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Meta-Analysis
. 2011 Sep 7;2011(9):CD006413.
doi: 10.1002/14651858.CD006413.pub2.

Managerial supervision to improve primary health care in low- and middle-income countries

Xavier Bosch-Capblanch  1 , Sajil Liaqat, Paul Garner
Affiliations
Meta-Analysis

Managerial supervision to improve primary health care in low- and middle-income countries

Xavier Bosch-Capblanch et al. Cochrane Database Syst Rev. .

Abstract

Background: Primary healthcare (PHC) workers often work alone or in isolation. Healthcare managerial supervision is recommended to help assure quality; but this requires skilled supervisors and takes time and resources. It is therefore important to assess to what extent supervision is beneficial and the ways in which it can be implemented.

Objectives: To review the effects of managerial supervision of health workers to improve the quality of PHC (such as adherence to guidance or coverage of services) in low- and middle-income countries.

Search strategy: We searched The Cochrane Central Register of Controlled Trials (CENTRAL) 2011, Issue 1, part of The Cochrane Library. www.thecochranelibrary.com, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (searched 10 March 2011); MEDLINE, Ovid 1950 to March Week 1 2011 (searched 08 March 2011); EMBASE, Ovid 1980 to 2011 Week 12 (searched 08 March 2011); CINAHL, Ebsco 1981 - present (searched 10 March 2011); LILACS, VHL (searched 10 March 2011).

Selection criteria: Randomised controlled trials, controlled before-and-after studies, and interrupted time series studies, conducted in PHC in low- and middle-income countries. Supervision includes site visits from a central level of the health system, plus at least one supervisory activity. We excluded studies aimed solely at improving the clinical skills of PHC workers.

Data collection and analysis: We extracted data using a predefined form and assessed for risk of bias using the EPOC risk of bias criteria. Data are presented in a narrative way without pooling the effects on the outcomes as studies and outcomes were diverse.

Main results: Nine studies met the inclusion criteria: three compared supervision with no supervision, five compared enhanced supervision with routine supervision, and one study compared less intensive supervision with routine supervision. Most outcomes were scores relating to providers' practice, knowledge and provider or user satisfaction. The majority of the outcomes were measured within nine months after the interventions were introduced. In two studies comparing supervision with no supervision, small benefits on provider practice and knowledge were found. For methods of enhancing supervision, we identified five studies, and two studies of frequent supportive supervision demonstrated small benefits on workers performance. The one study examining the impact of less intensive supervision found no evidence that reducing the frequency of visits had any effect on the utilisation of services. The GRADE evidence quality for all comparisons and outcomes was "low" or "very low".

Authors' conclusions: It is uncertain whether supervision has a substantive, positive effect on the quality of primary health care in low- and middle-income countries. The long term effectiveness of supervision is unknown.

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Conflict of interest statement

None declared.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Ayele 1993 {published data only}
    1. Ayele F, Desta A, Larson C. The functional status of community health agents: a trial of refresher courses and regular supervision. Health Policy and Planning 1993;8(4):379‐84.
Foreit 1984 {published data only}
    1. Foreit JR, Foreit KG. Quarterly versus monthly supervision of CBD family planning programs: an experimental study in northeast Brazil. Studies in Family Planning May/June 1984;15(3):112‐20. - PubMed
Kafle 1995 {published data only}
    1. Kafle KK. Intervention test of training supervision and supervision on prescribing. Unpublished. Tribhuvan University: Tribhuvan University,, August 1995.
Loevinsohn 1995 {published data only}
    1. Loevinsohn BP, Erlinda TG, Susan PG. Improving primary health care through systematic supervision: a controlled field trial. Health Policy and Planning 1995;10(2):144‐53. - PubMed
Rowe 2009 {published data only}
    1. Rowe AK, Onikpo F, Lama M, Osterholt DM, Rowe SY, Deming MS. A multifaceted intervention to improve health worker adherence to integrated management of childhood illness guidelines in Benin. American Journal of Public Health 2009;99(5):837‐46. - PMC - PubMed
Sennun 2006 {published data only}
    1. Sennun P, Suwannapong N, Howteerakul N, Pacheun O. Participatory supervision model: building health promotion capacity among health officers and the community. Rural and Remote Health. 2006;6(2):1‐12. - PubMed
Stanback 2007 {published data only}
    1. Stanback J, Griffey S, Lynam P, Ruto C, Cummings S. Improving adherence to family planning guidelines in Kenya: an experiment. International Journal for Quality in Health Care 2007;19(2):68‐73. - PubMed
Trap 2001 {published data only}
    1. Trap B, Todd CH, Moore H, Laing R. The impact of supervision on stock management and adherence to treatment guidelines: a randomized controlled trial. Health Policy and Planning 2001;16(3):273‐80. - PubMed
Uys 2005 {published data only}
    1. Uys LR, Minnaar A, Simpson B, Reid S. The effect of two models of supervision on selected outcomes. Journal of Nursing Scholarship 2005;37(3):282‐8. - PubMed

References to studies excluded from this review

Agampodi 2008 {published data only}
    1. Agampodi SB, Agampodi TC. Effect of low cost public health staff training on exclusive breastfeeding. Indian Journal of Pediatrics 2008;75(11):1115‐9. - PubMed
Armstrong 2004 {published data only}
    1. Armstrong Schellenberg JR, Adam T, Mshinda H, Masanja H, Kabadi G, Mukasa O, et al. Effectiveness and cost of facility‐based Integrated Management of Childhood Illness (IMCI) in Tanzania. Lancet 2004;364(9445):1583‐94. - PubMed
Ashworth 2005 {published data only}
    1. Ashworth NL, Chad KE, Harrison EL, Reeder BA, Marshall SC. Home versus centre based physical activity programs in older adults. Cochrane Database of Systematic Reviews 2005, Issue 1. [DOI: 10.1002/14651858.CD000409.pub2] - DOI - PMC - PubMed
Bang 1994 {published data only}
    1. Bang AT, Bang RA, Sontakke PG. Management of childhood pneumonia by traditional birth attendants. Bulletin of the World Health Organization 1994;72(6):897‐905. - PMC - PubMed
Bang 1999 {published data only}
    1. Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home‐based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet 1999;354(9194):1955‐61. - PubMed
Bradley 2005 {published data only}
    1. Bradley J, Igras S. Improving the quality of child health services: Participatory action by providers. International Journal for Quality in Health Care 2005;17(5):391‐9. - PubMed
Brewster 1997 {published data only}
    1. Brewster DR, Manary MJ, Graham SM. Case management of kwashiorkor: An intervention project at seven nutrition rehabilitation centres in Malawi. European Journal of Clinical Nutrition 1997;51(3):139‐47. - PubMed
Chalker 2001 {published data only}
    1. Chalker J. Improving antibiotic prescribing in Hai Phong Province, Viet Nam: the "antibiotic‐dose" indicator. Bulletin of the World Health Organization 2001;79(4):313‐20. - PMC - PubMed
Chinbuah 2006 {published data only}
    1. Chinbuah A M, Gyapong J O, Pagnoni F, Wellington E K, Gyapong M. Feasibility and acceptability of the use of artemether‐lumefantrine in the home management of uncomplicated malaria in children 6‐59 months old in Ghana. Tropical Medicine & International Health 2006;11(7):1003‐16. - PubMed
Chopra 2005 {published data only}
    1. Chopra M, Patel S, Cloete K, Sanders D, Peterson S. Effect of an IMCI intervention on quality of care across four districts in Cape Town, South Africa. Archives of Disease in Childhood 2005;90(4):397‐401. - PMC - PubMed
Chukwujekwu 2010 {published data only}
    1. Chukwujekwu O, Chabikuli NO, Merrigan M, Awi D, Hamelmann C. Integrating reproductive health and HIV indicators into the Nigerian health system‐‐building an evidence base for action. African Journal of Reproductive Health 2010;14(1):109‐16. - PubMed
Comolet 1997 {published data only}
    1. Comolet TM, Rakotomalala RA, Rasolomahefa D. An evaluation of a district level supervision program. [French]. Cahiers Sante 1997;7(2):103‐8. - PubMed
Conteh 2010 {published data only}
    1. Conteh L, Patouillard E, Kweku M, Legood R, Greenwood B, Chandramohan D. Cost effectiveness of seasonal intermittent preventive treatment using amodiaquine & artesunate or sulphadoxine‐pyrimethamine in Ghanaian children. PLoS ONE 2010;5(8):1‐11. - PMC - PubMed
Curtale 1995 {published data only}
    1. Curtale F, Siwakoti B, Lagrosa C, LaRaja M, Guerra R. Improving skills and utilization of community health volunteers in Nepal. Social Science & Medicine 1995;40(8):1117‐25. - PubMed
Dehne 1995 {published data only}
    1. Dehne KL, Wacker J, Cowley J. Training birth attendants in the Sahel. World Health Forum 1995;16(4):415‐9. - PubMed
De Jong 1996 {published data only}
    1. Jong JTVM. A comprehensive public mental health programme in Guinea‐Bissau: A useful model for African, Asian and Latin‐American countries. Psychological Medicine 1996;26(1):97‐108. - PubMed
Delacollette 1996 {published data only}
    1. Delacollette C, Stuyft P, Molima K. Using community health workers for malaria control: Experience in Zaire. Bulletin of the World Health Organization 1996;74(4):423‐30. - PMC - PubMed
Delgado 1983 {published data only}
    1. Delgado Fernandez JG, Villarreal Gonzalez J, Lopez Uresti S. La clinica del niño sano. Boletín médico del Hospital Infantil de México 1983;40(2):89‐94. - PubMed
Di Sorbo 2010 {published data only}
    1. Sorbo PG, Chifamba DD, Mastrojohn III J, Sisimayi CN, Williams SH. The Zimbabwe rural palliative care initiative: PCI‐Z. J Pain Symptom Manage 2010;40(1):19‐22. - PubMed
Dolo 2010 {published data only}
    1. Dolo A, Diallo M, Saye R, Konaré A, Ouattara A, Poudiougo B, et al. Obstacles to laboratory diagnosis of malaria in Mali‐‐perspectives. Medecine Tropicale : Revue Du Corps De Sante Colonial 2010;70(2):158‐62. - PubMed
Dumont 2005 {published data only}
    1. Dumont A, Gaye A, Mahe P, Bouvier‐Colle MH. Emergency obstetric care in developing countries: impact of guidelines implementation in a community hospital in Senegal. BJOG: An International Journal of Obstetrics & Gynaecology 2005;112(9):1264‐9. - PubMed
Edginton 1999 {published data only}
    1. Edginton ME. Tuberculosis patient care decentralised to district clinics with community‐based directly observed treatment in a rural district of South Africa. International Journal of Tuberculosis & Lung Disease 1999;3(5):445‐50. - PubMed
Fauveau 1991 {published data only}
    1. Fauveau V, Stewart K, Khan SA, Chakraborty J. Effect on mortality of community‐based maternity‐care programme in rural Bangladesh. Lancet 1991;338(8776):1183‐6. - PubMed
Floyd 2003 {published data only}
    1. Floyd K, Skeva J, Nyirenda T, Gausi F, Salaniponi F. Cost and cost‐effectiveness of increased community and primary care facility involvement in tuberculosis care in Lilongwe District, Malawi. International Journal of Tuberculosis & Lung Disease 2003;7(9 SUPPL 1):S29‐37. - PubMed
Frazao 2009 {published data only}
    1. Frazao P, Marques D. Effectiveness of a community health worker program on oral health promotion. Revista de Saúde Pública 2009;43(3):463‐71. - PubMed
Ghoneim 2004 {published data only}
    1. Ghoneim EH, Hassan MH, Amine EK. An intervention programme for improving the nutritional status of children. Eastern Mediterranean Health Journal November 2004; Vol. 10, issue 6:828‐43. - PubMed
Giugliani 2010 {published data only}
    1. Giugliani C, Duncan BB, Harzheim E, Breysse S, Jarrige L. The impact of a short‐term intervention using the WHO guidelines for the management of severe malnutrition at a rural facility in Angola. Archives of Disease in Childhood 2010;95(3):198. - PubMed
Grosskurth 1995 {published data only}
    1. Grosskurth H, Mosha F, Todd J, Mwijarubi E, Klokke A, Senkoro K, et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet 1995;346(8974):530‐6. - PubMed
Grosskurth 2000 {published data only}
    1. Grosskurth H, Mwijarubi E, Todd J, Rwakatare M, Orroth K, Mayaud P, et al. Operational performance of an STD control programme in Mwanza Region, Tanzania. Sexually Transmitted Infections. 2000;76(6):426‐36, 2000 Dec.. - PMC - PubMed
Hayes 2005 {published data only}
    1. Hayes RJ, Changalucha J, Ross DA, Gavyole A, Todd J, Obasi AI, et al. The MEMA kwa Vijana project: design of a community randomised trial of an innovative adolescent sexual health intervention in rural Tanzania. Contemporary Clinical Trials 2005;26(4):430‐42. - PubMed
Hidalgo 1997 {published data only}
    1. Hidalgo CG, Cabezas AM, Collados M. Clima organizacional en un centro de salud de atención primaria: evaluación e intervención para mejorar la satisfacción laboral del equipo de salud. Cuadernos medico socials 1997;38(3):3‐12.
Hill 2000 {published data only}
    1. Hill AG, MacLeod WB, Joof D, Gomez P, Ratcliffe AA, Walraven G. Decline of mortality in children in rural Gambia: The influence of village‐level Primary Health Care. Tropical Medicine & International Health 2000;5(2):107‐18. - PubMed
Htay 2003 {published data only}
    1. Htay TT, Sauvarin J, Khan S. Integration of post‐abortion care: The role of township medical officers and midwives in Myanmar. Reproductive Health Matters 2003;11(21):27‐36. - PubMed
Irawati 2007 {published data only}
    1. Irawati SR, Basri C, Arias MS, Prihatini S, Rintiswati N, Voskens J, et al. Hospital DOTS linkage in Indonesia: A model for DOTS expansion into government and private hospitals. International Journal of Tuberculosis & Lung Disease 2007;11(1):33‐9. - PubMed
Jacquier 2000 {published data only}
    1. Jacquier NM, Dos Santos L. Evaluacion operativa de la cadena de frío de las vacunas. Desafios 2000;1(5):62‐5.
Janowitz 2000 {published data only}
    1. Janowitz B, Chege J, Thompson A, Rutenberg N, Homan R. Community‐based distribution in Tanzania: costs and impacts of alternative strategies to improve worker performance. International Family Planning Perspectives 2000;26(4):158‐60 & 193‐5.
Jaramillo 2001 {published data only}
    1. Arias IJ, Palomino AI, Pasmio de Osorio S, Pinzon BF. Mejoramiento continuo de la atencion prenatal y su impacto en la mortalidad perinatal en dos instituciones de salud de Popayan. Revista Colombiana De Obstetricia Y Ginecologia 2001;52(1):33‐42.
Jin 1993 {published data only}
    1. Jin BW, Kim SC, Mori T, Shimao T. The impact of intensified supervisory activities on tuberculosis treatment. Tubercle & Lung Disease 1993;74(4):267‐72. - PubMed
Kafle 2009 {published data only}
    1. Kafle KK, Bhuju GB, Karkee SB, Prasad RR, Shrestha N, Shrestha AD, et al. An intervention improving prescribing practices and monitoring drugs availability in a district.. Nepal Medical College Journal 2009;11(4):217‐21. - PubMed
Katabarwa 2005 {published data only}
    1. Katabarwa MN, Habomugisha P, Richards Jr FO, Hopkins D. Community‐directed interventions strategy enhances efficient and effective integration of health care delivery and development activities in rural disadvantaged communities of Uganda. Tropical Medicine & International Health 2005;10(4):312‐21. - PubMed
Kelly 2001 {published data only}
    1. Kelly PM. Local problems, local solutions: Improving tuberculosis control at the district level in Malawi. Bulletin of the World Health Organization 2001;79(2):111‐7. - PMC - PubMed
Kim 2002 {published data only}
    1. Kim Y‐M, Figueroa ME, Martin A, Silva R, Acosta SF, Hurtado M, et al. Impact of supervision and self‐assessment on doctor‐patient communication in rural Mexico. International Journal for Quality in Health Care 2002;14(5):359‐67. - PubMed
Kirkwood 2010 {published data only}
    1. Kirkwood BR, Manu A, Tawiah‐Agyemang C, Asbroek G, Gyan T, Weobong B, et al. NEWHINTS cluster randomised trial to evaluate the impact on neonatal mortality in rural Ghana of routine home visits to provide a package of essential newborn care interventions in the third trimester of pregnancy and the first week of life: Trial protocol. Trials 2010;11:58. - PMC - PubMed
Lamboray 1979 {published data only}
    1. Lamboray JL. The rural health area of Kisantu, Zaire: Rationalisation of the primary consultation; supervision and evaluation; integration of the services. [French]. Annales de la Société Belge de Médecine Tropicale 1979;59 Suppl:15‐32.
Libamba 2006 {published data only}
    1. Libamba E, Makombe S, Mhango E, Teck ODA, Limbambala E, Schouten E, et al. Supervision, monitoring and evaluation of nationwide scale‐up of antiretroviral therapy in Malawi. Bulletin of the World Health Organization 2006;84(4):320‐6. - PMC - PubMed
Libamba 2007 {published data only}
    1. Libamba E, Makombe SD, Harries AD, Schouten EJ, Yu JK‐L, Pasulani O, et al. Malawi's contribution to '3 by 5': Achievements and challenges. Bulletin of the World Health Organization 2007;85(2):156‐60. - PMC - PubMed
Lofmark 2010 {published data only}
    1. Lofmark A, Thorell‐Ekstrand I. Strengthening and updating supervising staff nurses in educational workshops ‐ An international partnership project. Nurse Education in Practice 2010;10(5):262‐7. - PubMed
Lynch 1994 {published data only}
    1. Lynch O, Derveeuw M. The impact of training and supervision on traditional birth attendants. Tropical Doctor 1994;24(3):103‐7. - PubMed
Maung 2006 {published data only}
    1. Maung M, Kluge H, Aye T, Maung W, Noe P, Zaw M, et al. Private GPs contribute to TB control in Myanmar: Evaluation of a PPM initiative in Mandalay Division. International Journal of Tuberculosis & Lung Disease 2006;10(9):982‐7. - PubMed
Mogassale 2010 {published data only}
    1. Mogasale V, Wi TC, Das A, Kane S, Singh AK, George B, et al. Quality assurance and quality improvement using supportive supervision in a large‐scale STI intervention with sex workers, men who have sex with men/transgenders and injecting‐drug users in India. Sexually Transmitted Infections 2010;86:i83‐8. - PMC - PubMed
Osterholt 2006 {published data only}
    1. Osterholt DM, Rowe AK, Hamel MJ, Flanders WD, Mkandala C, Marum LH, et al. Predictors of treatment error for children with uncomplicated malaria seen as outpatients in Blantyre district, Malawi. Tropical Medicine & International Health 2006;11(8):1147‐56. - PubMed
PAHO 1999 {published data only}
    1. Pan American Health Organisation. Nursing and Midwifery Making a Difference PANMCC Meeting, 7‐8 October 1998. The Pan American Network of Nursing and Midwifery Collaborating Centers. Organization and Management of Health Systems and Services. 1999, issue 18.
PAHO 1999a {published data only}
    1. Pan American Health Organisation. Nursing in the Regions of the Americas. Series Organization and Management of Health Systems and Services 1999; Vol. 16.
PAHO 2005 {published data only}
    1. Pan American Health Organisation. Report on the activities of the internal oversight services. 136th Session of the Executive Committee, Buenos Aires, Argentina, 20‐24 June 2005. Provisional Agenda Item 5.4 19 May 2005, issue CE136/21.
Powell 1989 {published data only}
    1. Powell C, Grantham‐McGregor S. Home visiting of varying frequency and child development. Pediatrics 1989;84(1):157‐64. - PubMed
Rao 1998 {published data only}
    1. Rao BR, Krishnamurthy P. A comparative study of the cost and effectiveness of a modified system of MDT drug delivery system in a high endemic district (Nalagonda) of South India. Indian Journal of Leprosy 1998;70(SUPPL.):63S‐71S. - PubMed
Reynolds 2008 {published data only}
    1. Reynolds HW, Toroitich‐Ruto C, Nasution M, Beaston‐Blaakman A, Janowitz B. Effectiveness of training supervisors to improve reproductive health quality of care: a cluster‐randomized trial in Kenya. Health Policy & Planning 2008;23(1):56‐66. - PubMed
Ronsmans 2001 {published data only}
    1. Ronsmans C, Endang A, Gunawan S, Zazri A, McDermott J, Koblinsky M, et al. Evaluation of a comprehensive home‐based midwifery programme in South Kalimantan, Indonesia. Tropical Medicine & International Health 2001;6(10):799‐810. - PubMed
Roos 1995 {published data only}
    1. Roos BR, Brakel WH, Chaurasia AK. Integration of leprosy control into basic health services; An example from Nepal. International Journal of Leprosy 1995;63(3):422‐9. - PubMed
Ross 2007 {published data only}
    1. Ross DA, Changalucha J, Obasi AI, Todd J, Plummer ML, Cleophas‐Mazige B, et al. Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community‐randomized trial. AIDS 2007;21(14):1943‐55. - PubMed
Sujpluem 1981 {published data only}
    1. Sujpluem C, Kanchanasinith K, Narkavonakit T. Thailand: Utilization of TBAs in family planning and maternal and child care. Public Health Papers 1981;75:167‐204. - PubMed
Thiam 2007 {published data only}
    1. Thiam S, LeFevre AM, Hane F, Ndiaye A, Ba F, Fielding KL, et al. Effectiveness of a strategy to improve adherence to tuberculosis treatment in a resource‐poor setting: a cluster randomized controlled trial. JAMA 2007;297(4):380‐6. - PubMed
Tirado 1990 {published data only}
    1. Tirado NC, Guzman M, Burgos FL. Workload contribution of a physician assistant in an ambulatory care setting. Puerto Rico Health Sciences Journal 1990;9(2):165‐7. - PubMed
Wasunna 2010 {published data only}
    1. Wasunna B, Zurovac D, Bruce J, Jones C, Webster J, Snow RW. Health worker performance in the management of paediatric fevers following in‐service training and exposure to job aids in Kenya. Malaria Journal 2010;9(1):231. - PMC - PubMed
Wesson 2008 {published data only}
    1. Wesson J, Olawo A, Bukusi V, Solomon M, Pierre‐Louis B, Stanback J, et al. Reaching providers is not enough to increase iud use: A factorial experiment of 'academic detailing' in Kenya. Journal of Biosocial Science 2008;40(1):69‐82. - PubMed
Zenni 1996 {published data only}
    1. Zenni E A, Robinson T N. Effects of structured encounter forms on paediatric house staff knowledge. Archives of Pediatrics & Adolescent Medicine 1996;150(9):975‐80. - PubMed

Additional references

Aitken 1994
    1. Aitken JM. Voices from the inside: managing district health services in Nepal. International Journal of Health Planning and Management 1994;9(4):309‐40. - PubMed
Bennet 1994
    1. Bennet S, Dakpalla G, Garner P, Gilson L, Nittayaramphong S, Zurita B, et al. Carrot and stick: state mechanisms to influence private behaviour. Health Policy and Planning 1994;9(1):1‐13. - PubMed
Bosch‐Capblanch 2008
    1. Bosch‐Capblanch X, Garner P. Primary health care supervision in developing countries. Tropical Medicine and International Health 2008;13(3):369‐83. - PubMed
Burns 1998
    1. Burns CB, Clough AR, Currie BJ, Thomsen P, Wirudjal R. Resource requirements to develop a large, remote Aboriginal health service: Whose responsibility?. Australian and New Zealand Journal of Public Health 1998;22(1):133‐9. - PubMed
Cairncross 1997
    1. Cairncross S, Periès H, Cutts F. Vertical health programmes. Lancet 1997;349(supl III):20‐2.
Cueto 2004
    1. Cueto M. The origins of primary health care and selective primary health care. American Journal of Public Health 2004;94(11):1864‐74. - PMC - PubMed
EPOC 2002
    1. EPOC. The data collection checklist. 2002.
Flahault 1988
    1. Flahault D, Piot M, Franklin A. The supervision of health personnel at district level. Geneva: World Health Organization, 1988.
Gill 1990
    1. Gill W (ed). Community Health Workers in national programmes. Just another pair of hands?. Philadelphia: Open University Press, 1990.
Greenwood 1990
    1. Greenwood BM, Bradley AK, Byass P, Greenwod AM, Menon A, Snow RW, et al. Evaluation of a primary health care programme in The Gambia. II Its impact on mortality and morbidity in young children. Journal of Tropical Medicine and Hygiene 1990;93:87‐97. - PubMed
Kilminster 2000
    1. Kilminster SM, Jolly BC. Effective supervision in clinical practice settings: a literature review. Medical Education 2000;34(10):827‐40. - PubMed
Kleczkowski 1984
    1. Kleczkowski BM, Elling RH, Smith DL. Health system support for primary health care. A study based on the technical discussions held during the thirty‐fourth World Health Assembly, 1981. Public Health Papers 1984;80:1–104. - PubMed
Lin 2006
    1. Lin IB, Goodale BJ. Improving the supervision of therapy assistants in Western Australia: the Therapy Assistant Project (TAP). Rural and Remote Health 2006; Vol. 1. - PubMed
MAQ 2002
    1. MAQ. Making Supervisions Supporting and Sustainable: A new Approach to old Problems. Maximising Access and Quality. MAQ Paper No. 4.
McMahon 1992
    1. McMahon R, Barton E, Piot M. On being in charge. A guide to management in primary health care. 2nd Edition. Geneva: WHO, 1992.
Ministerial 2002
    1. Rural health in rural hands. Strategic directions for rural, remote, northern, aboriginal communities. Ministerial Advisory Council on Rural Health 2002.
O'Brien 2008
    1. O'Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard‐Jensen J, Kristoffersen DT, et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD000409.pub2] - DOI - PMC - PubMed
WHO 1978a
    1. WHO. Joint report of the Director‐General of the World Health Organization and the Executive Director of the United Nations Children's Fund. Primary Health Care. Report of the International Conference on Primary Health Care. Alma‐Ata (USSR). Geneva: WHO, 1978:Primary Health Care. Report of the International Conference on Primary Health Care. Alma‐Ata (USSR). WHO. Geneva 1978.
WHO 1978b
    1. WHO. Declaration of Alma‐Ata. International Conference on Primary Health Care, Alma‐Ata, USSR, 6‐12 September 1978. 1978. - PubMed
WHO 1991
    1. WHO. Community involvement in health development: challenging health services. WHO Technical Report Series. Geneva, 1991; Vol. 809. - PubMed
WHO 1994
    1. WHO. Ninth General Programme of Work covering the period 1996‐2001. Health for All series. Geneva: WHO, 1994; Vol. 11.
World Bank
    1. World Bank. Data and Statistics. Country Classification. http://web.worldbank.org/WBSITE/EXTERNAL/DATASTATISTICS/0,,contentMDK:20... Accessed 19/09/06.

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