Supportive supervision to improve primary healthcare services in sub-Saharan Africa: a systematic review

Clinical Expertise
This article from the Evidence for Action (E4A) quality of care series reviews the literature from sub-Saharan Africa on the effects of supportive supervision on quality of care and health worker motivation and performance.

The paper, summarised here, aims to provide key recommendations for the implementation of supportive supervision systems to improve maternal, newborn, and child health in African primary health care settings. 


Supportive supervision is a process of helping staff to improve their own work performance continuously. It can encourage quality improvements by strengthening relationships, identifying and solving problems, and maximizing resource allocation. 


The authors carried out a systematic literature review in September 2014 of seven databases of both qualitative and quantitative studies. Peer-reviewed articles were included in the review if they were based in primary healthcare settings in Sub-Saharan Africa and presented primary data about supportive supervision. 

Key findings

  • 18 articles were include in the review; 3 were based on qualitative data only, 12 on quantitative data only, and 3 were a combination of both methods.
  • Findings indicated that supportive supervision can improve some aspects of quality of care and can increase job satisfaction when compared with traditional models of supervision or no supervision at all.
  • Supportive supervision can improve motivation by providing opportunities for health workers to share their concerns, discuss and be heard.
  • Three studies described that supportive supervision can increase staff retention.
  • Evidence was mixed on whether supportive supervision increases clinical ability, possibly partly due to challenges of measuring clinical abilities and a lack of clear indicators for measuring quality of care.
  • Nine papers found improvements in quality of care systems and processes, e.g. following clinical protocols, record keeping, and data management.
  • There was limited evidence of a direct link between supportive supervision and improved health outcomes, partly due to limitations in  study designs. Assessing health outcomes such as mortality (death) or morbidity (disease) requires complex study designs, and many of the studies assessed were not appropriate to associate supportive supervision with health outcomes.
  • Many papers highlighted that supportive supervision was limited by external resources, such as drug and equipment shortages, staff shortages, high workloads, and a lack of incentives and career development opportunities.

Conclusions and Recommendations

The authors concluded that there is a lack of strong evidence on the effects of supportive supervision on quality of care and clinical outcomes due to limitations in research design and the complexity of evaluating such interventions. The paper recommends that supportive supervision should be placed within a broader quality improvement system.

Bailey, C., Blake, C., Schriver, M., Cubaka, V., Thomas, T., & Hilber, A. M. (2015). A systematic review of supportive supervision as a strategy to improve primary healthcare services in Sub-Saharan Africa. International Journal of Gynecology and Obstetrics, 132(1), 117–125.
Mother and baby