TABLE 2.

Determinants, Where They Operate, and the Strategies to Address Them During the Exploration and Preparation Phase in the AHI Partnership Projects

EthiopiaGhanaMozambique
Determinants: The barriers to high-quality PHC that each project sought to address
Individual levelPoor use of data at the point of careSupervisors’ beliefs about what supervision is and their roles as supervisor vis-à-vis the frontline workerPoor use of data for management and point-of-care decision making
Process levelAbsence of procedural guidance and planning on how to embed SSMLack of programmatic structure and technical guidance for supervision at subdistrict and CHPS levelsWeak institutional planning and coordination for supervision and frontline worker management
Inner settingUnavailability of human resources for mentoring and poor supervision information flow and feedback loopsInadequate resources and incentives for supportive supervision to frontline workersInadequate human and financial resources for SSM
Outer settingInadequate structures for mentorship in the national HIS programAbsence of incentives to motivate performance improvement
Implementation strategy: The intervention that each team adapted according to the context and barriers to high-quality PHC
CBMPFSVSSM
Adaptation of MOH HIS mentorship guideDistrict-to-district peer learning exchanges aimed at supervisor capacity building, experience sharingBuilding frontline worker and PHC team capacity to record and manage high-quality service statistics and use for point-of-care decision making and benchmarking.
Multisectoral partnerships for mentorship selection and trainingStrengthened tools and procedural guidance for carrying out routine FSVFacilitation of planning and engagement of frontline worker teams within/across districts through a district-level audit and feedback intervention
Health worker training in data use for quality improvementOrganizational incentives to support and motivate ongoing conduct of FSV of frontline workers at subdistrict and CHPS levelTransparent data-driven prioritization and customization of SSM to PHC teams and promotion of patients’ needs during SSM
Standardization of follow up/coaching/ mentoring practices and feedback loops linking management to point of careIncentives to motivate PHC team action planning and execution
  • 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; MOH, Ministry of Health; PHC, primary health care; SSM, supportive supervision and mentoring.