title: How to create more supportive supervision for primary healthcare: lessons from Ngamiland district of Botswana: co-operative inquiry group.
abstract: BACKGROUND
  Supportive supervision is a way to foster performance, productivity, motivation, and retention of health workforce. Nevertheless there is a dearth of evidence of the impact and acceptability of supportive supervision in low- and middle-income countries. This article describes a participatory process of transforming the supervisory practice of district health managers to create a supportive environment for primary healthcare workers.
  
  
  OBJECTIVE
  The objective of the study was to explore how district health managers can change their practice to create a more supportive environment for primary healthcare providers.
  
  
  METHODS
  A facilitated co-operative inquiry group (CIG) was formed with Ngamiland health district managers. CIG belongs to the participatory action research paradigm and is characterised by a cyclic process of observation, reflection, planning, and action. The CIG went through three cycles between March 2013 and March 2014.
  
  
  RESULTS
  Twelve district health managers participated in the inquiry group. The major insights and learning that emerged from the inquiry process included inadequate supervisory practice, perceptions of healthcare workers' experiences, change in the managers' supervision paradigm, recognition of the supervisors' inadequate supervisory skills, and barriers to supportive supervision. Finally, the group developed a 10-point consensus on what they had learnt regarding supportive supervision.
  
  
  CONCLUSIONS
  Ngamiland health district managers have come to appreciate the value of supportive supervision and changed their management style to be more supportive of their subordinates. They also developed a consensus on supportive supervision that could be adapted for use nationally. Supportive supervision should be prioritised at all levels of the health system, and it should be adequately resourced.
authors.affiliation: Faculty of Medicine, University of Botswana, Gaborone, Botswana; nkomazanao@mopipi.ub.bw.
authors.forename: Oathokwa
authors.initials: O
authors.lastname: Nkomazana
authors.affiliation: Division of Family Medicine and Primary Care, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Robert
authors.initials: R
authors.lastname: Mash
authors.affiliation: Unit Ethnomedicine and International Health, Department of General Practice and Family Medicine, Centre of Public Health, Medical University of Vienna, Vienna, Austria.
authors.forename: Silvia
authors.initials: S
authors.lastname: Wojczewski
authors.affiliation: Unit Ethnomedicine and International Health, Department of General Practice and Family Medicine, Centre of Public Health, Medical University of Vienna, Vienna, Austria.
authors.forename: Ruth
authors.initials: R
authors.lastname: Kutalek
authors.affiliation: School of Nursing, University of Botswana, Gaborone, Botswana.
authors.forename: Nthabiseng
authors.initials: N
authors.lastname: Phaladze
mesh_terms: D001291:Attitude of Health Personnel; D001902:Botswana; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006302:Health Services Research; D006801:Humans; D007318:Inservice Training; D007857:Leadership; D008297:Male; D009042:Motivation; D011320:Primary Health Care; D036301:Qualitative Research
keywords: co-operative inquiry group; district health managers; healthcare workers; primary healthcare; supportive supervision