The Impact of Supportive Supervision on the Implementation of HRM processes; A Mixed-Methods study in Tanzania

Background: Supportive supervision is a key determinant of service quality and provider performance, and is particularly pertinent to low-resources settings where supervisors are pivotal to the performance of health workers. To strengthen the human resource management (HRM) function at district and health facility level we implemented the Support, Train and Empower Managers (STEM) project to increase the capacity of managers to support and supervise their staff in Tanzania. Methods: This study used a mixed-methods design, utilising data from health facilities to assess changes in practice and employing focus group discussions to explore perceptions of supervisors 12 months following implementation of STEM in three regions of Tanzania. The present study focused on the perceptions of supervisors on the implementation of supportive HRM processes and how these influenced the supervision practice. Results: The most notable behavioural change attributed to STEM was the introduction of systemic record keeping systems, including staff files and job descriptions. The systems led to an improved work environment and improved communication between health providers and supervisors. In-turn this eased the supervision process and saved on time spent supervising staff. Introduction of registers to monitor staff movement into and out of the facility reduced unexplained absences while availability of clear job descriptions led to more efficient use of HR. Conclusion: Supportive supervision can promote implementation of HRM policies leading to an enabling environment for management to support staff, thereby improving staff morale and retention. Lessons learned from STEM can be incorporated in rolling out such an intervention in other settings and can also enhance our knowledge about developing supportive supervision interventions.