Training And Supervision Did Not Meaningfully Improve Quality Of Care For Pregnant Women Or Sick Children In Sub-Saharan Africa

Abstract

In-service training courses and supportive supervision of health workers are among the most common interventions to improve the quality of health care in low- and middle-income countries. Despite extensive investment from donors, evaluations of the long-term effect of these two interventions are scarce. We used nationally representative surveys of health systems in seven countries in sub-Saharan Africa to examine the association of in-service training and supervision with provider quality in antenatal and sick child care. The results of our analysis showed that observed quality of care was poor, with fewer than half of evidence-based actions completed by health workers, on average. In-service training and supervision were associated with quality of sick child care; they were associated with quality of antenatal care only when provided jointly. All associations were modest-at most, improvements related to interventions were equivalent to 2 additional provider actions out of the 18-40 actions expected per visit. In-service training and supportive supervision as delivered were not sufficient to meaningfully improve the quality of care in these countries. Greater attention to the quality of health professional education and national health system performance will be required to provide the standard of health care that patients deserve.

Integration of the Opportunity‐Ability‐Motivation behavior change framework into a coaching‐based WHO Safe Childbirth Checklist program in India

“…The use of OAMS‐informed coaching was associated with an increase in adherence to EBPs . By contrast, supervision—as currently delivered in some settings—is not always associated with higher quality of care . The present findings support the potential for coaching informed by the OAMS framework in conjunction with the WHO SCC to inspire behavior change in front‐line providers and encourage them to use the skills they have gained through pre‐ and in‐service training.…”

Clinical performance among recent graduates in nine low‐ and middle‐income countries

“…When governments do seek to improve health worker performance, efforts focus on in-service training for clinicians already in practice. Studies have found that such training has only a modest impact on quality and cannot by itself close the large quality deficits observed [8,9].…”

Content of Care in 15,000 Sick Child Consultations in Nine Lower‐Income Countries

“…To support uptake of protocols, global funders and national governments invested heavily in in‐service training courses, but this too has had limited effect on quality of care (Leslie et al. ).…”

“…However, despite the existence of protocols, quality of clinical care for sick children remains weak in many low-income countries (Gera et al 2016). To support uptake of protocols, global funders and national governments invested heavily in in-service training courses, but this too has had limited effect on quality of care (Leslie et al 2016).…”