Health Policy and Planning Advance Access published online on October 17, 2007
Health Policy and Planning, doi:10.1093/heapol/czm037
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Effectiveness of training supervisors to improve reproductive health quality of care: a cluster-randomized trial in Kenya
1 Research Scientist, Health Services Research Division, Family Health International, Research Triangle Park, NC, USA.
2 Research Associate, Africa Region Office, Family Health International, Nairobi, Kenya.
3 Biostatistician, Biostatistics Division, Family Health International, Research Triangle Park, NC, USA.
4 Economist, Health Services Research Division, Family Health International, Research Triangle Park, NC, USA.
5 Director, Health Services Research Division, Family Health International, Research Triangle Park, NC, USA.
* Corresponding author. Health Services Research Division, Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA. Tel: +1 919 544 7040 x510. Fax: +1 919 544 7261. E-mail: hreynolds{at}fhi.org
Health facility supervisors are in a position to increase motivation, manage resources, facilitate communication, increase accountability and conduct outreach. This study evaluated the effectiveness of a training intervention for on-site, in-charge reproductive health supervisors in Kenya using an experimental design with pre- and post-test measures in 60 health facilities. Cost information and data from supervisors, providers, clients and facilities were collected. Regression models with the generalized estimating equation approach were used to test differences between study groups and over time, accounting for clustering and matching. Total accounting costs per person trained were calculated. The intervention resulted in significant improvements in quality of care at the supervisor, provider and client–provider interaction levels. Indicators of improvements in the facility environment and client satisfaction were not apparent. The costs of delivering the supervision training intervention totalled US$2113 per supervisor trained. In making decisions about whether to expand the intervention, the costs of this intervention should be compared with other interventions designed to improve quality.
Key Words: Organization and administration, quality of health care, Kenya, reproductive health services, programme evaluation
Accepted for publication 13 August 2007.