Summary of findings 3. 'Less intense' versus routine supervision to improve the quality of primary health care.
| 'Less intense' versus routine supervision to improve the quality of primary health care | ||||||
| Patient or population: providers and users Settings: low‐ and middle‐income countries Intervention: less 'intensive' 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 | Less 'intensive' supervision | |||||
| New clients gained by health facility based posts (number per quarter) Daily log completed by the supervisor reporting activities of providers | The mean new clients gained by health facility based posts (number per quarter) in the control groups was 3.5 New clients | The mean new clients gained by health facility based posts (number per quarter) in the intervention groups was 2.1 higher (0 to 0 higher) | 247 (1 study1) | ⊕⊕⊝⊝ low2,3,4 | 1 cluster RCT: study found no differences in three quality of care indicators in the intervention groups compared to the control groups | |
| New clients gained by community‐based posts (number per quarter) Daily log completed by the supervisor reporting activities of providers | The mean new clients gained by community‐based posts (number per quarter) in the control groups was 0.76 New clients | The mean new clients gained by community‐based posts (number per quarter) in the intervention groups was 3.4 higher (0 to 0 higher) | 247 (1 study1) | ⊕⊕⊝⊝ low2,3,4 | 1 cluster RCT: study found no differences in three quality of care indicators in the intervention groups compared to the control groups | |
| Average number of revisits per quarter (health‐facility‐based posts) Daily log completed by the supervisor reporting activities of providers | The mean average number of revisits per quarter (health facility based posts) in the control groups was 10.6 New clients | The mean average number of revisits per quarter (health facility based posts) in the intervention groups was 0.7 lower (0 to 0 higher) | 247 (1 study1) | ⊕⊕⊝⊝ low2,3,4 | 1 cluster RCT: study found no differences in three quality of care indicators in the intervention groups compared to the control groups | |
| Average number of revisits per quarter (community‐based posts) Daily log completed by the supervisor reporting activities of providers | The mean average number of revisits per quarter (community‐based posts) in the control groups was 1.4 New clients | The mean average number of revisits per quarter (community‐based posts) in the intervention groups was 14.9 higher (0 to 0 higher) | 247 (1 study1) | ⊕⊕⊝⊝ low2,3,4 | 1 cluster RCT: study found no differences in three quality of care indicators in the intervention groups compared to the control groups | |
| *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. | ||||||
1Foreit 1984 is a cluster RCT of community‐based family planning distribution workers in Brazil. 6 regions were assigned to the intervention and control group, with 6 supervisors in each group and 140 and 138 community‐based workers respectively. The intervention group received quarterly supervision visits over 9 months whilst the control group continued to receive monthly supervisory visits 2 Serious limitations: No baseline characteristics or outcomes provided 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