The effectiveness of supervision strategies to improve health care provider practices in low- and middle-income countries: secondary analysis of a systematic review

Although supervision is a ubiquitous approach to support health programs and improve health care provider (HCP) performance in low- and middle-income countries (LMICs), quantitative evidence of its effects is unclear. The objectives of this study are to describe the effect of supervision strategies...

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Bibliographic Details
Published in:Human resources for health 2022-01, Vol.20 (1), p.1-1, Article 1
Main Authors: Rowe, Samantha Y, Ross-Degnan, Dennis, Peters, David H, Holloway, Kathleen A, Rowe, Alexander K
Format: Article
Language:English
Subjects:
Bias
Community support
Demographic aspects
Developing Countries
Evaluation
Feedback
Health care
Health care industry
Health education
Health Personnel
Health workers
Humans
Interrupted Time Series Analysis
Intervention
Malaria
Management
Peer review
Poverty
Problem solving
Quality improvement
Services
Supervision
Supervision of employees
Systematic review
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Summary:Although supervision is a ubiquitous approach to support health programs and improve health care provider (HCP) performance in low- and middle-income countries (LMICs), quantitative evidence of its effects is unclear. The objectives of this study are to describe the effect of supervision strategies on HCP practices in LMICs and to identify attributes associated with greater effectiveness of routine supervision. We performed a secondary analysis of data on HCP practice outcomes (e.g., percentage of patients correctly treated) from a systematic review on improving HCP performance. The review included controlled trials and interrupted time series studies. We described distributions of effect sizes (defined as percentage-point [%-point] changes) for each supervision strategy. To identify attributes associated with supervision effectiveness, we performed random-effects linear regression modeling and examined studies that directly compared different approaches of routine supervision. We analyzed data from 81 studies from 36 countries. For professional HCPs, such as nurses and physicians, primarily working at health facilities, routine supervision (median improvement when compared to controls: 10.7%-points; IQR: 9.9, 27.9) had similar effects on HCP practices as audit with feedback (median improvement: 10.1%-points; IQR: 6.2, 23.7). Two attributes were associated with greater mean effectiveness of routine supervision (p 
ISSN:1478-4491
1478-4491
DOI:10.1186/s12960-021-00683-z