Arab republic of Egypt Ministry of Health

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Ministry of Health Population, EGYPT
IMCI SUPERVISION Country Experience
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Transition from F/up to Routine Supervision

• In Early Implementation central supervisory
  visits to HFs
• With expansion central supervision of HFs not
  feasible
• Subsequently,local facilitators assigned
  supervisory responsibility
• In parallel, irregular central visits
• Supervisory package developed

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Rationale for Developing a Supervisory Package

• F/up a one-shot activity
• Special F/up visits unexpected to continue
• Responding to EIP review recommendation
• Sustainability contingent on decentralization
• District is the crucial level

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Integrating IMCI into the existing supervisory
system

• Avoid creating a parallel system
• Existing systems strengths
• Supervisory team
• Transportation means
• Systems limitations
• Seniority-based recruitment
• Limited programme-based supervisory training
• Misconception of supervision

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Approach for integration

• Identify proper supervisory target at district
  level
• Identify supervisors training needs
• Develop training materials
• Train target on relevant skills
• Select venue for training

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1- Contents of the Package

• The package consists of modules, each address a
  target
• CM orientation
• A guide for district supervisory
• physician checklist
• Nurse supervisory guide checklist
• 2 guide modules under field testing
• For district pharmacists
• For national/governorate supervisors

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1- Contents of the Package

• Supervisory modules describes
• Supervisory responsibilities
• Supervisory visit tasks
• Tools checklist including a summary list
  monthly summary form

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Supervisory responsibilities
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Supervisory Visit Tasks
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Selected indicators

• children examined by trained physician
• Average daily caseload by trained physician
• children with cough/difficult breathing
  classified as pneumonia
• children with diarrhoea classified as dysentery
• children classified as anaemia
• antibiotics prescribed for eligible children
• antibiotics prescribed for non-eligible children

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Training methodology Supervisory tools

• Course duration 4 days for
• physicians 3 days for nurses
• Training methods include readings, examples,
  written exercises, demonstrations, role plays,
  group discussions practice in a HF

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Implementation Process

• Training is not a big load, since a course
  covers 8 districts on average
• 5 courses for physicians, covered 44 districts in
  9 governorates
• 2 courses for nurses covered 16 districts in 5
  governorates
• After training
• - Joint visits by central or governorate
  district level supervisors
• - Review of monthly summary reports at central
  level with feedback

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1- Assessment of the approach

• Assessment based on monthly reports
• ProcessVariations in
• Regularity completeness of reporting
• Errors in filling visit reports
• Involvement of different cadres of supervisors
• HF coverage by supervisory visits

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1- Assessment of the approach

• Content variations in
• Observation of child care
• Checking facility supports
• Calculating interpreting selected indicators

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3- Assessment of the approach

• Competence of technical supervisors
• Fairly good supervisors needing minimum support
• Promising supervisors needing intensive support
• Inadequate supervisors needing replacement for CM
  observation

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Constraints

• No chance to select supervisors on basis of
  desired criteria.
• Some supervisors are neither motivated nor
  technically competent
• Length of the checklist
• Long time for the visit
• Problems of transportation
• Delays in conducting joint visits

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Lessons Learned

• The course meets a real need
• Supervisors training should immediately follow
  IMCI introduction into a district
• Technical competency is crucial for success
• Need for follow-up of trained supervisors
• Keeping contact with trained supervisors helps
  improvement
• Turnover would not increase training load