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Altaras R, Worges M, La Torre S, Audu BM, Mwangi G, Zeh-Meka A, Yikpotey P, Domkam Kammogne I, Chanda-Kapata P, Vanderick C, Yukich J, Streat E. Outreach Training and Supportive Supervision for Quality Malaria Service Delivery: A Qualitative Evaluation in 11 Sub-Saharan African Countries. Am J Trop Med Hyg 2024; 110:20-34. [PMID: 38320314 PMCID: PMC10919231 DOI: 10.4269/ajtmh.23-0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/28/2023] [Indexed: 02/08/2024] Open
Abstract
Quality improvement of malaria services aims to ensure that more patients receive accurate diagnosis, appropriate treatment, and referral. The Outreach Training and Supportive Supervision Plus (OTSS+) approach seeks to improve health facility readiness and provider competency through onsite supportive supervision, troubleshooting, and on-the-job training. As part of a multicomponent evaluation, qualitative research was conducted to understand the value of the OTSS+ approach for malaria quality improvement. Semistructured key informant interviews, focus group discussions, and structured health facility-based interviews were used to gather stakeholder perspectives at subnational, national, and global levels. Data were collected globally and in 11 countries implementing OTSS+; in-depth data collection was done in four: Cameroon, Ghana, Niger, and Zambia. Study sites and participants were selected purposively. Verbatim transcripts were analyzed thematically, following the Framework approach. A total of 262 participants were included in the analysis; 98 (37.4%) were supervisees, 99 (37.8%) were supervisors, and 65 (24.8%) were other stakeholders. The OTSS+ approach was perceived to improve provider knowledge and skills in malaria service delivery and to improve data and supply management indirectly. Improvements were attributed to a combination of factors. Participants valued the relevance, adaptation, and digitization of supervision checklists; the quality and amount of contact with problem-solving supervisors; and the joint identification of problems and solutions, and development of action plans. Opportunities for improvement were digitized checklist refinement, assurance of a sufficient pool of supervisors, prioritization of health facilities, action plan dissemination and follow-up, and data review and use. The OTSS+ approach was perceived to be a useful quality improvement approach for malaria services.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Joshua Yukich
- Tropical Health, New Orleans, Louisiana
- Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
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Ibikunle OO, Afape AO, Bakare CA, Ipinnimo TM, Ibirongbe DO, Ajidahun EO, Ibikunle AI, Seluwa AG, Akinleye SA, Filani O. Effect of integrated supportive supervision on availability of resources for health care service delivery and uptake of services in Ekiti State, Southwest Nigeria, evidence from the Saving One Million Lives program for result supported facilities. Pan Afr Med J 2024; 47:45. [PMID: 38681113 PMCID: PMC11055192 DOI: 10.11604/pamj.2024.47.45.34291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 01/17/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction a world bank performance-based financing program. The Saving One Million Lives program for results supported integrated supportive supervision (ISS) in selected primary health facilities (PHF) in Ekiti State, Nigeria. The study assessed the impact of ISS on health service outputs and outcomes such as infrastructure, basic equipment, human resources for health (HRH), essential drugs, number of children receiving immunization, number of mothers who gave birth in the facility, number of new and continuing users of modern family planning and the number of pregnant women screened for HIV (human immunodeficiency virus). Methods a cross-sectional survey of 70 SOME-supported facilities was used for the study. Parametric and non-parametric method of analysis was employed to compare the mean values of study indicators gathered over the 4 rounds of ISS visits from January 2018 to August 2020. Results the study demonstrated that ISS approach has a positive effect on PHC service outputs and outcomes such as infrastructure, basic equipment, health human resources (HRH), essential drugs, contraceptives prevalence rate, skilled birth attendant as well as postnatal care. However, there was no significant impact on HIV screening for pregnant women. Conclusion integrated supportive supervision approach has a positive effect on the quality of health care delivery in PHCs in Ekiti State, Nigeria. It is therefore recommended that periodic ISS visits should be routinely carried out in all PHCs across the State in the country and can be further extended to secondary and tertiary facilities.
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Affiliation(s)
| | | | | | | | | | - Esther Opeyemi Ajidahun
- Department of Pediatrics, Wesley Guild Hospital Unit of Obafemi Awolowo University Teaching Hospital Complex, Ilesha, Nigeria
| | | | | | | | - Oyebanji Filani
- Ekiti State Ministry of Health and Human Services, Ado-Ekiti, Nigeria
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George J, Jack S, Gauld R, Colbourn T, Stokes T. Impact of health system governance on healthcare quality in low-income and middle-income countries: a scoping review. BMJ Open 2023; 13:e073669. [PMID: 38081664 PMCID: PMC10729209 DOI: 10.1136/bmjopen-2023-073669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Improving healthcare quality in low-/middle-income countries (LMICs) is a critical step in the pathway to Universal Health Coverage and health-related sustainable development goals. This study aimed to map the available evidence on the impacts of health system governance interventions on the quality of healthcare services in LMICs. METHODS We conducted a scoping review of the literature. The search strategy used a combination of keywords and phrases relevant to health system governance, quality of healthcare and LMICs. Studies published in English until August 2023, with no start date limitation, were searched on PubMed, Cochrane Library, CINAHL, Web of Science, Scopus, Google Scholar and ProQuest. Additional publications were identified by snowballing. The effects reported by the studies on processes of care and quality impacts were reviewed. RESULTS The findings from 201 primary studies were grouped under (1) leadership, (2) system design, (3) accountability and transparency, (4) financing, (5) private sector partnerships, (6) information and monitoring; (7) participation and engagement and (8) regulation. CONCLUSIONS We identified a stronger evidence base linking improved quality of care with health financing, private sector partnerships and community participation and engagement strategies. The evidence related to leadership, system design, information and monitoring, and accountability and transparency is limited.
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Affiliation(s)
- Joby George
- Department of General Practice & Rural Health, University of Otago, Dunedin, New Zealand
| | - Susan Jack
- Te Whatu Ora - Southern, National Public Health Service, Dunedin, New Zealand
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
- Otago Business School, University of Otago, Dunedin, New Zealand
| | | | - Tim Stokes
- Department of General Practice & Rural Health, University of Otago, Dunedin, New Zealand
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Lutwama GW, Sartison LJ, Yugi JO, Nehemiah TN, Gwang ZM, Kibos BA, Jacobs E. Health services supervision in a protracted crisis: a qualitative study into supportive supervision practices in South Sudan. BMC Health Serv Res 2022; 22:1249. [PMID: 36242016 PMCID: PMC9568951 DOI: 10.1186/s12913-022-08637-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/05/2022] [Indexed: 11/21/2022] Open
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08637-4.
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Affiliation(s)
- George William Lutwama
- KIT Health, Royal Tropical Institute, Mauritskade 63, Amsterdam, 1090 HA, The Netherlands.
| | - Lodi Joseph Sartison
- Montrose International, Africa Office, 31b Bukoto Crescent, Naguru, Kampala, P.O. Box 11161, Uganda
| | - James Onyango Yugi
- Montrose International, Africa Office, 31b Bukoto Crescent, Naguru, Kampala, P.O. Box 11161, Uganda
| | - Taban Nickson Nehemiah
- Montrose International, Africa Office, 31b Bukoto Crescent, Naguru, Kampala, P.O. Box 11161, Uganda
| | | | - Barbara Akita Kibos
- Crown Agents Limited, South Sudan Office, Plot 541, Block 3K, 2nd Class Tong Piny, Juba, South Sudan
| | - Eelco Jacobs
- KIT Health, Royal Tropical Institute, Mauritskade 63, Amsterdam, 1090 HA, The Netherlands
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Desta BF, Beshir IA, Tefera BB, Argaw MD, Demeke HZ, Kibret MA. Does frequency of supportive supervisory visits influence health service delivery?-Dose and response study. PLoS One 2020; 15:e0234819. [PMID: 32544186 PMCID: PMC7297318 DOI: 10.1371/journal.pone.0234819] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022] Open
Abstract
High quality care—at a minimum—is a combination of the availability of tangible resources as well as a capable and motivated health workforce. Researchers have suggested that supportive supervision can increase both the performance and motivation of health workers and the quality of care. This study is aimed at assessing the required number of visits and time between visits to bring about improvements in health service delivery. The study employed a primary health care performance improvement conceptual framework which depicts building blocks for improved health service delivery using longitudinal program outcome monitoring data collected from July 2017 to December 2019. The analysis presented in this study is based on 3,080 visits made to 1,479 health centers in the USAID Transform: Primary Health Care project’s intervention districts. To assess the effects of the visits on the repeated measure of the outcome variable (Service-Delivery), multilevel linear mixed model (LMM) with maximum likelihood (ML) estimation was employed. The results showed that there was a significant dose-response relationship that consistent and significant improvement on Service-Delivery indicator was observed from first (β = -26.07, t = -7.43, p < 0.001) to second (β = -21.17, t = -6.00, p < 0.01), third (β = -15.20, t = -4.49, p < 0.02), fourth (β = -12.35, t = -3.58, p < 0.04) and fifth (β = -11.18, t = -2.86, p < 0.03) visits. The incremental effect of the visits was not significant from fifth visit to the sixth suggesting five visits are the optimal number of visits to improve service delivery at the health center level. The time interval between visits also suggested visits made between 6 to 9 months (β = -2.86, t = -2.56, p < 0.01) showed more significant contributions. Therefore, we can conclude that five visits each separated by 6 to 9 months elicits a significant service delivery improvement at health centers.
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Affiliation(s)
- Binyam Fekadu Desta
- USAID Transform: Primary Health Care project, JSI Training & Research Institute, Inc., Addis Ababa, Ethiopia
- * E-mail: ,
| | - Ismael Ali Beshir
- USAID Transform: Primary Health Care project, JSI Training & Research Institute, Inc., Addis Ababa, Ethiopia
| | - Bekele Belayhun Tefera
- USAID Transform: Primary Health Care project, Pathfinder International Ethiopia, Addis Ababa, Ethiopia
| | - Mesele Damte Argaw
- USAID Transform: Primary Health Care project, JSI Training & Research Institute, Inc., Addis Ababa, Ethiopia
| | - Habtamu Zerihun Demeke
- USAID Transform: Primary Health Care project, Pathfinder International Ethiopia, Addis Ababa, Ethiopia
| | - Mengistu Asnake Kibret
- USAID Transform: Primary Health Care project, Pathfinder International Ethiopia, Addis Ababa, Ethiopia
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