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Introduction: Supportive supervision is crucial for enhancing healthcare quality by improving internal relationships, resolving issues, and optimizing resources. Recent evidence from India shows it enhances immunization coverage and strengthens the local health system. Objective: To evaluate routine immunization services in terms of input and process through supportive supervision and compare service delivery between two quarters.Method: This cross-sectional study, conducted between July 2021 and February 2022, assessed the delivery of routine immunization services by frontline workers (FLWs) within Village Health Sanitation and Nutrition Day (VHSND) sessions in Assam. Five districts were selected to represent each zone of the state. Micro-plans for VHSND sessions were reviewed to visit 25-30 sessions per district based on operational feasibility. Data collected by district coordinators using a standardized checklist assessed logistics and service delivery. Statistical analysis included quarterly group comparisons using Chi-square and Fisher's exact tests (p < 0.05 significance). The findings were shared in district-level review meetings to facilitate corrective actions by all stakeholders.Results: A total of 140 VHSND sites were assessed. Paracetamol was available at 123 sites (87.9%), and updated due list was present at 120 sites (85.7%). However, Vitamin A was available at 26 sites (18.6%), ORS and Zinc were at 11 sites (7.9%) and 14 sites (10.0%), respectively. The presence of Anganwadi Workers (AWWs) at VHSND sites increased significantly from 61.2% in the first quarter to 76.7% in the second quarter (p = 0.04). Adherence to micro plans among Accredited Social Health Activists (ASHAs) was high, rising from 97.0% in the first quarter to 100% in the second quarter. Record-keeping also improved, with headcount survey documentation increasing from 83.6% in the first quarter to 95.9% in the second quarter (p = 0.01). Conclusion: The study highlighted improvements in logistics, documentation, and ASHA performance under supportive supervision. Continued focus on essential supplies and educational materials, alongside effective supervision and further research, is crucial for enhancing child health outcomes.

Doctoral student creativity is critical for technological innovation and knowledge production. Based on the extended scientific and technical human capital (STHC) theory, a moderated mediation model was constructed to explore how supportive supervision is associated with doctoral student creativity through the simultaneous mediating effects of academic buoyancy and network ties and the moderating role of family support. A sample of 637 doctoral students from China participated in this study. In particular, the findings suggest that supportive supervision is positively related to doctoral student creativity through the simultaneous indirect effects of both academic buoyancy and network ties, while the mediating effect of academic buoyancy is stronger than that of network ties. Moreover, the significant moderation effect of family support on the relationship between network ties, academic buoyancy, and creativity reveals that students with greater family support are more likely to benefit from the academic buoyancy while leading the mediating effect of network ties to be dispensable, implying that family support can be a double-edged sword. The findings provide implications for supervision that can improve doctoral student creativity by attaching importance to social capital and psychological capital while considering the nuanced influence that family support may exert. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare workers are tasked with ensuring that patient needs are well taken care of and managed as it relates to specific health challenges. A significant way of ensuring the efficacy of treatment is through human interaction with a focus on caring behavior. There are few studies examining factors within the health sector and their impact on the caring behavior of healthcare workers. Accordingly, this study examined the mediating role of job satisfaction in the relationship between supportive supervision and caring behavior among healthcare workers in the public sector. Methods: A quantitative method of collecting data via the cross-sectional design was adopted. Simple and convenient sampling techniques were used in the study. Simple random sampling was adopted for selecting the public hospitals while convenience sampling was used for selecting the participating healthcare workers. Three standardized self-report instruments with good psychometric properties were used for collecting the data. A regression-based analysis (complemented with PROCESS Macro v4.2) was used for testing the hypotheses through the IBM SPSS v25. Results: The participants consisted of 204 healthcare workers currently working in publicly owned hospitals in Delta State, Nigeria. The sample consisted of 97(47.5%) males and 107(52.5%) females with mean age of 40.74years (SD= ±8.877). The results of the study provided support for the four hypotheses that were tested. Supportive supervision (b= .19, t = 3.10, p < .01) and job satisfaction (b= .11, t = 4.33, p < .001) positively and significantly predicted caring behaviour. Also, supportive supervision (b= .33, t = 2.19, p < .05) positively and significantly predicted job satisfaction while job satisfaction mediated the relationship between supportive supervision and caring behavior. Conclusion: This study demonstrates the importance of supportive supervision and job satisfaction in predicting the caring behavior of healthcare workers in Delta State, Nigeria. Consequently, it is recommended that policymakers, hospital administrators, and practitioners in the health sector put in place frameworks that will promote supportive supervision and job satisfaction.

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Summary: Background: In sub-Saharan Africa, the provision of infection prevention and control (IPC) measures are often limited by resource constraints. Aim: To determine the association of supportive supervision activities with the availability of the WHO core components for IPC at health facilities in Southwestern Uganda. Methods: We employed a before and after quality improvement study design. We conducted a baseline assessment of the availability of the WHO IPC core components and provided supportive supervision activities, which was followed by a second IPC assessment. We included health centers II-IV, which have increasing clinical care capacity, and regional hospitals. Findings: Of 244 regional health facilities, baseline assessment occurred at 111 (45%) of which 23 (21%) were reassessed. The number of facilities in the Red (85%) category for each core component stayed the same or was increased at each facility type, but there was a decrease from four to two health center III facilities scoring Green (>85%) for instrument processing. There was an increase in the median (interquartile range [IQR]) overall score for all facilities (65 [54–72] vs 75 [68–83], P=0.0001). Conclusion: Supportive supervision activities were associated with improved availability of the core components of IPC at health facilities in Southwestern Uganda. PPE should be prioritized in health care facilities in Southwestern Uganda.

Supervision is considered integral to quality mental health and psychosocial support (MHPSS) interventions and features as a key recommendation in all major international guidelines. Despite this, provision of supervision remains a gap within MHPSS programming and is often one of the most challenging aspects and unmet needs in programme implementation within humanitarian contexts.The IFRC Reference Centre for Psychosocial Support (PSC) and Trinity Centre for Global Health (TCGH) have developed the Integrated Model for Supervision (IMS) Handbook and accompanying training guidelines using participatory action research approaches. The IMS reflects input from a range of stakeholders, ensuring a user-centered design. The IMS was piloted within four organizations in Afghanistan, Nigeria, Jordan, and Ukraine.The acceptability, appropriateness, and feasibility of the IMS were assessed through (a) surveys of training participants (n-40), (b) in-session feedback gathered during training workshops (n ​= ​2 workshops), and (c) in depth interviews with workshop participants (n ​= ​8). Interview participants were supervisors, supervisees and leadership and management who had completed the IMS training and workshops.Results point to the acceptability and appropriateness of the IMS Handbook and its accompanying training for use within humanitarian contexts; with participants indicating that the IMS addressed issues and challenges that were present in their organizations. Preliminary data suggests that training in the IMS is associated with improvements in knowledge of MHPSS and perceived supervision practices, as well as reductions in secondary traumatic stress and burnout. Themes emerging from the qualitative analysis suggest that the IMS training promotes buy-in for supervision practices within organizations, and that the IMS training meet the need for providing emotional support within organizations. Participants indicate that the follow-up support and practical guidance offered as part of the IMS training is essential for effective supervision. This study bolsters evidence for the importance of strengthening support structures for human resources for mental health programming.

Abstract Objective Community health workers (CHW) are undertaking more complex tasks as part of the move towards universal health coverage in many low- and middle-income settings. They are expected to provide promotive and preventative care, make referrals to the local clinic, and follow up on non-attendees for a range of health conditions. CHW programmes can improve access to care for vulnerable communities, but many such programmes struggle due to inadequate supervision, low levels of CHW literacy, and the marginalized status of CHW in the health system. In this paper, we assess the effect of a roving nurse mentor on the coverage and quality of care of the CHW service in two vulnerable communities in South Africa. Participants CHW, their supervisors, household members. Intervention Roving professional nurse mentor to build skills of supervisors and CHW teams. Methods Three household surveys to assess household coverage of the CHW service (baseline, end of the intervention, and 6 months after end of intervention); structured observations of CHW working in households to assess quality of care. Results The intervention led to a sustained 50% increase in the number of households visited by a CHW in the last year. While the proportion of appropriate health messages given to household members by CHW remained constant at approximately 50%, CHW performed a greater range of more complex tasks. They were more likely to visit new households to assess health needs and register the household in the programme, to provide care to pregnant women, children and people who had withdrawn from care. CHW were more likely to discuss with clients the barriers they were facing in accessing care and take notes during a visit. Conclusion A nurse mentor can have a significant effect both on the quantity and quality of CHW work, allowing them to achieve their potential despite their marginalised status in the health system and their limited prior educational achievement. Supportive supervision is important in enabling the benefit of having a health cadre embedded in marginalised communities to be realised.

Background: The reproductive maternal newborn child health + adolescence (RMNCH + A) strategy is based on the provision of comprehensive care through the five pillars, or thematic areas, of reproductive, maternal, neonatal, child, and adolescent health, and is guided by central tenets of equity, universal care, entitlement, and accountability. This study aims to assess the services available in public health facilities among the selected high-priority districts (HPDs) of Jharkhand under RMNCH + A and also to compare the services available in public health facilities among different HPDs of Jharkhand under RMNCH + A. Materials and Methods: The proposed study was an observational study done by the Department of PSM/Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, with a total duration of the study (24 months) (April 2015–March 2017). Supportive supervision (SS) was conducted in the HPDs selected as Palamu, Latehar, Lohardaga, Gumla, and Simdega of Jharkhand state. The Government of India SS checklist was used during the field visits as data collection tool. After visit, compiled report was prepared as observations. Results: The observations of the visits were done under three broad headings of health-care utilization, health system, and service delivery in a comparative manner for all the five HPDs. It was found that outpatient department numbers and deliveries of pregnant women were maximum at district hospitals. Some logistics such as comprehensive abortion care needs to be ensured at the health facilities. Immunization services were available in almost all the selected facilities. Supply of few drugs such as albendazole, salbutamol, and zinc needed to be ensured so that it can be served to the poor and deprived population of the selected districts. Conclusion: It was concluded from the study that under various public health facilities are available at different health centers of the state which are being utilized by the beneficiaries in huge numbers. Some facilities still need to be strengthened and some logistics availability needs to be ensured.

Introduction: The duties of nursing administration include tasks such as placing orders, conducting regular checks on ward supplies, and ensuring regular updation of the stock register. This study assesses the effect of a supportive supervision strategy on the process of indenting and stock management by senior nursing ward in-charges and the barriers faced by them during the discharge of this duty. Methods: A cross-sectional study with mixed-method approach was conducted. Senior nursing officers were administered structured questionnaires and in-depth interviews for the quantitative and qualitative approaches, respectively. Quantitative analysis was done using statistical software and qualitative content analysis was done manually for the audio recorded and transcribed in-depth interviews. Results: The availability, legibility, accuracy, completeness, chronology, continuity, timeliness, safety, etc., of records, saw improvements on successive follow-up visits. On analyzing the in-depth interviews, administrative and management issues such as constantly changing personnel, unsystematic handover process, and problems related to supply chain and disposal came up. Work-related issues, such as lack of training, workload pressure, as well as staff-related and personal issues, were also identified. Conclusion: Transfers of designated senior nursing ward in-charges should be avoided if possible. In case done, the process of proper charge transfer should be followed. Issues such as the lengthy process of indenting and lack of training of nursing staff should be addressed. Incentivizing such work should be encouraged along with increasing autonomy for handling wards by senior nursing officers. Communication with all the stakeholders should be improved.

The reproductive maternal newborn child health + adolescence (RMNCH + A) strategy is based on the provision of comprehensive care through the five pillars, or thematic areas, of reproductive, maternal, neonatal, child, and adolescent health, and is guided by central tenets of equity, universal care, entitlement, and accountability. This study aims to assess the services available in public health facilities among the selected high-priority districts (HPDs) of Jharkhand under RMNCH + A and also to compare the services available in public health facilities among different HPDs of Jharkhand under RMNCH + A. Materials and Methods: The proposed study was an observational study done by the Department of PSM/Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, with a total duration of the study (24 months) (April 2015--March 2017). Supportive supervision (SS) was conducted in the HPDs selected as Palamu, Latehar, Lohardaga, Gumla, and Simdega of Jharkhand state. The Government of India SS checklist was used during the field visits as data collection tool. After visit, compiled report was prepared as observations. Results: The observations of the visits were done under three broad headings of health-care utilization, health system, and service delivery in a comparative manner for all the five HPDs. It was found that outpatient department numbers and deliveries of pregnant women were maximum at district hospitals. Some logistics such as comprehensive abortion care needs to be ensured at the health facilities. Immunization services were available in almost all the selected facilities. Supply of few drugs such as albendazole, salbutamol, and zinc needed to be ensured so that it can be served to the poor and deprived population of the selected districts. Conclusion: It was concluded from the study that under various public health facilities are available at different health centers of the state which are being utilized by the beneficiaries in huge numbers. Some facilities still need to be strengthened and some logistics availability needs to be ensured. [ABSTRACT FROM AUTHOR]

Abstract Background The health system in South Sudan faces extreme domestic resource constraints, low capacity, and protracted humanitarian crises. Supportive supervision is believed to improve the quality of health care and service delivery by compensating for flaws in health workforce management. This study aimed to explore the current supervision practices in South Sudan and identify areas for quality improvement. Methods The study employed qualitative approaches to collect and analyse data from six purposefully selected counties. Data were collected from 194 participants using semi-structured interviews (43 health managers) and focus group discussions (151 health workers). Thematic content analysis was used to yield an in-depth understanding of the supervision practices in the health sector. Results The study found that integrated supportive supervision and monitoring visits were the main approaches used for health services supervision in South Sudan. Supportive supervision focused more on health system administration and less on clinical matters. Although fragmented, supportive supervision was carried out quarterly, while monitoring visits were either conducted monthly or ad hoc. Prioritization for supportive supervision was mainly data driven. Paper-based checklists were the most commonly used supervision tools. Many supervisors had no formal training on supportive supervision and only learned on the job. The health workers received on-site verbal feedback and, most times, on-the-job training sessions through coaching and mentorship. Action plans developed during supervision were inadequately followed up due to insufficient funding. Insecurity, poor road networks, lack of competent health managers, poor coordination, and lack of adequate means of transport were some of the challenges experienced during supervision. The presumed outcomes of supportive supervision were improvements in human resource management, drug management, health data reporting, teamwork, and staff respect for one another. Conclusion Supportive supervision remains a daunting task in the South Sudan health sector due to a combination of external and health system factors. Our study findings suggest that strengthening the processes and providing inputs for supervision should be prioritized if quality improvement is to be attained. This necessitates stronger stewardship from the Ministry of Health, integration of different supervision practices, investment in the capacity of the health workforce, and health infrastructure development.

Objective: Community health workers (CHW) are undertaking more complex tasks as part of the move towards universal health coverage in many low- and middle-income settings. They are expected to provide promotive and preventative care, make referrals to the local clinic, and follow up on non-attendees for a range of health conditions. CHW programmes can improve access to care for vulnerable communities, but many such programmes struggle due to inadequate supervision, low levels of CHW literacy, and the marginalized status of CHW in the health system. In this paper, we assess the effect of a roving nurse mentor on the coverage and quality of care of the CHW service in two vulnerable communities in South Africa. Participants: CHW, their supervisors, household members. Intervention: Roving professional nurse mentor to build skills of supervisors and CHW teams. Methods: Three household surveys to assess household coverage of the CHW service (baseline, end of the intervention, and 6 months after end of intervention); structured observations of CHW working in households to assess quality of care. Results: The intervention led to a sustained 50% increase in the number of households visited by a CHW in the last year. While the proportion of appropriate health messages given to household members by CHW remained constant at approximately 50%, CHW performed a greater range of more complex tasks. They were more likely to visit new households to assess health needs and register the household in the programme, to provide care to pregnant women, children and people who had withdrawn from care. CHW were more likely to discuss with clients the barriers they were facing in accessing care and take notes during a visit. Conclusion: A nurse mentor can have a significant effect both on the quantity and quality of CHW work, allowing them to achieve their potential despite their marginalised status in the health system and their limited prior educational achievement. Supportive supervision is important in enabling the benefit of having a health cadre embedded in marginalised communities to be realised. [ABSTRACT FROM AUTHOR]

Aims: To synthesize available data on the impact of the COVID‐19 pandemic on clinical supervision practices of healthcare workers and students in healthcare settings. Design: A quantitative rapid review of the literature. Data Sources: A search of MEDLINE, Embase, PsycINFO, the Cochrane Library and Scopus for English language papers published between December 2019 (initial onset of the pandemic) to March 2021. Review methods: Using the World Health Organization and Cochrane guidelines for rapid reviews, following an identification of relevant papers and data extraction, a narrative synthesis approach was used to develop themes. Results: Eight studies met the inclusion criteria. Four themes identified from data synthesis were nature and extent of disruptions to clinical supervision, unmet need for psychological support, supervisors also need support and unpacking telesupervision. Findings highlight the extent and nature of disruption to clinical supervision at the point of care. Further information on factors that facilitate high‐quality telesupervision have come to light. Conclusion: The COVID‐19 pandemic has placed tremendous burden on healthcare workers compromising their own health and well‐being. It is essential to restore effective clinical supervision practices at the point of care, so as to enhance patient, healthcare worker and organizational outcomes into the post‐COVID‐19 pandemic period. Impact This review has provided initial evidence on the adverse impacts of the COVID‐19 pandemic on clinical supervision of healthcare workers and students at the point of care. Available evidence indicates the urgent need to restore effective and high‐quality clinical supervision practices in health settings. The review has highlighted a paucity of studies in this area, calling for further high‐quality studies. [ABSTRACT FROM AUTHOR]

Abstract Background The strength of a health system—and ultimately the health of a population—depends to a large degree on health worker performance. However, insufficient support to build, manage and optimize human resources for health (HRH) in low- and middle-income countries (LMICs) results in inadequate health workforce performance, perpetuating health inequities and low-quality health services. Methods The USAID-funded Human Resources for Health in 2030 Program (HRH2030) conducted a systematic review of studies documenting supervision enhancements and approaches that improved health worker performance to highlight components associated with these interventions’ effectiveness. Structured by a conceptual framework to classify the inputs, processes, and results, the review assessed 57 supervision studies since 2010 in approximately 29 LMICs. Results Of the successful supervision approaches described in the 57 studies reviewed, 44 were externally funded pilots, which is a limitation. Thirty focused on community health worker (CHW) programs. Health worker supervision was informed by health system data for 38 approaches (67%) and 22 approaches used continuous quality improvement (QI) (39%). Many successful approaches integrated digital supervision technologies (e.g., SmartPhones, mHealth applications) to support existing data systems and complement other health system activities. Few studies were adapted, scaled, or sustained, limiting reports of cost-effectiveness or impact. Conclusion Building on results from the review, to increase health worker supervision effectiveness we recommend to: integrate evidence-based, QI tools and processes; integrate digital supervision data into supervision processes; increase use of health system information and performance data when planning supervision visits to prioritize lowest-performing areas; scale and replicate successful models across service delivery areas and geographies; expand and institutionalize supervision to reach, prepare, protect, and support frontline health workers, especially during health emergencies; transition and sustain supervision efforts with domestic human and financial resources, including communities, for holistic workforce support. In conclusion, effective health worker supervision is informed by health system data, uses continuous quality improvement (QI), and employs digital technologies integrated into other health system activities and existing data systems to enable a whole system approach. Effective supervision enhancements and innovations should be better integrated, scaled, and sustained within existing systems to improve access to quality health care.

COVID-19 pandemic will be the most dreaded public health challenge world has ever faced and health-care workers play a crucial role in combating it, risking their own lives. Health workers serving COVID faced discrimination. Many new set up like COVID-19 screening clinics with complete new set of rules and logistics were set up. In North Bengal Medical College (NBMCH), it was functional round the clock since its inception. Our case that was a chronic smoker, alcoholic, and had records of defiant behavior was posted as a guard here. The anguish and pan of the patients attending, an increased job responsibility thrust on him along with the dependence of patients on his behavior brought about a change. Witnessing able tireless fearless leaderships from major wards, supportive supervision, empathy, and regular counseling sessions are thought to herald the positive behavioral change in him. The role of self-actualization theories and adoption of behaviors with effective health communications and theories of ergonomics were reinstated. Using health belief models, a deep understanding of the preventive behaviors was tried.

Fauziah Rabbani,1,2 Hyder Ali Khan,2 Suneel Piryani,2 Nousheen Akber Pradhan,2 Natasha Shaukat,2 Anam Shahil Feroz,2 Shagufta Perveen2 1Office of Research and Graduate Studies, The Aga Khan University, Karachi, Sindh, Pakistan; 2Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, PakistanCorrespondence: Fauziah RabbaniOffice of Research and Graduate Studies, The Aga Khan University, Stadium Road, P.O Box 3500, Karachi, 74800, Sindh, PakistanEmail fauziah.rabbani@aku.eduPurpose: Diarrhea and pneumonia greatly contribute to high childhood mortality in Pakistan. Frontline community health workers or the Lady Health Workers (LHWs) provide care at the doorstep of over 60% of Pakistan’s rural residents. Difficult terrain, lack of supplies, and inadequate supervision put these LHWs at an added disadvantage in the timely diagnosis and delivery of known treatment options to community caregivers (CCGs). This study aims to assess whether a supportive supervision intervention through Lady Health Supervisors (LHSs) using enhanced mentorship and written feedback cards have the potential to improve case management of childhood diarrhea and pneumonia.Study Setting and Design: This perception-based qualitative inquiry nested within the Nigraan Plus trial included LHSs, LHWs, and CCGs as the participants. Twenty-two in-depth interviews (IDIs) and 16 focus group discussions (FGDs) were conducted before a supportive supervision intervention in 2017, and 10 FGDs were conducted in 2019 once the intervention concluded. Data were analyzed using manual content analysis.Results: The perceived ability of LHWs and LHSs to describe the danger signs of diarrhea and pneumonia, classify dehydration and relate respiratory rate to the severity of pneumonia improved over time. Appropriate prescription of zinc in diarrhea and antibiotics in pneumonia was noted. Furthermore, CCGs’ trust in LHWs increased following the intervention, and they reported a growing inclination to contact LHWs as their first point of care. LHWs in the intervention arm were more satisfied with their job due to frequent supervisory visits and continuous feedback by LHSs.Conclusion: Despite geographic, social, and economic inequities, supportive supervision has the potential to improve knowledge, practice, and skills of frontline health workers related to CCM of childhood diarrhea and pneumonia in disadvantaged rural communities. Additionally, the trust of CCGs in the health workers’ ability to manage such cases is also enhanced.Keywords: community health workers, community caregivers, community case management, childhood diarrhea and pneumonia, supportive supervision, Pakistan

Background: The health system in South Sudan faces extreme domestic resource constraints, low capacity, and protracted humanitarian crises. Supportive supervision is believed to improve the quality of health care and service delivery by compensating for flaws in health workforce management. This study aimed to explore the current supervision practices in South Sudan and identify areas for quality improvement.Methods: The study employed qualitative approaches to collect and analyse data from six purposefully selected counties. Data were collected from 194 participants using semi-structured interviews (43 health managers) and focus group discussions (151 health workers). Thematic content analysis was used to yield an in-depth understanding of the supervision practices in the health sector.Results: The study found that integrated supportive supervision and monitoring visits were the main approaches used for health services supervision in South Sudan. Supportive supervision focused more on health system administration and less on clinical matters. Although fragmented, supportive supervision was carried out quarterly, while monitoring visits were either conducted monthly or ad hoc. Prioritization for supportive supervision was mainly data driven. Paper-based checklists were the most commonly used supervision tools. Many supervisors had no formal training on supportive supervision and only learned on the job. The health workers received on-site verbal feedback and, most times, on-the-job training sessions through coaching and mentorship. Action plans developed during supervision were inadequately followed up due to insufficient funding. Insecurity, poor road networks, lack of competent health managers, poor coordination, and lack of adequate means of transport were some of the challenges experienced during supervision. The presumed outcomes of supportive supervision were improvements in human resource management, drug management, health data reporting, teamwork, and staff respect for one another.Conclusion: Supportive supervision remains a daunting task in the South Sudan health sector due to a combination of external and health system factors. Our study findings suggest that strengthening the processes and providing inputs for supervision should be prioritized if quality improvement is to be attained. This necessitates stronger stewardship from the Ministry of Health, integration of different supervision practices, investment in the capacity of the health workforce, and health infrastructure development. [ABSTRACT FROM AUTHOR]

Community Health Worker (CHW) supervision is an under-researched area. This mixed-methods study engaged key stakeholders involved in CHW supervision in Mukono District, Uganda including CHWs (n = 14), District Health Office officials (n = 5), NGO programme managers (n = 3) and facility-based health staff (n = 3). Our study aimed to explore how supervision is currently conceptualised and delivered in this setting, the desired qualities of a potential supervisor, as well as the challenges regarding supervision and potential solutions to address these. To understand these concepts, we conducted structured surveys and individual interviews. Survey data were analysed in SPSS using descriptive statistics. Interview transcripts were thematically analysed in NVivo using conventional content analysis. This study revealed current CHW supervision in this context is fragmented. Supervision is perceived both as a means of motivating CHWs and facilitating ongoing training, as well as a way of holding CHWs accountable for their work. Stakeholders identified technical knowledge and expertise, strong interpersonal skills and cultural awareness as desirable qualities for a supervisor. Challenges surrounding supervision included a shortage of funding, a lack of guidelines on supervision, and infrequent supervision. To address these challenges, stakeholders proposed the need for increased funding, creating clearer job descriptions for supervisors, and in-person supervisory meetings. [ABSTRACT FROM AUTHOR]

Abstract Background Supervision is essential for optimizing performance and motivation of community health workers (CHWs). This paper, the seventh in our series, “Community health workers at the dawn of a new era”, supplements the existing evidence on CHW supervision in low- and middle-income countries by reviewing what supervision approaches are employed in specific contexts, identifying potential facilitators of CHW supervision including mobile health (mHealth) interventions, and noting challenges of supervision including the relationship between supervision and other CHW programme elements. Methods For this exploratory research study on CHW supervision, we reviewed the supervisory interventions described in a compendium of 29 case studies of large-scale CHW programmes, performed an electronic search of multiple databases to identify articles related to CHW supervision published between 15 June 2017 and 1 December 2020, and from those articles followed additional references that appeared to be relevant for our results. Results We reviewed 55 case studies, academic articles, and grey literature resources as part of this exploratory research. A variety of supervision approaches have been adapted over time, which we grouped into five categories: external supervision, community supervision, group supervision, peer supervision, and dedicated supervision. These approaches are frequently used in combination. Digital (mHealth) technologies are being explored as potential facilitators of CHW supervision in both small- and large-scale programmes; however, evidence of their effectiveness remains limited to date. Inadequate support for supervisors is a major challenge, particularly given the numerous and varied roles they are expected to fulfil, spanning administrative, clinical, and supportive activities. Supervisors can help CHWs acquire other critical elements needed from the health system for them to perform more effectively: incentives to foster motivation, clarity of roles and tasks, adequate tools and supplies, appropriate knowledge and skills, and a safe work environment. Conclusion In the absence of a universal “best approach” for CHW supervision, our recommendation is that countries and programmes prioritize homegrown evolution over time to suit the local context. In some cases, this may involve scaling up novel approaches that have proven effective at small scale or testing approaches that have worked in other countries.

This article tends to fill the existing knowledge gap in understanding if work-life balance (WLB) can not only make a direct impact on employee well-being, but also play a mediating role between work culture and well-being. The purpose of this study was to investigate the mediating effect of WLB on the relationship between the structural dimensions of work culture – temporal flexibility, supportive supervision and operational flexibility – and employee well-being. The data were collected on the basis of a survey of employees employed by business and public sector organisations in Lithuania. The research revealed that all the components of work culture were important factors in defining employee well-being, had a strong direct impact on well-being and affected WLB. The results demonstrated that a direct effect of work culture on well-being was much stronger than the one moderated by an indirect effect of WLB. The findings also suggest that family-friendly culture can help employees to reach a better WLB, which, in its turn, assists employees in feeling higher satisfaction with general well-being at work. The current study expands the role of WLB as a mediator in organisational settings and its findings may be important for practitioners who seek to improve the performance of their organisation by enhancing the well-being of employees.

Background: COVID-19 pandemic is a unique public health challenge causing unprecedented disruptions in normalcy. Low-and-middle-income countries need more context-relevant approaches since a majority of the world population lives here. Pandemic response in India was graded, and routine healthcare came to a screeching halt. COVID 19 Screening clinic was initiated with the intent to screen suspects and provide needful care after required consultation. It imparted preventive health education and addressed relevant queries, alleviating stress in the process. The second wave hit hard despite vaccination. Objectives: To determine the pattern of patients attending, to conduct SWOT analysis for an insight into clinic functioning and to generate a database for further simulation were primary objectives. Methods: Descriptive cross-sectional hospital-based secondary data analysis was conducted in North Bengal medical college and hospital (NBMCH) for three months with the help of preformed proforma, interview guide and available records. An exit interview was conducted. Willing participants were enrolled. Verbal consent and Institutional Ethics Clearance were taken. Results: An induction program was held every two months by the Department of Medicine, NBMCH. The clinic recorded 60,427 cases from 23rd March 2020 to 28th February 2021. The majority were males, Hindus and from rural areas of the Darjeeling district. 60.4% were symptomatic. Total cases quarantined, tested and admitted were 39.8%, 74.9% and 34.7%, respectively. However, unlike before, from September, 80.1% of the cases were symptomatic, and the majority came only for testing as national lockdown had ceased. SWOT Analysis revealed Strength as being able to operate 24*7 with coordination among all tiers of health care workers. Select seniors helped in its smooth conduction. The Weakness identified was clinic location beside the emergency, creating confusion. [ABSTRACT FROM AUTHOR]

Abstract Poor health worker motivation, and the resultant shortages and geographic imbalances of providers, impedes the provision of quality care in low- and middle-income countries (LMICs). This systematic review summarizes the evidence on interventions used to motivate health workers in LMICs. A standardized keyword search strategy was employed across five databases from September 2007 -September 2017. Studies had to meet the following criteria: original study; doctors and/or nurses as target population for intervention(s); work motivation as study outcome; study design with clearly defined comparison group; categorized as either a supervision, compensation, systems support, or lifelong learning intervention; and conducted in a LMIC setting. Two independent reviewers screened 3845 titles and abstracts and, subsequently, reviewed 269 full articles. Seven studies were retained from China (n = 1), Ghana (n = 2), Iran (n = 1), Mozambique (n = 1), and Zambia (n = 2). Study data and risk of bias were extracted using a standardized form. Though work motivation was the primary study outcome, four studies did not provide an outcome definition and five studies did not describe use of a theoretical framework in the ascertainment. Four studies used a randomized trial—group design, one used a non-randomized trial—group design, one used a cross-sectional design, and one used a pretest–posttest design. All three studies that found a significant positive effect on motivational outcomes had a supervision component. Of the three studies that found no effects on motivation, two were primarily compensation interventions and the third was a systems support intervention. One study found a significant negative effect of a compensation intervention on health worker motivation. In conducting this systematic review, we found there is limited evidence on successful interventions to motivate health workers in LMICs. True effects on select categories of health workers may have been obscured given that studies included health workers with a wide range of social and professional characteristics. Robust studies that use validated and culturally appropriate tools to assess worker motivation are greatly needed in the Sustainable Development Goals era.

Supportive supervision is an important but often over-looked practice in contemporary social work, often assisting in maintaining practitioner well-being. The following research explores how eleven social workers in Australia experience supportive supervision and its impact on their well-being and job satisfaction. The research used interpretative phenomenological analysis to reveal the complex and important role supportive supervision has for social workers, working within risk-adverse, managerialist settings. Participants revealed how supportive supervision allowed them to feel cared for and valued within their work environment. This was contrasted with their experience of the tokenistic supervision they received in many agencies leading to feelings of emotional unsafety in the workplace. Whilst social work is inherently an emotionally driven profession, this study revealed how supervisory practices that focus on risk and surveillance place supportive supervision as an afterthought. This research highlights the importance of supportive supervision in 'caring for the carers' in front line social work positions. [ABSTRACT FROM AUTHOR]

Background and Objective: The burden of maternal mortality attributable to postpartum hemorrhage (PPH) remains high in Nigeria. Currently, oxytocin, and misoprostol, which are largely of suboptimal quality, are used for PPH prevention and treatment. Heat-stable carbetocin (HSC) is a viable uterotonic option for PPH prevention in a setting like Nigeria where compromised supply and cold chain systems result in the preponderance of poor-quality oxytocin and suboptimal PPH management. It is crucial to understand how healthcare providers (HCPs) accept and use HSC for PPH prevention, and what factors encourage correct uterotonic usage in health facilities, given PPH's ongoing public health challenge. This study aims to elucidate the current prophylactic use of HSC, oxytocin, and misoprostol in secondary and tertiary public health facilities while assessing HSC acceptability to clinicians and establishing factors that enable the appropriate use of uterotonics in health facilities., Methods: Descriptive analysis conducted on quantitative data from patient chart reviews, HCP interviews and assessment, and facility assessment using Stata 15 and Microsoft Excel are presented as counts and percentages, while qualitative data from key informant interviews and in-depth interviews are coded and analyzed using NVivo. The findings from 18 publicly owned secondary and tertiary healthcare facilities across Kano, Lagos, and Niger states in Nigeria were interpreted according to thematic areas. Health facilities selection criteria were high volume of deliveries (≥30 deliveries per month), accessible location, availability of trained HCPs (specifically doctors, nurses, and midwives), and willingness to participate in the study., Results: HSC was administered prophylactically in 10,284 (56%) of 18,364 deliveries, with a total of 148 (0.8%) women developing PPH. Approximately 76% of HCPs preferred HSC for PPH prevention compared to other available uterotonics, with clinical guidance from senior HCPs (76%), in-service training (76%), mentoring (84%), and supportive supervision (75%) contributing significantly to the choice and practice of uterotonics use by HCPs., Conclusion and Global Health Implications: HSC, a thermostable analog of oxytocin, holds the potential to prevent PPH without the added cost of administering additional uterotonics and interventions. The introduction of HSC requires concerted procurement and capacity-building efforts to create an enabling environment for scale-up. HSC is non-inferior to oxytocin in preventing PPH, has few side effects compared to misoprostol or oxytocin-misoprostol combination, and more cost-effective when compared with the other three uterotonics. Although the geographical scope of our study is only three states in Nigeria, the preponderance of suboptimal uterotonics across the country makes our findings applicable to the whole country and other low- and middle-income countries with similar challenges., Competing Interests: The authors have no conflicts of interest., (© 2024 The Authors. Published by Global Health and Education Projects, Inc., USA.)

Background: The strength of a health system-and ultimately the health of a population-depends to a large degree on health worker performance. However, insufficient support to build, manage and optimize human resources for health (HRH) in low- and middle-income countries (LMICs) results in inadequate health workforce performance, perpetuating health inequities and low-quality health services.Methods: The USAID-funded Human Resources for Health in 2030 Program (HRH2030) conducted a systematic review of studies documenting supervision enhancements and approaches that improved health worker performance to highlight components associated with these interventions' effectiveness. Structured by a conceptual framework to classify the inputs, processes, and results, the review assessed 57 supervision studies since 2010 in approximately 29 LMICs.Results: Of the successful supervision approaches described in the 57 studies reviewed, 44 were externally funded pilots, which is a limitation. Thirty focused on community health worker (CHW) programs. Health worker supervision was informed by health system data for 38 approaches (67%) and 22 approaches used continuous quality improvement (QI) (39%). Many successful approaches integrated digital supervision technologies (e.g., SmartPhones, mHealth applications) to support existing data systems and complement other health system activities. Few studies were adapted, scaled, or sustained, limiting reports of cost-effectiveness or impact.Conclusion: Building on results from the review, to increase health worker supervision effectiveness we recommend to: integrate evidence-based, QI tools and processes; integrate digital supervision data into supervision processes; increase use of health system information and performance data when planning supervision visits to prioritize lowest-performing areas; scale and replicate successful models across service delivery areas and geographies; expand and institutionalize supervision to reach, prepare, protect, and support frontline health workers, especially during health emergencies; transition and sustain supervision efforts with domestic human and financial resources, including communities, for holistic workforce support. In conclusion, effective health worker supervision is informed by health system data, uses continuous quality improvement (QI), and employs digital technologies integrated into other health system activities and existing data systems to enable a whole system approach. Effective supervision enhancements and innovations should be better integrated, scaled, and sustained within existing systems to improve access to quality health care. [ABSTRACT FROM AUTHOR]

We examined the interaction effect of supportive supervision and postgraduate students' core self-evaluations on academic creativity, as well as the mediating role of creative self-efficacy in this effect. Participants were 348 Chinese postgraduate students. The results show that supportive supervision was positively associated with students' academic creativity, and that creative self-efficacy mediated this association. Students' core self-evaluations and supportive supervision had a synergistic interactive effect on creative self-efficacy, and creative self-efficacy partially mediated the interactive effect of supportive supervision and core self-evaluations on students' academic creativity. The positive indirect effect of supportive supervision on students' academic creativity through creative self-efficacy was stronger when core self-evaluations were highly positive, compared to when they were less positive. The implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

What is already known about the topic? • The supportive supervision of RNs in long-term care facilities (LTCFs) are related to the job satisfaction, job-related stress and turnover of personal support workers (PSWs) and have a direct impact on quality of resident care. • What specific factors influence the level of supportive supposition needs to be further clarified. What this paper adds ༟ • The PSW's years of working in the profession, the RN's gender, education, position, number of years in nursing, having access to managerial training as well as the RN/PSW ratio in the unit are the influencing factors for supportive supervision. • Several factors can be modified to potentially influence the supportive capacity of RNs working in LTCFs, such as having access to managerial training and working in environments with an appropriate RN/PSW ratio on the unit. Quality of care provided by personal support workers (PSWs) in long-term care facilities (LTCFs) is associated with the supportive supervisory performance of registered nurses (RNs). To determine the level of supportive supervision of RNs and its influencing factors in LTCFs in East China, a cross-sectional survey was conducted in 12 LTCFs using self-designed sociodemographic questionnaires and the Chinese version of the Supportive Supervisory Scale. A total of 643 PSWs supervised by 260 RNs were surveyed. The average supportive supervision score was 59.60 ± 7.53, representing a moderate level of supervisory support. Supportive supervision was found to be positively correlated with the PSW's years of working, the RN's education, position, number of years in nursing, having access to managerial training as well as the RN/PSW ratio in the unit (p < 0.05). These factors can be modified to potentially influence the supportive capacity of nurse supervisors in LTCFs. [ABSTRACT FROM AUTHOR]

Background To strengthen medicines management capacity, including supply chain management, at public sector health facilities in Uganda, the Ministry of Health introduced a multipronged supervision, performance assessment, and recognition strategy (SPARS). The aim of this study was to assess the impact of SPARS on improving supply chain management. A series of four papers on SPARS described the SPARS concept, its impact on overall and domain practices and appropriate medicines use, and now in the fourth paper describing the effect on supply chain management. Methods District-based health workers trained as supervisors build facility-level capacity in medicines management using an indicator-based performance assessment followed by targeted supervisory visits. From 2010 to 2013, 1222 SPARS visits were implemented, and the SPARS performance indicator scores determined. This article assesses impact on 13 indicators in three of the five SPARS domains—stock management, storage management, and ordering and reporting quality—using a pre–post design. We also explored factors that may have influenced these outcomes. Results Between the first and last visit within one year of SPARS implementation, we found an average improvement of 16 percentage points (p

Purpose: The study explored the relationship between supportive supervision and empathic behavior and the indirect effect of occupational self-efficacy (OSE) among healthcare professionals in public hospitals in Delta State, Nigeria. Design/Methodology: The study is a quantitative cross-sectional survey, and the correlational design was adopted. Through convenience and systematic sampling, data were obtained from 127 healthcare professionals (doctors and nurses) from public hospitals. The sample consisted of 127 healthcare professionals with a mean age of 33.91 (SD, 5.64). Regression analysis via Model 4 of Hayes' PROCESS Macro was used to analyze the direct and indirect effect model with the help of the IBM-SPSS version 23. Findings: The study's findings indicated that supportive supervision and OSE positively and significantly predicted empathic behavior among healthcare professionals. The results further indicated that OSE mediated the relationship between supportive supervision and empathic behavior. Practical Implications: Based on the research findings, it is recommended that public healthcare administrators and managers should ensure that employees who handle direct patient care in public hospitals receive enough training in enhancing their skills, professional development and provided with enough supportive supervision in the workplace to foster empathic concern for their patients. Originality/Value: The research findings enhance and add new knowledge to the empathic behavior literature by investigating supportive supervision and OSE as predictors and checking for the mediating role of OSE.

Background: Absenteeism is widespread in Nigerian health facilities and is a major barrier to achievement of effective Universal Health Coverage. We have examined the role of internal (by managerial staff within facilities) and external (by managers at a higher level) supervision arrangements on health worker absenteeism. Specifically, we sought to determine whether these forms of supervision have any role to play in reducing health worker absenteeism in health facilities in Enugu State Nigeria.Methods: We conducted interviews with 412 health workers in urban and rural areas of Enugu State, in South-Eastern Nigeria. We used binary logistic regression to estimate the role of different types of supervision on health worker absenteeism in selected health facilities in Enugu State.Results: Internal supervision arrangements significantly reduce health worker absenteeism (odds ratio = 0.516, p = 0.03). In contrast, existing external supervision arrangements were associated with a small but significant increase in absenteeism (OR = 1.02, 0.043). Those reporting a better financial situation were more likely to report being absent (OR = 1.36, p < 0.01) but there was no association with age and marital status of respondents. Our findings also pointed to the potential for alternative forms of supervision, provided in a supportive rather than punitive way, for example by community groups monitoring the activities of health workers but trying to understand what support these workers may need, within or beyond the work environment.Conclusion: The existing system of external supervision of absenteeism in health facilities in Nigeria is not working but alternatives that take a more holistic approach to the lived experiences of health workers might offer an alternative.

Background: Supervision is essential for optimizing performance and motivation of community health workers (CHWs). This paper, the seventh in our series, "Community health workers at the dawn of a new era", supplements the existing evidence on CHW supervision in low- and middle-income countries by reviewing what supervision approaches are employed in specific contexts, identifying potential facilitators of CHW supervision including mobile health (mHealth) interventions, and noting challenges of supervision including the relationship between supervision and other CHW programme elements.Methods: For this exploratory research study on CHW supervision, we reviewed the supervisory interventions described in a compendium of 29 case studies of large-scale CHW programmes, performed an electronic search of multiple databases to identify articles related to CHW supervision published between 15 June 2017 and 1 December 2020, and from those articles followed additional references that appeared to be relevant for our results.Results: We reviewed 55 case studies, academic articles, and grey literature resources as part of this exploratory research. A variety of supervision approaches have been adapted over time, which we grouped into five categories: external supervision, community supervision, group supervision, peer supervision, and dedicated supervision. These approaches are frequently used in combination. Digital (mHealth) technologies are being explored as potential facilitators of CHW supervision in both small- and large-scale programmes; however, evidence of their effectiveness remains limited to date. Inadequate support for supervisors is a major challenge, particularly given the numerous and varied roles they are expected to fulfil, spanning administrative, clinical, and supportive activities. Supervisors can help CHWs acquire other critical elements needed from the health system for them to perform more effectively: incentives to foster motivation, clarity of roles and tasks, adequate tools and supplies, appropriate knowledge and skills, and a safe work environment.Conclusion: In the absence of a universal "best approach" for CHW supervision, our recommendation is that countries and programmes prioritize homegrown evolution over time to suit the local context. In some cases, this may involve scaling up novel approaches that have proven effective at small scale or testing approaches that have worked in other countries. [ABSTRACT FROM AUTHOR]

Background: Lack of programmatic support and supervision is one of the underlying reasons of the poor performance of Pakistan's Lady Health Worker Program (LHWP). This study describes the findings and potential for scale-up of a supportive supervision intervention in two districts of Pakistan for improving LHWs skills for integrated community case management (iCCM) of childhood diarrhea and pneumonia.Methods: The intervention comprised an enhanced supervision training to lady health supervisors (LHSs) and written feedback to LHWs by LHSs, implemented in Districts Badin and Mirpur Khas (MPK). Clinical skills of LHWs and LHSs and supervision skills of LHSs were assessed before, during, and after the intervention using structured tools.Results: LHSs' practice of providing written feedback improved between pre- and mid-intervention assessments in both trials (0% to 88% in Badin and 25% to 75% in MPK) in the study arm. Similarly, supervisory performance of study arm LHSs was better than that in the comparison arm in reviewing the treatment suggested by workers' (94% vs 13% in MPK and 94% vs 69% in Badin) during endline skills assessment in both trials. There were improvements in LHWs' skills for iCCM of childhood diarrhea and pneumonia in both districts. In intervention arm, LHWs' performance for correctly assessing for dehydration (28% to 92% in Badin and 74% to 96% in MPK), and measuring the respiratory rate correctly (12% to 44% in Badin and 46% to 79% in MPK) improved between baseline and endline assessments in both trials. Furthermore, study arm LHWs performed better than those in comparison arm in classifying diarrhea correctly during post-intervention skills assessment (68% vs 40% in Badin and 96% vs 83% in MPK).Conclusion: Supportive supervision including written feedback and frequent supervisor contact could improve the performance of community-based workers in managing diarrhea and pneumonia among children. Positive lessons for provincial scale-up can be drawn. Trial registration Both trials are registered with the 'Australian New Zealand Clinical Trials Registry'. Registration numbers: Nigraan Trial: ACTRN1261300126170; Nigraan Plus: ACTRN12617000309381. [ABSTRACT FROM AUTHOR]

This article tends to fill the existing knowledge gap in understanding if work-life balance (WLB) can not only make a direct impact on employee well-being, but also play a mediating role between work culture and well-being. The purpose of this study was to investigate the mediating effect of WLB on the relationship between the structural dimensions of work culture - temporal flexibility, supportive supervision and operational flexibility - and employee well-being. The data were collected on the basis of a survey of employees employed by business and public sector organisations in Lithuania. The research revealed that all the components of work culture were important factors in defining employee well-being, had a strong direct impact on well-being and affected WLB. The results demonstrated that a direct effect of work culture on well-being was much stronger than the one moderated by an indirect effect of WLB. The findings also suggest that family-friendly culture can help employees to reach a better WLB, which, in its turn, assists employees in feeling higher satisfaction with general well-being at work. The current study expands the role of WLB as a mediator in organisational settings and its findings may be important for practitioners who seek to improve the performance of their organisation by enhancing the well-being of employees. [ABSTRACT FROM AUTHOR]

Background: Quality of HIV sentinel surveillance (HSS) depends on preparedness of the site and adherence to the standard operating procedures (SOPs) for HSS. A designated sentinel site is considered prepared for the round of sentinel surveillance based on the availability of infrastructure, human resource, and consumables. Objectives: The study objectives were to describe the site level preparedness and adherence to SOP of antenatal care clinic (ANC) sites during the 16th round of HSS in India. Methods: This was a cross-sectional study based on the findings of the supervisory visits conducted by public health specialists in ANC sites during the 16th round of HSS from January to March 2019. Semi-structured checklists were used to assess site-preparedness and adherence to the SOP for HSS. All supervisors were expected to upload the filled pro forma to the HSS management information system (MIS). We present here a descriptive analysis of the uploaded visit reports. Results: Of 870 HSS sites, 783 (90%) were visited, and 479 (61.2%) reports were uploaded to MIS. Preround HSS training was not attended by one-fifth (22.6%) of the site in-charges; 35.8% of them had never received any HSS training. SOP was followed at most (94%) of the sites. The most frequently reported problem at the sites was inadequate or delayed availability of consumables. Conclusion: The overall quality of site-level preparedness at antenatal clinic sites in India was good. Attention needs to be given to timely and adequate availability of consumables at sentinel sites along with proper administrative support and preround training of site in-charges.

Abstract Background Universal Health Coverage only leads to the desired health outcomes if quality of health services is ensured. In Tanzania, quality has been a major concern for many years, including the problem of ineffective and inadequate routine supportive supervision of healthcare providers by council health management teams. To address this, we developed and assessed an approach to improve quality of primary healthcare through enhanced routine supportive supervision. Methods Mixed methods were used, combining trends of quantitative quality of care measurements with qualitative data mainly collected through in-depth interviews. The former allowed for identification of drivers of quality improvements and the latter investigated the perceived contribution of the new supportive supervision approach to these improvements. Results The results showed that the new approach managed to address quality issues that could be solved either solely by the healthcare provider, or in collaboration with the council. The new approach was able to improve and maintain crucial primary healthcare quality standards across different health facility level and owner categories in various contexts. Conclusion Together with other findings reported in companion papers, we could show that the new supportive supervision approach not only served to assess quality of primary healthcare, but also to improve and maintain crucial primary healthcare quality standards. The new approach therefore presents a powerful tool to support, guide and drive quality improvement measures within council. It can thus be considered a suitable option to make routine supportive supervision more effective and adequate.

The political situation in Yemen has been precarious since 2011 when popular protest broke out amid the Arab Spring, calling for President Saleh to step down. In March 2015, a Houthi insurgency took control of the capital, Sana’a and ignited a civil conflict that is now characterised by foreign political and military involvement. Since 2015, health facilities have been a primary target for airstrikes and bombing. Seaports have been blockaded barring the delivery of essential medicines and supplies, contributing to the near collapse of an already fragile health system. Since 2012, Save the Children (SC) has been implementing a Family Planning (FP) and Post-abortion Care (PAC) programme in two governorates heavily affected by the conflict. Despite the risks associated with the conflict, there remains a strong demand for SC's FP and PAC services. Ongoing programmatic support and capacity strengthening have allowed quality FP and PAC services to continue for Yemenis even when humanitarian access is impeded. Since the onset of conflict in March 2015, 16 facilities provided services to 43,218 new FP clients (with 23% accepting a long-acting method) and treated 3627 women with PAC. Over 93% of FP clients would recommend FP services at the facility to a friend or family member. Findings support growing evidence that women affected by conflict require family planning services, and that demand does not decline as long as quality services remain accessible. An adaptable reproductive health programme model that embraces innovative approaches is necessary for establishing services and maintaining quality during acute conflict.

Background: To strengthen medicines management capacity, including supply chain management, at public sector health facilities in Uganda, the Ministry of Health introduced a multipronged supervision, performance assessment, and recognition strategy (SPARS). The aim of this study was to assess the impact of SPARS on improving supply chain management. A series of four papers on SPARS described the SPARS concept, its impact on overall and domain practices and appropriate medicines use, and now in the fourth paper describing the effect on supply chain management. Methods: District-based health workers trained as supervisors build facility-level capacity in medicines management using an indicator-based performance assessment followed by targeted supervisory visits. From 2010 to 2013, 1222 SPARS visits were implemented, and the SPARS performance indicator scores determined. This article assesses impact on 13 indicators in three of the five SPARS domains—stock management, storage management, and ordering and reporting quality—using a pre–post design. We also explored factors that may have influenced these outcomes. Results: Between the first and last visit within one year of SPARS implementation, we found an average improvement of 16 percentage points (p < 0.001) in supply chain management measures across all levels of care. The improvement in scores for stock management, storage management, and ordering and reporting was 22 (ns), 16 (p < 0.001), and 11 (p = 0.032) percentage points, respectively. The study identified the key predictors of positive change as a low initial indicator score, frequent supervisory visits, and engagement of the district health officer. Conclusions: The multipronged SPARS approach was effective in building supply chain management capacity in lower-level health care facilities with statistically significant improvements in supply chain management overall and in almost all stock and storage- management and ordering and reporting measures after one year of implementation. We recommend broad dissemination of the SPARS approach as an effective strategy to strengthen supply chain management in low-income countries. Trial registration: The study did not involve or use human participants or identifiable personal data, human tissue, or animals and thus did not require ethical approval or a waiver. It is a study implemented in collaboration with the Ministry of Health and does not require trial registration. [ABSTRACT FROM AUTHOR]

Background: Despite routine supportive supervision of health service delivery, maternal and newborn outcomes have remained poor in sub-Saharan Africa in general and in Tanzania in particular. There is limited research evidence on factors limiting the effectiveness of supportive supervision in improving the quality of maternal and newborn care. Objective: This study explored enablers of and barriers to supportive supervision in maternal and newborn care at the district and hospital levels in Shinyanga region in Tanzania. Methods: This study employed a qualitative case study design. A purposeful sampling approach was employed to recruit a stratified sample of health system actors: members of the council health management team (CHMT), members of health facility management teams (HMTs), heads of units in the maternity department and health workers. Results: This study identified several barriers to the effectiveness of supportive supervision. First, the lack of a clear policy on supportive supervision. Despite the general acknowledgement of supportive supervision as a managerial mechanism for quality improvement at the district and lower-level health facilities, there is no clear policy guiding it. Second, limitations in measurement of progress in quality improvement; although supportive supervision is routinely conducted to improve maternal and newborn outcomes, efforts to measure progress are limited due to shortfalls in the setting of goals and targets, as well as gaps in M&E. Third, resource constraints and low motivation; that is, the shortage of resources – CHMT supervisors, health staff and funds – results in irregular supervision and low motivation. Conclusion: Besides resource constraints, lack of clear policies and limitations related to progress measurement impair the effectiveness of supportive supervision in improving maternal and newborn outcomes. There is a need to reform supportive supervision so that it aids and measures progress not only at the district but also at the health facility level.

Background To strengthen appropriate medicine use (AMU) including the prescribing and dispensing quality at public sector health facilities in Uganda, the Ministry of Health introduced a multipronged approach known as the Supervision, Performance Assessment, and Recognition Strategy (SPARS). This paper assesses the impact of the first year of SPARS implementation on key AMU indicators. Methods District-based health workers trained as supervisors provide in-service training in medicines management complemented by indicator-based performance assessment and targeted supervision during each SPARS facility visit. From 2010 to 2013, health facilities that started the SPARS intervention were assessed during the first and last visit during a period of 12 months of implementing SPARS. This study examines 12 AMU indicators with 57 individual outcomes covering prescribing and dispensing quality. We also explored factors influencing 1-year improvement. Results We found an overall increase in AMU indicators of 17 percentage points (p < 0.000) between the first and last visit during a period of 12 months of supervisions, which was significant in all levels of health care facilities and in both government and private not-for-profit faith-based sectors. Appropriate dispensing (25 percentage points, p < 0.005) improved more than appropriate prescribing (12 percentage points, p = 0.13). Specific facilities that reached an average score of over 75% across all AMU measures within the first year of supervision improved from 3 to 41% from the first visit (baseline). The greatest overall impact on AMU occurred in lower-level facilities; the level of improvement varied widely across indicators, with the greatest improvements seen for the lowest baseline measures. Supervision frequency had a significant impact on level of improvement in the first year, and private not-for-profit faith-based health facilities had notably higher increases in several dispensing and prescribing indicator scores than public sector facilities. Conclusions The multipronged SPARS approach was effective in building appropriate medicine use capacity, with statistically significant improvements in AMU overall and almost all prescribing and dispensing quality measures after 12 months of supervision. We recommend broad dissemination of the SPARS approach as an effective strategy to strengthen appropriate medicine use in low-income countries.

INTRODUCTION: In this study, determinants of improved data consistency for routine immunization information at health facilities was measured to identify associated factors. METHODS: between June and August 2015, 1055 HFs were visited across 44 Local Government Areas in Kano state. We assessed data consistency, frequency of supportive supervision visits, availability of trained staff and attendance to monthly LGA RI review meetings. We compared RI monthly summary forms (MSF) versus national health management information system summary form (NHMIS) and vaccine management form 1a (VM1a) versus HF vaccine utilization summary monthly summary (HFVUM) for consistency. Data consistency at HF was determined at +10% between number of children reportedly immunized, and doses of vaccine opened using 3 antigens (BCG, Penta and Measles). Levels of discrepancy =10% were considered as good data consistency. Bivariate and multivariate analysis used to determine association. RESULTS: data Consistency was observed in 195 (18.5%) HFs between (MSF vs NHMIS) and 90 (8.5%) HFs between (VM1a vs HFVUM). Consistency between MSF vs NHMIS was associated with receiving one or more SS visits in the previous month (p=0.001), data collection tools availability (p=0.001), recent attendance to monthly LGA RI review meeting and availability of trained staff. Data consistency between VM1a form and the HF VU summary was associated with a recent documented SS visit (p=0.05) and availability of trained staff (p=0.05). CONCLUSION: low level of data consistency was observed in Kano. Enhanced SS visits and availability of trained staff are associated with improved data quality.

Abstract Background Progress in health service quality is vital to reach the target of Universal Health Coverage. However, in order to improve quality, it must be measured, and the assessment results must be actionable. We analyzed an electronic tool, which was developed to assess and monitor the quality of primary healthcare in Tanzania in the context of routine supportive supervision. The electronic assessment tool focused on areas in which improvements are most effective in order to suit its purpose of routinely steering improvement measures at local level. Methods Due to the lack of standards regarding how to best measure quality of care, we used a range of different quantitative and qualitative methods to investigate the appropriateness of the quality assessment tool. The quantitative methods included descriptive statistics, linear regression models, and factor analysis; the qualitative methods in-depth interviews and observations. Results Quantitative and qualitative results were overlapping and consistent. Robustness checks confirmed the tool’s ability to assign scores to health facilities and revealed the usefulness of grouping indicators into different quality dimensions. Focusing the quality assessment on processes and structural adequacy of healthcare was an appropriate approach for the assessment’s intended purpose, and a unique key feature of the electronic assessment tool. The findings underpinned the accuracy of the assessment tool to measure and monitor quality of primary healthcare for the purpose of routinely steering improvement measures at local level. This was true for different level and owner categories of primary healthcare facilities in Tanzania. Conclusion The electronic assessment tool demonstrated a feasible option for routine quality measures of primary healthcare in Tanzania. The findings, combined with the more operational results of companion papers, created a solid foundation for an approach that could lastingly improve services for patients attending primary healthcare. However, the results also revealed that the use of the electronic assessment tool outside its intended purpose, for example for performance-based payment schemes, accreditation and other systematic evaluations of healthcare quality, should be considered carefully because of the risk of bias, adverse effects and corruption.

Background: Immunization coverage in Chhattisgarh has never been abysmal but the improvement is rather insignificant over the years. Some more interventions are essential to strengthen different aspects of immunization services such as micro-planning, cold-chain and logistics management, monitoring/supportive supervision, and community mobilization. The present study was considered as a part of ongoing UNICEF funded Project on Supportive Supervision of Routine Immunization in Rajnandgaon district undertaken by the Department of Community Medicine, Government Medical College, and Rajnandgaon CG with the objectives to observe key quality parameters at Ice Lined Refrigerator (ILR) points and to assess knowledge and practice of Vaccine Cold Chain Handler (VCCH). Methods: A facility-based, cross-sectional study (repeat survey) was conducted from May 2017 to June 2018 in the Rajnandgaon district of Chhattisgarh. First phase of the study was conducted from May 2017 to November 2017 and repeat survey was conducted from December 2017 to June 2018. Structured questionnaires as a part of standard tool prescribed by Government of India was used for the collection of required data. Results: The cumulative score status out of all the 50 centres in Rajnandgaon district showed improvement in 35 centres. The score of important components such as vaccine management, equipment maintenance, temperature monitoring, and monitoring and supervision information improved, but that of background information and human resource component decreased. Conclusion: Supportive supervision strategy can be more beneficial in improving the cold chain maintenance process provided that components such as logistic, infrastructure, and manpower are in place to enhance service delivery. Supportive supervision is a continuous process, so regular follow-up and monitoring visits are essential to achieve the targets.

Abstract Background Supportive supervision is one of the interventions that fosters program improvement by way of imparting knowledge and skills to health workers. The basic challenge in supportive supervision is the availability of data in real time for timely and effective feedback. Thus, the main objective of this study was to determine the contribution of real-time data collection during supportive supervision for timely feedback and generation of evidence for health intervention planning. Methods We analyzed supportive supervision records collected through handheld devices employing the open data kit (ODK) platform from July 2015 to June 2016. Supervision was conducted across the country by 592 World Health Organization (WHO) officers. The availability of real-time data and the distance of health facilities to the community were analyzed. Results During the study period, 90,396 health facilities were supervised. The average time spent during supervision varied from 1.53 to 3.78 h across the six geopolitical zones of the country. The average interval between completion of the supervisory checklist and synchronization with the server varied from 3.9 h to 7.5 h. The average distance between the health facility and a ward varied from 5 to 24 km. Conclusion The use of handheld devices for supportive supervision provided real-time data from health facilities to state and zonal levels for analysis and feedback. Program officers used the findings to rectify process indicators in time for a better outcome.

Abstract Background Accurate diagnosis of malaria and reduced reliance on presumptive treatment are crucial components of quality case management. From 2008 to 2012, the Improving Malaria Diagnostics project, in collaboration with the Zambia National Malaria Control Centre, implemented an external quality assurance scheme partially comprised of outreach training and supportive supervision (OTSS) in an effort to improve malaria case management across a spectrum of health facilities performing laboratory-based malaria diagnostics. OTSS assessments were conducted by project-trained laboratory and clinical supervisors on a regular basis and measured changes in health facility staff performance over time. Standardized supervision tools were used for data collection and guided OTSS teams to assess health facility infrastructure, record keeping practices, stores of supplies and consumables, good laboratory practices, and staff adherence to guidelines for the case management and diagnosis of suspected malaria cases via direct observations or record reviews. The structure of OTSS also allowed supervisors to provide ongoing support to clinicians and laboratory staff through regular mentoring and on-the-job training. Results This analysis included 88 laboratories and 64 clinics each with four repeated supervisory assessments. Over the course of the project there were significant declines in the number of laboratories experiencing stock-outs of microscopy reagents/consumables (p

Poor health worker motivation, and the resultant shortages and geographic imbalances of providers, impedes the provision of quality care in low- and middle-income countries (LMICs). This systematic review summarizes the evidence on interventions used to motivate health workers in LMICs. A standardized keyword search strategy was employed across five databases from September 2007 -September 2017. Studies had to meet the following criteria: original study; doctors and/or nurses as target population for intervention(s); work motivation as study outcome; study design with clearly defined comparison group; categorized as either a supervision, compensation, systems support, or lifelong learning intervention; and conducted in a LMIC setting. Two independent reviewers screened 3845 titles and abstracts and, subsequently, reviewed 269 full articles. Seven studies were retained from China (n = 1), Ghana (n = 2), Iran (n = 1), Mozambique (n = 1), and Zambia (n = 2). Study data and risk of bias were extracted using a standardized form. Though work motivation was the primary study outcome, four studies did not provide an outcome definition and five studies did not describe use of a theoretical framework in the ascertainment. Four studies used a randomized trial-group design, one used a non-randomized trial-group design, one used a cross-sectional design, and one used a pretest-posttest design. All three studies that found a significant positive effect on motivational outcomes had a supervision component. Of the three studies that found no effects on motivation, two were primarily compensation interventions and the third was a systems support intervention. One study found a significant negative effect of a compensation intervention on health worker motivation. In conducting this systematic review, we found there is limited evidence on successful interventions to motivate health workers in LMICs. True effects on select categories of health workers may have been obscured given that studies included health workers with a wide range of social and professional characteristics. Robust studies that use validated and culturally appropriate tools to assess worker motivation are greatly needed in the Sustainable Development Goals era. [ABSTRACT FROM AUTHOR]

Background: Despite routine supportive supervision of health service delivery, maternal and newborn outcomes have remained poor in sub-Saharan Africa in general and in Tanzania in particular. There is limited research evidence on factors limiting the effectiveness of supportive supervision in improving the quality of maternal and newborn care. Objective: This study explored enablers of and barriers to supportive supervision in maternal and newborn care at the district and hospital levels in Shinyanga region in Tanzania. Methods: This study employed a qualitative case study design. A purposeful sampling approach was employed to recruit a stratified sample of health system actors: members of the council health management team (CHMT), members of health facility management teams (HMTs), heads of units in the maternity department and health workers. Results: This study identified several barriers to the effectiveness of supportive supervision. First, the lack of a clear policy on supportive supervision. Despite the general acknowledgement of supportive supervision as a managerial mechanism for quality improvement at the district and lower-level health facilities, there is no clear policy guiding it. Second, limitations in measurement of progress in quality improvement; although supportive supervision is routinely conducted to improve maternal and newborn outcomes, efforts to measure progress are limited due to shortfalls in the setting of goals and targets, as well as gaps in M&E. Third, resource constraints and low motivation; that is, the shortage of resources – CHMT supervisors, health staff and funds – results in irregular supervision and low motivation. Conclusion: Besides resource constraints, lack of clear policies and limitations related to progress measurement impair the effectiveness of supportive supervision in improving maternal and newborn outcomes. There is a need to reform supportive supervision so that it aids and measures progress not only at the district but also at the health facility level. [ABSTRACT FROM AUTHOR]

Objective: To determine the treatment success rate among TB patients and associated factors in Anambra and Oyo, the two states with the largest burden of tuberculosis in Nigeria.Methods: A health facility record review for 2016 was conducted in the two states (Anambra and Oyo). A checklist was used to extract relevant information from the records kept in each of the selected DOTS facilities to determine TB treatment success rates. Treatment success rate was defined as the proportion of new smear-positive TB cases registered under DOTS in a given year that successfully completed treatment, whether with bacteriologic evidence of success ('cured') or without ('treatment completed'). Treatment success rate was classified into good (≥85%) and poor (<85%) success rates using the 85% national target for TB treatment outcome. Data were analysed using descriptive statistics and chi-square at P < 0.05.Results: There were 1281 TB treatment enrollees in 2016 in Anambra and 3809 in Oyo (total = 4835). An overall treatment success rate of 75.8% was achieved (Anambra-57.5%; Oyo-82.0%). The percentage cure rates were 61.5% for Anambra and 85.2% for Oyo. Overall, only 28.6% of the facilities in both states (Anambra-0.0%; Oyo-60.0%) had a good treatment success rate. More facilities in Anambra (100.0%) than Oyo (40.0%) had a poor treatment success rate (p < 0.001), as did more private/FBO (100.0%) than public health facilities (60.0%) (p = 0.009). All tertiary facilities had a poor treatment success rate followed by 87.5% of secondary health facilities and 56.5% of primary healthcare facilities (P = 0.035).Conclusion: Treatment success and cure rates in Anambra state were below the 85.0% of the recommended target set by the WHO. Geographical location, and level/tier and type of facility were factors associated with this. Interventions are recommended to address these problems. [ABSTRACT FROM AUTHOR]

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A lack of supportive supervision of operational managers is a disturbing phenomenon in the management of primary healthcare facilities in developing countries. The North West province of South Africa is not exempt from a lack of supportive supervision of operational managers. This occurs despite the burden of disease and a high demand for the provision of quality services. The study explored and described experiences of operational managers regarding supportive supervision by local area managers in the facilities of the North West province. Operational managers' perceptions of how supportive supervision can be facilitated effectively were also described. A qualitative, descriptive, exploratory, and contextual study was conducted. The population comprised operational managers who worked for at least one year in the primary healthcare facilities. Purposive sampling was used and fundamental ethical principles underlying the protection of human participants were adhered to. Four semi-structured in-depth focus group interviews were conducted in the four districts of North West. The analysis of data followed Tesch's method of content analysis. The first theme that surfaced concerned the participants' experiences of factors related to compromised critical aspects of supportive supervision. The second theme embodied experiences of factors related to a lack of the qualities and competencies of a supportive supervisor. Perceptions of how effective supportive supervision of operational managers can be facilitated constituted the third theme. Based on the results, it was apparent that supportive supervision of operational managers in primary healthcare facilities should be enhanced. [ABSTRACT FROM AUTHOR]