SUPPORTIVE SUPERVISION: CONCEPTS

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SUPPORTIVE SUPERVISIONCONCEPTS PERSPECTIVES.

• SIDE MEETING ON CAPACITY BUILDING
• 11th TFI 2003, Luanda, 3 December 2003.

Presented by Dr Evariste Mutabaruka, VPD/AFRO
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PRESENTATION PLAN

• Context and problem statement
• What is supportive supervision?
• Why supportive supervision?
• Prerequisite for supportive
• supervision
• Benefits of Supportive Supervision
• Supportive Supervision Process
• Challenges
• Perspectives

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SS Background(1)

• Health sector reforms decentralization and
  integration
• New Immunisation goals 90/80
• New strategy RED components
• Supervision as critical support for
• service delivery
• Supervision for access to quality services that
  clients want or need
• Supervision to improve performance of health
  workers

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SS Background(2)

• GAVI 2000 80 DPT3 in every district of 80 of
  developing countries by 2005
• TFI 2001 AFRO EPI Strategic Plan 2001-
• 2005 with 80/80 goal
• United Nations General Assembly Special Session
  (UNGASS) 2002 90 FIC nationally, with at least
  80 DTP3 coverage in every district by 2010.

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Five operational components needed to Reach
Every District

• Re-establishment of outreach services
• regular outreach for communities with poor access
• Supportive supervision
• on site training by supervisors
• Community links with service delivery
• regular meetings between community and health
  staff
• Monitoring and use of data for action
• chart doses, map population in each health
  facility
• Planning and management of resources
• better management of human and financial
  resources

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CONCEPTS

• SUPERVISION

• WORK

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OUR COMMON GOAL..

• Building HWs capacity and commitment to carry
  out safe, good quality immunization services,
  enabling each individual to perform at their
  personal best, through coaching and performance
  management

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WHY SUPERVISION ?

• To make sure that operational objectives are
  appropriate.
• To find out what is being done well.
• To help staff to identify and solve problems
• To motivate the staff.
• To improve the skills of the staff

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SUPERVISION AS AN OPPORTUNITY

• - Helping service providers to achieve work
• objectives by improving their performance
• -   Ensuring uniformity to set standards
• - Identifying problems and solving them at
• appropriate time
• -   Helping other people take responsibility
• - Following up decision reached during last
• supervision visit
• -  Identification of the staffing needs e.g.
  training
• needs
• -Providing opportunities for personal
  development
• - Maintaining and reinforcing the
  administrative
• and technical link between high and lower
  levels

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SUPPORTIVE SUPERVISION PROBLEM STATEMENT

• Narrow focus of supervision on inspection of
  certain areas
• Punitive approach
• Lack of supervisory skills and knowledge
• Lack of supervisor authority to reward or
  sanction performance
• Infrequent or irregular supervision due to lack
  of resources

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MAKING SUPERVISION MORE EFFFECTIVE

• CHANGE!
• Need to change objectives of supervision
• Need to change frequency , duration and nature of
  supervisory encounters
• Need to make supervision more supportive and
  facilitative

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CHARACTERISTICS OF SS.

• Focus on problem solving to assure quality and
  meet client needs
• Responsibility of entire team(supervisor-supervise
  es) to ensure quality
• Empowerment of health providers to monitor and
  improve their performance
• Supervisor acts as facilitator, trainer and coach
• Supervisees participate in supervising themselves
  and each other
• Decision-making is participatory.

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COMPARISON OF TRADITIONAL AND SUPPORTIVE
SUPERVISION
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PREREQUISITE FOR SS

• - A functional and accessible health care
  delivery system
• - Competent human resources both for
  delivery of health care and for carrying out
  supervision
• - Team spirit between supervisors and health
  personnel to be supervised
• - Supervision tools with key information on
  various technical programmes included in the
  health care delivery package
• - Well prepared supervision plan with
  schedule of supervision
• - A reliable Health management information
  system
• - Availability of logistics and financial
  resources.

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THE PROCESS OF SS
Set expectations Job description, standards
Take action -support-
Monitor and Assess performance -performance
gaps/best practices
Identify problems and opportunities -collectively
-
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MECHANISMS OF SS

• Self/peer supervision Internal superv.
• External superv.

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BENEFITS OF SS

• Ø      Builds partnerships with health workers
  to maximize quality of services as opposed to the
  traditional top-down approach of supervision
• Ø      Increases accountability and helps health
  workers to see the progress in their work
• Ø      Identifies areas for improvement
• T - Provides on-site training and improves
  skills of health workers
• Ø      Involves communities in supervision
  process increasing demand for health
  interventions (e.g. immunisation, IMCI, etc.)
• Ø      Opens opportunities for a peer
  supervision when other centres in the district
  meet to discuss progress and share lessons
  learned
• Ø      Stimulates advocacy for supervised
  district or health centre at province or central
  levels to get needed support for better
  performance.

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ON SITE TRAINING

• Interactive short training (2 3 hours)
• Selected priority topicsmicro-planning, using
  monitoring chart, vaccine stock ordering,
  ensuring uninterrupted supply of AD syringes,
  making a map with target population, monitoring
  of adverse events following immunization, safe
  disposal of waste equipment
• According to individual training needs.
• Use simplified updated job-aids

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CHALLENGES IN IMPLEMENTING SUPPORTIVE SUPERVISION.

• Too many actors involved
• More labour intensive
• Motivation and behaviour change of supervisors
• Need time and investment
• Need local appropriate and tested tools
• Need support from senior officials
• Has tobe integrated into the existing human
  resource management system
• Build on success
• Sustainability through collaborationg public
  sector institutions

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The Reality of Today Integration!

• Health Sector Reforms
• Decentralization
• Integrated Planning at District Level/Health
  minimum package
• Integrated disease surveillance
• Integrated Supervision Plan and Checklist
• Efficiency
• Shared Logistics/Transport
• Allowances
• Polyvalent service provider vs Polyvalent
  supervisor
• Shift towards Community Health Provider
• Integrated Checklist
• Cost Effective Human Resource utilization

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WAY FORWARD FOR SS IN THE AFRICAN REGION

• Document best practices on site training,
  motivation, self assessment
• Adapt local SS tools
• Train supervisors
• Advocate SS resource mobilisation
• Implement integrated SS within selected
  countries(see RED strategy)15 countries
• Monitor SS
• Evaluate the effects/ impact of SS on the
  performance of health services.

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FOR DISCUSSIONS

• HOW TO IMPROVE INTEGRATION COLLABORATION
  BETWEEN VARIOUS HEALTH PROGRAMMES AT DISTRICT
  LEVEL?
• WHAT CONCRETE SUGGESTIONS/RECOMMENDATIONS TO
  BETTER IMPLEMENT INTEGRATED TRAINING AND
  SUPPORTIVE SUPERVISION?