Centre for Global Health, Trinity College Dublin, Dublin, Ireland.
School of Medicine, University College Dublin, Dublin, Ireland.
Hum Resour Health. 2017 Aug 30;15(1):57. doi: 10.1186/s12960-017-0225-0.
A systematic and structured approach to the support and supervision of health workers can strengthen the human resource management function at the district and health facility levels and may help address the current crisis in human resources for health in sub-Saharan Africa by improving health workers' motivation and retention.
A supportive supervision programme including (a) a workshop, (b) intensive training and (c) action learning sets was designed to improve human resource management in districts and health facilities in Tanzania. We conducted a randomised experimental design to evaluate the impact of the intervention. Data on the same measures were collected pre and post the intervention in order to identify any changes that occurred (between baseline and end of project) in the capacity of supervisors in intervention a + b and intervention a + b + c to support and supervise their staff. These were compared to supervisors in a control group in each of Tanga, Iringa and Tabora regions (n = 9). A quantitative survey of 95 and 108 supervisors and 196 and 187 health workers sampled at baseline and end-line, respectively, also contained open-ended responses which were analysed separately.
Supervisors assessed their own competency levels pre- and post-intervention. End-line samples generally scored higher compared to the corresponding baseline in both intervention groups for competence activities. Significant differences between baseline and end-line were observed in the total scores on 'maintaining high levels of performance', 'dealing with performance problems', 'counselling a troubled employee' and 'time management' in intervention a + b. In contrast, for intervention a + b + c, a significant difference in distribution of scores was only found on 'counselling a troubled employee', although the end-line mean scores were higher than their corresponding baseline mean scores in all cases. Similar trends to those in the supervisors' reports are seen in health workers data in terms of more efficient supervision processes, although the increases are not as marked.
A number of different indicators were measured to assess the impact of the supportive supervision intervention on the a + b and a + b + c intervention sites. The average frequency of supervision visits and the supervisors' competency levels across the facilities increased in both intervention types. This would suggest that the intervention proved effective in raising awareness of the importance of supervision and this understanding led to action in the form of more supportive supervision.
系统和结构化的卫生工作者支持和监督方法可以加强地区和卫生机构层面的人力资源管理职能，并通过提高卫生工作者的积极性和保留率，帮助解决撒哈拉以南非洲目前的人力资源危机。
设计了一个支持性监督方案，包括（a）研讨会、（b）强化培训和（c）行动学习小组，以改善坦桑尼亚地区和卫生机构的人力资源管理。我们采用随机对照实验设计来评估干预措施的影响。在干预前后收集了相同措施的数据，以确定干预 a+b 和干预 a+b+c 中的监督者在支持和监督其工作人员方面的能力是否发生了变化（在基线和项目结束之间）。在坦噶、伊林加和塔波拉地区的对照组中，对每组 9 名监督者进行了比较（n=9）。在基线和终点分别对 196 名和 187 名卫生工作者进行了 95 名和 108 名监督者的定量调查，还分别分析了开放式回答。
监督者在干预前后评估了自己的能力水平。在干预组中，终点样本的总分一般高于基线，在“保持高水平绩效”、“处理绩效问题”、“辅导有问题的员工”和“时间管理”方面的得分均高于基线。相比之下，对于干预 a+b+c，只有在“辅导有问题的员工”方面发现了得分分布的显著差异，尽管所有情况下终点的平均得分都高于相应的基线平均得分。在卫生工作者的数据中，也可以看到与监督者报告相似的趋势，即监督过程更加高效，尽管增加幅度不大。
使用了多种不同的指标来评估支持性监督干预对干预 a+b 和 a+b+c 干预地点的影响。在这两种干预类型中，设施的监督访问平均频率和监督者的能力水平都有所提高。这表明干预措施在提高监督重要性的认识方面是有效的，而这种理解导致了更多支持性监督的行动。
