Supportive supervision of mid level health workers in rural Nepal for improved job satisfaction, motivation and quality of care. (360G-Wellcome-110316_Z_15_Z)

Many low-income countries are suffering from a shortage of health workers in rural areas. In response to this, tasks are being shifted to mid level cadres who are often working without adequate management and support mechanisms. These cadres require emotional and clinical support in order to develop and retain their skills, and an enabling environment to provide good quality care. The evidence base about the impact of supportive supervision on primary health care is weak, and there is a need to develop the theory about how supportive supervisions may work. We will conduct action research with central and district level stakeholders, and health workers to describe and explore the difficulties facing mid level health workers, and discuss current weaknesses in existing supervisory mechanisms. We will also explore supervision preferences of mid level health workers, and the effect of gender and difference in cadre on supervisory needs through qualitative interviews in three districts. We will critically examine pilot interventions and conduct a realist review of the national and international literature to identify potential interventions which could be implemented for mid level health workers in rural Nepal. Findings will be fed back and discussed in a working group, and interventions presented to a wider group of stakeholders at a workshop. Cost information will also be prepared and presented at this workshop. After participatory prioritisation of interventions, we will develop an evaluation methodology and theories of change, which we will present at a dissemination meeting. We will seek funding for the implementation and evaluation of the prioritised supportive supervision interventions, and identify pilot districts in which to test interventions. We will disseminate our methodology and interventions among academic and practitioner audiences.