District health managers’ perceptions of supervision in Malawi and Tanzania

Human Resources for Health

Eilish McAuliffe⁴  Camille Boostrom⁴  Rachel Waxman¹  Helen de Pinho¹  Honorati Masanja³  Francis Kamwendo²  Susan Bradley⁴ 

[1] Averting Maternal Death and Disability Program (AMDD), Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA;University of Malawi, College of Medicine, Centre for Reproductive Health, Blantyre, Malawi;Ifakara Health Institute, Dar Es Salaam, Tanzania;Centre for Global Health, University of Dublin, Trinity College, Dublin, Ireland

关键词: Measuring performance;    Supervision paradigm;    District health management;    Tanzania;    Malawi;    Mid-level cadres;    Supervision;   

Others  :  822364
DOI  :  10.1186/1478-4491-11-43

 received in 2013-04-18, accepted in 2013-08-11,  发布年份 2013

【 摘 要 】

Background

Mid-level cadres are being used to address human resource shortages in many African contexts, but insufficient and ineffective human resource management is compromising their performance. Supervision plays a key role in performance and motivation, but is frequently characterised by periodic inspection and control, rather than support and feedback to improve performance. This paper explores the perceptions of district health management teams in Tanzania and Malawi on their role as supervisors and on the challenges to effective supervision at the district level.

Methods

This qualitative study took place as part of a broader project, “Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers”. Semi-structured interviews were conducted with 20 district health management team personnel in Malawi and 37 council health team members in Tanzania. The interviews covered a range of human resource management issues, including supervision and performance assessment, staff job descriptions and roles, motivation and working conditions.

Results

Participants displayed varying attitudes to the nature and purpose of the supervision process. Much of the discourse in Malawi centred on inspection and control, while interviewees in Tanzania were more likely to articulate a paradigm characterised by support and improvement. In both countries, facility level performance metrics dominated. The lack of competency-based indicators or clear standards to assess individual health worker performance were considered problematic. Shortages of staff, at both district and facility level, were described as a major impediment to carrying out regular supervisory visits. Other challenges included conflicting and multiple responsibilities of district health team staff and financial constraints.

Conclusion

Supervision is a central component of effective human resource management. Policy level attention is crucial to ensure a systematic, structured process that is based on common understandings of the role and purpose of supervision. This is particularly important in a context where the majority of staff are mid-level cadres for whom regulation and guidelines may not be as formalised or well-developed as for traditional cadres, such as registered nurses and medical doctors. Supervision needs to be adequately resourced and supported in order to improve performance and retention at the district level.

【 授权许可】

   
2013 Bradley et al.; licensee BioMed Central Ltd.

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