One of the studies in the September issue of Health Affairs evaluates how much in-service training and supervision affect the quality of care for pregnant women and sick children in sub-Saharan Africa. The study, by Hannah Leslie of the Harvard T. H. Chan School of Public Health and coauthors, examined nationally representative health system surveys from seven countries in the region, pooling data from Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda between 2006 and 2014. This is one of the few studies to analyze training and supervision in a multicountry sample, drawing upon observations of over 5,000 providers. For antenatal care, the authors found that receiving both recent in-service training and supervision was associated with a small difference in quality score. Also, the quality of sick child care was moderately associated with both training and supervision. Clinical quality increased slightly when a greater percentage of training topics or supervisory actions was covered, but quality did not exceed 50 percent of expected performance (see the exhibit below.)
"In-service training and supportive supervision as delivered were not sufficient to meaningfully improve the quality of care in these countries," the authors conclude. "Greater attention to the quality of health professional education and national health system performance will be required to provide the standard of health care that patients deserve."
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