Systematic review of performance-enhancing health worker supervision approaches in low- and middle-income countries

Human Resources for Health

Mekdelawit Bayu¹  Sarah S. Abdullah¹  Rachel Deussom¹  Doris Mwarey²  Rachel Marcus³ 

[1] HRH2030 Program, Chemonics International, 1717 H Street NW, 20006, Washington, DC, United States of America;Human Resources for Health Consultant, Formerly With Chemonics International, PO Box 26432–00100, Nairobi, Kenya;Office of Health Systems, Bureau for Global Health, United States Agency for International Development, 1300 Pennsylvania Avenue NW, 20004, Washington, DC, United States of America;

关键词: Human resources for health;    Health workforce;    Workforce development;    Supportive supervision;    Health systems;    Performance management;    Enhanced supervision;    Systematic review;    Quality improvement;   

DOI  :  10.1186/s12960-021-00692-y

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsThe 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.ResultsOf 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.ConclusionBuilding 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.

【 授权许可】

CC BY