Managerial supervision to improve primary health care in low- and middle-income countries

Abstract

It is uncertain whether supervision has a substantive, positive effect on the quality of primary health care in low- and middle-income countries. The long term effectiveness of supervision is unknown.

Health Care Systems in Low- and Middle-Income Countries

“…21 Financial incentives represent just one means of improving levels of health care utilization and the quality of services, but virtually no studies in low-and middle-income countries have compared the use of financial incentives with alternative ways of achieving these outcomes, 16 such as nonfinancial approaches to changing professional behavior. 22,23 This lack of information on alternative approaches makes it difficult to develop clear policy recommendations. …”

Development and validation of the ExPRESS instrument for primary health care providers’ evaluation of external supervision

“…Such an instrument should assess the construct ‘Perceived quality of supportive aspects within external supervision of primary health care providers’ . It reflects a view of the provider as a direct beneficiary of external supervision despite its managerial and evaluative purposes [6,7]. …”

“…supervision delivered by supervisors from outside the facility) of primary health care facilities appears to be common practice [6–9]. External supervision often focuses on management and administration more than on problem solving and feedback [6,7].…”

“…supervision delivered by supervisors from outside the facility) of primary health care facilities appears to be common practice [6–9]. External supervision often focuses on management and administration more than on problem solving and feedback [6,7]. Yet, health policies across Africa describe support for providers’ professional development as a component of external supervision [7,10–12], sometimes referred to as supportive supervision [8,13].…”

“…The external supportive supervision model [6–9,13] is described as unique to developing countries [15]. Numerous instruments have been developed in high-income settings to evaluate the quality of provider-centred supervision [16,17] and training [18] practices.…”