POST 01392E: MORE ON SUPPORTIVE SUPERVISION

POST 01392E: MORE ON SUPPORTIVE SUPERVISION FOLLOW-UP ON POSTS 01386E AND 01388E 21 FEBRUARY 2009 ****************************************** Dear Technet moderator, Your constituency may be interested in a new approach to supportive supervision we are introducing in Mali. In past years, as part of the training activities held to support strengthening of the immunization program and introduction of pentavalent vaccine initiated by the Ministry of Health, in collaboration with CVD-Mali and supported in part by the Merck Vaccine Network-Africa, we have used supportive supervision as a way to provide training at the health center level. National, regional, and district level training had been done using a modification of the WHO African Region Mid-Level Modules, using training methodology developed by WHO’s Global Training Network. We had counted on supervisory activities to provide training at the health center level, after observing that information provided at workshops for health center staff was rarely applied. Supervision was based on a comprehensive checklist along with feedback provided on the day of the visit as well as through an abbreviated manual (about 70 pages long) covering most of the information provided in week long training sessions for the higher levels. This approach had very little success. We postulated several reasons for this: (1) the supervisory sessions covered a large number of issues, meaning that a great deal of information was provided at one time; (2) the information provided in the manual, although targeted to the peripheral level, was theoretical, not practical, and was often buried in the 70 page document; (3) in addition, since most supervisory activities in Mali are meant to be integrated with other primary health care interventions, there was little time during the scheduled supervisory sessions to reinforce training. We have now elaborated a series of supervisory tools, each one focused on a specific area (for example, injection safety, or use of pentavalent vaccine), each containing a brief checklist from 14-16 items which can be answered “yes” or “no”, as well as a sheet explaining the correct behavior for each observation, based on national policy. Supervisory visits are based on a brief observation of the activities indicated in the checklist, followed by a brief feedback covering only those items. The process is focused enough so that it can easily fit into a larger integrated supervisory activity; implementation, including the feedback session, takes a total of 30-90 minutes. This approach has been appreciated by both district level staff performing supervision, and by the health center staff, as these supervisory tools allow pinpointing rapidly the most important achievements and gaps in a given area of immunization. We are now assessing the efficacy of this approach by a formal study in two regions of Mali. In each of these regions, two health centers in one district will receive quarterly supervision for a year, using each of the four supervisory tools one time, and the following year the centers in the other district will receive the same kind of supervision. Baseline, mid-study and final comprehensive assessments will be done to assess the impact of the supervision. We would be pleased to share the results of our work and the supervisory tools to those interested in replicating this approach in other countries. Best regards! Julie Milstien ([[email protected]][email protected][/email]) -------- Many thanks to Julie Milstien for sharing experiences of implementing supportive supervision in Mali. She has promised to share the tools that they have developed with TechNet21 readers once they are available in a standardized format and the documents have been translated into English. Post generated using Mail2Forum (http://www.mail2forum.com)