Supportive supervision to improve service delivery in low-income countries: is there a conceptual problem or a strategy problem?

Abstract

Supportive supervision is perceived as an intervention that strengthens the health system, enables health workers to offer quality services and improve performance. Unfortunately, numerous studies show that supervisory mechanisms in many low-income countries (LICs) are suboptimal. Further, the understanding of the concept and its implementation is still shrouded in misinterpretations and inconsistencies. This analysis contributes to a deeper understanding of the concept of supportive supervision and how reorganisation of the approach can contribute to improved performance. The effectiveness of supportive supervision is mixed, with some studies noting that evidence on its role, especially in LICs is inconclusive. Quality of care is a core component of universal health coverage which, accentuates the need for supportive supervision. In the context of LICs, it is imperative for supportive supervision to be implemented as an on-going approach. Factors that affect supportive supervision encompass cultural, social, organizational and context dimensions but the capacity of majority of LIC to address these is limited. To this end, we underscore the need to review the supportive supervision approach to improve its effectiveness, and ensure that facility-based supervision embodies as many of the envisioned qualities as possible. We thus make a case for a stronger focus on internal supportive supervision where internal refers to health facility/unit/ward level. Inherent in the approach is what we refer to as ‘supervisee initiated supportive supervision’. The success of this approach must be anchored on a strong system for monitoring, data and information management at the health facility level.

Regulatory inspection of registered private drug shops in East-Central Uganda—what it is versus what it should be: a qualitative study

“…It is therefore not surprising that inspectors compensate for this shortage of funds by soliciting illicit money in the form of bribes. These results agree with similar studies dealing with regulation of the private sector which found that regulation by actors may be hindered by organizational challenges which may not be limited to lack of motivation as a result of inadequate incentives [3,48]. There is a need to identify recurrent funding, especially in low-income countries if inspection especially of retail drug shops is to be sustainable.…”

Baseline Assessment of Primary Healthcare Delivery Through Subcenters of Northern India

“…Originally, the examination comprises several "stations" in which examinees are expected to perform several clinical tasks within a specified period against specific predetermined criteria essential to demonstrate adequate competence for that particular clinical skill. Moreover, the OSCE evaluates areas that are pertinent to the optimal performance of healthcare providers, such as their ability to record/interpret data, problemsolving, teaching, communication, and handling unpredictable patient behavior, which is otherwise impossible in the traditional clinical examination [15].…”

‘I know those people will be approachable and not mistreat us’: a qualitative study of inspectors and private drug sellers on peer supervision in rural Uganda

“…However, Bernard's discrimination model does not elaborate in detail the supervision relationship which makes it hard to compare with results of this study. There is growing support for the need to improve supervisor-supervisee relationships because this improves internal support supervision quality rather than supervision frequency which is emphasized by many government agencies involved in supervision at unit level like drug shops in low income countries [32,33]. As far as rural drug sellers are concerned, this can best be achieved when the supervision relationship between the supervisor and drug seller is cordial.…”