Supervision
Supervision plays a key role in maintaining the quality of performance of health providers and the services they deliver. Supportive feedback is also highly valued by health providers and helps motivate them in their work.
However, routine supervision is one of the weakest areas in many developing country settings. Lack of transportation means, fuel, financial resources, as well as inadequate training in supervisory skills, approach to supervision and supervisors’ attitudes are some of the constraints reported to supervision.
WHO child health-related programmes have over the years promoted the concept of supervision as supportive supervision and an opportunity for strengthening services, including clinical management, to replace the deeply rooted idea of supervision as “inspection” or a purely administrative task.
The standard approach to follow-up visits after IMCI training (Integrated Management of Child Health) has been used in all countries implementing IMCI in the Region to both reinforce health provider skills and improve health system support elements at the health facility. Findings of the visits are not only discussed with facility staff but also usually reported to district health officials for supportive action.
However, IMCI-trained health providers receive only few follow-up visits (one to two on average), within the first few weeks and/or months of training. Follow-up visits then leave the place to routine supervision, which should further improve or at least maintain the levels and standards of care achieved initially.
Information from reviews and data from IMCI health facility surveys suggest that much needs to be done to improve routine supervision. According to those findings, the frequency of supervision varies remarkably from place to place; only a small proportion of facilities visited receive clinical supervision and have the findings recorded in a supervisory book as a reference for the facility staff and future follow-up.
Efforts to improve the quality of supervision in child health have been made by selected countries. Integrated supervisory checklists have been developed in several countries (e.g. Djibouti, Egypt, Islamic Republic of Iran, Sudan, Syrian Arab Republic, Tunisia) to standardize the child health component of routine supervision, although their effects still need to be properly evaluated.
A supervisory skills training package has been developed in Egypt for governorate, district and health facility levels.
Developing checklists and training supervisors in their use is however only one of the issues. Supervision requires, as seen also for other health system elements, a more comprehensive approach.