An assessment of the effectiveness of supervision in preventive healthcare institutions under the purview of the Regional Directorate of Health Services, Kalutara
Authors: Arachchi K. A. N. L. K. , Samarage S. 
Published: January 2024

Background: Supervision is an essential element in primary healthcare. It is not only the number that matters but the quality and effectiveness of supervision as well. Ineffective supervision is a cause of poor performance that can lead to sub-optimal health outcomes.Objective: To assess the effectiveness of supervision in preventive healthcare institutions under the administrative purview of the Regional Directorate of Health Services (RDHS), Kalutara.Method: A descriptive cross-sectional study was designed and carried out in all preventive sector healthcare institutions under the administrative purview of the RDHS, Kalutara. The entire population of the supervisors (Regional Director and Deputy Regional Director of Health Services, Consultant Community Physician, Medical Officer-Maternal & Child Health, Regional Epidemiologist, District Dental Surgeon, Supervisory Public Health Nursing Officers, Supervisory Public Health Inspector, Medical Officers of Health, Additional Medical Officers of Health, Supervisory Public Health Inspectors, Public Health Nursing Sisters, and Supervisory Public Health Midwives) and supervisees (Public Health Inspectors and School Dental Therapists) in the RDHS division except the Public Health Midwives (PHMs) was included in the study as their actual numbers are low. The selection of PHMs, the major category of supervisees, was subjected to random sampling. Self-administered questionnaires, focus group discussions, and observatory visits were used to collect the data. Data were analyzed both quantitatively and qualitatively. The effectiveness of supervision was assessed utilizing Manchester Clinical Supervision Scale (MCSS-26). Knowledge, attitudes, and practices of supervisors were assessed through a self-administered questionnaire and to some extent through observations.Results: The overall response rate was 67.8%. The knowledge related to supportive supervision among the supervisors was moderate. The level of knowledge was not significantly different among the different categories of supervisors. The level of attitudes towards supervision was also moderate. However, it was significantly different among the supervisory categories. As per the scale devised through the questionnaire, the supervisory practice was moderate as well, but it was not significantly different among the different categories of supervisors. The mean score of MCSS-26 was 65.67 indicating that overall supervision was ineffective by its threshold limit of 73. Apart from the administrative function of supervision, the supportive and educational functions were largely ineffective.Conclusion and recommendations: The effectiveness of supervision was suboptimal in preventive care health institutions of the RDHS division Kalutara. Appropriate measures that focused on enhancing supportive and educational functions of supervision are therefore required to improve the effectiveness of supervision among different categories of supervisors in the division. Designing and implementing more focused training and development activities to improve knowledge, attitude, and practices in supportive supervision; facilitating, encouraging, and empowering the supervisors to implement their post-supervisory recommendations; and utilizing the MCSS-26 as a tool of measuring supervisory effectiveness for the purpose of monitoring and evaluating the supervisory activities, are therefore recommended to improve the effectiveness of supervision in the division.