How, why, and under what circumstances can supportive supervision programs improve malaria case management? A realist...

Area of Science:

• Public Health
• Health Systems Strengthening
• Quality Improvement

Background:

• Supportive supervision (SS) programs are crucial for enhancing healthcare quality by improving health provider performance.
• These programs are increasingly vital in low- and middle-income countries for improving malaria case management.
• However, the specific factors driving the effectiveness of SS programs remain underexplored.

Purpose of the Study:

• To explain the mechanisms through which SS programs improve facility-based management of uncomplicated malaria in children under five.
• To identify the contextual factors influencing the success of SS programs in Tanzania and Benin.
• To develop a program theory explaining the dynamics of SS program outcomes.

Main Methods:

• A realist evaluation was conducted in Tanzania and Benin.
• Data collection involved 218 in-depth interviews, 12 structured interviews, 154 case management audits, and 4 health facility audits.
• A program theory was developed through team-based analysis of empirical data.

Main Results:

• Three key acceptability mechanisms were identified: affective attitude, self-efficacy, and perceived program burden.
• Program integration, visit frequency, coaching approach, and collaboration influenced malaria case management practices.
• Program actors' perception of effectiveness was critical for sustainability.

Conclusions:

• SS program outcomes are driven by the cognitive and emotional responses of program actors.
• Effective SS programs require a focus on provider acceptability and supportive supervisory practices.
• These findings offer transferable insights for designing and implementing SS programs globally.