The impact of a human resource management intervention on the capacity of supervisors to support and supervise their staff at health facility level

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.

Challenges in day-to-day midwifery practice; a qualitative study from a regional referral hospital in Dar es Salaam, Tanzania

“…The feeling of demoralization and lack of motivation is in line with findings from other studies conducted in the region [15–17]. Positive support from supervisors have been demonstrated to be of importance for the quality of services that health workers are able to deliver [18]. In the World Health report on improving performance in healthcare, the WHO stress that supportive supervision can contribute to improved performance of health workers [18,19].…”

“…Positive support from supervisors have been demonstrated to be of importance for the quality of services that health workers are able to deliver [18]. In the World Health report on improving performance in healthcare, the WHO stress that supportive supervision can contribute to improved performance of health workers [18,19]. In situations where employees experience lack of motivation, consequences are lack of courtesy to patients, poor process quality and failure to treat patients at an appropriate time [20].…”

“…The health outcomes of patients are therefore critically dependent on the nurses’ motivation [21]. Changing the management strategy, or providing supportive management training for supervisors, are documented measures that can be taken to increase the level of motivation in the workplace [16,18]. Another important factor to improve performance is adequate salaries [21].…”

Real‐Time Warning and Risk Assessment of Tailings Dam Disaster Status Based on Dynamic Hierarchy‐Grey Relation Analysis

“…Equations (4) and (5) are used to obtain the weights of the two matrices. The maximum eigenvalues are obtained using (7) and verified one at a time using (8), indicating that they are acceptable judgment matrices and satisfactory results. This proves that this method is highly efficient.…”

“…Furthermore, given that humans sometimes intervene in warning systems and that supervision errors can sometimes occur, avoiding accidents is difficult on a fundamental level [5]. In addition, improvements in management systems and supervision have been found to have been needed in investigations of accidents [6][7][8]. This is why the role of enterprise leader is a very important position; their management ability determines how the enterprise develops.…”