Original Research

The relationship between primary healthcare providers and their external supervisors in Rwanda

Michael Schriver, Vincent K. Cubaka, Laetitia Nyirazinyoye, Sylvere Itangishaka, Per Kallestrup
African Journal of Primary Health Care & Family Medicine | Vol 9, No 1 | a1508 | DOI: https://doi.org/10.4102/phcfm.v9i1.1508 | © 2017 Michael Schriver, Vincent K. Cubaka, Laetitia Nyirazinyoye, Sylvere Itangishaka, Per Kallestrup | This work is licensed under CC Attribution 4.0
Submitted: 17 May 2017 | Published: 01 November 2017

About the author(s)

Michael Schriver, Centre for Global Health, Department of Public Health, Aarhus University, Denmark; Aarhus University Hospital, Denmark
Vincent K. Cubaka, Centre for Global Health, Department of Public Health, Aarhus University, Denmark; School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
Laetitia Nyirazinyoye, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Rwanda
Sylvere Itangishaka, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
Per Kallestrup, Centre for Global Health, Department of Public Health, Aarhus University, Denmark


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Abstract

Background: External supervision of Rwandan primary healthcare facilities unfolds as an interaction between supervisors and healthcare providers. Their relationship has not been thoroughly studied in Rwanda, and rarely in Africa.
Aim: To explore perceived characteristics and effects of the relationship between providers in public primary healthcare facilities and their external supervisors in Rwanda.
Setting: We conducted three focus group discussions with primary healthcare providers (n = 16), three with external supervisors (n = 15) and one mixed (n = 5).
Methods: Focus groups were facilitated under low-moderator involvement. Findings were extracted thematically and discussed with participating and non-participating providers and supervisors.
Results: While external supervision is intended as a source of motivation and professional development in addition to its managerial purpose, it appeared linked to excessive evaluation anxiety among Rwandan primary healthcare providers. Supervisors related this mainly to inescapable evaluations within performance-based financing, whereas providers additionally related it to communication problems.
Conclusion: External supervision appeared driven by systematic performance evaluations, which may prompt a strongly asymmetric supervisory power relation and challenge intentions to explore providers’ experienced work problems. There is a risk that this may harm provider motivation, calling for careful attention to factors that influence the supervisory relationship. It is a dilemma that providers most in need of supervision to improve performance may be most unlikely to benefit from it. This study reveals a need for provider-oriented supportive supervision including constructive attention on providers who have performance difficulties, effective relationship building and communication, objective and diligent evaluation and two-way feedback channels.

Keywords

supportive supervision; managerial supervision; supervisory relationship

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