A Supportive Supervision Framework for Operational Managers in the Primary Health Care Facilities of the North-West Province

Abstract

Lack of Supportive Supervision (SS) of Operational Managers is raised as a serious challenge in the Primary Health Care facilities of the North-West Province. These occur despite the burden of disease and a high demand of quality services that should be provided to clients. Regardless of the challenges, Operational Managers (OPMs) are expected to play an effective supervisory role by ensuring that all the health care programmes are implemented according to the set norms and standards. The enhancement of Supportive Supervision of OPMs is necessary as it could impact positively on the provision of services and the burden of disease. In this regard, a qualitative, descriptive, exploratory and contextual research study was conducted aimed at developing a SS framework for Operational Managers in the Primary Health Care facilities of the North West Province. The objectives were: (1) to explore and describe experiences of Operational Managers regarding SS in the Primary Health Care (PHC) facilities of the North West Province, (2) to describe OPMs' perceptions of how Supportive Supervision of OPM can be facilitated effectively in PHC facilities of the North West Province, (3) to describe a framework for SS of OPMs in the Primary Health Care facilities, (4) to develop a Supportive Supervision framework of OPMs in the PHC facilities, (5) to validate a Supportive Supervision framework of OPMs in the Primary Health Care facilities, and (6) to describe the guidelines for operationalization of a SS framework in the Primary Health Care facilities of the North West Province. The population of this study comprised of OPMs who worked as supervisors for a period of more than a year in the PHC facilities of the North West Province. Purposive sampling was used to select the participants of this study. The researcher followed and applied applicable ethical principles throughout all phases of this study. The study was divided into two phases−the first phase explored and described experiences of OPMs and OPMs' perception of how Supportive Supervision can be facilitated in the PHC facilities. The data collection methods used was semi-structured in-depth focus group interviews. For this reason, four semi-structured in-depth focus group interviews were conducted in the four sub-districts of the NWP. The total number of Operational Managers who participated in this study, was twenty three. Their ages ranged from thirty seven to fifty eight years, three of the participants were males whereas twenty were females. The analysis of data followed Tesch's method of content analysis and open-coding (Creswell, 2009: 184). Four broad themes with their respective categories and sub-categories emerged from the consensus meeting held with the independent co-coder. In the first theme, the participants expressed experiences of factors related to compromised critical aspects of SS. The second theme embodied experiences of factors related to lack of qualities and competencies of a supportive supervisor. The third theme focused on experiences of factors that contribute to poor delegation and supervision in the PHC facilities. In the fourth theme, the participants expressed the factors that can enhance facilitation of effective supportive supervision. Phase two was divided into two stages, and the first stage stage focused on a description of a framework for Supportive Supervision of OPMs in the Primary Health Care facilities of NWP. The second stage focused on a framework development and description, validation and development of the proposed guidelines for operationalization of the framework. The University of Wisconsin Extension (UWEX) Logic Model guided the whole process of a framework for SS description and development (Powel and Henert, 2008:56). The recommendations included, amongst others, in-service training regarding the critical elements of SS for Local Area Managers and Operational Managers for enhancement of supervision by OPMs in the Primary Health Care facilities, shortage and retention of nursing staff needs an urgent intervention. The health department also needs to advertise vacant posts for managers playing a role in SS of PHCs in order to close the gap caused by acting positions. A developed supportive supervision framework for Operational Managers in the North West Province could improve supervision and management of Primary Health Care facilities.