IFGH 2012: An In-Depth Exploration of Health Worker Supervision in Malawi and Tanzania

January 30, 2012

Authors:Bradley S.1, Kamwendo F.2, Masanja H.3, de Pinho H.4, Waxman R.4, Boostrom C.1, McAuliffe E.1

Author Affiliations:1 Centre for Global Health, University of Dublin, Trinity College, Dublin, 2 University of Malawi, College of Medicine, Centre for Reproductive Health, Malawi, 3 Ifakara Health Institute, Dar Es Salaam, Tanzania, 4 Averting Maternal Death and Disability Program (AMDD), Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, USA

Option 1– Scientific / Empirical Research Findings Presented as – Oral Presentation


To explore the perceptions of district health management teams (DHMT) in Tanzania and Malawi on their role as supervisors and the challenges to effective supervision at the district level.


This qualitative study took place from Oct-Dec 2008 as part of a broader project, “Health System Strengthening for Equity: The Power and Potential of Mid- Level Providers”. Semi-structured interviews with DHMT personnel in Malawi (n=20) and Tanzania (n=39) covered a range of human resource management (HRM) issues. These included supervision and performance assessment, staff job descriptions and roles, motivation and working conditions.


Participants reported considerable autonomy in supervision of facilities in their districts but displayed varying attitudes to the nature and purpose of the supervision process. Much of the discourse in Malawi centred on inspection and control; interviewees in Tanzania were more likely to articulate a paradigm represented by support and improvement. In both countries facility level performance metrics dominated. The lack of competency based indicators or clear standards to assess individual health worker performance was considered problematic. Shortages of staff were a major impediment to carrying out regular supervisory visits. Other challenges included conflicting and multiple responsibilities of DHMT staff, and financial constraints.

Discussion/conclusions/ implications:

Supervision is a central component of HRM, not just a quality assurance mechanism. It plays a key role in performance and motivation, and is particularly important in a challenging work environment or in the context of task shifting. Policy level attention is crucial to ensure a systematic, structured process that is based on common understandings of the role and purpose of supervision. It needs to be adequately resourced and supported in order to improve health worker performance and retention at the district level.




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