Shifting tasks to mid-level health workers has been recommended as an effective strategy to provide care in rural and remote areas where it is difficult to recruit and retain doctors and specialists. Clinical supervision is important to maintain and update knowledge and skills, and emotional and logistical support is needed to respond to individual and contextual concerns. In this context, HERD International and the Institute of Global Health, University College London have received funds from the UK Medical Research Council to develop an intervention in collaboration with the Government of Nepal which improves the support and supervision of mid-level health workers in rural areas.


The general objective of the study is to describe systems of supportive supervision for mid-level health workers and explore their feasibility in the Nepal health system context. The specific objectives are:

  • To conduct a realist review of the national, international, grey and academic literature about what works to provide supportive supervision, develop a theory around how interventions work and identify potentially effective interventions for Nepal
  • To describe current systems of supervision for mid-level health workers, and explore how they could be improved to support mid-level health workers
  • To learn from national pilot projects that aim to support mid-level health workers
  • To explore how a lack of supportive supervision of mid-level health workers affects health service provision and quality of care
  • To explore how mid-level health workers prefer to be supervised, and how district managers and central level stakeholders envisage supporting mid-level health workers better
  • To explore the management needs of different mid-level cadres, and different genders of health worker in consideration of intervention development.
  • To investigate what tools and training would be required to better support mid-levels and what systems changes would need to occur for supportive supervision to be developed.

Project Information

Thematic areas

Health system


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