‘Good emergency management is all about systems’: A qualitative investigation into the monitoring and evaluation of supportive supervision for mental health and psychosocial support workers across diverse humanitarian contexts

‘Good emergency management is all about systems’: A qualitative investigation into the monitoring and evaluation of supportive supervision for mental health and psychosocial support workers across diverse humanitarian contexts | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article ‘Good emergency management is all about systems’: A qualitative investigation into the monitoring and evaluation of supportive supervision for mental health and psychosocial support workers across diverse humanitarian contexts Charles Zemp, Azza Warraitch, Salam Jabbour, Ahmad Alshibi, Michelle Engels, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9282392/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: Monitoring and evaluation (M&E) is an essential component of humanitarian response. Supportive supervision for humanitarian workers is increasingly recognised as a key mechanism to protect the quality and sustainability of mental health and psychosocial support (MHPSS) services, with the 'Integrated Model for Supervision’ (IMS) offering operational guidance for how humanitarian organisations can strengthen their supervisory systems. While general guidance on the M&E of humanitarian MHPSS activities exists, minimal guidance on how to specifically conduct the M&E ofsupportive supervision for humanitarian MHPSS workers is available. To address this knowledge gap, our study aimed to identify the factors that contribute to the successful M&E of supportive supervision across a diverse range of humanitarian organisations, as well as assess the fitness-for-purpose of the IMS’ updated M&E framework to guide M&E efforts. Methods: To achieve these objectives, we conducted 10 key informant interviews with diverse humanitarian mental health practitioners, supervisors, and M&E technical experts. Interviews were analysed using thematic analysis. Results: Our findings highlight the influence of the organisational system, the need to standardise M&E practices, and the importance of adequate well-trained human resources in successfully conducting the M&E of supportive supervision. While participants thought the IMS M&E Framework could prove useful, challenges relating to each of these factors suggest that continued advocacy, funding, and inter-disciplinary collaboration are required to support meaningful and sustained M&E of supportive supervision for humanitarian MHPSS workers. Conclusions: Through identifying key barriers and facilitators to conducting the M&E of supportive supervision, our findings provide evidence that can help inform the development of M&E policies and procedures for humanitarian organisations and, therefore, contribute to enhancing the sustainably delivery of quality MHPSS services to populations affected by humanitarian crisis. qualitative monitoring & evaluation mental health and psychosocial support supportive supervision Integrated Model for Supervision service quality humanitarian contexts 1. Introduction As of early 2026, an estimated 239 million people need humanitarian assistance (UNOCHA, 2025 ), primarily driven by climate-related events, violence and armed conflict, and poverty (UNOCHA, 2024 ). Often accompanying these crises are profound mental health and psychosocial consequences (Tol et al., 2015 ; Bangpan et al., 2019 ), including the onset or aggravation of mental health conditions (Murthy & Lakshminarayana, 2006; Charlson et al., 2019 ). Accordingly, the provision of mental health and psychosocial support (MHPSS) services – defined as “any type of local or outside support that aims to protect or promote psychosocial well-being and/or prevent or treat mental disorder” (Inter-Agency Standing Committee [IASC], 2007, p.1) - is increasingly recognised as a key component of humanitarian assistance (Tol et al., 2020 ; UNHCR, 2024 ). With growing demand for MHPSS services, however, comes a corresponding need to ensure their quality and sustainability (Tol et al. 2023 ; Abujaber et al., 2024 ), both of which depend on a well-supported MHPSS workforce (Dickson & Bangpan, 2018 ; Perera et al., 2021 ). Humanitarian contexts are inherently challenging environments for humanitarian aid workers (HAWs), many of whom face high workloads, experience primary and secondary trauma, and have limited access to organisational supports and professional development opportunities (Foo et al., 2023 ; Abujaber et al., 2024 ; Vallières et al., 2025 ). These challenges can negatively affect HAW wellbeing (Jachens, 2018 ; Aldamman et al., 2019 ) and contribute to high rates of staff turnover (Jachens, 2018 ), thereby threatening the quality and continuity of care. In recent years, supportive supervision has been increasingly identified as a key mechanism for addressing these challenges, given the positive and cascading influence its provision can have on HAW wellbeing (Kurt et al., 2025 ; Ryan & Zemp et al., 2025 ; Zemp et al., 2025 ). Despite its noted benefits, however, the provision of supportive supervision within humanitarian organisations remains under-prioritised and inconsistent (Abujaber et al., 2022 ; Ryan et al., 2023 ; Abujaber et al., 2024 ), partly due to an absence of evidence-based guidance on how humanitarian organisations can strengthen their supervisory practices (Ryan & Zemp et al., 2025 ). To address this gap, the Integrated Model for Supervision (IMS) was launched in 2021. Details of the use of participatory approaches for the IMS’ development and subsequent iterations are reported elsewhere (Ryan & Zemp et al., 2025 ) and ongoing research on the IMS offers evidence of its utility in supporting organisations to enhance their supervisory systems (Ryan et al., 2023 ; Ryan & Zemp et al., 2025 ; Zemp et al., 2025 ). In contrast to earlier models of supervision (Clements et al., 2007 ), the IMS posits that supportive supervision is a collaborative and non-hierarchical relationship between supervisor and supervisee(s), through which a supervisor should strive to achieve three key outcomes: providing emotional support to the supervisee, enhancing their skills, and monitoring the quality of their work (IFRC PS Centre & Trinity Centre for Global Health [TCGH], 2023). In doing so, the IMS seeks to address the multifaceted needs of MHPSS practitioners while aligning with organisational goals and standards (Ryan et al., 2023 ). Working towards building the global evidence-base for emergency MHPSS initiatives, the Inter-Agency Standing Committee (IASC) Reference Group on MHPSS Support in Emergency Settings developed their "Common Monitoring and Evaluation Framework for Mental Health and Psychosocial Support in Emergency Settings” in 2021. While serving as a seminal resource for the meaningful monitoring and evaluation (M&E) of humanitarian MHPSS programming, the IASC (2021) stipulates that the common M&E framework does not capture the full breadth of MHPSS initiatives, and that “every programme, project, or activity will require its own unique M&E framework that is appropriate and relevant to its design” (p. 11). That said, heterogeneity in the “goals, outcomes, indicators, and means of verification” (MoV) common in M&E practices poses a challenge to assessing the overall value and impact of MHPSS programming (IASC, 2021, p. 4). Indeed, a recent consensus-based research agenda for humanitarian MHPSS programming saw endorsement of how to develop effective M&E systems as the third highest priority (Tol et al., 2023 ). Echoing these calls, follow-up consultations with those trained in the IMS also revealed a demand for ongoing M&E that meets the specific needs of HAWs and that can be adapted to each implementer’s cultural and organisational context (Ryan et al., 2023 ; Abujaber et al., 2024 ; Ryan & Zemp et al., 2025 ; Zemp et al., 2025 ). In response, the IMS team has developed an ‘IMS M&E Framework’ to supplement the implementation of the IMS within implementing organisations (Red Cross Red Crescent Movement MHPSS Hub & TCGH, in press). Among other content - and heeding the call for “a user-friendly overview of psychometrically sound tools” for conducting the M&E of humanitarian MHPSS programming (Augustinavicius et al., 2018 , p. 9) - the IMS M&E Framework contains a compendium of indicators and accompanying MoVs that organisations may choose to include in their M&E of supportive supervision. MoVs were included based on meeting all or most of the following criteria: (i) suitable for measuring changes in supervision-related outcomes, (ii) validated for use in low-and middle-income countries (LMICs; where a disproportionate amount of humanitarian emergencies occur (Al Omari et al., 2024 )), (iii) previously used in research to measure its associated outcome among HAWs, healthcare workers, and/or populations affected by humanitarian crises, (iv) free to access and administer, and (v) available in multiple languages. The IMS M&E Framework also includes a sample logistical framework (i.e., Logframe) for guiding M&E, linking suggested indicators across all levels of M&E – goal, outcomes, inputs, etc. – to their relevant MoV, where applicable. Like the common M&E framework developed by the IASC (2021), the IMS M&E Framework is intended to allow for greater synchronicity among supportive supervision M&E practices, while also avoiding an entirely prescriptive approach. Instead, organisations are encouraged to select the most relevant components for their unique IMS implementation. Currently undergoing final design processes, the IMS M&E Framework has not yet undergone piloting or any formal evaluation of its fitness for purpose. Furthermore, while the need for robust M&E practices within MHPSS is clear, to our knowledge, there is no existing academic literature that provides insights into how to develop and implement an M&E system specifically for supportive supervision practices in humanitarian contexts. The objectives of the current study are thus three-fold. First, we aimed to identify the factors that contribute to the successful implementation of the M&E of supportive supervision within existing organisations. Second, we sought to ascertain how well the IMS M&E Framework reflects these factors and, third, how it could be improved to reflect these factors going forward. Therefore, and in pursuing these objectives, this qualitative study yields the potential to not only meet the call for more research and guidance on the M&E of humanitarian MHPSS programming (Augustinavicius et al., 2018 ; Tol et al., 2023 ), but to also contribute to a better supported humanitarian MHPSS workforce and, by extension, the quality and sustainability of the services they deliver (Tol et al., 2023 ). 2. Materials & Methods 2.1 Participants and Procedures Participants were recruited via purposive and snowball sampling from seven humanitarian organisations operating across different countries and actively implementing the IMS, as well as from two members of the IMS team with knowledge and/or experience in M&E. Of the N = 31 eligible individuals contacted to participate, n = 10 individuals consented to an interview. Most of these participants ( n = 8) had previously participated in an IMS training and had knowledge of their organisation’s IMS implementation process. The remaining participants ( n = 2) had direct involvement in developing the IMS M&E Framework and in providing M&E support to IMS-implementing organisations. Table 1 provides demographic information for each participant. Table 1 Participant demographic information Participant Code Organisational Role Country Sex A MHPSS Technical Lead/IMS Focal Point Jordan Male B International MHPSS Technical Advisor Ukraine Male C MHPSS Technical Team Lead/Supervision Trainer Ukraine Male D Mental Health Pharmacist/Supervisor Jordan Female E Counselling Supervisor/IMS focal point Ethiopia Female F Psychotherapist Trainer/Supervisor Ethiopia Male G Psychologist Jordan Female H IMS Technical Advisor Denmark Female I M&E Technical Advisor Denmark Female J Staff Supervisor Jordan Female 2.2 Interviews Semi-structured individual interviews with all participants took place between July and November 2024 via Microsoft Teams. Interviews were conducted in English ( n = 8) and Arabic ( n = 2). Following verbal consent, interviews were audio-recorded and transcribed either through using Microsoft Teams' built-in recording and transcription tools for English interviews, or by simultaneously translating and transcribing the Arabic interviews. English interview recording transcriptions were then checked for accuracy against the audio recording. Interviews with the eight participants from IMS-implementing organisations were guided by an open-ended interview schedule on the implementation of the M&E of supportive supervision within the organisation, including barriers and facilitators to its implementation (towards achieving our first objective). The subsequent two interviews with participants involved in the development of the IMS M&E Framework (Participants H & I) were guided by a separate open-ended interview schedule, developed following initial theme generation from the previous eight interviews in order to illicit responses to implementers’ initial feedback (towards achieving our second objective). Please see Supplementary File 1 for the complete interview schedules. 2.3 Analytical Strategy Data was analysed by co-authors CZ and AW using Braun and Clarke’s ( 2006 ) six-step thematic analysis methodology. First, the co-authors familiarised themselves with the data by listening to interview recordings and actively reading transcripts. Next, the transcripts were re-read, and initial codes were generated based on the research objectives. Coding was both deductive - looking specifically for mention of barriers and facilitators to conducting the M&E of the IMS - and inductive, allowing for open-coding. The third step involved the review and grouping of initial codes into preliminary themes and sub-themes. Steps four and five focused on refining these themes and final theme definition. Finally, the defined themes were narratively synthesised, with relevant quotes selected to illustrate each theme. All analysis was conducted using NVivo Version 12 (QSR International, 2018). 2.4 Ethics Ethical approval for this study was obtained from the Trinity Centre for Health Policy and Management/Centre for Global Health Research Ethics Committee of Trinity College Dublin (Dublin, Ireland, Approval No. 3270) on June 7, 2024. 3. Results We identified three main themes from our analysis. Table 2 provides an overview of these themes and any accompanying sub-themes. Table 2 Qualitative results organised by theme and sub-themes Theme 3.1: Influence of the organisational system Theme 3.2: Standardisation of M&E practices Theme 3.3: Human resources for the M&E of supportive supervision 3.2.1 Benefits of standardisation 3.3.1 Total reliance on supervisors 3.2.2 What to include as part of standardisation? 3.3.2 Increasing the capacity of available human resources 3.3.3 How to standardise? 3.1 Influence of the organisational system Conducting the M&E of supportive supervision represents “an organisational system problem” and, as such, its implementation “needs to be embedded into that system” (Participant I). Participants highlighted several barriers and facilitators to this integration. First among these was the bureaucratic nature of humanitarian organisations, which participants identified as delaying or thwarting the implementation of novel M&E-related practices. For example, because of “competing priorities” for organisational review, the approval of M&E-related requests can be “less important and forgotten, so that nobody will keep asking about such things” (Participant E). Participant B built on these comments, detailing how their organisation’s M&E practices are “usually confined by a maximum number of indicators and things that we can measure ” across all the organisation’s programmes. This means that programme implementers must “be selective into what we are measuring” , which results in having to “ ... deprioritise M&E for supportive supervision” (Participant B). They attributed this to the fact the M&E of supportive supervision is perceived by decision makers to be “ as if we are measuring part of the work...part of the job of people is to do supportive supervision” , and, as not directly related to programming, was not seen as something warranting its own M&E activities. These comments reflect the importance of raising organisational awareness around the utility of conducting M&E of supervision practices, and may necessitate a change in what humanitarian organisations view as the purpose of conducting M&E. For instance, a common assertion is that M&E is often “done purely for donors and not for organisational learning” , with Participant I contending that M&E of humanitarian programming is “very much still considered [to be] about compliance”. While monitoring the “specific criteria that [donors] are going to ask you to monitor” is unavoidable in humanitarian programming, the prioritisation of M&E of supportive supervision should consider “what do you want to know about for your organisation?....Why do you think it's important to have supervision?” (Participant H). One reason for this is that the inclusion of organisationally-relevant M&E indicators of supportive supervision would serve as a useful “advocacy tool” (Participant B) to support the continued provision of supportive supervision within an organisation: You might only have one indicator that at an organisational level is being collected on supervision and that might help you get budget internally to continue to do supervision. (Participant I). Finally, multiple participants commented on the benefit of “leveraging existing M&E within the organisation” (Participant I) to facilitate the M&E of supportive supervision. This could involve using data already provided by “the resources and tools that [organisations already] use” (Participant H) as part of their supportive supervision M&E practices. It could also mean adopting a more active approach and making “ adaptations to the existing system” (Participant F) to better tailor it to supervision – including adapting “existing tools” already used in organisational M&E, as well as and trying to “incorporate [new] tools” into data collection procedures (Participant F). Adaptation could also involve the addition of “an indicator to measure supportive supervision within our programmes” - the findings of which would not necessarily have to be “[sent]...to the donor” (Participant B) - such as the number of supervisory agreements in place, compared with the number of MHPSS workers delivering services. 3.2 Standardisation of M&E practices Whether through leveraging an existing system or implementing entirely new protocols, participants underscored the advantages of adopting a “standardised approach” (Participants A & D) when implementing the M&E of supportive supervision into their organisation, provided examples of what this could include, and highlighted considerations for the standardisation process. 3.2.1 Benefits of standardisation Participants began by highlighting the drawbacks of relying on informal methods to conduct the M&E of supervision practices. Participant D, for example, criticised the ad hoc collection of feedback on supervision, such as through “internal chats between staff and the supervisor” as opposed to more systematic feedback collection. They suggested that “every staff [member] should have the opportunity to reflect on his supervisor, just as every supervisor has the chance to reflect on his staff”. Participant A expressed a similar sentiment, explaining how existing M&E practices for supervision were “relying on...random feedback from the supervisees” to ascertain how their supervision was progressing and how it could be improved. They highlighted how this was “not structured, not systematised” and stressed the importance of standardisation to better measure the “quality of [supervision] sessions”. Participant G reinforced this, explaining the benefit of having an organisational “open-door policy” in relation to providing feedback on organisational practices: “A month ago, for example, the admin visited the clinics and we discussed a few things together. So, there is a very good atmosphere for freedom of expression and participation. This is a good motivation”. The potential benefit of standardisation in increasing engagement with M&E practices becomes particularly relevant when juxtaposed with HAWs’ resistance to have “their work monitored or evaluated” , partly stemming from them being “worried about what comes out in monitoring and evaluation” - that it functions as a “ scorecard of their work” (Participant I). If a standardised M&E system were designed to reinforce that M&E is “not a judgement of their work...that it’s actually about acknowledging what they have done and just helping them do it better” it could catalyse a greater willingness to engage with M&E for supportive supervision. Limited engagement with M&E practices may also be a result of the “very real sense of urgency” that characterises humanitarian responses and the consequent perception among HAWs that they “don’t have the time [for M&E] because we just need to do XYZ because...it [service delivery] is a matter of life and death” (Participant I). Standardisation could be useful toward rectifying any misunderstanding of the time required for participation in M&E: So, we felt that after the monitoring and evaluation was introduced, we felt [that if] it was somehow structured, it [would] give a clarity about frequency – when to do it (Participant A). Finally, standardisation of the M&E practices, particularly if involving “collaboration across [organisational] departments” , could coalesce into greater learning around “what the strengths of the organisation are, where the weaknesses are, where the gaps are ” in relation to the implementation of supportive supervision (Participant J). 3.2.2 - What to include as part of standardisation? Serving to address Participant D’s assertion that humanitarian organisations “ don’t know what to monitor and follow-up" for IMS implementation, participants spoke to the outcome indicators that should be included within a standardised M&E of supportive supervision. To help evaluate the extent to which supervision is being implemented across the organisation, multiple participants endorsed the need to ensure consistent tracking of “the hours and types of supervision” (Participant E) received. Other suggested indicators included levels of supervisee “burnout” (Participants A, F and J) and “compassion fatigue” (Participant A and F), which would be useful to gain insights on the influence of supervision on the “wellbeing of our staff” (Participant C). Additionally, indicators around any “improvement in performance among the staff” (Participant D), such as the “ degree to which the employee can solve the cases” and “[their] documentation and reporting” could help elucidate the impact of supervision from a “technical [perspective]” (Participant J). An especially salient suggestion among participants, largely due to its non-existence or minimal integration within existing M&E practices, was assessment of the “quality of supervision” (Participants B and C), with particular concern around the “satisfaction among the [supervised] team with the supervision” (Participant D). This was echoed by Participant E, who stated that they planned on using a “satisfaction survey among the staff so that we know if the supervis[ees] are getting the kind of supervision which is quality and with positive impact”. This could function as a proxy to “ensure that we are providing a quality service also for beneficiaries” (Participant E). Participant G provided example questions that could be explored toward this end: Do you feel like the supervisor values or appreciates your work? Does your supervisor thank you? Does your supervisor explain the purpose of the duties you have to do?... Do you see that the way supervision is happening is useful or are there other ways to better set it up? [...] Lots of questions like this would be able to show whether a person is really feeling supported or not. It is important to note, however, that assessment of these “quality benchmarks” may be hindered by a lack of access to “verified tools” that are “validated [and] translated into” the language of a humanitarian organisation’s operational context(s) - as inaccessible MoVs can prohibit the “link between improvement of quality and the supportive supervision” (Participant B). To help mitigate this, it may be useful to integrate more qualitative methods of inquiry into M&E practices, as reflected in Participant G’s suggestion that there should be a comprehensive " discussion where the supervisor places importance to the team” - creating a safe space for supervisees to provide open-ended feedback - as part of the standardised M&E system. Finally, while Participant A heralded that “standardisation is better” when it comes to the outcomes that are measured due to its "power to ensure...consistency of the data" , they also stressed that there should be room for “ flexibility for supervisors to pick extra tools” in accordance with their supervisory relationships. Allowing for this autonomy could also help supervisors be more "willing partners” (Participant H) in M&E, as previously discussed and essential to achieving “properly embedded M&E systems” (Participant I). 3.2.3 - How to standardise? Participants provided insights on how an organisation should go about standardising their M&E of supportive supervision practices, emphasising the importance of preparation and organisational collaboration as key factors to support standardisation. For example, Participant I recommended that the first step in any standardisation process should be taking the “time to sit down before you do something” to plan a “sort of simplified” system that aligns with “what is...possible...with limited resources”. To achieve the “pragmatism...[that] is required” when creating this plan, Participant I asserted that humanitarian organisations do not attempt to answer “every single question that they want to”. Instead, and while balancing organisational learning with donor-mandated practices (Participant I), humanitarian organisations should start by identifying “one or two goals and how you can measure [them]” (Participant H). For this to result in “something suitable for the organisation” , Participant J underscored that, while it is “the management [who] has to take a decision and implement it...all the levels should be involved....because each person has their own input on whether something is feasible or not”. This reflects Participant I’s comment that “everyone needs to feel responsible for this [the M&E]... from the supervisee to the supervisor to HR [human resources] staff, [and] M&E staff”. They continued by highlighting the importance of engaging supervisors and supervisees: So, you should have supervisors and supervisees in workshops determining what it is we want to know, as a team about our supervision system so that way when they're having to fill out the form...they know why they’re doing it . As shared by Participant E, this inclusive approach should also involve higher-level staff, such as “clinical advisors [and] international directors that oversee all the programmes, and also the monitoring and evaluation officer who is in HQ [headquarters] ”. Adopting this collaborative methodology could also help in dispelling the misconception, in Participant I’s mind, that “monitoring and evaluation is considered specialist” . While certain aspects of it can be specialist, “a lot of it isn’t” and “ most people that work in MHPSS programmes can think...with a little bit of support, how to build a system to help them collect some data” (Participant I). Reinforcing the importance of raising organisational awareness around the purpose of M&E, Participant I suggested that achieving standardised M&E may necessitate a “culture change within organisations” . According to Participant I, this change must be propelled by “people within their organisation” , as opposed to “outsourc[ing] [M&E] to a consultant”. These organisational "M&E champions....working within the team at different levels” could serve to “advocate for it to really take it forward” . 3.3 Human resources for the M&E of supportive supervision Humanitarian organisations must frequently operate with limited resources and, as such, are “constantly lacking capacity” (Participant I) to effectively conduct M&E. Akin to the benefit of having organisational M&E champions, participants underscored the deterministic influence of human resources on the successful M&E of supportive supervision and offered recommendations for preparing available staff to facilitate its implementation. 3.3.1 Total reliance on supervisors A principal consequence of operating with limited human resources is organisations “relying on supervisors to ensure that the [M&E] processes are done” (Participant A). Indeed, Participant F commented that “it’s the responsibility of the supervisor to recall this information and submit to M&E” , with Participant E (from the same organisation) confirming this dependency on supervisors for M&E-related data collection: The supervisors are tracking the time and frequency of supervision they have provided, whether it's individual supervision or group or live supervision, they're tracking that one. Given Participant A’s assertion that their pre-existing “workload is one of the biggest challenges for supervisors” , relying on supervisors to conduct a “structured, regular” M&E of supportive supervision would “not [be] an easy job” . Participant A further suggested that “there [is] a need for someone dedicated” , ideally sourced from inside the organisation: I would prefer dedicated [internal] staff rather than external staff because we need someone familiar. That's why we tried to explore some sort of adaptation that the monitoring and evaluation team can take over this role [M&E of supportive supervision] while they are doing the routine monitoring and evaluation. While Participant I agreed that “dedicated M&E staff are always needed” , they qualified that “very few teams are going to get a dedicated M&E person just for [the] IMS” , bolstering the importance of integrating the M&E of supportive supervision into ongoing M&E practices. Importantly, participants recommended that any individuals involved in the M&E of supportive supervision have “a strong mental health background” and be “ familiar with the IMS” (Participant A). 3.3.2 Increasing the capacity of available human resources Participants, however, described the distinct lack of human resources in their organisation who are “qualified or who [are] trained or [have] the proper way to follow up” on the M&E of supportive supervision, underscoring the need to ensure that M&E personnel “are well trained and have the right framework” (Participant D). To achieve the former, multiple participants recommended that “ M&E team[s] should be present in the [IMS] training, so they understand what the IMS is in the first place” (Participant J), and learn “how they can do, you know, outcome kind of analysis, how they can provide information back to the clinical team” in relation to the impact of supportive supervision (Participant F). Participant B emphasised that the integration of M&E personnel into an IMS training should be as inclusive as possible: Yeah it will be very useful. The more we have people trained, like people who understand MHPSS generally and IMS specifically, the better. Including M&E personnel within an IMS training could not only enhance their understanding of the IMS but also may be advantageous towards helping them pinpoint how to best “adapt it [any extant M&E system] to fit the IMS” (Participant H). Moreover, given how discussion of M&E is an explicit component within “the training curriculum of the IMS” (Participant H), inclusion of M&E staff may work to strengthen these discussions, which, in turn, could serve to reinforce the importance of intra-organisational collaboration within M&E practices: I really think that kind of the thing around awareness and knowledge of M&E, it's not just that people, that M&E people understand about IMS, it's the other way round. It's that people who are in supervision understand what data needs to be collected, that they're part of the decision making, right? (Participant I). On a more personal level, M&E staff participating in IMS trainings - as a precursor to M&E staff “receive[ing] [their own] clinical supervision regularly” (Participant F) - could directly support their personal wellbeing: M&E colleagues, they may not see it with their clients, with survivors of torture or trauma. They may not see directly, but they are the ones reading all the information which is captured in the assessment forms. So, reading those stories is exposing them to….you know, retraumatisation or secondary trauma. So, I would say I highly encourage that [they] attend an IMS training. Building on suggestions that M&E personnel have access to “the right framework” (Participant D) or “a step by step explanation” (Participant B) to guide them in their M&E of supportive supervision, Participant D expounded that “someone has to prepare the documents...the guideline... a clear monitoring and evaluation plan or checklist, indicators, that we can follow and see the achievement”. Indeed, reflecting on their experiences facilitating IMS trainings with diverse organisations, Participant H acknowledged that, “we realised that we needed something even more practical, more centred on the experience and the needs from the people working in the field” to support organisations in their M&E efforts. When asked about how well the IMS M&E Framework responded to what the eight IMS-implementing participants – as the “people working in the field” - shared in their interviews, Participant H (as someone directly involved in the development of the framework) shared that “overall, I think we managed to match the expectations of people.....in a way that is clear and logical” . By providing “a brief overview of what M&E is...related to supervision” , Participant H believed the IMS M&E Framework provides more tailored guidance than what is found within the multitude of other “M&E guides out there” . Beyond the content of the framework, Participant H also reflected on the utility of “the way it is designed....because of the way we divided it” , specifying how there is a section “specific for the [M&E] system, right, it’s about the [M&E] system and do we implement the system” - relating to the need to standardise the M&E of supportive supervision within an organisation. Participant I (the other participant involved in developing the framework) agreed with this overall sentiment, commenting that the IMS M&E Framework stands to help organisations acquire a clearer understanding of “at base level, here’s what it is you should try to do” , while simultaneously highlighting how humanitarian organisations “can build on that” through adapting the guidance “for their own context and programme” . The room for flexibility is a result of the framework’s intentional design as a “choose your own adventure kind of document” , particularly in relation to its “indicator bank and...suite of means of verification to choose from”. Additional remarks from Participant H reinforce this, commenting that by providing “something that is written...the list of things that we can [do]” the framework may help humanitarian organisations who are “stuck on the practicalities ” of M&E for supportive supervision, synchronously making it “easier to negotiate... easier to advocate for prioritising M&E when it comes to supervision” and “for making sure that there are people responsible for this” - as suggested by other participants. This may be in part due to the framework’s explicit emphasis on the role that “leadership and management and getting buy in” (Participant I) plays in implementing the M&E of supportive supervision, corroborating remarks previously explored. However, while “preparing those things and...hand[ing] them to the [monitoring and evaluation] department” (Participant D) may be sufficient, Participant A suggested that M&E staff also “need to understand the nature of the monitoring and evaluation document” . Indeed, Participant H, stressed that “when it comes to M&E [of supportive supervision]...we need probably to have extra training, right? Extra information” . In accordance with this request for more guidance on how to effectively use an IMS M&E guidance document, the IMS team intends to develop a “ workshop guidance” document (Participant I) to supplement the framework. This is intended to “give them [humanitarian organisations] time to familiarise themselves with the framework” , providing them with a “rough outline for a half-day workshop...where they go through and talk about...the IMS [M&E] framework” , including discussions around “the outcomes...the indicators...a draft Logframe”. This workshop guidance thus has the potential to give humanitarian organisations the means to better “work with and understand” the framework, facilitating “conversations about...what it is they want to know about their supervision system” , in alignment with “their own context...and their own programming” (Participant I). As a final note, while lauding the multifaceted potential that the IMS M&E Framework has in facilitating the successful practice of the M&E of supportive supervision, Participant I also cautioned that “the framework can’t be an answer to all of” the issues raised within the previous themes. They primarily attributed this to the universality of these themes within the M&E of multi-sectoral humanitarian programming: I think we need to be a little bit careful a bit saying that...these themes are totally associated with the IMS. I think they are...you could replace supervision with any type of progamme...and it would all be relevant. So, I think we can’t solve that with a framework. 4. Discussion Monitoring and evaluation (M&E) remains a high-priority component within MHPSS programming in humanitarian contexts (IASC, 2007; Tol et al., 2023 ). While the IASC provides essential guidance on the M&E of humanitarian MHPSS (IASC, 2021), there is a distinct need for both research and technical guidance on conducting the M&E of specific, unique MHPSS implementations (Augustinavicius et al., 2018 ; IASC, 2021; Tol et al., 2023 ), such as the integration of supportive supervision approaches. Thus, this study sought to (i) identify which factors contribute to the successful implementation of the M&E of supportive supervision within humanitarian organisations, (ii) ascertain how well the IMS M&E Framework reflects these factors, and (iii) how it could be improved. Through doing so, we contribute to “the development of practically relevant knowledge for [humanitarian] MHPSS activities”, as highlighted by Augustinavicius and colleagues ( 2018 , p. 2). Reflecting the broader humanitarian MHPSS literature (Troup et al., 2021 ), participants first spoke to the importance of their organisational system – both as a barrier and facilitator – towards effectuating the successful M&E of supportive supervision. More specifically, they described how the bureaucratic nature of their organisations can stagnate the approval of any M&E-related protocols. This concern echoes well-documented critiques of how humanitarian bureaucracy contributes to ineffective programming (Spiegel, 2017 ; Carlson et al., 2018 ; Sihombing et al., 2025 ). For instance, Carlson et al. ( 2018 ) claimed that the bureaucracy of aid organisations contributes directly to crisis mismanagement, particularly through their creation of information vacuums, consistent with our findings that misconceptions around the purpose and utility of M&E feed into its deprioritisation within organisational systems. In their investigation into the M&E factors that influence effective humanitarian programming in Nairobi, Kenya, Ouma & Nyang’au ( 2024 ) found that clear and accessible M&E communication, including its purpose, significantly predicted enhanced project performance. Taken together, these findings suggest that humanitarian organisations must prioritise regular stakeholder-inclusive communication of the M&E activities related to supportive supervision, ensuring that such messaging considers the diverse cultural, literacy, and language needs of all stakeholders (Ouma & Nyang’au 2024 ). Given the multitude of factors that contribute to humanitarian bureaucracy - some of which, such as donor requirements, are often beyond the capacity of organisation-level personnel to control (Ozkul & Jarrous, 2021 ) - it becomes especially important to focus on other changes that are achievable within existing constraints. In this context, leveraging and adapting existing M&E practices emerged as a critical strategy, reflecting broader literature on humanitarian MHPSS programming (Troup et al., 2021 ; Sihombing et al., 2025 ). As emphasized by our participants and supported by previous qualitative IMS investigations (Ryan et al., 2023 ; Abujaber et al. 2024 ), this could involve adapting and repurposing available tools, indicators, or data flows to capture pertinent supervisory information - as a low-cost, minimum effort solution where resources are scarce. Drawing support from past IMS literature (Ryan et al., 2023 ; Abujaber et al., 2024 ; Ryan & Zemp et al., 2025 ), participants suggested that another essential component of facilitating the organisational integration of the M&E of supportive supervision is sustained advocacy around its importance across different organisational cohorts, particularly leadership/management. This can include active efforts by individuals within the organisation (so called ‘M&E Champions’) to emphasise the inclusion of organisationally-relevant and context-specific indicators of supportive supervision – decided on collaboratively with supervisors/supervisees (Kuchio, 2023 ). This helps to ensure that the outcomes selected are meaningful to the organisation and its workers, rather than only representing donor-mandated outcomes (Ouma & Nyang’au, 2024 ). This is particularly important when considering that providing supportive supervision solely to comply with donor requirements may lead to insufficient improvements in quality of care (Avortri et al., 2019 ). Integrating more organisationally-driven indicators would likely lead to organisations gleaning more insightful information about the utility of supportive supervision in improving workforce wellbeing and the quality of MHPSS services (Dickson & Bangpan, 2018 ; Perera et al., 2021 ), as well as how supervision practices could be improved to better achieve these outcomes (Ryan & Zemp et al., 2025 ). It is therefore imperative that advocacy efforts for implementation of supportive supervision include consideration of M&E as a vital aspect of successful implementation. This could help lend its practice a greater degree of “institutional legitimacy”, as a key factor in successful humanitarian MHPSS coordination (Sihombing et al., 2025 , p. 62). Participants underscored the necessity of intra-organisational standardisation of M&E practices to improve the informal and inconsistent M&E procedures occurring within their organisations. As examples of these informalities, participants highlighted how irregular feedback mechanisms and scattered documentation negatively affected their efforts to assess supervision quality and impact. This reflects Carlson and colleagues’ ( 2018 ) that system-level interventions cannot be effective if implemented in an ad hoc manner. Indeed, a recent systematic review focused on the coordination of mental health services in humanitarian crises identified “fragmentation of information systems” as a principal impediment to effective coordination efforts (Sihombing et al., 2025 , p. 55). Part of this standardisation of the M&E of supportive supervision could be selecting a limited number of indicators to maintain the feasibility of the M&E (Augustinavicius et al., 2018 ), such as the type, duration, and frequency of supervision sessions, assessments of supervisee wellbeing (e.g. compassion fatigue, burnout, etc.), the levels of satisfaction with supervision, and the quality of supervision provided, as suggested by participants. However, participants mentioned that the lack of access to adapted and validated tools precluded them from establishing quality baselines or benchmarks. This suggests not only a continued need for researchers and practitioners to continue to adapt and test the cross-cultural validity of existing tools, ensuring that these efforts result in tools that “more closely meet real world needs” (Augustinavicius et al., 2018 , p. 9), but also the need for a central, open access repository where these tools can be housed and downloaded from. Please visit the IMS Community page within Zenodo for a basic version of such a repository, which can be accessed and added to by researchers and practitioners. In a similar vein, a critical path forward for the M&E of supportive supervision is the development, piloting, and roll-out of a standardised tool to assess the competencies of supportive supervisors. The ‘Ensuring Quality in Psychosocial and Mental Health Care’ (EQUIP) platform ( https://equipcompetency.org/en-gb/home ) is an evidence-based resource that could be leveraged to achieve this at scale. EQUIP is a widely used digital platform that provides a suite of freely accessible standardised tools to assess the competencies of MHPSS practitioners and improve the quality of services they provide (Kohrt et al., 2025 ). The current battery of tools hosted on EQUIP can purportedly “facilitate competency-based training and supervision” (i.e., supervision sessions tailored to the competencies of supervisees; Korht et al., 2025, p. 67). Inherent to this claim is the need for supervisors themselves to have the necessary competencies to provide effective supervision. Moreover, the role that supportive supervision can play in protecting the quality and sustainability of MHPSS services (Kurt et al., 2025 ; Ryan & Zemp et al., 2025 ; Zemp et al., 2025 ) also likely depends on supervisors possessing a certain level of supervision-specific competencies. To date, however, no tools within EQUIP have been developed exclusively to assess the competencies of supportive supervisors, some of which likely diverge from those of MHPSS service providers. This suggests a key area for the future development of the platform, with the team behind EQUIP recommending the “develop[ment] of new tools” be achieved through collaboration with “people with lived experience” (i.e., supervisors and supervisees in this case; Kohrt et al., p. 77). While standardised integration of tools across different organisational teams and/or supervisory relationships is recommended (Ouma & Nyang’au, 2024 ), participants also spoke to the importance of creating space for flexibility through allowing supervisors to select additional contextually relevant tools. This balance between standardisation and flexibility reflects a broader tension between “structural authority and local adaptability” in humanitarian MHPSS programming (Sihombing et al., 2025 , p. 62), with literature emphasising the importance of adaptable humanitarian M&E systems (Kevany et al., 2012 ). Participants also highlighted the importance of balancing information provided by quantitative metrics with qualitative insights (Augustinavicius et al., 2018 ; Sihombing et al., 2025 ). For example, asking supervisees reflective questions to evaluate the process of implementing supportive supervision (Augustinavicius et al., 2018 ), as well as the relational and practical quality of supervision, could provide a more nuanced understanding of its impact and areas for improvement. Reminiscent of the chronic resource limitations that impact MHPSS humanitarian programming globally (Troup et al., 2021 ; Giebel et al., 2024 ; Sihombing et al., 2025 ), participants highlighted how human resource constraints present a significant challenge to the execution of M&E for supportive supervision. They stressed how M&E responsibilities are allocated to already overburdened supervisors, who, in addition to lacking the necessary time, may not possess the requisite knowledge and skills to conduct systematic M&E (see Kevany et al., 2012 ; Troup et al., 2021 ). As a response, participants emphasised the need for dedicated personnel – ideally from existing M&E staff (i.e., not external consultants) – to conduct M&E activities associated with supportive supervision. This reflects multiple studies indicating a need for increases in M&E personnel across distinct sectors of humanitarian programming to ensure its consistent and quality practice (Kuchio, 2023 ; Ouma & Nyang’au, 2024 ). Complementary to having dedicated M&E personnel, task-sharing approaches to the M&E of supportive supervision may also enhance its sustainable practice. With a strong evidence-base for facilitating the provision of quality MHPSS services in resource-constrained settings (Le et al., 2022 ), task-sharing could be leveraged for the M&E of supportive supervision by actively involving a range of staff (including supervisors, management, HR personnel, administrative staff) working in collaboration on the M&E. This could directly relieve some of the pressure placed on supervisors, thereby allowing them to focus more on the quality of their supervisory practices. Second, it may lead to boosts in staff morale, and the “fostering [of] a sense of ownership and dedication” among M&E staff (Kuchio, 2023 , p. 543). Third, is the direct impact that adequate resource allocation for M&E has on improving the effectiveness of programme implementation (Kuchio 2023 ). Beyond increasing the human resources available for the M&E of supportive supervision, ensuring that they have the knowledge and skills to appropriately carry out their M&E-related responsibilities is paramount (Kevany et al., 2012 ; Kuchio, 2023 ; Ndothya & Chege, 2023 ; Ouma & Nyang’au, 2024 ). A key component of this is the targeted training of relevant staff - including supervisors and supervisees - on M&E principles, procedures, and practices (Augustinavicius et al., 2018 ; Kuchio, 2023 ; Ouma & Nyang’au, 2024 ), as endorsed by our participants. This could serve as another useful strategy to increase their knowledge of the purpose of M&E. It could also lead to more willingness to engage in M&E activities, which both past research (Kuchio, 2023 ) and our participants suggest is essential towards supporting programme implementation. Including M&E staff within IMS trainings also emerged as a crucial recommendation by our participants. This reflects calls for enhanced alignment between M&E training outcomes (i.e., development of a Logframe) and the outcomes meant to be achieved by a particular project (i.e., implementation plan for supportive supervision), in order to create a “seamless integration of acquired skills into project monitoring and evaluation” activities (Kuchio, 2023 , p. 541). While building their technical capacity, participants underscored that including M&E staff in IMS training may also serve a protective role, fulfill the humanitarian principle of caring for staff and volunteers (IFRC PS Centre, 2019), ideally preparing them to participate in their own supervision – reinforcing the IMS’s creed of ‘supervision for all’ engaged in humanitarian MHPSS (IFRC PS Centre & TCGH, 2023). However, while trainings for M&E staff are essential capacity-building exercises, regular opportunities for peer learning and knowledge exchange among M&E staff should also be embedded into organisational practice (Kuchio, 2023 ). As Sihombing et al. ( 2025 ) note, such “transformative local learning mechanisms” (p. 67) are more effective in building long-term capacity than procedural approaches alone. Participants also called for more practical guidelines – including a clear checklist and selection of indicators - to facilitate their M&E of supportive supervision within their organisations. The two participants directly involved in the development of the IMS M&E Framework acknowledged its potential to achieve this, emphasising the framework’s bespoke focus on the M&E of supportive supervision within humanitarian MHPSS programming. By providing examples of standardised terminology and indicators for the M&E of supportive supervision, the IMS M&E Framework facilitates cross-organisational learnings and knowledge sharing on supportive supervision implementation (Augustinavicius et al., 2018 ; Broaddus-Shea et al., 2019 ; Troup et al., 2021 ). Moreover, participants highlighted the framework’s balance between providing structural pragmatic information while simultaneously encouraging flexible and adaptable application – as recommended by humanitarian MHPSS M&E (Kevany et al., 2012 ; Augustinavicius et al., 2018 ) and coordination literature (Sihombing et al., 2025 ). The workshop guidance document designed to supplement the IMS M&E framework reflects the need for additional practical support requested by our participants and reinforced by past IMS literature (Ryan et al., 2023 ). Finally, by directly contributing to increasing the capacity of humanitarian organisations to conduct the M&E of supportive supervision, the IMS M&E Framework presents an opportunity for humanitarian organisations to partner with academic institutions to systematically document and evaluate their M&E practices (Augustinavicius et al., 2018 ) - as an essential ingredient in improving MHPSS services in humanitarian contexts (Tol et al., 2020 ). However, the implementation of the framework must be continually accompanied by commitment of all involved stakeholders, particularly those from organisational leadership and donor organisations, to promote the integrated, robust, and sustainable M&E of supportive supervision within humanitarian programming. 4.1 Future research directions Our study provides an important introduction to the M&E of supportive supervision. However, there remains a need for a more systematic investigation into the diverse M&E practices that humanitarian organisations employ to assess the impact of supportive supervision. This could be supported by the development of a single, online, and open access data repository in which organisations could store their supervision-related data – as called for by Broaddus-Shea et al. ( 2019 ) for related humanitarian health programming. This, in turn, could contribute to building a strong, multi-context evidence-base for the importance of implementing supportive supervision systems. Please visit the following link for an excel sheet that allows organisations to enter and analyse data for each of the tools recommended within the IMS M&E Framework across four timepoints: https://zenodo.org/records/18386058 . Another opportunity, as previously discussed, is for researchers to engage in a deliberate process of developing a tool specifically aimed at assessing the competencies of supportive supervisors and exploring its possible integration into the EQUIP platform. In their recent article, Kohrt and colleagues (2025) provide a detailed overview of the process that led to the development and refinement of the battery of tools contained in the current EQUIP platform, which can serve as a model for future tool development. There is also a need to pilot the IMS M&E Framework among diverse cohorts of humanitarian staff, including M&E personnel, to better understand the utility of the framework among its intended end users. A streamlined way to do this would be to integrate review of the framework as a dedicated session within future IMS trainings. Still in the design phase, the IMS M&E Framework is intended to be published in 2026. Please contact [email protected] for more information. 4.2 Limitations There are multiple limitations of this study. Chief among these is the limited number of IMS-trained staff that agreed to take part in the interviews and the fact that results of the second objective of our study were derived from two individuals who are part of the IMS team and were directly involved in the development of the updated IMS M&E Framework. As such, there is a potential bias in how well they perceived the framework to address some of the issues raised by other participants relating to the M&E of supportive supervision. Moreover, results do not incorporate the views of the remaining individuals trained in the IMS, who may have contributed additional insights into the factors that contribute to successful implementation of M&E for supportive supervision. Third, and relatedly, none of our participants explicitly mentioned being a supervisee during their interviews (see Table 1 ), meaning that the perhaps unique perspectives of supervisees in relation to what should be included in the M&E of supportive supervision or how the M&E should be done is likely not fully captured. Taken together, these limitations reinforce the need for future research that pilot tests the IMS M&E Framework with additional humanitarian personnel. 5. Conclusion This study provides initial insights into what contributes to the successful M&E of supportive supervision in humanitarian contexts and how well the recently developed IMS M&E Framework for supportive supervision aligns with the needs and perspectives of humanitarian practitioners. Our findings have illuminated the necessity of integrating the M&E of supportive supervision within an organisational system and structure, how to ensure that this integration is intra-organisationally standardised, and the need to have dedicated and adequately trained and supported personnel for the M&E of supportive supervision. While the updated IMS M&E Framework was perceived to be useful in helping organisations achieve these considerations, there is a need for continued advocacy, investment, and collaboration between researchers and practitioners to support the meaningful, sustainable, and quality of both supportive supervision and its M&E across different organisations. Declarations Contributions: Charles Zemp : conceptualisation, data curation, formal analysis, investigation, methodology, project administration, visualisation, writing – original draft preparation, writing –review & editing; Azza Warraitch : conceptualisation, methodology, data curation, formal analysis, writing – review & editing; Salam Jabbour :conceptualisation, investigation, methodology, project administration, writing – review & editing; Ahmad Alshibi: writing – original draft preparation, writing – review & editing; Michelle Engels: project administration, writing – review & editing; Cátia Sofia Peres de Matos : project administration; Kelly A. McBride : project administration; Meg Ryan : project administration, writing – review & editing; Pia Tingsted Blum : project administration, funding acquisition; Áine Travers – project administration, writing – review & editing; Shona Whitton : project administration; Professor Frédérique Vallières : conceptualisation, funding acquisition, project administration, supervision, writing – review & editing. Acknowledgements : Foremost, we would like to thank all the participants for giving their time to share their thoughts during their respective interview. We would also like to express our gratitude to all those who are championing supportive supervision across different humanitarian organisations, including those actively implementing the IMS into their organisational structure. Finally, we must acknowledge the global cohort of humanitarian workers, MHPSS or otherwise, who dedicate their careers to helping people deal with the adverse impacts of a humanitarian emergency. Thank you for all that you do. Ethics approval and consent to participate: Ethical approval for this study was obtained from the Trinity Centre for Health Policy and Management/Centre for Global Health Research Ethics Committee of Trinity College Dublin (Dublin, Ireland, Approval No. 3270) on June 7, 2024. All participants granted informed consent prior to their interview, using an ethically approved consent form. This study was performed in accordance with relevant regulations, including the European Union’s General Data Protection Requirements (GDPR). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Availability of data and materials The materials and data that supports the findings of this study are available from the corresponding author upon reasonable request. 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Correlates of risk-taking behaviour and suicidality among humanitarian aid workers. Compr Psychiatr. 2025;136. https://doi.org/10.1016/j.comppsych.2024.152541 . Zemp C, et al. Addressing the unique supervisory needs of humanitarian volunteers: insights from piloting the ‘Integrated Model for Supervision. Bangladesh’ Social Sci Med – Mental Health. 2025. https://doi.org/10.1016/j.ssmmh.2025.100403 . 7. Additional Declarations No competing interests reported. Supplementary Files InterviewScheduleforIMSME.docx InterviewSchedulewithtwoparticipantsinvolvedinIMSMEFramework.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 15 Apr, 2026 Editor assigned by journal 14 Apr, 2026 Editor invited by journal 07 Apr, 2026 Submission checks completed at journal 07 Apr, 2026 First submitted to journal 07 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9282392","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":624863727,"identity":"2c51f9e4-757f-4568-b009-800c08d96e3b","order_by":0,"name":"Charles Zemp","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAoUlEQVRIiWNgGAWjYNCCCiA+wNhAipYzBqRqYWwDaSFWtXx7d9qDn/P+yPMdYG58QJwFPWe3G/ZuMzCceYCx2YAoLcwSudukGbcZJBgcYGyTIEoLm/xboJY5YC3tP4jSwiPBC9TSALGFKB0MEjy52w17jhkbzjzM2Eycw+Tbz2578KNGTp7vePvDD8RZA/QOhGImVj1CyygYBaNgFIwCXAAAW8YtEpAjVn8AAAAASUVORK5CYII=","orcid":"","institution":"Trinity College Dublin","correspondingAuthor":true,"prefix":"","firstName":"Charles","middleName":"","lastName":"Zemp","suffix":""},{"id":624863728,"identity":"7ddeb543-1a63-4c2c-b98d-b47eef93e30d","order_by":1,"name":"Azza Warraitch","email":"","orcid":"","institution":"Trinity College Dublin","correspondingAuthor":false,"prefix":"","firstName":"Azza","middleName":"","lastName":"Warraitch","suffix":""},{"id":624863729,"identity":"aa66bb78-abca-42c4-9bb1-001fe000bcc6","order_by":2,"name":"Salam Jabbour","email":"","orcid":"","institution":"Trinity College Dublin","correspondingAuthor":false,"prefix":"","firstName":"Salam","middleName":"","lastName":"Jabbour","suffix":""},{"id":624863730,"identity":"8f9c99d7-0c14-4bcc-b252-387f12742988","order_by":3,"name":"Ahmad Alshibi","email":"","orcid":"","institution":"Independent Mental Health and Psychosocial Support Consultant","correspondingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Alshibi","suffix":""},{"id":624863731,"identity":"0b0e5ef0-92ca-482d-b34b-d00ebb5ea386","order_by":4,"name":"Michelle Engels","email":"","orcid":"","institution":"Engels Mental Health Consulting","correspondingAuthor":false,"prefix":"","firstName":"Michelle","middleName":"","lastName":"Engels","suffix":""},{"id":624863733,"identity":"bb26bd0b-3f10-4994-a9ae-c292cca797bb","order_by":5,"name":"Cátia Sofia Peres Matos","email":"","orcid":"","institution":"Red Cross Red Crescent Movement MHPSS Hub","correspondingAuthor":false,"prefix":"","firstName":"Cátia","middleName":"Sofia Peres","lastName":"Matos","suffix":""},{"id":624863736,"identity":"e4d79f07-c2ba-4161-858c-b3038433fdba","order_by":6,"name":"Kelly A. McBride","email":"","orcid":"","institution":"Independent Mental Health and Psychosocial Support Specialist","correspondingAuthor":false,"prefix":"","firstName":"Kelly","middleName":"A.","lastName":"McBride","suffix":""},{"id":624863738,"identity":"ec1df655-afe2-46b2-9c1d-a96b84e2f704","order_by":7,"name":"Meg Ryan","email":"","orcid":"","institution":"Trinity College Dublin","correspondingAuthor":false,"prefix":"","firstName":"Meg","middleName":"","lastName":"Ryan","suffix":""},{"id":624863741,"identity":"09aae5e7-9148-4e16-a330-837c695396ae","order_by":8,"name":"Pia Tingsted Blum","email":"","orcid":"","institution":"Red Cross Red Crescent Movement MHPSS Hub","correspondingAuthor":false,"prefix":"","firstName":"Pia","middleName":"Tingsted","lastName":"Blum","suffix":""},{"id":624863743,"identity":"50272aa4-a68b-44ec-a4d2-d3ad62569539","order_by":9,"name":"Áine Travers","email":"","orcid":"","institution":"Dublin City University","correspondingAuthor":false,"prefix":"","firstName":"Áine","middleName":"","lastName":"Travers","suffix":""},{"id":624863745,"identity":"5bcc7908-0bba-4ae2-adf8-f830dcc61349","order_by":10,"name":"Shona Whitton","email":"","orcid":"","institution":"Red Cross Red Crescent Movement MHPSS Hub","correspondingAuthor":false,"prefix":"","firstName":"Shona","middleName":"","lastName":"Whitton","suffix":""},{"id":624863746,"identity":"5214d696-8b1a-4a2a-b7e6-ed991bb1c5ef","order_by":11,"name":"Frédérique Vallières","email":"","orcid":"","institution":"Trinity College Dublin","correspondingAuthor":false,"prefix":"","firstName":"Frédérique","middleName":"","lastName":"Vallières","suffix":""}],"badges":[],"createdAt":"2026-03-31 16:08:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9282392/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9282392/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107708035,"identity":"7d67c46b-6dbd-4845-ab80-31fcc38a9137","added_by":"auto","created_at":"2026-04-24 09:21:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":428913,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9282392/v1/1c4f1f87-68f0-443d-a11d-37f8075012df.pdf"},{"id":107668167,"identity":"2b4a421e-b6e9-4170-9e70-ef93d81f0b07","added_by":"auto","created_at":"2026-04-23 19:49:34","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":25078,"visible":true,"origin":"","legend":"","description":"","filename":"InterviewScheduleforIMSME.docx","url":"https://assets-eu.researchsquare.com/files/rs-9282392/v1/3517dad3a1488a364f22887d.docx"},{"id":107668168,"identity":"3bde5e52-f684-4dc2-a8c5-837bf4174025","added_by":"auto","created_at":"2026-04-23 19:49:34","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17966,"visible":true,"origin":"","legend":"","description":"","filename":"InterviewSchedulewithtwoparticipantsinvolvedinIMSMEFramework.docx","url":"https://assets-eu.researchsquare.com/files/rs-9282392/v1/233f8fd3babb2d784191b7e0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"‘Good emergency management is all about systems’: A qualitative investigation into the monitoring and evaluation of supportive supervision for mental health and psychosocial support workers across diverse humanitarian contexts","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAs of early 2026, an estimated 239\u0026nbsp;million people need humanitarian assistance (UNOCHA, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), primarily driven by climate-related events, violence and armed conflict, and poverty (UNOCHA, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Often accompanying these crises are profound mental health and psychosocial consequences (Tol et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Bangpan et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), including the onset or aggravation of mental health conditions (Murthy \u0026amp; Lakshminarayana, 2006; Charlson et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Accordingly, the provision of mental health and psychosocial support (MHPSS) services \u0026ndash; defined as \u0026ldquo;any type of local or outside support that aims to protect or promote psychosocial well-being and/or prevent or treat mental disorder\u0026rdquo; (Inter-Agency Standing Committee [IASC], 2007, p.1) - is increasingly recognised as a key component of humanitarian assistance (Tol et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; UNHCR, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). With growing demand for MHPSS services, however, comes a corresponding need to ensure their quality and sustainability (Tol et al. \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Abujaber et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), both of which depend on a well-supported MHPSS workforce (Dickson \u0026amp; Bangpan, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Perera et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHumanitarian contexts are inherently challenging environments for humanitarian aid workers (HAWs), many of whom face high workloads, experience primary and secondary trauma, and have limited access to organisational supports and professional development opportunities (Foo et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Abujaber et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Valli\u0026egrave;res et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). These challenges can negatively affect HAW wellbeing (Jachens, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Aldamman et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) and contribute to high rates of staff turnover (Jachens, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), thereby threatening the quality and continuity of care. In recent years, supportive supervision has been increasingly identified as a key mechanism for addressing these challenges, given the positive and cascading influence its provision can have on HAW wellbeing (Kurt et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Ryan \u0026amp; Zemp et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Zemp et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Despite its noted benefits, however, the provision of supportive supervision within humanitarian organisations remains under-prioritised and inconsistent (Abujaber et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Ryan et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Abujaber et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), partly due to an absence of evidence-based guidance on \u003cem\u003ehow\u003c/em\u003e humanitarian organisations can strengthen their supervisory practices (Ryan \u0026amp; Zemp et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo address this gap, the Integrated Model for Supervision (IMS) was launched in 2021. Details of the use of participatory approaches for the IMS\u0026rsquo; development and subsequent iterations are reported elsewhere (Ryan \u0026amp; Zemp et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) and ongoing research on the IMS offers evidence of its utility in supporting organisations to enhance their supervisory systems (Ryan et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ryan \u0026amp; Zemp et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Zemp et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). In contrast to earlier models of supervision (Clements et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2007\u003c/span\u003e), the IMS posits that \u003cem\u003esupportive\u003c/em\u003e supervision is a collaborative and non-hierarchical relationship between supervisor and supervisee(s), through which a supervisor should strive to achieve three key outcomes: providing emotional support to the supervisee, enhancing their skills, and monitoring the quality of their work (IFRC PS Centre \u0026amp; Trinity Centre for Global Health [TCGH], 2023). In doing so, the IMS seeks to address the multifaceted needs of MHPSS practitioners while aligning with organisational goals and standards (Ryan et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWorking towards building the global evidence-base for emergency MHPSS initiatives, the Inter-Agency Standing Committee (IASC) Reference Group on MHPSS Support in Emergency Settings developed their \"Common Monitoring and Evaluation Framework for Mental Health and Psychosocial Support in Emergency Settings\u0026rdquo; in 2021. While serving as a seminal resource for the meaningful monitoring and evaluation (M\u0026amp;E) of humanitarian MHPSS programming, the IASC (2021) stipulates that the common M\u0026amp;E framework does not capture the full breadth of MHPSS initiatives, and that \u0026ldquo;every programme, project, or activity will require its own unique M\u0026amp;E framework that is appropriate and relevant to its design\u0026rdquo; (p. 11). That said, heterogeneity in the \u0026ldquo;goals, outcomes, indicators, and means of verification\u0026rdquo; (MoV) common in M\u0026amp;E practices poses a challenge to assessing the overall value and impact of MHPSS programming (IASC, 2021, p. 4). Indeed, a recent consensus-based research agenda for humanitarian MHPSS programming saw endorsement of how to develop effective M\u0026amp;E systems as the third highest priority (Tol et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Echoing these calls, follow-up consultations with those trained in the IMS also revealed a demand for ongoing M\u0026amp;E that meets the specific needs of HAWs and that can be adapted to each implementer\u0026rsquo;s cultural and organisational context (Ryan et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Abujaber et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Ryan \u0026amp; Zemp et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Zemp et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn response, the IMS team has developed an \u0026lsquo;IMS M\u0026amp;E Framework\u0026rsquo; to supplement the implementation of the IMS within implementing organisations (Red Cross Red Crescent Movement MHPSS Hub \u0026amp; TCGH, in press). Among other content - and heeding the call for \u0026ldquo;a user-friendly overview of psychometrically sound tools\u0026rdquo; for conducting the M\u0026amp;E of humanitarian MHPSS programming (Augustinavicius et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, p. 9) - the IMS M\u0026amp;E Framework contains a compendium of indicators and accompanying MoVs that organisations may choose to include in their M\u0026amp;E of supportive supervision. MoVs were included based on meeting all or most of the following criteria: (i) suitable for measuring changes in supervision-related outcomes, (ii) validated for use in low-and middle-income countries (LMICs; where a disproportionate amount of humanitarian emergencies occur (Al Omari et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)), (iii) previously used in research to measure its associated outcome among HAWs, healthcare workers, and/or populations affected by humanitarian crises, (iv) free to access and administer, and (v) available in multiple languages.\u003c/p\u003e \u003cp\u003eThe IMS M\u0026amp;E Framework also includes a sample logistical framework (i.e., Logframe) for guiding M\u0026amp;E, linking suggested indicators across all levels of M\u0026amp;E \u0026ndash; goal, outcomes, inputs, etc. \u0026ndash; to their relevant MoV, where applicable. Like the common M\u0026amp;E framework developed by the IASC (2021), the IMS M\u0026amp;E Framework is intended to allow for greater synchronicity among supportive supervision M\u0026amp;E practices, while also avoiding an entirely prescriptive approach. Instead, organisations are encouraged to select the most relevant components for their unique IMS implementation.\u003c/p\u003e \u003cp\u003eCurrently undergoing final design processes, the IMS M\u0026amp;E Framework has not yet undergone piloting or any formal evaluation of its fitness for purpose. Furthermore, while the need for robust M\u0026amp;E practices within MHPSS is clear, to our knowledge, there is no existing academic literature that provides insights into \u003cem\u003ehow\u003c/em\u003e to develop and implement an M\u0026amp;E system specifically for supportive supervision practices in humanitarian contexts. The objectives of the current study are thus three-fold. First, we aimed to identify the factors that contribute to the successful implementation of the M\u0026amp;E of supportive supervision within existing organisations. Second, we sought to ascertain how well the IMS M\u0026amp;E Framework reflects these factors and, third, how it could be improved to reflect these factors going forward.\u003c/p\u003e \u003cp\u003eTherefore, and in pursuing these objectives, this qualitative study yields the potential to not only meet the call for more research and guidance on the M\u0026amp;E of humanitarian MHPSS programming (Augustinavicius et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Tol et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), but to also contribute to a better supported humanitarian MHPSS workforce and, by extension, the quality and sustainability of the services they deliver (Tol et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e"},{"header":"2. Materials \u0026 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Participants and Procedures\u003c/h2\u003e \u003cp\u003eParticipants were recruited via purposive and snowball sampling from seven humanitarian organisations operating across different countries and actively implementing the IMS, as well as from two members of the IMS team with knowledge and/or experience in M\u0026amp;E.\u003c/p\u003e \u003cp\u003eOf the N\u0026thinsp;=\u0026thinsp;31 eligible individuals contacted to participate, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10 individuals consented to an interview. Most of these participants (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8) had previously participated in an IMS training and had knowledge of their organisation\u0026rsquo;s IMS implementation process. The remaining participants (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2) had direct involvement in developing the IMS M\u0026amp;E Framework and in providing M\u0026amp;E support to IMS-implementing organisations. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides demographic information for each participant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eParticipant demographic information\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eParticipant Code\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eOrganisational Role\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCountry\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSex\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eA\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMHPSS Technical Lead/IMS Focal Point\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eJordan\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMale\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eB\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eInternational MHPSS Technical Advisor\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eUkraine\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMale\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eC\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMHPSS Technical Team Lead/Supervision Trainer\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eUkraine\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMale\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eD\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMental Health Pharmacist/Supervisor\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eJordan\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFemale\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eE\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCounselling Supervisor/IMS focal point\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eEthiopia\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFemale\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eF\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePsychotherapist Trainer/Supervisor\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eEthiopia\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMale\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eG\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePsychologist\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eJordan\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFemale\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eH\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIMS Technical Advisor\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDenmark\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFemale\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eI\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eM\u0026amp;E Technical Advisor\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDenmark\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFemale\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eJ\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eStaff Supervisor\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eJordan\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFemale\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Interviews\u003c/h2\u003e \u003cp\u003eSemi-structured individual interviews with all participants took place between July and November 2024 via Microsoft Teams. Interviews were conducted in English (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8) and Arabic (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2).\u003c/p\u003e \u003cp\u003e Following verbal consent, interviews were audio-recorded and transcribed either through using Microsoft Teams' built-in recording and transcription tools for English interviews, or by simultaneously translating and transcribing the Arabic interviews. English interview recording transcriptions were then checked for accuracy against the audio recording.\u003c/p\u003e \u003cp\u003eInterviews with the eight participants from IMS-implementing organisations were guided by an open-ended interview schedule on the implementation of the M\u0026amp;E of supportive supervision within the organisation, including barriers and facilitators to its implementation (towards achieving our first objective). The subsequent two interviews with participants involved in the development of the IMS M\u0026amp;E Framework (Participants H \u0026amp; I) were guided by a separate open-ended interview schedule, developed following initial theme generation from the previous eight interviews in order to illicit responses to implementers\u0026rsquo; initial feedback (towards achieving our second objective). Please see Supplementary File 1 for the complete interview schedules.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Analytical Strategy\u003c/h2\u003e \u003cp\u003eData was analysed by co-authors CZ and AW using Braun and Clarke\u0026rsquo;s (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) six-step thematic analysis methodology. First, the co-authors familiarised themselves with the data by listening to interview recordings and actively reading transcripts. Next, the transcripts were re-read, and initial codes were generated based on the research objectives. Coding was both deductive - looking specifically for mention of barriers and facilitators to conducting the M\u0026amp;E of the IMS - and inductive, allowing for open-coding. The third step involved the review and grouping of initial codes into preliminary themes and sub-themes. Steps four and five focused on refining these themes and final theme definition. Finally, the defined themes were narratively synthesised, with relevant quotes selected to illustrate each theme. All analysis was conducted using NVivo Version 12 (QSR International, 2018).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Ethics\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e for this study was obtained from the Trinity Centre for Health Policy and Management/Centre for Global Health Research Ethics Committee of Trinity College Dublin (Dublin, Ireland, Approval No. 3270) on June 7, 2024.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eWe identified three main themes from our analysis. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e provides an overview of these themes and any accompanying sub-themes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eQualitative results organised by theme and sub-themes\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eTheme 3.1: Influence of the organisational system\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eTheme 3.2: Standardisation of M\u0026amp;E practices\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eTheme 3.3: Human resources for the M\u0026amp;E of supportive supervision\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3.2.1 Benefits of standardisation\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3.3.1 Total reliance on supervisors\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3.2.2 What to include as part of standardisation?\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3.3.2 Increasing the capacity of available human resources\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3.3.3 How to standardise?\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Influence of the organisational system\u003c/h2\u003e \u003cp\u003eConducting the M\u0026amp;E of supportive supervision represents \u003cem\u003e\u0026ldquo;an organisational system problem\u0026rdquo;\u003c/em\u003e and, as such, its implementation \u003cem\u003e\u0026ldquo;needs to be embedded into that system\u0026rdquo;\u003c/em\u003e (Participant I). Participants highlighted several barriers and facilitators to this integration.\u003c/p\u003e \u003cp\u003eFirst among these was the bureaucratic nature of humanitarian organisations, which participants identified as delaying or thwarting the implementation of novel M\u0026amp;E-related practices. For example, because of \u003cem\u003e\u0026ldquo;competing priorities\u0026rdquo;\u003c/em\u003e for organisational review, the approval of M\u0026amp;E-related requests can be \u003cem\u003e\u0026ldquo;less important and forgotten, so that nobody will keep asking about such things\u0026rdquo;\u003c/em\u003e (Participant E). Participant B built on these comments, detailing how their organisation\u0026rsquo;s M\u0026amp;E practices are \u003cem\u003e\u0026ldquo;usually confined by a maximum number of indicators and things that we can measure\u003c/em\u003e\u0026rdquo; across all the organisation\u0026rsquo;s programmes. This means that programme implementers must \u003cem\u003e\u0026ldquo;be selective into what we are measuring\u0026rdquo;\u003c/em\u003e, which results in having to \u003cem\u003e\u0026ldquo;\u003c/em\u003e...\u003cem\u003edeprioritise M\u0026amp;E for supportive supervision\u0026rdquo;\u003c/em\u003e (Participant B). They attributed this to the fact the M\u0026amp;E of supportive supervision is perceived by decision makers to be \u0026ldquo;\u003cem\u003eas if we are measuring part of the work...part of the job of people is to do supportive supervision\u0026rdquo;\u003c/em\u003e, and, as not directly related to programming, was not seen as something warranting its own M\u0026amp;E activities.\u003c/p\u003e \u003cp\u003eThese comments reflect the importance of raising organisational awareness around the utility of conducting M\u0026amp;E of supervision practices, and may necessitate a change in what humanitarian organisations view as the purpose of conducting M\u0026amp;E. For instance, a common assertion is that M\u0026amp;E is often \u003cem\u003e\u0026ldquo;done purely for donors and not for organisational learning\u0026rdquo;\u003c/em\u003e, with Participant I contending that M\u0026amp;E of humanitarian programming is \u003cem\u003e\u0026ldquo;very much still considered [to be] about compliance\u0026rdquo;.\u003c/em\u003e While monitoring the\u003cem\u003e\u0026ldquo;specific criteria that [donors] are going to ask you to monitor\u0026rdquo;\u003c/em\u003e is unavoidable in humanitarian programming, the prioritisation of M\u0026amp;E of supportive supervision should consider \u003cem\u003e\u0026ldquo;what do you want to know about for your organisation?....Why do you think it's important to have supervision?\u0026rdquo;\u003c/em\u003e (Participant H). One reason for this is that the inclusion of organisationally-relevant M\u0026amp;E indicators of supportive supervision would serve as a useful \u003cem\u003e\u0026ldquo;advocacy tool\u0026rdquo;\u003c/em\u003e (Participant B) to support the continued provision of supportive supervision within an organisation:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eYou might only have one indicator that at an organisational level is being collected on supervision and that might help you get budget internally to continue to do supervision.\u003c/em\u003e (Participant I).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFinally, multiple participants commented on the benefit of \u003cem\u003e\u0026ldquo;leveraging existing M\u0026amp;E within the organisation\u0026rdquo;\u003c/em\u003e (Participant I) to facilitate the M\u0026amp;E of supportive supervision. This could involve using data already provided by \u003cem\u003e\u0026ldquo;the resources and tools that [organisations already] use\u0026rdquo;\u003c/em\u003e (Participant H) as part of their supportive supervision M\u0026amp;E practices. It could also mean adopting a more active approach and making \u0026ldquo;\u003cem\u003eadaptations to the existing system\u0026rdquo;\u003c/em\u003e (Participant F) to better tailor it to supervision \u0026ndash; including adapting \u003cem\u003e\u0026ldquo;existing tools\u0026rdquo;\u003c/em\u003e already used in organisational M\u0026amp;E, as well as and trying to \u003cem\u003e\u0026ldquo;incorporate [new] tools\u0026rdquo;\u003c/em\u003e into data collection procedures (Participant F).\u003c/p\u003e \u003cp\u003eAdaptation could also involve the addition of \u003cem\u003e\u0026ldquo;an indicator to measure supportive supervision within our programmes\u0026rdquo; -\u003c/em\u003e the findings of which would not necessarily have to be \u003cem\u003e\u0026ldquo;[sent]...to the donor\u0026rdquo;\u003c/em\u003e (Participant B) - such as the number of supervisory agreements in place, compared with the number of MHPSS workers delivering services.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Standardisation of M\u0026amp;E practices\u003c/h2\u003e \u003cp\u003eWhether through leveraging an existing system or implementing entirely new protocols, participants underscored the advantages of adopting a \u003cem\u003e\u0026ldquo;standardised approach\u0026rdquo;\u003c/em\u003e (Participants A \u0026amp; D) when implementing the M\u0026amp;E of supportive supervision into their organisation, provided examples of what this could include, and highlighted considerations for the standardisation process.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Benefits of standardisation\u003c/h2\u003e \u003cp\u003eParticipants began by highlighting the drawbacks of relying on informal methods to conduct the M\u0026amp;E of supervision practices. Participant D, for example, criticised the ad hoc collection of feedback on supervision, such as through \u003cem\u003e\u0026ldquo;internal chats between staff and the supervisor\u0026rdquo;\u003c/em\u003e as opposed to more systematic feedback collection. They suggested that \u003cem\u003e\u0026ldquo;every staff [member] should have the opportunity to reflect on his supervisor, just as every supervisor has the chance to reflect on his staff\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eParticipant A expressed a similar sentiment, explaining how existing M\u0026amp;E practices for supervision were \u003cem\u003e\u0026ldquo;relying on...random feedback from the supervisees\u0026rdquo;\u003c/em\u003e to ascertain how their supervision was progressing and how it could be improved. They highlighted how this was \u003cem\u003e\u0026ldquo;not structured, not systematised\u0026rdquo;\u003c/em\u003e and stressed the importance of standardisation to better measure the \u003cem\u003e\u0026ldquo;quality of [supervision] sessions\u0026rdquo;.\u003c/em\u003e Participant G reinforced this, explaining the benefit of having an organisational \u003cem\u003e\u0026ldquo;open-door policy\u0026rdquo;\u003c/em\u003e in relation to providing feedback on organisational practices: \u003cem\u003e\u0026ldquo;A month ago, for example, the admin visited the clinics and we discussed a few things together. So, there is a very good atmosphere for freedom of expression and participation. This is a good motivation\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThe potential benefit of standardisation in increasing engagement with M\u0026amp;E practices becomes particularly relevant when juxtaposed with HAWs\u0026rsquo; resistance to have \u003cem\u003e\u0026ldquo;their work monitored or evaluated\u0026rdquo;\u003c/em\u003e, partly stemming from them being \u003cem\u003e\u0026ldquo;worried about what comes out in monitoring and evaluation\u0026rdquo; -\u003c/em\u003e that it functions as a \u0026ldquo;\u003cem\u003escorecard of their work\u0026rdquo;\u003c/em\u003e (Participant I). If a standardised M\u0026amp;E system were designed to reinforce that M\u0026amp;E is \u003cem\u003e\u0026ldquo;not a judgement of their work...that it\u0026rsquo;s actually about acknowledging what they have done and just helping them do it better\u0026rdquo;\u003c/em\u003e it could catalyse a greater willingness to engage with M\u0026amp;E for supportive supervision.\u003c/p\u003e \u003cp\u003eLimited engagement with M\u0026amp;E practices may also be a result of the \u003cem\u003e\u0026ldquo;very real sense of urgency\u0026rdquo;\u003c/em\u003e that characterises humanitarian responses and the consequent perception among HAWs that they \u003cem\u003e\u0026ldquo;don\u0026rsquo;t have the time [for M\u0026amp;E] because we just need to do XYZ because...it\u003c/em\u003e [service delivery] \u003cem\u003eis a matter of life and death\u0026rdquo;\u003c/em\u003e (Participant I). Standardisation could be useful toward rectifying any misunderstanding of the time required for participation in M\u0026amp;E:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eSo, we felt that after the monitoring and evaluation was introduced, we felt [that if] it was somehow structured, it [would] give a clarity about frequency \u0026ndash; when to do it\u003c/em\u003e (Participant A).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFinally, standardisation of the M\u0026amp;E practices, particularly if involving \u003cem\u003e\u0026ldquo;collaboration across [organisational] departments\u0026rdquo;\u003c/em\u003e, could coalesce into greater learning around \u003cem\u003e\u0026ldquo;what the strengths of the organisation are, where the weaknesses are, where the gaps are\u003c/em\u003e\u0026rdquo; in relation to the implementation of supportive supervision (Participant J).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 - What to include as part of standardisation?\u003c/h2\u003e \u003cp\u003eServing to address Participant D\u0026rsquo;s assertion that humanitarian organisations \u0026ldquo;\u003cem\u003edon\u0026rsquo;t know what to monitor and follow-up\"\u003c/em\u003e for IMS implementation, participants spoke to the outcome indicators that should be included within a standardised M\u0026amp;E of supportive supervision. To help evaluate the extent to which supervision is being implemented across the organisation, multiple participants endorsed the need to ensure consistent tracking of \u003cem\u003e\u0026ldquo;the hours and types of supervision\u0026rdquo;\u003c/em\u003e (Participant E) received.\u003c/p\u003e \u003cp\u003eOther suggested indicators included levels of supervisee \u003cem\u003e\u0026ldquo;burnout\u0026rdquo;\u003c/em\u003e (Participants A, F and J) and \u003cem\u003e\u0026ldquo;compassion fatigue\u0026rdquo;\u003c/em\u003e (Participant A and F), which would be useful to gain insights on the influence of supervision on the \u003cem\u003e\u0026ldquo;wellbeing of our staff\u0026rdquo;\u003c/em\u003e (Participant C). Additionally, indicators around any \u003cem\u003e\u0026ldquo;improvement in performance among the staff\u0026rdquo;\u003c/em\u003e (Participant D), such as the \u0026ldquo;\u003cem\u003edegree to which the employee can solve the cases\u0026rdquo;\u003c/em\u003e and \u003cem\u003e\u0026ldquo;[their] documentation and reporting\u0026rdquo;\u003c/em\u003e could help elucidate the impact of supervision from a \u003cem\u003e\u0026ldquo;technical [perspective]\u0026rdquo;\u003c/em\u003e (Participant J).\u003c/p\u003e \u003cp\u003eAn especially salient suggestion among participants, largely due to its non-existence or minimal integration within existing M\u0026amp;E practices, was assessment of the \u003cem\u003e\u0026ldquo;quality of supervision\u0026rdquo;\u003c/em\u003e (Participants B and C), with particular concern around the \u003cem\u003e\u0026ldquo;satisfaction among the [supervised] team with the supervision\u0026rdquo;\u003c/em\u003e (Participant D). This was echoed by Participant E, who stated that they planned on using a \u003cem\u003e\u0026ldquo;satisfaction survey among the staff so that we know if the supervis[ees] are getting the kind of supervision which is quality and with positive impact\u0026rdquo;.\u003c/em\u003e This could function as a proxy to \u003cem\u003e\u0026ldquo;ensure that we are providing a quality service also for beneficiaries\u0026rdquo;\u003c/em\u003e (Participant E). Participant G provided example questions that could be explored toward this end:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eDo you feel like the supervisor values or appreciates your work? Does your supervisor thank you? Does your supervisor explain the purpose of the duties you have to do?... Do you see that the way supervision is happening is useful or are there other ways to better set it up? [...] Lots of questions like this would be able to show whether a person is really feeling supported or not.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIt is important to note, however, that assessment of these \u003cem\u003e\u0026ldquo;quality benchmarks\u0026rdquo;\u003c/em\u003e may be hindered by a lack of access to\u003cem\u003e\u0026ldquo;verified tools\u0026rdquo;\u003c/em\u003e that are \u003cem\u003e\u0026ldquo;validated [and] translated into\u0026rdquo;\u003c/em\u003e the language of a humanitarian organisation\u0026rsquo;s operational context(s) - as inaccessible MoVs can prohibit the \u003cem\u003e\u0026ldquo;link between improvement of quality and the supportive supervision\u0026rdquo;\u003c/em\u003e (Participant B). To help mitigate this, it may be useful to integrate more qualitative methods of inquiry into M\u0026amp;E practices, as reflected in Participant G\u0026rsquo;s suggestion that there should be a comprehensive \"\u003cem\u003ediscussion where the supervisor places importance to the team\u0026rdquo; -\u003c/em\u003e creating a safe space for supervisees to provide open-ended feedback - as part of the standardised M\u0026amp;E system.\u003c/p\u003e \u003cp\u003eFinally, while Participant A heralded that \u003cem\u003e\u0026ldquo;standardisation is better\u0026rdquo;\u003c/em\u003e when it comes to the outcomes that are measured due to its \u003cem\u003e\"power to ensure...consistency of the data\"\u003c/em\u003e, they also stressed that there should be room for \u0026ldquo;\u003cem\u003eflexibility for supervisors to pick extra tools\u0026rdquo;\u003c/em\u003e in accordance with their supervisory relationships. Allowing for this autonomy could also help supervisors be more \u003cem\u003e\"willing partners\u0026rdquo;\u003c/em\u003e (Participant H) in M\u0026amp;E, as previously discussed and essential to achieving \u003cem\u003e\u0026ldquo;properly embedded M\u0026amp;E systems\u0026rdquo;\u003c/em\u003e (Participant I).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e3.2.3 - How to standardise?\u003c/h2\u003e \u003cp\u003eParticipants provided insights on how an organisation should go about standardising their M\u0026amp;E of supportive supervision practices, emphasising the importance of preparation and organisational collaboration as key factors to support standardisation.\u003c/p\u003e \u003cp\u003eFor example, Participant I recommended that the first step in any standardisation process should be taking the \u003cem\u003e\u0026ldquo;time to sit down before you do something\u0026rdquo;\u003c/em\u003e to plan a \u003cem\u003e\u0026ldquo;sort of simplified\u0026rdquo;\u003c/em\u003e system that aligns with \u003cem\u003e\u0026ldquo;what is...possible...with limited resources\u0026rdquo;.\u003c/em\u003e To achieve the \u003cem\u003e\u0026ldquo;pragmatism...[that] is required\u0026rdquo;\u003c/em\u003e when creating this plan, Participant I asserted that humanitarian organisations do not attempt to answer \u003cem\u003e\u0026ldquo;every single question that they want to\u0026rdquo;.\u003c/em\u003e Instead, and while balancing organisational learning with donor-mandated practices (Participant I), humanitarian organisations should start by identifying \u003cem\u003e\u0026ldquo;one or two goals and how you can measure [them]\u0026rdquo;\u003c/em\u003e (Participant H).\u003c/p\u003e \u003cp\u003eFor this to result in \u003cem\u003e\u0026ldquo;something suitable for the organisation\u0026rdquo;\u003c/em\u003e, Participant J underscored that, while it is \u003cem\u003e\u0026ldquo;the management [who] has to take a decision and implement it...all the levels should be involved....because each person has their own input on whether something is feasible or not\u0026rdquo;.\u003c/em\u003e This reflects Participant I\u0026rsquo;s comment that \u003cem\u003e\u0026ldquo;everyone needs to feel responsible for this\u003c/em\u003e [the M\u0026amp;E]...\u003cem\u003efrom the supervisee to the supervisor to HR\u003c/em\u003e [human resources] \u003cem\u003estaff, [and] M\u0026amp;E staff\u0026rdquo;.\u003c/em\u003e They continued by highlighting the importance of engaging supervisors and supervisees:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eSo, you should have supervisors and supervisees in workshops determining what it is we want to know, as a team about our supervision system so that way when they're having to fill out the form...they know why they\u0026rsquo;re doing it\u003c/em\u003e.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAs shared by Participant E, this inclusive approach should also involve higher-level staff, such as \u003cem\u003e\u0026ldquo;clinical advisors [and] international directors that oversee all the programmes, and also the monitoring and evaluation officer who is in HQ\u003c/em\u003e [headquarters]\u003cem\u003e\u0026rdquo;.\u003c/em\u003e Adopting this collaborative methodology could also help in dispelling the misconception, in Participant I\u0026rsquo;s mind, that \u003cem\u003e\u0026ldquo;monitoring and evaluation is considered specialist\u0026rdquo;\u003c/em\u003e. While certain aspects of it can be specialist, \u003cem\u003e\u0026ldquo;a lot of it isn\u0026rsquo;t\u0026rdquo;\u003c/em\u003e and \u0026ldquo;\u003cem\u003emost people that work in MHPSS programmes can think...with a little bit of support, how to build a system to help them collect some data\u0026rdquo;\u003c/em\u003e (Participant I).\u003c/p\u003e \u003cp\u003eReinforcing the importance of raising organisational awareness around the purpose of M\u0026amp;E, Participant I suggested that achieving standardised M\u0026amp;E may necessitate a \u003cem\u003e\u0026ldquo;culture change within organisations\u0026rdquo;\u003c/em\u003e. According to Participant I, this change must be propelled by \u003cem\u003e\u0026ldquo;people within their organisation\u0026rdquo;\u003c/em\u003e, as opposed to \u003cem\u003e\u0026ldquo;outsourc[ing] [M\u0026amp;E] to a consultant\u0026rdquo;.\u003c/em\u003e These organisational \u003cem\u003e\"M\u0026amp;E champions....working within the team at different levels\u0026rdquo;\u003c/em\u003e could serve to \u003cem\u003e\u0026ldquo;advocate for it to really take it forward\u0026rdquo;\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Human resources for the M\u0026amp;E of supportive supervision\u003c/h2\u003e \u003cp\u003eHumanitarian organisations must frequently operate with limited resources and, as such, are \u003cem\u003e\u0026ldquo;constantly lacking capacity\u0026rdquo;\u003c/em\u003e (Participant I) to effectively conduct M\u0026amp;E. Akin to the benefit of having organisational M\u0026amp;E champions, participants underscored the deterministic influence of human resources on the successful M\u0026amp;E of supportive supervision and offered recommendations for preparing available staff to facilitate its implementation.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1 Total reliance on supervisors\u003c/h2\u003e \u003cp\u003eA principal consequence of operating with limited human resources is organisations \u003cem\u003e\u0026ldquo;relying on supervisors to ensure that the [M\u0026amp;E] processes are done\u0026rdquo;\u003c/em\u003e (Participant A). Indeed, Participant F commented that \u003cem\u003e\u0026ldquo;it\u0026rsquo;s the responsibility of the supervisor to recall this information and submit to M\u0026amp;E\u0026rdquo;\u003c/em\u003e, with Participant E (from the same organisation) confirming this dependency on supervisors for M\u0026amp;E-related data collection:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThe supervisors are tracking the time and frequency of supervision they have provided, whether it's individual supervision or group or live supervision, they're tracking that one.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eGiven Participant A\u0026rsquo;s assertion that their pre-existing \u003cem\u003e\u0026ldquo;workload is one of the biggest challenges for supervisors\u0026rdquo;\u003c/em\u003e, relying on supervisors to conduct a \u003cem\u003e\u0026ldquo;structured, regular\u0026rdquo;\u003c/em\u003e M\u0026amp;E of supportive supervision would \u003cem\u003e\u0026ldquo;not [be] an easy job\u0026rdquo;\u003c/em\u003e. Participant A further suggested that \u003cem\u003e\u0026ldquo;there [is] a need for someone dedicated\u0026rdquo;\u003c/em\u003e, ideally sourced from inside the organisation:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI would prefer dedicated [internal] staff rather than external staff because we need someone familiar. That's why we tried to explore some sort of adaptation that the monitoring and evaluation team can take over this role\u003c/em\u003e [M\u0026amp;E of supportive supervision] \u003cem\u003ewhile they are doing the routine monitoring and evaluation.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eWhile Participant I agreed that \u003cem\u003e\u0026ldquo;dedicated M\u0026amp;E staff are always needed\u0026rdquo;\u003c/em\u003e, they qualified that \u003cem\u003e\u0026ldquo;very few teams are going to get a dedicated M\u0026amp;E person just for [the] IMS\u0026rdquo;\u003c/em\u003e, bolstering the importance of integrating the M\u0026amp;E of supportive supervision into ongoing M\u0026amp;E practices.\u003c/p\u003e \u003cp\u003eImportantly, participants recommended that any individuals involved in the M\u0026amp;E of supportive supervision have \u003cem\u003e\u0026ldquo;a strong mental health background\u0026rdquo;\u003c/em\u003e and be \u0026ldquo;\u003cem\u003efamiliar with the IMS\u0026rdquo;\u003c/em\u003e (Participant A).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.3.2 Increasing the capacity of available human resources\u003c/h2\u003e \u003cp\u003eParticipants, however, described the distinct lack of human resources in their organisation who are \u003cem\u003e\u0026ldquo;qualified or who [are] trained or [have] the proper way to follow up\u0026rdquo;\u003c/em\u003e on the M\u0026amp;E of supportive supervision, underscoring the need to ensure that M\u0026amp;E personnel \u003cem\u003e\u0026ldquo;are well trained and have the right framework\u0026rdquo;\u003c/em\u003e (Participant D).\u003c/p\u003e \u003cp\u003eTo achieve the former, multiple participants recommended that \u0026ldquo;\u003cem\u003eM\u0026amp;E team[s] should be present in the [IMS] training, so they understand what the IMS is in the first place\u0026rdquo;\u003c/em\u003e (Participant J), and learn \u003cem\u003e\u0026ldquo;how they can do, you know, outcome kind of analysis, how they can provide information back to the clinical team\u0026rdquo;\u003c/em\u003e in relation to the impact of supportive supervision (Participant F). Participant B emphasised that the integration of M\u0026amp;E personnel into an IMS training should be as inclusive as possible:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eYeah it will be very useful. The more we have people trained, like people who understand MHPSS generally and IMS specifically, the better.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIncluding M\u0026amp;E personnel within an IMS training could not only enhance their understanding of the IMS but also may be advantageous towards helping them pinpoint how to best \u003cem\u003e\u0026ldquo;adapt it\u003c/em\u003e [any extant M\u0026amp;E system] \u003cem\u003eto fit the IMS\u0026rdquo;\u003c/em\u003e (Participant H). Moreover, given how discussion of M\u0026amp;E is an explicit component within \u003cem\u003e\u0026ldquo;the training curriculum of the IMS\u0026rdquo;\u003c/em\u003e (Participant H), inclusion of M\u0026amp;E staff may work to strengthen these discussions, which, in turn, could serve to reinforce the importance of intra-organisational collaboration within M\u0026amp;E practices:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI really think that kind of the thing around awareness and knowledge of M\u0026amp;E, it's not just that people, that M\u0026amp;E people understand about IMS, it's the other way round. It's that people who are in supervision understand what data needs to be collected, that they're part of the decision making, right?\u003c/em\u003e (Participant I).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eOn a more personal level, M\u0026amp;E staff participating in IMS trainings - as a precursor to M\u0026amp;E staff \u003cem\u003e\u0026ldquo;receive[ing] [their own] clinical supervision regularly\u0026rdquo;\u003c/em\u003e (Participant F) - could directly support their personal wellbeing:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eM\u0026amp;E colleagues, they may not see it with their clients, with survivors of torture or trauma. They may not see directly, but they are the ones reading all the information which is captured in the assessment forms. So, reading those stories is exposing them to\u0026hellip;.you know, retraumatisation or secondary trauma. So, I would say I highly encourage that [they] attend an IMS training.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eBuilding on suggestions that M\u0026amp;E personnel have access to \u003cem\u003e\u0026ldquo;the right framework\u0026rdquo;\u003c/em\u003e(Participant D) or \u003cem\u003e\u0026ldquo;a step by step explanation\u0026rdquo;\u003c/em\u003e (Participant B) to guide them in their M\u0026amp;E of supportive supervision, Participant D expounded that \u003cem\u003e\u0026ldquo;someone has to prepare the documents...the guideline... a clear monitoring and evaluation plan or checklist, indicators, that we can follow and see the achievement\u0026rdquo;.\u003c/em\u003e Indeed, reflecting on their experiences facilitating IMS trainings with diverse organisations, Participant H acknowledged that, \u003cem\u003e\u0026ldquo;we realised that we needed something even more practical, more centred on the experience and the needs from the people working in the field\u0026rdquo;\u003c/em\u003e to support organisations in their M\u0026amp;E efforts. When asked about how well the IMS M\u0026amp;E Framework responded to what the eight IMS-implementing participants \u0026ndash; as the \u003cem\u003e\u0026ldquo;people working in the field\u0026rdquo;\u003c/em\u003e - shared in their interviews, Participant H (as someone directly involved in the development of the framework) shared that \u003cem\u003e\u0026ldquo;overall, I think we managed to match the expectations of people.....in a way that is clear and logical\u0026rdquo;\u003c/em\u003e. By providing \u003cem\u003e\u0026ldquo;a brief overview of what M\u0026amp;E is...related to supervision\u0026rdquo;\u003c/em\u003e, Participant H believed the IMS M\u0026amp;E Framework provides more tailored guidance than what is found within the multitude of other \u003cem\u003e\u0026ldquo;M\u0026amp;E guides out there\u0026rdquo;\u003c/em\u003e. Beyond the content of the framework, Participant H also reflected on the utility of \u003cem\u003e\u0026ldquo;the way it is designed....because of the way we divided it\u0026rdquo;\u003c/em\u003e, specifying how there is a section \u003cem\u003e\u0026ldquo;specific for the [M\u0026amp;E] system, right, it\u0026rsquo;s about the [M\u0026amp;E] system and do we implement the system\u0026rdquo;\u003c/em\u003e - relating to the need to standardise the M\u0026amp;E of supportive supervision within an organisation.\u003c/p\u003e \u003cp\u003eParticipant I (the other participant involved in developing the framework) agreed with this overall sentiment, commenting that the IMS M\u0026amp;E Framework stands to help organisations acquire a clearer understanding of \u003cem\u003e\u0026ldquo;at base level, here\u0026rsquo;s what it is you should try to do\u0026rdquo;\u003c/em\u003e, while simultaneously highlighting how humanitarian organisations \u003cem\u003e\u0026ldquo;can build on that\u0026rdquo;\u003c/em\u003e through adapting the guidance \u003cem\u003e\u0026ldquo;for their own context and programme\u0026rdquo;\u003c/em\u003e. The room for flexibility is a result of the framework\u0026rsquo;s intentional design as a \u003cem\u003e\u0026ldquo;choose your own adventure kind of document\u0026rdquo;\u003c/em\u003e, particularly in relation to its \u003cem\u003e\u0026ldquo;indicator bank and...suite of means of verification to choose from\u0026rdquo;.\u003c/em\u003e Additional remarks from Participant H reinforce this, commenting that by providing \u003cem\u003e\u0026ldquo;something that is written...the list of things that we can [do]\u0026rdquo;\u003c/em\u003e the framework may help humanitarian organisations who are \u003cem\u003e\u0026ldquo;stuck on the practicalities\u003c/em\u003e\u0026rdquo; of M\u0026amp;E for supportive supervision, synchronously making it \u003cem\u003e\u0026ldquo;easier to negotiate... easier to advocate for prioritising M\u0026amp;E when it comes to supervision\u0026rdquo;\u003c/em\u003e and \u003cem\u003e\u0026ldquo;for making sure that there are people responsible for this\u0026rdquo; -\u003c/em\u003e as suggested by other participants. This may be in part due to the framework\u0026rsquo;s explicit emphasis on the role that \u003cem\u003e\u0026ldquo;leadership and management and getting buy in\u0026rdquo;\u003c/em\u003e (Participant I) plays in implementing the M\u0026amp;E of supportive supervision, corroborating remarks previously explored.\u003c/p\u003e \u003cp\u003eHowever, while \u003cem\u003e\u0026ldquo;preparing those things and...hand[ing] them to the [monitoring and evaluation] department\u0026rdquo;\u003c/em\u003e (Participant D) may be sufficient, Participant A suggested that M\u0026amp;E staff also \u003cem\u003e\u0026ldquo;need to understand the nature of the monitoring and evaluation document\u0026rdquo;\u003c/em\u003e. Indeed, Participant H, stressed that \u003cem\u003e\u0026ldquo;when it comes to M\u0026amp;E [of supportive supervision]...we need probably to have extra training, right? Extra information\u0026rdquo;\u003c/em\u003e. In accordance with this request for more guidance on how to effectively use an IMS M\u0026amp;E guidance document, the IMS team intends to develop a \u0026ldquo;\u003cem\u003eworkshop guidance\u0026rdquo;\u003c/em\u003e document (Participant I) to supplement the framework. This is intended to \u003cem\u003e\u0026ldquo;give them\u003c/em\u003e [humanitarian organisations] \u003cem\u003etime to familiarise themselves with the framework\u0026rdquo;\u003c/em\u003e, providing them with a \u003cem\u003e\u0026ldquo;rough outline for a half-day workshop...where they go through and talk about...the IMS [M\u0026amp;E] framework\u0026rdquo;\u003c/em\u003e, including discussions around \u003cem\u003e\u0026ldquo;the outcomes...the indicators...a draft Logframe\u0026rdquo;.\u003c/em\u003e This workshop guidance thus has the potential to give humanitarian organisations the means to better \u003cem\u003e\u0026ldquo;work with and understand\u0026rdquo;\u003c/em\u003e the framework, facilitating \u003cem\u003e\u0026ldquo;conversations about...what it is they want to know about their supervision system\u0026rdquo;\u003c/em\u003e, in alignment with \u003cem\u003e\u0026ldquo;their own context...and their own programming\u0026rdquo;\u003c/em\u003e (Participant I).\u003c/p\u003e \u003cp\u003eAs a final note, while lauding the multifaceted potential that the IMS M\u0026amp;E Framework has in facilitating the successful practice of the M\u0026amp;E of supportive supervision, Participant I also cautioned that \u003cem\u003e\u0026ldquo;the framework can\u0026rsquo;t be an answer to all of\u0026rdquo;\u003c/em\u003e the issues raised within the previous themes. They primarily attributed this to the universality of these themes within the M\u0026amp;E of multi-sectoral humanitarian programming:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI think we need to be a little bit careful a bit saying that...these themes are totally associated with the IMS. I think they are...you could replace supervision with any type of progamme...and it would all be relevant. So, I think we can\u0026rsquo;t solve that with a framework.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eMonitoring and evaluation (M\u0026amp;E) remains a high-priority component within MHPSS programming in humanitarian contexts (IASC, 2007; Tol et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). While the IASC provides essential guidance on the M\u0026amp;E of humanitarian MHPSS (IASC, 2021), there is a distinct need for both research and technical guidance on conducting the M\u0026amp;E of specific, unique MHPSS implementations (Augustinavicius et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; IASC, 2021; Tol et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), such as the integration of supportive supervision approaches. Thus, this study sought to (i) identify which factors contribute to the successful implementation of the M\u0026amp;E of supportive supervision within humanitarian organisations, (ii) ascertain how well the IMS M\u0026amp;E Framework reflects these factors, and (iii) how it could be improved. Through doing so, we contribute to \u0026ldquo;the development of practically relevant knowledge for [humanitarian] MHPSS activities\u0026rdquo;, as highlighted by Augustinavicius and colleagues (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, p. 2).\u003c/p\u003e \u003cp\u003eReflecting the broader humanitarian MHPSS literature (Troup et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), participants first spoke to the importance of their organisational system \u0026ndash; both as a barrier and facilitator \u0026ndash; towards effectuating the successful M\u0026amp;E of supportive supervision. More specifically, they described how the bureaucratic nature of their organisations can stagnate the approval of any M\u0026amp;E-related protocols. This concern echoes well-documented critiques of how humanitarian bureaucracy contributes to ineffective programming (Spiegel, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Carlson et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Sihombing et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). For instance, Carlson et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) claimed that the bureaucracy of aid organisations contributes directly to crisis mismanagement, particularly through their creation of information vacuums, consistent with our findings that misconceptions around the purpose and utility of M\u0026amp;E feed into its deprioritisation within organisational systems. In their investigation into the M\u0026amp;E factors that influence effective humanitarian programming in Nairobi, Kenya, Ouma \u0026amp; Nyang\u0026rsquo;au (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) found that clear and accessible M\u0026amp;E communication, including its purpose, significantly predicted enhanced project performance. Taken together, these findings suggest that humanitarian organisations must prioritise regular stakeholder-inclusive communication of the M\u0026amp;E activities related to supportive supervision, ensuring that such messaging considers the diverse cultural, literacy, and language needs of all stakeholders (Ouma \u0026amp; Nyang\u0026rsquo;au \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the multitude of factors that contribute to humanitarian bureaucracy - some of which, such as donor requirements, are often beyond the capacity of organisation-level personnel to control (Ozkul \u0026amp; Jarrous, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) - it becomes especially important to focus on other changes that are achievable within existing constraints. In this context, leveraging and adapting existing M\u0026amp;E practices emerged as a critical strategy, reflecting broader literature on humanitarian MHPSS programming (Troup et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Sihombing et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). As emphasized by our participants and supported by previous qualitative IMS investigations (Ryan et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Abujaber et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), this could involve adapting and repurposing available tools, indicators, or data flows to capture pertinent supervisory information - as a low-cost, minimum effort solution where resources are scarce.\u003c/p\u003e \u003cp\u003eDrawing support from past IMS literature (Ryan et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Abujaber et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Ryan \u0026amp; Zemp et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), participants suggested that another essential component of facilitating the organisational integration of the M\u0026amp;E of supportive supervision is sustained advocacy around its importance across different organisational cohorts, particularly leadership/management. This can include active efforts by individuals within the organisation (so called \u0026lsquo;M\u0026amp;E Champions\u0026rsquo;) to emphasise the inclusion of organisationally-relevant and context-specific indicators of supportive supervision \u0026ndash; decided on collaboratively with supervisors/supervisees (Kuchio, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This helps to ensure that the outcomes selected are meaningful to the organisation and its workers, rather than only representing donor-mandated outcomes (Ouma \u0026amp; Nyang\u0026rsquo;au, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This is particularly important when considering that providing supportive supervision solely to comply with donor requirements may lead to insufficient improvements in quality of care (Avortri et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Integrating more organisationally-driven indicators would likely lead to organisations gleaning more insightful information about the utility of supportive supervision in improving workforce wellbeing and the quality of MHPSS services (Dickson \u0026amp; Bangpan, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Perera et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), as well as how supervision practices could be improved to better achieve these outcomes (Ryan \u0026amp; Zemp et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). It is therefore imperative that advocacy efforts for implementation of supportive supervision include consideration of M\u0026amp;E as a vital aspect of successful implementation. This could help lend its practice a greater degree of \u0026ldquo;institutional legitimacy\u0026rdquo;, as a key factor in successful humanitarian MHPSS coordination (Sihombing et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2025\u003c/span\u003e, p. 62).\u003c/p\u003e \u003cp\u003eParticipants underscored the necessity of intra-organisational standardisation of M\u0026amp;E practices to improve the informal and inconsistent M\u0026amp;E procedures occurring within their organisations. As examples of these informalities, participants highlighted how irregular feedback mechanisms and scattered documentation negatively affected their efforts to assess supervision quality and impact. This reflects Carlson and colleagues\u0026rsquo; (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) that system-level interventions cannot be effective if implemented in an ad hoc manner. Indeed, a recent systematic review focused on the coordination of mental health services in humanitarian crises identified \u0026ldquo;fragmentation of information systems\u0026rdquo; as a principal impediment to effective coordination efforts (Sihombing et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2025\u003c/span\u003e, p. 55). Part of this standardisation of the M\u0026amp;E of supportive supervision could be selecting a limited number of indicators to maintain the feasibility of the M\u0026amp;E (Augustinavicius et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), such as the type, duration, and frequency of supervision sessions, assessments of supervisee wellbeing (e.g. compassion fatigue, burnout, etc.), the levels of satisfaction with supervision, and the quality of supervision provided, as suggested by participants. However, participants mentioned that the lack of access to adapted and validated tools precluded them from establishing quality baselines or benchmarks. This suggests not only a continued need for researchers and practitioners to continue to adapt and test the cross-cultural validity of existing tools, ensuring that these efforts result in tools that \u0026ldquo;more closely meet real world needs\u0026rdquo; (Augustinavicius et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, p. 9), but also the need for a central, open access repository where these tools can be housed and downloaded from. Please visit the IMS Community page within Zenodo for a basic version of such a repository, which can be accessed and added to by researchers and practitioners.\u003c/p\u003e \u003cp\u003eIn a similar vein, a critical path forward for the M\u0026amp;E of supportive supervision is the development, piloting, and roll-out of a standardised tool to assess the competencies of supportive supervisors. The \u0026lsquo;Ensuring Quality in Psychosocial and Mental Health Care\u0026rsquo; (EQUIP) platform (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://equipcompetency.org/en-gb/home\u003c/span\u003e\u003cspan address=\"https://equipcompetency.org/en-gb/home\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) is an evidence-based resource that could be leveraged to achieve this at scale. EQUIP is a widely used digital platform that provides a suite of freely accessible standardised tools to assess the competencies of MHPSS practitioners and improve the quality of services they provide (Kohrt et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The current battery of tools hosted on EQUIP can purportedly \u0026ldquo;facilitate competency-based training and supervision\u0026rdquo; (i.e., supervision sessions tailored to the competencies of supervisees; Korht et al., 2025, p. 67). Inherent to this claim is the need for supervisors themselves to have the necessary competencies to provide effective supervision. Moreover, the role that supportive supervision can play in protecting the quality and sustainability of MHPSS services (Kurt et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Ryan \u0026amp; Zemp et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Zemp et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) also likely depends on supervisors possessing a certain level of supervision-specific competencies. To date, however, no tools within EQUIP have been developed exclusively to assess the competencies of supportive supervisors, some of which likely diverge from those of MHPSS service providers. This suggests a key area for the future development of the platform, with the team behind EQUIP recommending the \u0026ldquo;develop[ment] of new tools\u0026rdquo; be achieved through collaboration with \u0026ldquo;people with lived experience\u0026rdquo; (i.e., supervisors and supervisees in this case; Kohrt et al., p. 77).\u003c/p\u003e \u003cp\u003eWhile standardised integration of tools across different organisational teams and/or supervisory relationships is recommended (Ouma \u0026amp; Nyang\u0026rsquo;au, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), participants also spoke to the importance of creating space for flexibility through allowing supervisors to select additional contextually relevant tools. This balance between standardisation and flexibility reflects a broader tension between \u0026ldquo;structural authority and local adaptability\u0026rdquo; in humanitarian MHPSS programming (Sihombing et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2025\u003c/span\u003e, p. 62), with literature emphasising the importance of adaptable humanitarian M\u0026amp;E systems (Kevany et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Participants also highlighted the importance of balancing information provided by quantitative metrics with qualitative insights (Augustinavicius et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Sihombing et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). For example, asking supervisees reflective questions to evaluate the process of implementing supportive supervision (Augustinavicius et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), as well as the relational and practical quality of supervision, could provide a more nuanced understanding of its impact and areas for improvement.\u003c/p\u003e \u003cp\u003eReminiscent of the chronic resource limitations that impact MHPSS humanitarian programming globally (Troup et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Giebel et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Sihombing et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), participants highlighted how human resource constraints present a significant challenge to the execution of M\u0026amp;E for supportive supervision. They stressed how M\u0026amp;E responsibilities are allocated to already overburdened supervisors, who, in addition to lacking the necessary time, may not possess the requisite knowledge and skills to conduct systematic M\u0026amp;E (see Kevany et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Troup et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). As a response, participants emphasised the need for dedicated personnel \u0026ndash; ideally from existing M\u0026amp;E staff (i.e., not external consultants) \u0026ndash; to conduct M\u0026amp;E activities associated with supportive supervision. This reflects multiple studies indicating a need for increases in M\u0026amp;E personnel across distinct sectors of humanitarian programming to ensure its consistent and quality practice (Kuchio, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ouma \u0026amp; Nyang\u0026rsquo;au, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Complementary to having dedicated M\u0026amp;E personnel, task-sharing approaches to the M\u0026amp;E of supportive supervision may also enhance its sustainable practice. With a strong evidence-base for facilitating the provision of quality MHPSS services in resource-constrained settings (Le et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), task-sharing could be leveraged for the M\u0026amp;E of supportive supervision by actively involving a range of staff (including supervisors, management, HR personnel, administrative staff) working in collaboration on the M\u0026amp;E. This could directly relieve some of the pressure placed on supervisors, thereby allowing them to focus more on the quality of their supervisory practices. Second, it may lead to boosts in staff morale, and the \u0026ldquo;fostering [of] a sense of ownership and dedication\u0026rdquo; among M\u0026amp;E staff (Kuchio, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, p. 543). Third, is the direct impact that adequate resource allocation for M\u0026amp;E has on improving the effectiveness of programme implementation (Kuchio \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBeyond increasing the human resources available for the M\u0026amp;E of supportive supervision, ensuring that they have the knowledge and skills to appropriately carry out their M\u0026amp;E-related responsibilities is paramount (Kevany et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Kuchio, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ndothya \u0026amp; Chege, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ouma \u0026amp; Nyang\u0026rsquo;au, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). A key component of this is the targeted training of relevant staff - including supervisors and supervisees - on M\u0026amp;E principles, procedures, and practices (Augustinavicius et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Kuchio, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ouma \u0026amp; Nyang\u0026rsquo;au, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), as endorsed by our participants. This could serve as another useful strategy to increase their knowledge of the purpose of M\u0026amp;E. It could also lead to more willingness to engage in M\u0026amp;E activities, which both past research (Kuchio, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and our participants suggest is essential towards supporting programme implementation.\u003c/p\u003e \u003cp\u003eIncluding M\u0026amp;E staff within IMS trainings also emerged as a crucial recommendation by our participants. This reflects calls for enhanced alignment between M\u0026amp;E training outcomes (i.e., development of a Logframe) and the outcomes meant to be achieved by a particular project (i.e., implementation plan for supportive supervision), in order to create a \u0026ldquo;seamless integration of acquired skills into project monitoring and evaluation\u0026rdquo; activities (Kuchio, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, p. 541). While building their technical capacity, participants underscored that including M\u0026amp;E staff in IMS training may also serve a protective role, fulfill the humanitarian principle of caring for staff and volunteers (IFRC PS Centre, 2019), ideally preparing them to participate in their own supervision \u0026ndash; reinforcing the IMS\u0026rsquo;s creed of \u0026lsquo;supervision for all\u0026rsquo; engaged in humanitarian MHPSS (IFRC PS Centre \u0026amp; TCGH, 2023). However, while trainings for M\u0026amp;E staff are essential capacity-building exercises, regular opportunities for peer learning and knowledge exchange among M\u0026amp;E staff should also be embedded into organisational practice (Kuchio, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). As Sihombing et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) note, such \u0026ldquo;transformative local learning mechanisms\u0026rdquo; (p. 67) are more effective in building long-term capacity than procedural approaches alone.\u003c/p\u003e \u003cp\u003eParticipants also called for more practical guidelines \u0026ndash; including a clear checklist and selection of indicators - to facilitate their M\u0026amp;E of supportive supervision within their organisations. The two participants directly involved in the development of the IMS M\u0026amp;E Framework acknowledged its potential to achieve this, emphasising the framework\u0026rsquo;s bespoke focus on the M\u0026amp;E of supportive supervision within humanitarian MHPSS programming. By providing examples of standardised terminology and indicators for the M\u0026amp;E of supportive supervision, the IMS M\u0026amp;E Framework facilitates cross-organisational learnings and knowledge sharing on supportive supervision implementation (Augustinavicius et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Broaddus-Shea et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Troup et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Moreover, participants highlighted the framework\u0026rsquo;s balance between providing structural pragmatic information while simultaneously encouraging flexible and adaptable application \u0026ndash; as recommended by humanitarian MHPSS M\u0026amp;E (Kevany et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Augustinavicius et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and coordination literature (Sihombing et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The workshop guidance document designed to supplement the IMS M\u0026amp;E framework reflects the need for additional practical support requested by our participants and reinforced by past IMS literature (Ryan et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, by directly contributing to increasing the capacity of humanitarian organisations to conduct the M\u0026amp;E of supportive supervision, the IMS M\u0026amp;E Framework presents an opportunity for humanitarian organisations to partner with academic institutions to systematically document and evaluate their M\u0026amp;E practices (Augustinavicius et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) - as an essential ingredient in improving MHPSS services in humanitarian contexts (Tol et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). However, the implementation of the framework must be continually accompanied by commitment of all involved stakeholders, particularly those from organisational leadership and donor organisations, to promote the integrated, robust, and sustainable M\u0026amp;E of supportive supervision within humanitarian programming.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Future research directions\u003c/h2\u003e \u003cp\u003eOur study provides an important introduction to the M\u0026amp;E of supportive supervision. However, there remains a need for a more systematic investigation into the diverse M\u0026amp;E practices that humanitarian organisations employ to assess the impact of supportive supervision. This could be supported by the development of a single, online, and open access data repository in which organisations could store their supervision-related data \u0026ndash; as called for by Broaddus-Shea et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) for related humanitarian health programming. This, in turn, could contribute to building a strong, multi-context evidence-base for the importance of implementing supportive supervision systems. Please visit the following link for an excel sheet that allows organisations to enter and analyse data for each of the tools recommended within the IMS M\u0026amp;E Framework across four timepoints: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://zenodo.org/records/18386058\u003c/span\u003e\u003cspan address=\"https://zenodo.org/records/18386058\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAnother opportunity, as previously discussed, is for researchers to engage in a deliberate process of developing a tool specifically aimed at assessing the competencies of supportive supervisors and exploring its possible integration into the EQUIP platform. In their recent article, Kohrt and colleagues (2025) provide a detailed overview of the process that led to the development and refinement of the battery of tools contained in the current EQUIP platform, which can serve as a model for future tool development.\u003c/p\u003e \u003cp\u003eThere is also a need to pilot the IMS M\u0026amp;E Framework among diverse cohorts of humanitarian staff, including M\u0026amp;E personnel, to better understand the utility of the framework among its intended end users. A streamlined way to do this would be to integrate review of the framework as a dedicated session within future IMS trainings. Still in the design phase, the IMS M\u0026amp;E Framework is intended to be published in 2026. Please contact \u003cb\[email protected]\u003c/b\u003e for more information.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Limitations\u003c/h2\u003e \u003cp\u003eThere are multiple limitations of this study. Chief among these is the limited number of IMS-trained staff that agreed to take part in the interviews and the fact that results of the second objective of our study were derived from two individuals who are part of the IMS team and were directly involved in the development of the updated IMS M\u0026amp;E Framework. As such, there is a potential bias in how well they perceived the framework to address some of the issues raised by other participants relating to the M\u0026amp;E of supportive supervision. Moreover, results do not incorporate the views of the remaining individuals trained in the IMS, who may have contributed additional insights into the factors that contribute to successful implementation of M\u0026amp;E for supportive supervision. Third, and relatedly, none of our participants explicitly mentioned being a supervisee during their interviews (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), meaning that the perhaps unique perspectives of supervisees in relation to what should be included in the M\u0026amp;E of supportive supervision or how the M\u0026amp;E should be done is likely not fully captured. Taken together, these limitations reinforce the need for future research that pilot tests the IMS M\u0026amp;E Framework with additional humanitarian personnel.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study provides initial insights into what contributes to the successful M\u0026amp;E of supportive supervision in humanitarian contexts and how well the recently developed IMS M\u0026amp;E Framework for supportive supervision aligns with the needs and perspectives of humanitarian practitioners. Our findings have illuminated the necessity of integrating the M\u0026amp;E of supportive supervision within an organisational system and structure, how to ensure that this integration is intra-organisationally standardised, and the need to have dedicated and adequately trained and supported personnel for the M\u0026amp;E of supportive supervision. While the updated IMS M\u0026amp;E Framework was perceived to be useful in helping organisations achieve these considerations, there is a need for continued advocacy, investment, and collaboration between researchers and practitioners to support the meaningful, sustainable, and quality of both supportive supervision and its M\u0026amp;E across different organisations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eContributions: Charles Zemp\u003c/strong\u003e: conceptualisation, data curation, formal analysis, investigation, methodology, project administration, visualisation, writing \u0026ndash; original draft preparation, writing \u0026ndash;review \u0026amp; editing; \u003cstrong\u003eAzza Warraitch\u003c/strong\u003e: conceptualisation, methodology, data curation, formal analysis, writing \u0026ndash; review \u0026amp; editing; \u003cstrong\u003eSalam Jabbour\u003c/strong\u003e:conceptualisation, investigation, methodology, project administration, writing \u0026ndash; review \u0026amp; editing; \u003cstrong\u003eAhmad Alshibi:\u0026nbsp;\u003c/strong\u003ewriting \u0026ndash; original draft preparation, writing \u0026ndash; review \u0026amp; editing; \u003cstrong\u003eMichelle Engels:\u0026nbsp;\u003c/strong\u003eproject administration, writing \u0026ndash; review \u0026amp; editing;\u0026nbsp;\u003cstrong\u003eC\u0026aacute;tia Sofia Peres de Matos\u003c/strong\u003e: project administration; \u003cstrong\u003eKelly A. McBride\u003c/strong\u003e: project administration; \u003cstrong\u003eMeg Ryan\u003c/strong\u003e: project administration, writing \u0026ndash; review \u0026amp; editing; \u003cstrong\u003ePia Tingsted Blum\u003c/strong\u003e: project administration, funding acquisition;\u0026nbsp;\u003cstrong\u003e\u0026Aacute;ine Travers\u0026nbsp;\u0026ndash;\u0026nbsp;\u003c/strong\u003eproject administration, writing \u0026ndash; review \u0026amp; editing;\u003cstrong\u003e\u0026nbsp;Shona Whitton\u003c/strong\u003e: project administration;\u003cstrong\u003e\u0026nbsp;Professor\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFr\u0026eacute;d\u0026eacute;rique Valli\u0026egrave;res\u003c/strong\u003e: conceptualisation, funding acquisition, project administration, supervision, writing \u0026ndash; review \u0026amp; editing.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: Foremost, we would like to thank all the participants for giving their time to share their thoughts during their respective interview. We would also like to express our gratitude to all those who are championing supportive supervision across different humanitarian organisations, including those actively implementing the IMS into their organisational structure. Finally, we must acknowledge the global cohort of humanitarian workers, MHPSS or otherwise, who dedicate their careers to helping people deal with the adverse impacts of a humanitarian emergency. Thank you for all that you do. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e Ethical approval for this study was obtained from the Trinity Centre for Health Policy and Management/Centre for Global Health Research Ethics Committee of Trinity College Dublin (Dublin, Ireland, Approval No. 3270) on June 7, 2024. All participants granted informed consent prior to their interview, using an ethically approved consent form. This study was performed in accordance with relevant regulations, including the European Union\u0026rsquo;s General Data Protection Requirements (GDPR).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003eThe materials and data that supports the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement:\u003c/strong\u003e This research was made possible by the American people through the United States Agency for International Development (USAID) [grant number 720BHA21IO00253] prior to the grant\u0026rsquo;s abrupt termination on January 24, 2025 \u0026ndash; severely curtailing ongoing humanitarian mental health research despite sustained need\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbujaber NA, et al. 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Addressing the unique supervisory needs of humanitarian volunteers: insights from piloting the \u0026lsquo;Integrated Model for Supervision. Bangladesh\u0026rsquo; Social Sci Med \u0026ndash; Mental Health. 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ssmmh.2025.100403\u003c/span\u003e\u003cspan address=\"10.1016/j.ssmmh.2025.100403\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"qualitative, monitoring \u0026 evaluation, mental health and psychosocial support, supportive supervision, Integrated Model for Supervision, service quality, humanitarian contexts","lastPublishedDoi":"10.21203/rs.3.rs-9282392/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9282392/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eMonitoring and evaluation (M\u0026amp;E) is an essential component of humanitarian response. Supportive supervision for humanitarian workers is increasingly recognised as a key mechanism to protect the quality and sustainability of mental health and psychosocial support (MHPSS) services, with the 'Integrated Model for Supervision’ (IMS) offering operational guidance for how humanitarian organisations can strengthen their supervisory systems. While general guidance on the M\u0026amp;E of humanitarian MHPSS activities exists, minimal guidance on how to specifically conduct the M\u0026amp;E ofsupportive supervision for humanitarian MHPSS workers is available. To address this knowledge gap, our study aimed to identify the factors that contribute to the successful M\u0026amp;E of supportive supervision across a diverse range of humanitarian organisations, as well as assess the fitness-for-purpose of the IMS’ updated M\u0026amp;E framework to guide M\u0026amp;E efforts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eTo achieve these objectives, we conducted 10 key informant interviews with diverse humanitarian mental health practitioners, supervisors, and M\u0026amp;E technical experts. Interviews were analysed using thematic analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOur findings highlight the influence of the organisational system, the need to standardise M\u0026amp;E practices, and the importance of adequate well-trained human resources in successfully conducting the M\u0026amp;E of supportive supervision. While participants thought the IMS M\u0026amp;E Framework could prove useful, challenges relating to each of these factors suggest that continued advocacy, funding, and inter-disciplinary collaboration are required to support meaningful and sustained M\u0026amp;E of supportive supervision for humanitarian MHPSS workers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThrough identifying key barriers and facilitators to conducting the M\u0026amp;E of supportive supervision, our findings provide evidence that can help inform the development of M\u0026amp;E policies and procedures for humanitarian organisations and, therefore, contribute to enhancing the sustainably delivery of quality MHPSS services to populations affected by humanitarian crisis.\u003c/p\u003e","manuscriptTitle":"‘Good emergency management is all about systems’: A qualitative investigation into the monitoring and evaluation of supportive supervision for mental health and psychosocial support workers across diverse humanitarian contexts","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-23 19:49:30","doi":"10.21203/rs.3.rs-9282392/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-15T11:44:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-14T16:16:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-07T12:06:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-07T10:14:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-04-07T08:27:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c06d273c-48fa-4a3c-a7e7-3980b16a709f","owner":[],"postedDate":"April 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-23T19:49:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-23 19:49:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9282392","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9282392","identity":"rs-9282392","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}