Managerial supervision to improve primary health care in low- and middle-income countries: effects are uncertain

Added April 13, 2020

Citation: Bosch-Capblanch X, Liaqat S, Garner P. Managerial supervision to improve primary health care in low- and middle-income countries. Cochrane Database of Systematic Reviews 2011; (9): CD006413

What is this? The COVID-19 pandemic is placing a great strain on health systems and healthcare workers. Primary healthcare (PHC) workers in low- and middle-income countries (LMICs) frequently work alone without managerial support but it is important to know if healthcare managerial supervision can help improve the quality of services.

In this Cochrane systematic review, the authors searched for randomized trial, interrupted time series and controlled before-and-after (CBS) studies from PHC settings in LMICs on the impact of supervisory site visits and activities from higher-levels of the health system. They did not restrict their searches by date, type or language of publication and did their searches in March 2011. They identified 5 cluster randomized trials and 4 CBA studies. The studies were from Africa, Asia and Latin America. The PHC was located in a rural area in five studies and in urban and rural in 4 (with one not specifying the PHC setting).

What works: Nothing noted.

What doesn’t work: Nothing noted.

What’s uncertain: It is uncertain whether managerial supervision produces substantive benefits on the quality of primary health care in low‐ and middle‐income countries, and long-term effectiveness has not been studied. If supervision is implemented, this should be done together with activities to evaluate its effects on health outcomes and costs.


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