title: A systematic review of supportive supervision as a strategy to improve primary healthcare services in Sub-Saharan Africa.
abstract: BACKGROUND
  It may be assumed that supportive supervision effectively builds capacity, improves the quality of care provided by frontline health workers, and positively impacts clinical outcomes. Evidence on the role of supervision in Sub-Saharan Africa has been inconclusive, despite the critical need to maximize the workforce in low-resource settings.
  
  
  OBJECTIVE
  To review the published literature from Sub-Saharan Africa on the effects of supportive supervision on quality of care, and health worker motivation and performance.
  
  
  METHODS
  A systematic review of seven databases of both qualitative and quantitative studies published in peer-reviewed journals.
  
  
  METHODS
  Selected studies were based in primary healthcare settings in Sub-Saharan Africa and present primary data concerning supportive supervision.
  
  
  METHODS
  Thematic synthesis where data from the identified studies were grouped and interpreted according to prominent themes.
  
  
  RESULTS
  Supportive supervision can increase job satisfaction and health worker motivation. Evidence is mixed on whether this translates to increased clinical competence and there is little evidence of the effect on clinical outcomes.
  
  
  CONCLUSIONS
  Results highlight the lack of sound evidence on the effects of supportive supervision owing to limitations in research design and the complexity of evaluating such interventions. The approaches required a high level of external inputs, which challenge the sustainability of such models.
authors.affiliation: Department of Social Statistics and Demography, University of Southampton, Southampton, UK. Electronic address: C.E.Bailey@soton.ac.uk.
authors.forename: Claire
authors.initials: C
authors.lastname: Bailey
authors.affiliation: Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Blake
authors.affiliation: Center for Global Health, Department of Public Health, Aarhus University, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Schriver
authors.affiliation: Center for Global Health, Department of Public Health, Aarhus University, Denmark; School of Medicine and Pharmacy, University of Rwanda, Rwanda.
authors.forename: Vincent Kalumire
authors.initials: VK
authors.lastname: Cubaka
authors.affiliation: Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Tisa
authors.initials: T
authors.lastname: Thomas
authors.affiliation: Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Adriane
authors.initials: A
authors.lastname: Martin Hilber
mesh_terms: D017954:Africa South of the Sahara; D002983:Clinical Competence; D003695:Delivery of Health Care / Q000379:methods* / Q000458:organization & administration / Q000592:standards; D006282:Health Personnel / Q000458:organization & administration* / Q000523:psychology; D006801:Humans; D007588:Job Satisfaction; D009934:Organization and Administration; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration / Q000592:standards; D011787:Quality of Health Care
keywords: Job performance; Primary health care; Quality of care; Sub-Saharan Africa; Supervision; Supportive supervision; Systematic review