title: Does supervision improve health worker productivity? Evidence from the Upper East Region of Ghana.
abstract: OBJECTIVE
  To assess whether supervision of primary health care workers improves their productivity in four districts of Northern Ghana.
  
  
  METHODS
  We conducted a time-use study during which the activities of health workers were repeatedly observed and classified. Classification included four categories: direct patient care; documentation and reporting; staff development and facility operations; and personal time. These data were supplemented by a survey of health workers during which patterns of supervision were assessed. We used logistic regression models with health facility fixed effects to test the hypothesis that supervision increases the amount of time spent providing direct patient care (productivity). We further investigated whether these effects depend on whether or not supervision is supportive.
  
  
  RESULTS
  Direct patient care accounted for <25% of observations. In bivariate analyses, productivity was higher among midwives and in facilities with a high volume of care. Supervisory visits were frequent in those four districts, but only a minority of health workers felt supported by their supervisors. Having been supervised within the last month was associated with a significantly higher proportion of time spent on direct patient care (OR = 1.57). The effects of supervision on productivity further depended on whether the health workers felt supported by their supervisors.
  
  
  CONCLUSIONS
  Supportive supervision was associated with increased productivity. Investments in supervision could help maximize the output of scarce human resources in primary health care facilities. Time-use studies represent an objective approach in monitoring the productivity of health workers and evaluating the impact of health-system interventions on human resources.
authors: Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. jf2584@columbia.edu
authors: Jemima A
authors: JA
authors: Frimpong
authors: Stéphane
authors: S
authors: Helleringer
authors: John Koku
authors: JK
authors: Awoonor-Williams
authors: Francis
authors: F
authors: Yeji
authors: James F
authors: JF
authors: Phillips
mesh_terms: D000328:Adult; D004526:Efficiency; D017598:Efficiency, Organizational / Q000592:standards / Q000639:trends; D005260:Female; D005869:Ghana; D006282:Health Personnel / Q000523:psychology* / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010559:Personnel Management / Q000379:methods / Q000592:standards / Q000639:trends; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D013647:Task Performance and Analysis; D000078329:Workforce