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      The impact of a supportive supervision intervention on health workers in Niassa, Mozambique: a cluster-controlled trial

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          Abstract

          Background

          Regular supportive supervision is critical to retaining and motivating staff in resource-constrained settings. Previous studies have shown the particular contribution that supportive supervision can make to improving job satisfaction amongst over-stretched health workers in such settings.

          Methods

          The Support, Train and Empower Managers (STEM) study designed and implemented a supportive supervision intervention and measured its’ impact on health workers using a controlled trial design with a three-arm pre- and post-study in Niassa Province in Mozambique. Post-intervention interviews with a small sample of health workers were also conducted.

          Results

          The quantitative measurements of job satisfaction, emotional exhaustion and work engagement showed no statistically significant differences between end-line and baseline. The qualitative data collected from health workers post the intervention showed many positive impacts on health workers not captured by this quantitative survey.

          Conclusions

          Health workers perceived an improvement in their performance and attributed this to the supportive supervision they had received from their supervisors following the intervention. Reports of increased motivation were also common. An unexpected, yet important consequence of the intervention, which participants directly attributed to the supervision intervention, was the increase in participation and voice amongst health workers in intervention facilities.

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          Most cited references12

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          Explaining the relationships between job characteristics, burnout, and engagement: The role of basic psychological need satisfaction

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            Primary health care supervision in developing countries.

            To (a) summarise opinion about what supervision of primary health care is by those advocating it; (b) compare these features with reports describing supervision in practice; and (c) to appraise the evidence of the effects of sector performance. Systematic review. Reports were classified into three groups and summarised using appropriate methods: policy and opinion papers (narrative summary), descriptive studies (systematically summarised) and experimental or quasi-experimental studies (design and outcomes systematically summarised). Data presented as narrative summaries and tables. 74 reports were included. In eight policy and opinion papers, supervision was conceptualised as the link between the district and the peripheral health staff; it is important in performance and staff motivation; it often includes problem solving, reviewing records, and observing clinical practice; and is usually undertaken by visiting the supervisees place of work. In 54 descriptive studies, the setting was the primary health care (PHC) or specific services and programmes. Supervisor-supervisee dyads were generally district personnel supervising health facilities or lay health workers. Supervision mostly meant visiting supervisees, but also included meetings in the centre; it appeared to focus on administration and checking, sometimes with checklists. Problem solving, feedback and clinical supervision, training and consultation with the community were less commonly described in the descriptive studies. Supervision appears expensive from studies that have reported costs. In 12 quasi-experimental trials, supervision interventions generally showed small positive effects in some of the outcomes assessed. However, trial quality was mixed, and outcomes varied greatly between studies. Supervision is widely recommended, but is a complex intervention and implemented in different ways. There is some evidence of benefit on health care performance, but the studies are generally limited in the rigor and follow up is limited. Further research delineating what supervision consists of and evaluating it in the context of unbiased comparisons would guide the implementation of effective supervision as part of the management of PHC.
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              Work engagement: Further reflections on the state of play

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                Author and article information

                Contributors
                tmadede@gmail.com
                mmsidat@gmail.com
                eilish.mcauliffe@ucd.ie
                sergioroques@gmail.com
                Ogenna.uduma@tcd.ie
                marie.galligan@ucd.ie
                Susan.Bradley@city.ac.uk
                cambeisabel@gmail.com
                Journal
                Hum Resour Health
                Hum Resour Health
                Human Resources for Health
                BioMed Central (London )
                1478-4491
                2 September 2017
                2 September 2017
                2017
                : 15
                : 58
                Affiliations
                [1 ]GRID grid.8295.6, Department of Community Health, Faculty of Medicine, , Eduardo Mondlane University, ; 702 Salvador Allende Ave., PO Box 257, Maputo, Mozambique
                [2 ]ISNI 0000 0001 0768 2743, GRID grid.7886.1, School of Nursing, Midwifery and Health Systems, , University College Dublin, ; Dublin, Ireland
                [3 ]ISNI 0000 0004 1936 9705, GRID grid.8217.c, Centre for Global Health, , Trinity College Dublin, ; Dublin, Ireland
                [4 ]ISNI 0000 0001 0768 2743, GRID grid.7886.1, School of Medicine, , University College Dublin, ; Dublin, Ireland
                [5 ]ISNI 0000 0004 1936 8497, GRID grid.28577.3f, School of Health Sciences, , City University London, ; 1 Myddelton Street, London, EC1R 1UW United Kingdom
                [6 ]National Health Institute, Maputo, Mozambique
                Author information
                http://orcid.org/0000-0002-9714-5040
                Article
                213
                10.1186/s12960-017-0213-4
                5581457
                28865466
                0935d335-3747-481d-a741-2e2dd32e677b
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 2 August 2016
                : 2 June 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000803, Directorate-General for Development and Cooperation - EuropeAid;
                Award ID: DCI-SANTE/2010/257-308
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100009099, Irish Aid;
                Categories
                Research
                Custom metadata
                © The Author(s) 2017

                Health & Social care
                supportive supervision,job satisfaction,retention,work engagement,burnout,participation,motivation

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