Results of Phase 2, Implementation of AHI Partnerships’ SSM Interventions in Ethiopia, Ghana, and Mozambique

Ethiopia: CBMPGhana: CHPS+ FSVMozambique: SSM
Mediator: The processes through which the SSM strategies catalyzed changes
IndividualBuild frontline workers’ capacity in data management, use, and visualizationIncrease supervisors’ confidence and self-efficacy vis-à-vis SSM for a clearer and more enthusiastic understanding of their roleBuild self-efficacy of mentors and supportive relationship with mentees; improve knowledge and attitudes toward the intervention; improve data use skills
ProcessConduct cascade trainings to expand coverage of SSM within PHC systemsImprove planning, engagement, and team capacities to reflect and evaluate, fostered by peer exchangesConduct meetings to foster meaningful engagement, planning, feedback, and reflection
Inner settingAdapt PHC structures to include a new group of “mentor of mentors” and create an implementation climate that promotes learning and a culture of data utilizationCreate an organizational culture and climate that encourages learning and incentivizes feedback and adaptation between teamsCreate an implementation climate that encourages learning and a culture of data utilization
Outer settingDisseminate HIS guidance and procedures to emphasize SSMConduct 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 interventionsImproved clarity and shared understandings of supportive supervisionIncreased self-efficacy, improved perceptions of organization and teams, increased skill at using interventions
Implementation climate that promotes innovation, learning, and improvementIncreased self-efficacy among supervisors, improved satisfaction with and self-identification within organization and teamsImplementation climate that drives and sustains quality improvement
Greater accountability, planning, engagement, and execution of team tasksImplementation climate that encourages quality improvement and learningIncreased confidence in SSM among implementers
Proximal outcomes: Results observed in the process evaluation
Improved use of data for health care worker performanceReliably routine implementation of facilitative supervisionImproved 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 careStronger 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 careImprove management and performance of PHC at district, subdistrict, and CHPS zone levels
  • Abbreviations: AHI, African Health Initiative; CBMP, capacity-building and mentorship program; CHPS, Community-based Health Planning and Services Program; FSV, facilitative supervision visits; HIS, health information system; PHC, primary health care; SSM, supportive supervision and mentoring.