Does frequency of supportive supervisory visits influence health service delivery?-Dose and response study.

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.