Supervision is an excellent opportunity to provide further training to improve performance and to solve other systemic problems that contribute to poor quality of care in a health district (health zone).
While supervision can be an interactive process, traditional supervision visits focus on the inspection and the discovery of faults instead of problem solving to improve performances. Health workers often receive little advice or guidance on how to improve their results. They are often left unsupervised without a clear definition of objectives. The motivation is difficult to maintain in such an environment.
The supervisors often do not have the technical, managerial and supervision skills required to effectively assess health facilities. Therefore, they are not able to provide technical advice and appropriate feedback to improve service delivery. Supportive supervision requires time on the part of staff, and induces extra-costs (per diem, transportation, etc.).
The supervision is “a process that promotes quality at all levels of the health system by strengthening the relationships within that system, with an emphasis on identifying and solving problems and contributing to the optimization of the allocation of resources – promotion of high standards, teamwork and better communication in both directions “(Marquez and Kean 2002).
One of the cornerstones of supportive supervision is to work with health staff to set goals, monitor performance, identify and correct problems and proactively improve service quality.
Together the supervisor and health workers identify shortcomings in the field and directly work on it, thus avoiding the bad practices become habits. Supervision visits are also an opportunity to encourage good practices and help health workers to maintain high quality delivery.
The transition from traditional and hierarchical supervision to a more positive approach requires – at all levels – enough time to change attitudes, perceptions and practices.
Tanzania made progress
Following the reform of the health sector in 1999, the Ministry of Health of Tanzania has developed a plan to send a team of supervisors in health facilities districts to assess how services are delivered, to share their observations and provide on-site training. The funding comes from MS supervision through grants from various donors to support the delivery of essential health services.
All members of the management team of the health district and some co-opted members were trained on the objectives of the reform: to promote partnerships within the district, to manage health resources , to plan and deliver health services at the district level. Training in supervision was included in the module on management.
Since the adoption of this system, health workers found a significant improvement in the supervision approach. Supervision visits became more collaborative, frequent problems are solved and practical training in the field are organized.
Supervision visits became for them the opportunity to solve problems and learn additional techniques. Health workers are not afraid anymore of the challenges that they face, and can work with the district team to deal with.
Formative supervision encourages a collaborative approach to strengthen the health system and to improve the quality of services. It is an effective tool for improving performances. Guidelines and tools must be adapted to the context of each country or region.
Supportive supervision is a process which promotes the sustainable management and efficient use of resources by encouraging communication, as well as planning and monitoring results.
From: Children Vaccination Programme. Guidelines for the implementation of formative supervision: a step by step guide with tools to support immunization. PATH (2003).