Publication:

Enhancing quality of care: the role of supportive supervision and mentorship in the female health worker program in Somalia’s hard to reach and fragile context

Background Supportive supervision and mentorship are critical to the improvement of community health worker performance. However, their specific functions in achieving health outcomes are often overlooked. This study analyzes the implementation of supportive supervision and mentorship approach within Somalia's female health worker (FHW) program to define and quantify its impact through distinct operational roles.

Methods A longitudinal program evaluation was conducted using retrospective analysis of routine health program data from the FHW program in Somalia from January 2022 to December 2025. Trends were analyzed for process indicators (number of active FHWs, percentage receiving timely supervision) and outcome indicators [antenatal care (ANC) contacts, pentavalent vaccination referrals].

Results The scaling of the supportive supervision and mentorship activities to over 90% coverage was associated with a 63% increase in the active FHW workforce (from an estimated 500 in January 2022, to >1,388 by December 2025). Cumulative ANC contacts exhibited exponential growth from 695 in 2022 to 80,782 in 2025, alongside a marked increase in children receiving Penta1 vaccination from approximately 1,478 in 2022 to over 198,820 in 2025. The supportive supervision and mentorship activities addressed different systemic weaknesses, contributing collectively to these outcomes.

Conclusions The supportive supervision and mentorship approach served not as a single activity but as a synergistic framework performing multiple critical functions. While mentorship improved service quality, the aspect of performance monitoring drove output accountability. In addition, it motivated and stabilized the FHWs and enhanced overall program responsiveness. This multi-layered framework provides a model for implementing supportive supervision and mentorship to achieve substantial health gains in fragile settings like Somalia.