District health managers' perceptions of supervision in Malawi and Tanzania

Hdl Handle:
http://hdl.handle.net/10147/302680
Title:
District health managers' perceptions of supervision in Malawi and Tanzania
Authors:
Bradley, Susan; Kamwendo, Francis; Masanja, Honorati; de Pinho, Helen; Waxman, Rachel; Boostrom, Camille; McAuliffe, Eilish
Citation:
Human Resources for Health. 2013 Sep 05;11(1):43
Issue Date:
5-Sep-2013
URI:
http://dx.doi.org/10.1186/1478-4491-11-43; http://hdl.handle.net/10147/302680
Abstract:
Abstract Background Mid-level cadres are being used to address human resource shortages in many African contexts, but insufficient and ineffective human resource management is compromising their performance. Supervision plays a key role in performance and motivation, but is frequently characterised by periodic inspection and control, rather than support and feedback to improve performance. This paper explores the perceptions of district health management teams in Tanzania and Malawi on their role as supervisors and on the challenges to effective supervision at the district level. Methods This qualitative study took place as part of a broader project, “Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers”. Semi-structured interviews were conducted with 20 district health management team personnel in Malawi and 37 council health team members in Tanzania. The interviews covered a range of human resource management issues, including supervision and performance assessment, staff job descriptions and roles, motivation and working conditions. Results Participants displayed varying attitudes to the nature and purpose of the supervision process. Much of the discourse in Malawi centred on inspection and control, while interviewees in Tanzania were more likely to articulate a paradigm characterised by support and improvement. In both countries, facility level performance metrics dominated. The lack of competency-based indicators or clear standards to assess individual health worker performance were considered problematic. Shortages of staff, at both district and facility level, were described as a major impediment to carrying out regular supervisory visits. Other challenges included conflicting and multiple responsibilities of district health team staff and financial constraints. Conclusion Supervision is a central component of effective human resource management. Policy level attention is crucial to ensure a systematic, structured process that is based on common understandings of the role and purpose of supervision. This is particularly important in a context where the majority of staff are mid-level cadres for whom regulation and guidelines may not be as formalised or well-developed as for traditional cadres, such as registered nurses and medical doctors. Supervision needs to be adequately resourced and supported in order to improve performance and retention at the district level.
Language:
en
Keywords:
HEALTH SERVICES AND THEIR MANAGEMENT; MANAGER

Full metadata record

DC FieldValue Language
dc.contributor.authorBradley, Susanen_GB
dc.contributor.authorKamwendo, Francisen_GB
dc.contributor.authorMasanja, Honoratien_GB
dc.contributor.authorde Pinho, Helenen_GB
dc.contributor.authorWaxman, Rachelen_GB
dc.contributor.authorBoostrom, Camilleen_GB
dc.contributor.authorMcAuliffe, Eilishen_GB
dc.date.accessioned2013-10-03T15:35:38Z-
dc.date.available2013-10-03T15:35:38Z-
dc.date.issued2013-09-05-
dc.identifier.citationHuman Resources for Health. 2013 Sep 05;11(1):43en_GB
dc.identifier.urihttp://dx.doi.org/10.1186/1478-4491-11-43-
dc.identifier.urihttp://hdl.handle.net/10147/302680-
dc.description.abstractAbstract Background Mid-level cadres are being used to address human resource shortages in many African contexts, but insufficient and ineffective human resource management is compromising their performance. Supervision plays a key role in performance and motivation, but is frequently characterised by periodic inspection and control, rather than support and feedback to improve performance. This paper explores the perceptions of district health management teams in Tanzania and Malawi on their role as supervisors and on the challenges to effective supervision at the district level. Methods This qualitative study took place as part of a broader project, “Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers”. Semi-structured interviews were conducted with 20 district health management team personnel in Malawi and 37 council health team members in Tanzania. The interviews covered a range of human resource management issues, including supervision and performance assessment, staff job descriptions and roles, motivation and working conditions. Results Participants displayed varying attitudes to the nature and purpose of the supervision process. Much of the discourse in Malawi centred on inspection and control, while interviewees in Tanzania were more likely to articulate a paradigm characterised by support and improvement. In both countries, facility level performance metrics dominated. The lack of competency-based indicators or clear standards to assess individual health worker performance were considered problematic. Shortages of staff, at both district and facility level, were described as a major impediment to carrying out regular supervisory visits. Other challenges included conflicting and multiple responsibilities of district health team staff and financial constraints. Conclusion Supervision is a central component of effective human resource management. Policy level attention is crucial to ensure a systematic, structured process that is based on common understandings of the role and purpose of supervision. This is particularly important in a context where the majority of staff are mid-level cadres for whom regulation and guidelines may not be as formalised or well-developed as for traditional cadres, such as registered nurses and medical doctors. Supervision needs to be adequately resourced and supported in order to improve performance and retention at the district level.-
dc.language.isoenen
dc.subjectHEALTH SERVICES AND THEIR MANAGEMENTen_GB
dc.subjectMANAGERen_GB
dc.titleDistrict health managers' perceptions of supervision in Malawi and Tanzaniaen_GB
dc.language.rfc3066en-
dc.rights.holderSusan Bradley et al.; licensee BioMed Central Ltd.-
dc.description.statusPeer Reviewed-
dc.date.updated2013-10-01T20:09:59Z-
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