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

许多低收入国家正面临农村地区卫生工作者短缺的问题。为了扩大获得卫生保健的机会，受过长达三年培训的中级卫生工作者预计将完成卫生工作者高级干部通常承担的任务。然而，在政策层面上，这些干部基本上被忽视了。为了使这些卫生工作者能够发挥他们的潜力并提供高质量的护理，他们需要得到充分的支持和监督。研究表明，如果卫生工作者的主管意识到他们的情感需求，并通过倾听、同理心和对他们个人关切的回应来建立信任，他们可能会对监督做出更好的反应(Cummings等人)。2010)。这笔发展赠款将使我们能够为尼泊尔农村的中层卫生工作者制定支持性监督干预措施，然后将通过现有系统实施，并在随后的研究中进行评估。我们将使用现实主义方法论对文献进行审查，以了解干预措施对谁以及在什么情况下有效。这将为尼泊尔制定支持性监督干预措施提供信息。我们将从政策制定者、方案实施者、管理人员和卫生工作者那里收集数据，以描述现有系统及其弱点，并整理从国家试点干预措施中吸取的经验教训。这一信息将在一个由政府和非政府参与者组成的工作组讨论，该工作组将定期举行会议。这将有助于我们制定得到广泛支持的可行干预措施。然后，一位健康经济学家将对干预成本进行建模。将在一个研讨会上介绍、辩论和确定干预措施的优先次序，参加者来自地区和中央一级。在最后确定干预措施时，将设计一种方法，以评估和了解这些干预措施的效果，并听取专家和工作组的意见。将确定资金来源，以实施干预措施，并研究对尼泊尔农村中层卫生工作者进行支持性监督干预的效果。我们将通过国际同行评议的出版物、简报、会议和社交媒体传播我们从这一进程中吸取的经验教训。

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.