Mechanisms of Supportive Supervision and their effectiveness in Primary Health care of low and - and Middle-Income Countries: A systematic review

BackgroundSupportive supervision (SS) is a systematic approach used to assess health facilities preparedness to provide quality healthcare service and support healthcare providers to identify and address barriers to the provision of quality health services. There is, however, inconclusive evidence of the full benefit and influence of SS on performance in different settings of primary health care (PHC). Additionally, not much is known about what constitutes an effective SS approach that can successfully improve service provision by influencing better problem solving. This review synthesised evidence on the effectiveness of mechanisms of SS in PHC in low- and middle-income countries (LMIC). MethodsO_ST_ABSSearch strategyC_ST_ABSThe first search was done in five relevant databases, then in the remaining database and finalised with a search in the reference list. Selection criteriaSelection criteria were guided by population (primary health care providers), intervention (mechanism of supportive supervision) and outcomes (positive or negative) in the context of low- and middle-income countries. Selection was based initially on title and abstract, then full-text articles. Data extraction and analysisA data extraction tool was used to extract the relevant information to answer the review question. Studies were analysed through frequency counting of articles. And qualitative content analysis was used, and synthesised results were reported narratively. ResultsA total of 29 studies were identified, ranging from 2013 to 2023. Methodologies identified included 6 cluster randomised control trials, 15 quasi-experimental studies, 5 qualitative studies, 5 analytical cross-sectional studies and 3 cohort studies. The studies were from the following: Egypt, Ethiopia, Pakistan, India, Kenya, Zambia, Nigeria, Mozambique, Tanzania and Malawi. Study results found multiple mechanisms used when conducting SS in PHC in LMIC. SS was either effective 69% (n=20), ineffective 3.5% (n=1) or had inconclusive 28% (n=8) results. The role of SS in primary care performance included improved attitudinal behaviour, knowledge, skills and practice, and health and patient outcomes. ConclusionThere are multiple approaches to conducting SS, and the mechanisms yielded both positive, negative and inconclusive results, supporting evidence of inconsistencies in what constitutes an effective mechanism of SS. Multiple external factors such as incentive, training and transport logistics were seen to influence the role of SS in PHC.