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.