Transcript NASCOP-IMPACT-JHPIEGO program: VCT for frontline

Supervision Training:
some lessons from
Kenya
Dr Pamela Lynam / Nancy Koskei
JHPIEGO-Johns Hopkins University
Chris Rakuom – DSRS-Ministry of
Health
Background
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1999 Supervision training needs
assessment found:
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There is little training for supervision
What there is, is theoretical and difficult to
apply
Supervisors do not have the time to spend 26 weeks (or longer) in training
Poor logistics and planning make “traveling
supervision” very difficult to apply
Few good practical tools for supervisors
Few or no supervision reference materials to
help them do a better job
Methodology
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JHPIEGO developed a supervision training
approach that addressed these needs
Pre-tested in one district (Busia)
Revised the package and incorporated
lessons learned
Used the package to train 28 on site
supervisors from MCH/FP clinic in district
hospitals and health centers
Introduced the Performance and Quality
Improvement process during the training
to solve actual problems supervisors were
facing
The Performance and Quality
Improvement Process
GET and MAINTAIN STAKEHOLDER AGREEMENT
CONSIDER
INSTITUTIONAL
CONTEXT
DEFINE
DESIRED
PERFORMANCE
MISSION
GAP
GOALS
FIND ROOT
CAUSES
Why does the
performance
gap exist?
SELECT
INTERVENTIONS
IMPLEMENT
What can be done INTERVENTIONS
to close the
performance gap?
STRATEGIES
CULTURE
CLIENT and
COMMUNITY
PERSPECTIVES
DESCRIBE
ACTUAL
PERFORMANCE
MONITOR AND EVALUATE PERFORMANCE
Methodology contd.
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Reinforced the course with
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Mailings for encouragement and also to get
feedback on implementation, challenges and
constraints
Distribution of further tools intermittently
Followup meeting for participants to share
experiences
Supportive supervision to each participant for
encouragement, answering questions,
modeling, etc.
Components of the
training
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Overview of supervision
Working with people
Defining desired performance
Assessing performance
Finding root causes
Selecting and implementing interventions
Monitoring and evaluating performance
Results
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Improved Infection
Prevention practices
e.g.:
• Improvised hand
washing
containers where
no running water
• Purchased
containers for
decontamination
An improvised hand washing container in one
of the health facilities – MCH/FP Department
The supervisor at Ikanga Health
Centre with containers for mixing jik
Results contd.
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Standards Developed:
 Performance standards set and
posted on the wall
Results contd.
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Community
feedback on
services:
• Suggestion
boxes
introduced
• Client Exit
Interviews
done by staff
Suggestion Box at Ikutha Health Centre introduced by the supervisor
(pictured right) as a way of getting feedback from the community
Results contd.
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Meetings improved
 Invitation &
agenda posted
on the notice
board
 Minutes filed
Meeting Agenda at Ekwanda Health Centre
Results contd.
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Privacy improved:
 Curtains
purchased and
put up
Curtains bought to provide privacy in one of the health
facilities – MCH/FP Clinic
Results contd.
Shared visions with other
stakeholders (staff and community )
led to:
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Opening of a maternity facility
• The community had complained that “…the
facility has been here for many years but
none of our children were born here…. We
need….”
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Reduced client waiting time
Results contd.
Staff Motivation: Supervisors developed
new ways to motivate staff, e.g.:
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Introducing tea provided by the clinic (a Kenya
tradition!)
One started a lunch club
Days off made more equitable by reorganizing the
duty rosters
Results contd..
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Supervisors enthusiastic about the
materials and tools, e.g.:
 Supervisory skills
 Infection Prevention manual
 Laminated Supervisors guide
 Laminated hand washing tools
FHI Evaluation
Examples of results:
Pretest/Posttest Item
Techniques used by supervisors to identify problems
% of supervisors obtaining feedback from staff
Techniques used by supervisors to motivate staff
% supervisors offering staff extra time off
% of supervisors providing free tea/staff breaks/staff parties
Infection prevention practices of providers
% of providers wash hands with soap and water before procedure
% of providers wash hands with soap and water after procedure
Training
Pre
Post
Control
Pre
Post
56.5
74.1
75.0
59.3
56.5
43.3
74.1
53.3
75.0
43.3
59.3
43.3
14.9
30.1
38.3
48.0
15.2
26.5
13.4
13.4
What next?
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Since the evaluation, the program has
continued to evolve:
Trained further cadres:
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Health Inspectors
Hospital Matrons
DPHNs
Employed more self assessment
Used a cross-cutting quality issue
(infection prevention)
Lessons learned
A short course with reinforcements
can be effective (vaccination
analogy)
 Some great changes can be made
with little outside input
 Both on-site and “traveling”
supervisors need access to training
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Recommendations
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Evaluate the further part of the program
(training of Health Inspectors and
Hospital Matrons)
Use this approach to train other cadres:
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MOHs
Med Sups
DRH staff
Provincial T&S team
Health Administrators
Recommendations contd.
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Enable the Ministry of Health to provide
this course to all staff who have been
promoted or assigned supervisory duties.
The Health Inspectors, who have been
trained in supervision, can continue
providing support supervision to the onsite supervisors.
Include a practicum day for visits to the
clinic for participants to have “hands on”
before implementation.
Quotes from the field
Some of the quotes from providers as they filled
the supervisory skills ratings questionnaire were:
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“This course really changed our supervisor a
great deal....”
“…she is ready always to give feedback and
assist every time....”
“He regularly provides feedback on
performance …like last year we were awarded
a certificate to MCH/FP department staff for
good performance.”
“He is a very good in-charge who listens to
problems of staff.... This happened after the
course.”
Thank you!