Access Approach

Supportive Supervision
Meeting of the Implementation Task Force Geneva, 15-17 October 2002

The Five Access Strategies

Re-establishing outreach vaccination Supportive supervision Links between community and service Monitoring for action Planning and management of resources

What is Supervision?
Supervision:
Are H-Ws performing tasks according to set standards?

About staff

Implementation
Monitoring:
About
Are strategies & activities being activities implemented according to plan?

What is Supportive Supervision?

Building health workers capacity and commitment to carry out safe, good quality immunization services, Enabling each individual to perform at their personal best, Thru coaching and performance management.

How does it work?

EPI Management
Sets objectives, standards & procedures

District Health Management Team

Appoints supervisors & allocates resources

Central Trainers
Directly train district level supervisors

District supervisory Team

Conducts Supportive Supervision of H.F. teams

Formal training
Supportive supervision

Health Faclity Teams

Provide Safe & Good Quality Immunization Services

Training district level supervisors

Knowledge
Technical Managerial Organizational

What a district supervisor must know

Skills

Technical Human relation Conceptual

Experience

Broadening horizon Learning by doing

Training district level supervisors

Technical
Vacc. Pr. Diseases Vaccines/Immuniz. Five operations

Knowledge
Comprehension acquired thru learning & study

Managerial

Material resources Human resources Financial resources

Organizational

Policies/procedures Immunization syst. Health system

Basis will be MLM Course

Training district level supervisors

Technical or
Job Know-How
Five operations Quality & methods Health & safety

Skills
Proficiency at performing tasks

Human relation

Human behavior Inter-pers commun. Personal style

Conceptual

Planning Problem solving Decision making

Basis will be Immunization in Practice and some I.E.C. Course

Training district level supervisors

Experience
Breadth gained by involvement in wide range of tasks, events & people

Broadening horizon

Other supervisors Manage-t meetings Sharing experience

Learning by doing

Observing Practicing Accepting to fail

Basis will be Coaching by District Medical Officer and continuous self-learning.

Supportive Supervision: Planning (1)

Phase 1: Explaining purpose

Include

other interventions as necessary (IMCI, Mal) initial level: Questionnaire & observation team progress: Check lists training: Handbook (binder + sheets)

Phase 2: Collecting information

Assess

Phase 3: Writing plan

Involve

Phase 4: Implementing plan

Monitor Provide

Phase 5: Final review Phase 6: Integrating achievements

Supportive Supervision: Planning (2)

Tools and materials to update / develop:
1. Initial Questionnaire 2. Initial Observation Guide 3. Supervisory check lists 4. Peripheral Health Workers Handbook (binder + sheets to be added during each supervisory visit)

Supportive Supervision: Managing performance (1)

Managing performance is about aligning the performance of the staff with set standards and procedures in order to achieve objectives.

Supportive Supervision: Managing performance (2)

Standards can be determined in terms of:
1. Time: completion schedules, delivery dates

2. Quantity: coverage, nb of vaccinated kids

3. Quality: regularity of service, nb of AEFIs 4. Cost: fuel consumption, vaccine usage rate 5. Health & safety: needle pricks, disposal

Supportive Supervision: Managing performance (3)

Performance is monitored during preparation and implementation of plans: Phase 1: Explaining need for standards Phase 2: Communicating set standards Phase 3: Involving staff in establishing new standards Phase 4: Implementing standards

Regular feedback

Phase 5: Final review Phase 6: Integrating standards

Supportive Supervision: Involving staff

Staff involvement is crucial in both planning and performance management. Failing to do so will result in blocked staff energy thru the vicious circle:
1. Imposed plan & standards 2. Loss of enthusiasm in implementation

3. Poor standards & performance

Supportive Supervision in practice: Example of Togo

Contexte: Declining coverage since1990 Reduced funding for EPI EPI Review in Feb. 2001 Frequent stockouts of vaccines in 2001:
DPT3

falled from 50% (2000) to 43% (fin

2001)

Overall disorganization of EPI: lack of outreach, supervision and monitorage

Supportive Supervision in Togo: Implementation steps

Selection of priority districts (criteria) Briefing of concerned Regions & districts:

RMO,

DMO, EPI officers, surveillance officers, midwives, members of district mngt committee

Preparation of district microplans Fund allocation to Regions and districts Implementation Monitoring valuation

Supportive Supervision in Togo: District selection criteria

DPT3 < 50% during 1st semester Target population >= 5000 80% of immunization centres functioning Central Region districts: District health system functioningl with GTZ support. 23 priority districts selected on 35 total.

Coverage by districts for 1st semester 2002

Supportive Supervision in Togo: Content

Emhasis on organization of sessions, techniques, coverage monitoring graph, vaccine wastage, completeness of reporting, AEFIs One supervision per month per health centre by district central team (DCT) Supervision team: 1 MD, 1 EPI Officer, 1 Surveillance Officer, 1 midwife Means required for supervision: one 4x4 vehicle; supervision guide; perdiems for supervisors, half for supervisees

Monitoring in Togo: Content

1 two-day monthly meeting per district Participants: DCT, health facility officers Resources: lump sum of FCFA 2000 per participant & per meeting Meeting content: EPI report analysis with emphasis on DTC3, measles, BCG, TT2+, drop-out rate BCG/VAR et DTC1/DTC3; vaccine wastage rates; completeness of reports; analysis of constraints.