health workforce. Nevertheless there is a dearth of evidence of the impact and acceptability of supportive supervision in low- and middle-income countries. This article describes a participatory process of transforming the supervisory practice of district health managers to create a supportive environment for primary healthcare workers.ObjectiveThe objective of the study was to explore how district health managers can change their practice to create a more supportive environment for primary healthcare providers.DesignA facilitated co-operative inquiry group (CIG) was formed with Ngamiland health district managers. CIG belongs to the participatory action research paradigm and is characterised by a cyclic process of observation, reflection, planning, and action. The CIG went through three cycles between March 2013 and March 2014.ResultsTwelve district health managers participated in the inquiry group. The major insights and learning that emerged from the inquiry process included inadequate supervisory practice, perceptions of healthcare workers’ experiences, change in the managers’ supervision paradigm, recognition of the supervisors’ inadequate supervisory skills, and barriers to supportive supervision. Finally, the group developed a 10-point consensus on what they had learnt regarding supportive supervision.ConclusionNgamiland health district managers have come to appreciate the value of supportive supervision and changed their management style to be more supportive of their subordinates. They also developed a consensus on supportive supervision that could be adapted for use nationally. Supportive supervision should be prioritised at all levels of the health system, and it should be adequately resourced.

Reflections on family medicine and primary healthcare in sub-Saharan Africa

“…Primary care providers typically have a limited range of resources, medications and clinical skills and work in poorly maintained infrastructure that is often rural or remote. In addition, governance systems are weak with a lack of supportive supervision and managerial leadership 1 16 18. Not surprisingly, primary care providers may feel unsupported, demoralised or suffer from burnout.…”

‘I know those people will be approachable and not mistreat us’: a qualitative study of inspectors and private drug sellers on peer supervision in rural Uganda

“…shows that when supervision is structured, the process offers an opportunity for feedback, selfassessment, and peer assessment [36,37]. This can only happen when there are clear terms of engagement handed to supervisors by the organisation responsible for supervision as well as a clear de nition of who does supervision, how and when it occurs [38,39]. From our study, there was no structure responsible for supervision of drug shops other than relegating the supervision function to the duly licensed drug sellers.…”

The Contribution of Family Medicine and Family Medicine Leaders to Primary Health Care Development in Americas - from Alma-Ata to Astana and beyond

“…The role of physicians has been evolving in response to an emphasis on team-based care to reduce dependency on workforce shortages 21 . Nonetheless, several teambased approaches have emerged in low-resource settings in other parts of the world as potential strategies to training non-clinical competencies of primary care physicians, including supportive supervision and collaborative styles of leadership [22][23][24][25] . Moreover, investing in leadership equips physicians to be champions for the next generation of physician leaders in addition to advocating for PHC reform at higher spheres of influence.…”