How supportive supervision can improve private health facility reporting in Ghana
Private sector facilities are an important part of Ghana’s health system. They provide approximately 40% of the care sought for sick children under 5, and around 35% of the population obtain their contraceptive methods from the private sector. Yet 51% of private clinical facilities and pharmacies do not report into the country’s District Health Information Management System 2 (DHIMS 2). This lack of reporting prevents the availability of comprehensive information on health service demand and use, which is critical to achieving an optimal health system. To address this issue SHOPS Plus collaborated with the USAID-SHOPS project in Ghana to co-design, test, and evaluate a sustainable mechanism to increase private facility reporting into DHIMS 2.
Co-creating a sustainable way to support private providers
To better understand private health facility reporting challenges and potential solutions, SHOPS Plus hosted a workshop with private providers and representatives from the national and district-level government entities that oversee health reporting. The providers identified the reasons for low reporting rates: lack of training and required personnel, low availability of paper forms, concerns about data privacy, perception of no feedback after submission, and no written documentation for the mandatory reporting requirement. The workshop participants worked together to identify regular quarterly supportive supervision to private facilities as a solution that was both sustainable and easy to implement. All facilities were supposed to receive quarterly supervision from their district health management teams, but reported that these visits either did not happen or were inconsistent.
RCT demonstrates impact of supportive supervision
SHOPS Plus conducted a randomized control trial (RCT) to determine the impact of regular supportive supervision on reporting, randomizing 150 facilities to either the control group, which received supervision visits per usual practice, or the treatment group, which received scheduled quarterly supportive supervision visits.
During the three quarters of observation, treatment facilities received an average of 2.9 visits, while control facilities received 1.3 visits. The RCT found these visits were associated with a statistically significant improvement in DHMIS 2 reporting, with 85% of treatment facilities submitting their reports during the observation period, compared to 73% of the control facilities.
Participants said that, in addition to improving DMIS 2 reporting, the regular supportive supervision visits provided opportunities for strengthening supply chain management of health commodities and human resources. This indicates far-reaching benefits and provides additional incentives for the Ghana Health Service and the Health Facilities Regulatory Agency to continue scaling the intervention nationwide.
This RCT is the first study to demonstrate the impact of how regular supportive supervision from the public sector can strengthen private sector representation in health information systems, serving as a model of a public-private partnership that could be sustainably scaled-up by governments to improve private sector reporting.