Department of Population and Family Health, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY 10032, USA.
John Snow Inc, 2733 Crystal Dr 4th floor, Arlington, VA 22202, USA.
Health Policy Plan. 2021 Jun 3;36(5):720-727. doi: 10.1093/heapol/czaa167.
Adequate supervision is critical to maintain the performance of health workers who provide essential maternal and child health services in low-resource areas. Supportive supervision emphasizing problem-solving, skill development and mentorship has been shown to improve the motivation and effectiveness of health workers, especially at the community level, but it is not always routinely provided. Previous studies have assessed the uptake of supportive supervision among volunteer health workers and paid health centre staff, but less is known about the supervision experiences of paid community-based staff, such as community health nurses (CHNs) in Ghana. This mixed-methods study explores the frequency and content of CHN supervision in five districts in the Greater Accra and Volta regions of Ghana. We analysed quantitative data from 197 satisfaction surveys and qualitative data from 29 in-depth interviews (IDIs) and four focus group discussions (FGDs) with CHNs. While the majority of CHNs received supervision at least monthly, they reported that supervision was primarily focused on meeting clinical targets (48%) rather than on handling specific cases or patients (23%). Over a third (34%) of CHNs did not agree that supervisors help them with job-related challenges and nearly half (43%) were unsatisfied with their jobs. When asked about their mentorship needs, CHNs reported wanting feedback on how to improve their job performance (40%) and encouragement (30%). There were only slight variations in the frequency and content of supervision based on type of supervisor. During IDIs and FGDs, CHNs offered ideas for how to improve supervision, including more frequent field visits so that supervisors could see the on-the-ground realities of their work, greater respect and positive reinforcement. Overall, CHN motivation and job satisfaction may be strengthened by aligning supervision more closely with the principles of supportive supervision.
在资源匮乏地区，为提供基本母婴保健服务的卫生工作者提供充分的监督对于保证其工作表现至关重要。支持性监督强调解决问题、技能发展和指导，已被证明可以提高卫生工作者的积极性和工作效果，尤其是在社区层面，但并非总是例行提供。以前的研究评估了志愿卫生工作者和有偿卫生中心工作人员对支持性监督的接受程度，但对于有偿社区工作人员（如加纳的社区卫生护士 (CHN)）的监督经验了解较少。这项混合方法研究探讨了加纳大阿克拉和沃尔特地区五个区的 CHN 监督频率和内容。我们分析了来自 197 份满意度调查的定量数据和来自 29 次深入访谈 (IDI) 和 4 次焦点小组讨论 (FGD) 的定性数据。尽管大多数 CHN 至少每月接受监督，但他们报告说监督主要侧重于达到临床目标（48%），而不是处理具体案例或患者（23%）。超过三分之一（34%）的 CHN 不同意监督者帮助他们解决工作相关挑战，近一半（43%）对他们的工作不满意。当被问及他们的指导需求时，CHN 报告希望得到有关如何提高工作表现的反馈（40%）和鼓励（30%）。基于监督者的类型，监督的频率和内容只有轻微的变化。在 IDI 和 FGD 期间，CHN 提出了改进监督的想法，包括更频繁的实地访问，以便监督者可以了解他们工作的实际情况，增强对他们的尊重和积极的强化。总体而言，通过更紧密地将监督与支持性监督的原则保持一致，可以增强 CHN 的积极性和工作满意度。
