A systematic review of supportive supervision as a strategy to improve primary healthcare services in Sub-Saharan Africa

Abstract

Background: It may be assumed that supportive supervision effectively builds capacity, improves the quality of care provided by frontline health workers, and positively impacts clinical outcomes. Evidence on the role of supervision in Sub-Saharan Africa has been inconclusive, despite the critical need to maximize the workforce in low-resource settings.

Objectives: To review the published literature from Sub-Saharan Africa on the effects of supportive supervision on quality of care, and health worker motivation and performance.

Search strategy: A systematic review of seven databases of both qualitative and quantitative studies published in peer-reviewed journals.

Selection criteria: Selected studies were based in primary healthcare settings in Sub-Saharan Africa and present primary data concerning supportive supervision.

Data collection and analysis: Thematic synthesis where data from the identified studies were grouped and interpreted according to prominent themes.

Main results: Supportive supervision can increase job satisfaction and health worker motivation. Evidence is mixed on whether this translates to increased clinical competence and there is little evidence of the effect on clinical outcomes.

Conclusions: Results highlight the lack of sound evidence on the effects of supportive supervision owing to limitations in research design and the complexity of evaluating such interventions. The approaches required a high level of external inputs, which challenge the sustainability of such models.

Keywords: Job performance; Primary health care; Quality of care; Sub-Saharan Africa; Supervision; Supportive supervision; Systematic review.