Comparison of the AHI SSM Implementation Strategies Carried Out in Ethiopia, Ghana, and Mozambique
| Similarities | Differences |
|---|---|
| Made process improvements, usually at the management level, to address weak institutional capacities for planning, reflecting, and executing SSM at the district levels. | In Ethiopia and Mozambique, capacity building focused on technical skill building. |
| In Ghana, this aimed at bolstering individuals’ understanding of supervision and their roles as mentors. | |
| Promoted better learning climate and circulation of goals and feedback in delivery settings. | The Ethiopia team created a firmer structure and guidance for mentorship within national health information system policy, revised health worker roles to better emphasize mentorship and coaching, and established multidisciplinary mentorship teams to operationalize it. |
| Mozambique used transparent benchmarking of quality improvement and peer exchanges between PHC teams. | |
| Ghana blended approaches by creating a subdistrict-level supervisor cadre to support community health workers and facilitate peer exchanges. | |
| Enhanced readiness for implementation with better tools and catalytic funds. | In Ethiopia and Ghana, expansion of SSM was achieved through training cascades that link district management to points of care. |
| In Mozambique, SSM implementation was based on evidence of the need to promote SSM quality where it is most required. | |
| Increased frontline worker and supervisor understanding of SSM and clinical and nonclinical skills (e.g., data interpretation and utilization). | In Ghana and Mozambique, hindrances were mainly insufficient financial and material resources to ensure adequate implementation. |
| Barriers to sustainment in Ethiopia related to lapses in fidelity to the core elements of the CBMP as the intervention grows. | |
| Introduced a new cadre and process strategies to extend SSM to peripheral levels. | |
| Facilitated use of data to enhance quality and soundness of implementation both in terms of “real-time” decision making and long-term performance improvement. | |
| Fostered an enabling policy environment, collaborated between local health systems and academia, and embedded policy makers in research and policy domains. | |
| Held peer exchanges across jurisdictions to support the adoption and quality of SSM. |
Abbreviations: CBMP, capacity-building and mentorship program; PHC, primary health care; SSM, supportive supervision and mentoring.