STRENGTHENING PRIMARY HEALTH CARE SYSTEMS TOWARDS DELIVERING HIGH-QUALITY HEALTH CARE SERVICES – IS THERE A ROLE FOR SUPPORTIVE SUPERVISION?
Abstract
Background: Health workers at the primary healthcare level in sub-Saharan Africa often work in
challenging conditions that influence their motivation, job satisfaction and performance. The
understanding that well-performing HWs are paramount to delivering high-quality healthcare
services, has moved attention to the implementation of strategies such as supervision. However, the
hierarchical and fault-finding approach to supervision provoked a paradigm shift towards supportive
supervision. So far, there have been little evidence to support the effectiveness of this strategy and
to guide implementation.
Objective: To describe and evaluate supportive supervision models and approaches implemented at
the primary health care level in sub-Saharan Africa, analyse the challenges of implementation and
explore the potential of supportive supervsion in improving health worker performance, quality of
healthcare and health outcomes.
Methodology: A systematic review of peer-reviewed articles was embarked upon using PubMed,
Google Scholar and Medline. Thematic analysis was conducted based on pre-defined themes
originating from key concepts within the conceptual framework.
Results: Nineteen papers were reviewed. The review highlighted that, supportive supervision can
improve motivation, productivity, competence, job satisfaction and clinical practices. Improvements
were noted in components of quality of healthcare and patient satisfaction. However, changes in
structural components of healthcare were minimal and no concrete evidence on the impact on
health outcomes. While there is some evidence on the different approaches adopted, the most
effective supportive supervision approach is uncertain.
Conclusion: Supportive supervision can be a sustainable strategy in sub-Saharan Africa if proper
organisation, right contextual approaches, and stakeholder/community participation are integrated
into implementation.