Vital to efficient health systems are health workers who provide high-quality and safe health services. Health workers are held accountable for their performance and motivated to provide optimal care through supervision. For decades, global health policymakers and practitioners in low- and middle-income countries have been instituting health worker supervision with a multitude of approaches and objectives. However, there is insufficient documentation on which supervisory approaches have been successfully implemented, sustainably-scaled, and/or are most effective, bearing measurable results. There is also little evidence on the direct attribution of supervision beyond human resources for health performance, motivation and satisfaction, to improved clinical and health outcomes. Documentation on how to adapt, implement, monitor, improve, scale up and sustain, and measure impact of health workforce supervision approaches is sparse.
USAID recognizes the need to collect this information so that global health practitioners and human resources managers can adapt best practices to their context and ensure sustainable, quality health worker performance. In their 2017 report, Acting on the Call to End Preventable Child and Maternal Deaths: A Focus on Health Systems, USAID defines enhanced supervision as “a broad set of supervisory interventions that improve provider performance through team-based, learning approaches, including supportive supervision, the use of checklists, and in-person visits.” The report notes that enhanced supervision may have the highest potential impact of all health systems interventions.
Phase I (completed): HRH2030 documented several of the most promising supervision systems or approaches – the combination or type of enhanced supervision which has the greatest likelihood of improving health outcomes, and how these best practices can be scaled up – to aid policymakers and program managers to design and mobilize resources for effective health systems strengthening. Findings can be found here.
Phase II (ongoing): HRH2030 is conducting operations research in Mali and the Philippines to determine the most impactful enhancements for health workforce supervision and to quantify what direct effects enhanced supervision can have on health worker and supervisor performance, client satisfaction, and/or service delivery improvements, including for maternal, newborn, and child health; family planning; and reproductive health.