Comparison of the AHI SSM Implementation Strategies Carried Out in Ethiopia, Ghana, and Mozambique

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.