Abstract
BackgroundMid-level health workers (MLHWs) form the front-line of service delivery in many low- and middle-income countries. Supervision is a critical institutional intervention linking their work to the health system, and it consists of activities intended to support health workers’ motivation and enable them to perform. However its impact depends not only on the frequency of these activities but also how they are carried out and received. This study aims to deepen understanding of the mechanisms through which supervision activities support the performance of auxiliary nurses, a cadre of MLHWs, in rural Guatemala.MethodsA multiple case study was conducted to examine the operation of supervision of five health posts using a realist evaluation approach. A program theory was formulated describing local understanding of how supervision activities are intended to work. Data was collected through interviews and document review to test the theory. Analysis focused on comparison of activities, outcomes, mechanisms and the influence of context across cases, leading to revision of the program theory.ResultsThe supervisor’s orientation was identified as the main mechanism contributing to variation observed in activities and their outcomes. Managerial control was the dominant orientation, reflecting the influence of standardized performance criteria and institutional culture. Humanized support was present in one case where the auxiliary nurse was motivated by the sense that the full scope of her work was valued. This orientation reflected the supervisor’s integration of her professional identity as a nurse.ConclusionsThe nature of the support health workers received was shaped by supervisors’ orientation, and in this study, nursing principles were central to humanized support. Efforts to strengthen the support that supervision provides to MLHWs should promote professional ethos as a means of developing shared performance goals and orient supervisors to a more holistic view of the health worker and their work.
Highlights
Mid-level health workers (MLHWs) form the front-line of service delivery in many low- and middleincome countries
This study examines the operation of health post supervision in rural districts of Guatemala in order to understand the mechanisms by which it contributes to the performance of auxiliary nurses, a cadre of MLHWs
This study demonstrated that supportive supervision consists of more than a checklist of techniques
Summary
Mid-level health workers (MLHWs) form the front-line of service delivery in many low- and middleincome countries. MLHWs are health care providers with formal accreditation but they have shorter training and a more restricted scope of Supervision is a common institutional intervention in health systems intended to support health workers’ capacity and motivation to perform It provides a link between service delivery in peripheral units and district management through measures to ensure that health workers carry out their work effectively and enable them to improve their competence [3]. Supervision serves as the point of human interconnection between health workers and the health system and it can encourage motivation through orientation to the organization’s values [4] This contact is a central tool for supporting front-line health workers such as MLHWs who deliver care in isolated rural settings with limited training [5]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call