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Leadership for Performance
A new approach for “supervision”
Management Sciences for Health
Leadership, Management and
Sustainability, Fall 2005
What is supervision: what are the
assumptions behind it?
• Supervise: to oversee the performance of
• Assumption: for quality performance, a
supervisor has to oversee, or inspect results.
• Question: when you have produced quality, was
it because a supervisor was using a checklist to
inspect you?
What are some weaknesses in
current supervision?
• Supervisors often act as inspectors, using the
checklist to find errors.
• Supervisors are often separate from day to day
challenges the service providers are facing.
• Fear and reduction of incentives are often used
as motivators resulting in demoralization and
“mis-reporting” of results to avoid negative
Leadership in Supervision
• In Upper Egypt, a leadership approach is
being added to supervision training.
• This leadership approach is enabling
service provision teams to identify and
face their own challenges and achieve
results with support from “supervisors.”
Leadership: A shift in mindset
• From Inspection to Coaching-inquiring into the
service provider teams ongoing process of
• From Blame to Shared Responsibility with the
service provision team.
• From providing solutions to working with
service providers on the challenge model to
overcome obstacles and achieve results.
• Enabling others to face challenges and
achieve results in complex conditions
Adding a Leadership Approach to
• The supervisors work together with the
service provision team to identify their
challenges and the results they want to
• Together they identify obstacles and root
causes and make an implementation plan.
• They use the “CHALLENGE MODEL.”
Aswan Leadership Development
Program 2002-2005
• M&L implemented pilot LDP in Aswan Governorate from
June 2002-June 2003. Program involved 41 district and
clinic managers, organized into 10 teams.
• M&L support ended in June 2003, however graduates
decided to replicate and expand the LDP to other clinics
and districts within the Governorate.
• End of 2005 185 health units (5 “generations”) and 35
facilitators are using original LDP approach and
• Results due to the relevance of LDP to health
professionals and to promotion of a few graduates to
senior positions in FP/RH at the district and Governorate
Service Provider Teams
• The service provider teams with support from
supervisors use the leadership practices. They:
– Scan client and community needs
– Focus on a common vision of the services
they want to provide
– Align and Mobilize their resources inside
of the clinic and outside in the community
– Inspire themselves by producing results
using only their own resources
Role of the external
• The supervisor works to support the team,
and finds ways to support them in
overcoming their obstacles.
• They use “coaching,” inquiring into the
obstacles the service providers are facing,
and helping them to find solutions.
• They empower the teams to take
responsibility for results.
Beyond supportive supervision
• Leadership uses and builds on the supportive
practices of facilitative supervision.
• What is different is that the service provider
teams create a shared vision of the care they
want to provide to fulfill client needs.
• They have a clear process – The Challenge
Model – by which they are identifying their
challenges and leading their teams to achieve
Using the “Checklist”
• The checklist is now used as a tool for selfassessment.
• It is used to enable the service providers to
acknowledge themselves for strengths and
target areas for improvements.
• It is used with other forms of assessment,
including client interviews and community focus
Service Providers work in teams
and are motivated and committed
• “It is the first time that a program respects team work.
The whole team existing at the clinic level; everybody is
involved, the nurse, the clinicians and even the book
• “It does not need lots of resources to implement, it does
not need us to build a hospital or buy equipment. It deals
with brains, ideas and mentalities. This work depends
mainly on people’s motivation and commitment.”
Leadership Development enables
providers to think for themselves
• “What is genius about this program is that it gives the
people a chance to have their own vision and a point of
view. These people had better solutions than we had,
this happens all the time.”
• “The main idea of the leadership training is to analyze
your own problems. People get involved because they
feel this helps their sense of self-esteem, while they are
providing the service, money is not everything, they feel
that they are able to help others and provide information
to them.”
Advice from Aswan on Supervision
1. There needs to be commitment to quality from
local managers. External supervision can initiate
the process of performance improvement, but to
continue and to sustain, local supervision is
2. Local supervisors know exactly the climate of
work, the exact needs of the community
concerns and the resources available.
3. Local supervisors can help the units to make
their priorities – they can facilitate and solve
many problems with the service providers.
Aswan Governorate Health and
Service Results, 2001-2004
• Maternal Mortality Rate – 85-68.9
• Infant Mortality Rate (less than one year) –
• ANC average visits – 1.9-2.7
• Family Planning Coverage – 55, 735 to 71
• 30% increase in new FP users
It would be useful to explore how adding a
leadership approach to service delivery
teams and supervisors can improve
commitment, teamwork and the attainment
of service and health improvements.