Transcript An in-depth exploration of health worker supervision in

UNIVERSITY
EDUARDO
MONDLANE
Faculty of Medicine
An in-depth exploration of health worker
supervision in Malawi and Tanzania
Susan Bradley, Centre for Global Health, TCD
& HSSE team
Supported by:
Irish Aid & Ministry of Foreign Affairs, Denmark
Part of the larger HSSE study
Objectives
• Describe DHMT perceptions of the role
and purpose of supervision
• Explore the problems faced in instituting
regular supportive supervision in their
health facilities
Methods
• Semi-structured interviews, covering a range of
HRM issues
• Malawi - 26/28 districts; n=20, District Health
Officers, District Nursing Officers, and a small
number of Human Resources Officers
• Tanzania - Random selection of one region in
each of Tanzania’s 8 zones; all districts in these
regions; n=39, District Health Secretaries,
Reproductive and Child Health Coordinators,
District Medical Officers and one District Nursing
Officer
Results - Malawi
• Wide range of attitudes to the nature and
purpose of the supervision process
• More discourse centred on inspection and
control
• Lack of clarity about systems and processes
• Lack of appraisal system or other mechanisms
to measure individual staff performance
• Some DHMT calls for a change to supervision
that is a supportive, continuous process
Results - Tanzania
• Broad agreement on a supervision paradigm
of support and improvement
• More discussion of supervision’s links to
performance and motivation of staff
• Clear systems reported – MOHSW supervision
guidelines, MTUHA logbooks, OPRAS (open
performance appraisal system) being
introduced
Barriers to effective supervision
HRM policy – implementation gap
• Plans for what to do, but not how to do it
• Lack of skills or HRM capacity
• Conflicting responsibilities and demands on
DHMT/senior facility staff time
• Finances, transport and accessibility
• National changes in SOP not communicated to
district level
Key findings
• Recognition that health workers need to be supported
and appreciated; lack of mechanisms to measure or
reward effort, or support performance
• Task shifting - link to underperformance of signal
functions despite being trained; implications for QOC
“...large numbers is nothing on its own. It is better to have
numbers of good quality…they need to be followed up,
supervised…when they start working. Not that after the
training just dump them...” DHO, Malawi
Recommendations
• Prioritisation and adequate resourcing of
supervision as a key HRM activity
• Increase MOH commitment to supportive
supervision as a mechanism to monitor and
improve QOC
• Strengthen HRM practice at district level and
facility level
• Shift the focus of supervision to teams
• Develop a supportive supervision model
Conclusion
Supervision plays a key role in performance and
motivation, and is particularly important in a
challenging work environment or in the
context of task shifting.
Policy level attention is crucial to ensure a
systematic, structured process that is
adequately resourced and supported in order
to improve health worker performance and
retention at the district level.
With Thanks
HSSE Team:
• AMDD, Mailman School of Public Health, Columbia University, USA
• Centre for Global Health, Trinity College, University of Dublin
• Centre for Reproductive Health, College of Medicine, Malawi
• Dept. of Community Health, Eduardo Mondlane University, Mozambique
• Ifakara Health Institute, Tanzania
• Realizing Rights: Ethical Globalization Initiative, USA
• Regional Prevention of Maternal Mortality Network, Ghana
Funders:
• IrishAid & Ministry of Foreign Affairs, Denmark