Summary of findings 2. 'Enhanced' versus routine supervision to improve the quality of primary health care.
| 'Enhanced' versus routine supervision to improve the quality of primary health care | ||||||
| Patient or population: providers and users Settings: low‐ and middle‐income countries Intervention: 'enhanced' supervision Comparison: routine supervision | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Routine supervision | 'enhanced' supervision | |||||
| Functional status of community health agents (Ayele 1993) | The mean functional status of community health agents (Ayele 1993) in the control groups was ‐2.6 | The mean functional status of community health agents (Ayele 1993) in the intervention groups was 8.8 higher (0 to 0 higher) | 102 (1 study1) | ⊕⊝⊝⊝ very low2,3,4 | 1 cluster RCT: study showed improvement in performance of community health agents in the intervention group compared to the control group | |
| Overall performance score midwives (Loevinsohn 1995) Scale from: 0 to 60. | The mean overall performance score midwives (Loevinsohn 1995) in the control groups was 4.9 | The mean overall performance score midwives (Loevinsohn 1995) in the intervention groups was 6.4 higher (0 to 0 higher) | 112 (1 study5) | ⊕⊝⊝⊝ very low3,4,6 | 1 CBA: study showed improvement in overall performance score of midwives (service quality, knowledge and management) in the intervention group | |
| Children receiving recommended or adequate care (Rowe 2009) | Moderate | Not estimable | 0 (1 study8) | ⊕⊝⊝⊝ very low3,4,9 | 1 cluster RCT: study found no differences between the intervention and control group when assessing implementation of IMCI quality of care indicators | |
| 7 | ||||||
| Health worker job satisfaction (Sennun 2006) Questionnaire. Scale from: 0 to 165. | The mean health worker job satisfaction (Sennun 2006) in the control groups was 8.4 | The mean health worker job satisfaction (Sennun 2006) in the intervention groups was 25.0 higher (0 to 0 higher)10 | 6 (1 study11) | ⊕⊝⊝⊝ very low2,3,4 | 1 CBA: study found improvements in client satisfaction and perceptions of service quality in the intervention group, but no difference in provider satisfaction | |
| Clients satisfaction (Sennun 2006) Questionnaire. Scale from: 0 to 90. | The mean clients satisfaction (Sennun 2006) in the control groups was ‐2.5 | The mean clients satisfaction (Sennun 2006) in the intervention groups was 5.8 higher (0 to 0 higher) | 390 (1 study11) | ⊕⊝⊝⊝ very low2,3,4 | 1 CBA: study found improvements in client satisfaction and perceptions of service quality in the intervention group, but no difference in provider satisfaction | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1Ayele 1993: A cluster randomised study of community health agent (CHAs) in Ethiopia. 52 CHAs were assigned respectively to the intervention (monthly 'supportive' supervision and 5 day training of CHAs) or control (routine supervision). 2 Very serious limitations in design: the study does not meet the EPOC quality criteria of having a minimum of two clusters in each of the comparison groups 3 No serious inconsistency: Not applicable as only one study 4 Serious imprecision: The studies contain a small number of clusters within the intervention and control groups 5Loevinsohn 1995 is controlled before and after study looking at the effectiveness of using a supervisory checklist on midwife performance in the Philippines. 4 intervention and 6 control provinces were selected, and 123 health facilities selected randomly proportional to the population size. 6 Serious limitations: Risk of selection bias as intervention provinces were selected by the programme managers 7 Number of participants not reported. 8Rowe 2009: A cluster randomised study examining the effects of enhanced supervision with a package of supports (intervention) with routine supervision and supports (control) in Benin. I districts was randomly allocated to the intervention and control groups respectively. 9 Serious limitations: there was a slow implementation of IMCI training for health workers and only 29% of supervisory visits took place 10 Analysis was not reported in the study due to the small number of individuals. 11Sennun 2006 is a controlled before and after study looking at the effect of involving the community in the supervisory process (intervention group) versus not doing so (control) in Thailand. Two primary care units were allocated to each of the comparison groups.