Results of Phase 2, Implementation of AHI Partnerships’ SSM Interventions in Ethiopia, Ghana, and Mozambique
| Ethiopia: CBMP | Ghana: CHPS+ FSV | Mozambique: SSM | |
|---|---|---|---|
| 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 | ||
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.