Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on ensuring quality of care
Conversely, there are many documented examples of poor outcomes where health programmes
have failed to invest in adequate supervision and support for health workers.
Over the past few years, the term “supportive supervision” has become well recognized in the
health-care community. Various studies suggest that supportive supervision is conducive to
improvements in health worker performance and to a more general strengthening of health
systems 139-142 . In particular, research has found that the integration of supportive supervision into
primary health-care models in developing countries can lead to improvements in the delivery of
health care by most levels of health-care worker 139 .
The WHO-Commissioned Study on Task Shifting also observed that task shifting yields better
outcomes where health workers are offered sustained and supportive supervision within the
structure and functions of the health team Annex a .
Occurring continuously, this type of supervision becomes a routine part of a health worker’s job.
Such supervision can have a motivating effect on health workers and is an opportune time to
provide follow-up training, improve performance and solve other systemic problems 139-143 .
Supportive supervision requires motivation on the part of supervisors and staff to adopt new
behaviour, locally appropriate tools and invest time and resources. Also of importance is the
commitment of the top management and the integration of the programme into existing human
resource management systems 139 .
As supportive supervision requires a new model of supervisory skills and the adoption of new
behaviours, it is important that those tasked with performing the supervision are properly
prepared. There is evidence that working with newly trained supervisors to assess their
competence and performance, and helping them create a plan for self-improvement, allows for
the successful implementation of supervisory programmes 144 . Internationally reviewed guidelines
for supportive supervision encourage the training of new supervisors on management skills as
well as communication and mentoring skills 142 .
Given that supportive supervision will place additional demands on supervisors’ time, task shifting
strategies should consider how to ensure that supervisors can effectively perform both their new
and current responsibilities. Along with the overarching need to increase the numbers of trained
health workers, this may entail a specific need to increase the numbers of health workers who will
assume supervisory responsibilities. Along with adequate numbers of appropriately trained health
workers, including in hard-to-reach areas, supportive supervision will require logistical support,
such as adequate transportation and telecommunication systems.
Advantages:
• Supportive supervision generates sustained performance improvement.
• Mentoring is a means of identifying and addressing deficiencies, gaps and weaknesses in
clinical practice 25 125 .
Uncertainties:
• Supervision is time consuming. This will need to be accommodated in job descriptions and
resources allocated to supervisors.
• Supportive supervision may be difficult to sustain in the event of inadequate management
capacity, staff turnover, loss of funding or loss of system support.
Selected examples of experience/additional resources:
The WHO-Commissioned Study on Task Shifting documents the ways in which supervision has
been integrated as a key element of task shifting programmes in Haiti, Malawi and Uganda Annex a .
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