Action is urgently needed. Our results suggest that to improve health care delivery, interventions should target both the health system and the community level.
Managers should monitor supervision, understand the evolving influences on supervision, and use their resources and authority to both promote supervision and remove impediments to supervision. Support from leaders can be crucial, thus donors and politicians should help make supervision a true priority. As with front-line clinicians, supervisors are health workers who need support. We emphasize the importance of research to identify effective and affordable strategies for improving supervision frequency and quality. (ClinicalTrials.gov number NCT00510679).
Many factors may influence health worker performance, and factors such as pre-service training may influence performance in unexpected ways. Identifying different errors and analysing them separately can help reveal potential causes that may be masked by combining errors into a single category.
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