Examining the evidence for best practice guidelines in supportive supervision of lay health care providers in humanitarian emergencies: A systematic scoping review.

Background: Supervision is widely recognised as an important form of support for lay health service providers. However, guidance in appropriate supervision practices for task-shifting health interventions within the unique context of humanitarian emergencies is lacking. This review set out to identify empirically supported features of supervisory practices for lay health care providers in humanitarian emergencies, towards a stronger evidential basis for best practice in supportive supervision.

Methods: In January 2021, six databases and five non-governmental organizations' websites were searched for articles examining the effectiveness of supervision for health care interventions delivered by lay providers in humanitarian settings. The inclusion criteria for study selection were qualitative or quantitative primary studies, articles published in peer reviewed journals or technical reports and the availability of the studies in English. The outcomes of interest were client clinical outcomes, health service efficiency and sustainability, and lay health care providers well-being. All articles were independently reviewed by the first and last authors.

Results: A total of 3371 articles were initially identified, with a total of 11 articles retained following the systematic screening process (two quantitative, four mixed methods and five qualitative studies). All studies generally reported positive impacts of supportive supervision on client outcomes, service sustainability, staff well-being and staff performance. Only four studies offered emotional support as part of supportive supervision. No studies evaluated the effect of supportive supervision on service efficiency. The narrative synthesis suggests significant challenges with providing supportive supervision, including excessive workloads, difficult supervisory relationships, geographic dispersion of lay providers, safety concerns, poorly trained supervisors, and lack of supervisory guidelines.

Conclusions: More efforts are needed to prioritize supportive supervision in task-shifting frameworks and to ensure that supervision is regular, consistent and of high-quality, with well-trained and well-supported supervisors.