Supportive supervision of mid level health workers in rural Nepal for improved job satisfaction, motivation and quality of care.

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Many low-income countries are suffering from shortages of health workers in rural areas. To expand access to health care, mid level health workers with up to three years training are being expected to complete tasks that higher cadres of health worker would usually undertake. Yet these cadres are largely ignored at a policy level. To enable these health workers to fulfill their potential and provide good quality care, they need to be adequately supported and supervised. Research suggests that health workers may respond better to supervision if their supervisor is aware of their emotional needs, and they build trust through listening, empathy and responding to their individual concerns (Cummings et al. 2010). This development grant will enable us to develop supportive supervision interventions for mid level health workers in rural Nepal, which will then be implemented through existing systems and evaluated in subsequent research. We will conduct a review of the literature using a realist methodology to understand for whom and in what circumstances interventions work. This will inform the development of supportive supervision interventions in Nepal. We will collect data from policy makers, programme implementers, managers, and health workers to describe existing systems, their weaknesses and collate the learning from national pilot interventions. This information will be discussed in a working group of government and non government participants who will meet regularly. This will help us to develop feasible interventions that have a broad level of support. A health economist will then model intervention costs. Interventions will be presented, debated and prioritised in a workshop with participants from the district and central level. On finalising interventions, a methodology will be designed to evaluate and understand the effect of these interventions, with input from experts and the working group. Funding sources will be identified to implement the interventions and research the effect of a supportive supervision intervention for mid level health workers in rural Nepal. We will disseminate our learning from this process through international peer reviewed publications, briefing papers, conferences and social media.