Glob Health Sci Pract. 2022 Sep 15;10(Suppl 1). doi: 10.9745/GHSP-D-21-00667.
Supportive supervision and mentoring (SSM) is crucial to primary care quality and effectiveness. Yet, there is little clarity on how to design and implement SSM and make it sustainable in primary health care (PHC) systems. The 3 African Health Initiative partnership projects introduced strategies to do this in Ethiopia, Ghana, and Mozambique. We describe: (1) how each partnership adapted SSM implementation strategies, (2) the dynamics of implementation and change that ensued after intervening within PHC systems, and (3) insights on the SSM sustainability as a mainstay of PHC.
Researchers from each project collaboratively wrote a cross-country protocol based on those objectives. For this, they adapted implementation science frameworks-the Exploration, Preparation, Implementation, and Sustainment model and the Consolidated Framework for Implementation Research-through a qualitative theme reduction process. This resulted in harmonized lines of inquiry on the design, implementation, and potential sustainability of each project's SSM strategy. In-depth interviews and focus group discussions were conducted with stakeholders from PHC systems in each country and thematic analyses ensued.
Across the projects, SSM strategies acquired multiple components to address individual, systems, and process-related determinants. Benefits arose from efforts that addressed worker-level attitudes and barriers, promoted a wider learning environment, and enhanced collaborative structures and tools for monitoring performance. Peer exchanges and embedded implementation research were critical to the perceived effectiveness of SSM strategies.
Despite differences in their approach to SSM implementation, there are common crucial ingredients across the SSM strategies of the 3 AHI partner projects from which important lessons arise: (1) positioning learning and adaptation opportunities within the routine workings of PHC systems, facilitation, and technical support to reflect and utilize new knowledge; (2) multisectoral collaboration, particularly with academic organizations; and (3) building PHC decision-makers' and implementation teams' capacity for evidence-informed change.
支持性监督和指导（SSM）对初级保健的质量和效果至关重要。然而，对于如何设计和实施 SSM 并使其在初级卫生保健（PHC）系统中可持续发展，仍缺乏清晰的认识。三个非洲卫生倡议合作项目在埃塞俄比亚、加纳和莫桑比克引入了相关策略。我们描述了：（1）每个合作项目如何调整 SSM 实施策略，（2）在干预 PHC 系统后随之而来的实施和变革动态，以及（3）作为 PHC 支柱的 SSM 可持续性的见解。
每个项目的研究人员都根据这些目标合作编写了一份跨国协议。为此，他们通过定性主题缩减过程改编了实施科学框架——探索、准备、实施和维持模型以及综合实施研究框架——使其适用于每个项目 SSM 策略的设计、实施和潜在可持续性。对每个国家 PHC 系统的利益相关者进行了深入访谈和焦点小组讨论，并进行了主题分析。
在整个项目中，SSM 策略获得了多个组件，以解决个人、系统和过程相关的决定因素。通过解决工人层面的态度和障碍、促进更广泛的学习环境以及增强协作结构和监测绩效的工具，取得了效益。同行交流和嵌入式实施研究对 SSM 策略的有效性至关重要。
尽管在实施 SSM 的方法上存在差异，但这三个 AHI 合作伙伴项目的 SSM 策略具有一些共同的关键要素，从中可以得出重要的经验教训：（1）在 PHC 系统的常规运作、促进和技术支持中定位学习和适应机会，以反映和利用新知识；（2）多部门合作，特别是与学术组织；（3）增强 PHC 决策者和实施团队的循证变革能力。
