Systematic review of performance-enhancing health worker supervision approaches in low- and middle-income countries

Abstract

Background The strength of a health system—and ultimately the health of a population—depends to a large degree on health worker performance. However, insufficient support to build, manage and optimize human resources for health (HRH) in low- and middle-income countries (LMICs) results in inadequate health workforce performance, perpetuating health inequities and low-quality health services. Methods The USAID-funded Human Resources for Health in 2030 Program (HRH2030) conducted a systematic review of studies documenting supervision enhancements and approaches that improved health worker performance to highlight components associated with these interventions’ effectiveness. Structured by a conceptual framework to classify the inputs, processes, and results, the review assessed 57 supervision studies since 2010 in approximately 29 LMICs. Results Of the successful supervision approaches described in the 57 studies reviewed, 44 were externally funded pilots, which is a limitation. Thirty focused on community health worker (CHW) programs. Health worker supervision was informed by health system data for 38 approaches (67%) and 22 approaches used continuous quality improvement (QI) (39%). Many successful approaches integrated digital supervision technologies (e.g., SmartPhones, mHealth applications) to support existing data systems and complement other health system activities. Few studies were adapted, scaled, or sustained, limiting reports of cost-effectiveness or impact. Conclusion Building on results from the review, to increase health worker supervision effectiveness we recommend to: integrate evidence-based, QI tools and processes; integrate digital supervision data into supervision processes; increase use of health system information and performance data when planning supervision visits to prioritize lowest-performing areas; scale and replicate successful models across service delivery areas and geographies; expand and institutionalize supervision to reach, prepare, protect, and support frontline health workers, especially during health emergencies; transition and sustain supervision efforts with domestic human and financial resources, including communities, for holistic workforce support. In conclusion, effective health worker supervision is informed by health system data, uses continuous quality improvement (QI), and employs digital technologies integrated into other health system activities and existing data systems to enable a whole system approach. Effective supervision enhancements and innovations should be better integrated, scaled, and sustained within existing systems to improve access to quality health care.

Health services supervision in a protracted crisis: a qualitative study into supportive supervision practices in South Sudan

“…Nonetheless, scholars report that supportive supervision should be regular [ 50 , 52 , 60 ]. Studies have demonstrated that supportive supervision interventions can be effective where there are regular supervisory visits to health facilities to develop relationships, monitor performance, and improve problem-solving skills [ 59 – 61 ]. Therefore, sufficient time investment is needed to achieve maximum benefits from supportive supervision.…”

Improving the Quality of Maternity Care through the Introduction of Professional Midwives and Mentoring in Selected Sub-District Hospitals in Bangladesh: A Mixed Method Study Protocol

“…The introduction of professional midwives is linked to increased utilization of maternal health services and quality of care [ 14 , 15 ]. In addition, mentoring and supervision can improve health worker performance and provide enabling environments to strengthen health systems [ 16 , 17 ]. Deussom et al conducted a recent systematic review (2022) and indicated a direct impact of clinical mentoring or supervision on the improved performance of health workers [ 17 ].…”

“…In addition, mentoring and supervision can improve health worker performance and provide enabling environments to strengthen health systems [ 16 , 17 ]. Deussom et al conducted a recent systematic review (2022) and indicated a direct impact of clinical mentoring or supervision on the improved performance of health workers [ 17 ]. The research conducted in Rwanda, India, Nepal, Ethiopia, South Africa, and Uganda found that mentoring does improve quality.…”

County Health Leadership Practices and Readiness for Noncommunicable Disease Services in Kenya

“…County health leaders also supervise multidisciplinary therapeutic committees that oversight the use of medicines, health products and technologies [21]. At various intervals, county health leaders also conduct supportive supervision visits to health facilities focused on improving health service coverage and quality [22]. There is however, a paucity…”

“…County health leaders also supervise multidisciplinary therapeutic committees that oversight the use of medicines, health products and technologies [ 21 ]. At various intervals, county health leaders also conduct supportive supervision visits to health facilities focused on improving health service coverage and quality [ 22 ]. There is however, a paucity of literature on whether any relationship exists between such leadership practices and readiness for NCD services at implementation level, which is the focus of this study.…”