Influence of Supportive Supervision on Performance of Community Health Promoters in Tuberculosis Service Delivery in Mombasa County, Kenya
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Abstract
Tuberculosis remains a major public health challenge globally and in Kenya. In Mombasa County, Community Health Promoters (CHPs) play a central role in community-level TB activities, including sensitization, referral of presumptive cases, contact tracing, and defaulter follow-up. This study examined how supportive supervision influences CHP performance in TB service delivery. A descriptive cross-sectional design was used, involving 233 participants (CHPs, Community Health Assistants, and Sub-County Community Health services Coordinators). We collected data through questionnaires and key informant interviews and analyzed using descriptive statistics, Mann–Whitney U tests, and logistic regression. Overall, CHPs reported moderate performance across TB service indicators, with notable gaps in pre-service preparation, refresher training, availability of tools, incentives, and feedback systems. The logistic regression model was statistically significant, explaining a moderate proportion of variance in performance (Cox & Snell R² = 0.329; Nagelkerke R² = 0.462). Three components of supportive supervision independently predicted higher CHP performance: adequate pre-service training (OR = 3.57, p = .002), timely feedback (OR = 3.45, p = .004), and regular review meetings (OR = 3.94, p = .001). The findings indicate that strengthening foundational training, institutionalizing structured review mechanisms, and ensuring timely supervisory feedback are critical for improving CHP performance in TB service delivery. The study recommends enhancing pre-service training, establishing clear feedback loops, integrating TB-specific review meetings into routine supervision, and ensuring adequate support systems to sustain effective community-based TB services.
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