Table 3.

Consensus on how to strengthen supportive supervisory practice of district health managers

Priority level	How can managers change their practice to create a more supportive environment for primary care providers
1	Provide the resources needed for supervision, especially transport Empower DHMT to have skills in supervision, like problem solving
2	Improve sharing of information from DHMT and cluster heads to health workers
3	Transform the organisational culture (values) to bring more congruence between actual experience and espoused/desired values
4	Offer psychosocial support to staff/be aware what is available to improve staff wellness
5	Create space during the supervisory visit to meet with staff and hear what is happening and do collaborative problem solving Give feedback to MOH on the reality of the situation on the ground such as staffing levels and effects of transfer policy on staff motivation
6	Have norms and standards of what should be in place in terms of equipment, medicines, and human resources according to facility level Have an appreciative style of supervision (not the blame game)
7	Change the leadership style to be more of a collaborative practice (teamwork) and model this downward
8	Clarify roles and contribution to supervision of primary healthcare workers by different levels of managers Improve coordination between managers/supervisors on how they supervise Have a policy on the length of stay in rural areas Build resilience of leaders by offering them support. e.g., psychological/emotional
9	Increase awareness of the importance of supervisory visits in DHMT Respond to the deficiencies in resources at the level of clinics/health posts Monitor and evaluate to hold people accountable for progress with actions/responsibilities
10	Give constant feedback to the healthcare workers on progress of jointly identified challenges and strategies Benchmark ourselves against best practice in supervision Recognise leaders/managers through promotion