The improvements in the enhanced supervision facilities were very modest and of questionable clinical significance.
Changes in test scores were compared between the intervention (enhanced supervision) and the non-intervention (routine supervision) facilities.
After two years, 16 intervention facilities (23.2%) had a visual acuity chart correctly placed and 19 (27.5%) had a working torch, compared to 4 (5.9%) and 6 (8.8%), respectively, in the routine supervision facilities.
During both rounds of supervision, facilities in all four districts consistently performed better in record-keeping for family planning and maternity services than in any other area of service delivery.
Five contextual factors which affect the implementation of P4P were identified by health workers: salary and employment benefits; resource availability, including staff, medicines and functioning equipment; supervision; facility access to utilities; and community preferences.
Health worker in a health centre, December 2012 This study identified five categories of contextual characteristics affecting the implementation of P4P, including salary and employment benefits, resource availability, supervision, facility access to utilities, and community attitudes.
Even so, despite having been provided with these, only about one-quarter of the enhanced-supervision facilities had working torches and correctly placed VA charts after two years.
External supervision of facilities and providers, for example, is argued to be one way of linking the peripheral facility to the district, which may be important for maintaining performance and for motivating staff.
The same may apply for public providers, with good health management team supervision, public facilities are more likely to abide by the new treatment recommendations, but this cannot be said for non-public facilities, hence significantly less use of SP for last malaria episodes was observed from non-public providers in this study.
CHMT members reported high levels of responsibility for supervision of facilities in the district.
"Decentralisation has fostered better supervision of facilities by the district because they are now answerable to the people at the district or within their areas of jurisdiction" (Secretary District Service Commission, Uganda) ".
