Mediator: The processes through which the SSM strategies catalyzed changes |
Individual | Build frontline workers’ capacity in data management, use, and visualization | Increase supervisors’ confidence and self-efficacy vis-à-vis SSM for a clearer and more enthusiastic understanding of their role | Build self-efficacy of mentors and supportive relationship with mentees; improve knowledge and attitudes toward the intervention; improve data use skills |
Process | Conduct cascade trainings to expand coverage of SSM within PHC systems | Improve planning, engagement, and team capacities to reflect and evaluate, fostered by peer exchanges | Conduct meetings to foster meaningful engagement, planning, feedback, and reflection |
Inner setting | Adapt PHC structures to include a new group of “mentor of mentors” and create an implementation climate that promotes learning and a culture of data utilization | Create an organizational culture and climate that encourages learning and incentivizes feedback and adaptation between teams | Create an implementation climate that encourages learning and a culture of data utilization |
Outer setting | Disseminate HIS guidance and procedures to emphasize SSM | | Conduct public benchmarking of performance to incite friendly competition |
Change mechanisms: Changes observed immediately after the start of SSM implementation |
| Improved motivation and skills at using interventions | Improved clarity and shared understandings of supportive supervision | Increased self-efficacy, improved perceptions of organization and teams, increased skill at using interventions |
| Implementation climate that promotes innovation, learning, and improvement | Increased self-efficacy among supervisors, improved satisfaction with and self-identification within organization and teams | Implementation climate that drives and sustains quality improvement |
| Greater accountability, planning, engagement, and execution of team tasks | Implementation climate that encourages quality improvement and learning | Increased confidence in SSM among implementers |
Proximal outcomes: Results observed in the process evaluation |
| Improved use of data for health care worker performance | Reliably routine implementation of facilitative supervision | Improved use of time and resources based on data and strategic planning (i.e., implementing SSM where evidence shows it is needed) |
| Improvement and problem solving at the point of care | Stronger linkages between levels of care (district, subdistrict, and CHPS zone) | Improved PHC worker adherence to clinical standards and guidelines |
| Sustainable mechanisms for supervision, information sharing, and feedback between management and point of care | Improve management and performance of PHC at district, subdistrict, and CHPS zone levels | |