Stakeholders' perspectives on facilitative supervision implementation in north-western Ghana: an exploration of adherence and quality of primary healthcare.

Abstract

Following growing concern about healthcare quality in many developing countries, this article analyses the relationship between facilitative supervision (FS) and the quality of primary healthcare (PHC) services in north-western Ghana. While adherence to the tenets of FS aims to trigger improvement in the quality of PHC services, research has seldom explored this relationship to facilitate effective planning and implementation of PHC services, particularly in deprived areas. Based on the implementation of FS in primary health facilities in a district and a municipality in north-western Ghana, a multi-case study approach was employed to collect and analyse the data. Specifically, 52 semi-structured interviews were conducted in the two study settings and the data were analysed using a thematic framework. Observation and secondary analysis were also employed to generate data to triangulate and supplement the interview data. The results reveal that health facilities in the Wa West district are relatively under-resourced, and this impedes the regularity of supervisory visits compared to the Wa Municipality. This notwithstanding, adherence to the prescriptions of FS is rated by the study participants as moderately satisfactory in both districts, culminating in improvement in the quality of PHC. This finding has implications for innovation in the mobilisation of health resources to increase the regularity of facilitation supervision in deprived settings. We advocate further research to establish whether the marginal improvement in the quality of PHC achieved in the two districts has resulted in an increase in uptake of PHC services to improve the health of the population or not.