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Supervision Training: some lessons from Kenya. Dr Pamela Lynam / Nancy Koskei JHPIEGO-Johns Hopkins University Chris Rakuom – DSRS-Ministry of Health. Background. 1999 Supervision training needs assessment found: There is little training for supervision

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supervision training some lessons from kenya

Supervision Training: some lessons from Kenya

Dr Pamela Lynam / Nancy Koskei JHPIEGO-Johns Hopkins University

Chris Rakuom – DSRS-Ministry of Health

background
Background
  • 1999 Supervision training needs assessment found:
    • There is little training for supervision
    • What there is, is theoretical and difficult to apply
    • Supervisors do not have the time to spend 2-6 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
Methodology
  • 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
slide5

The Performance and Quality Improvement Process

GET and MAINTAIN STAKEHOLDER AGREEMENT

CONSIDER

INSTITUTIONAL

CONTEXT

MISSION

GOALS

STRATEGIES

CULTURE

CLIENT and

COMMUNITY

PERSPECTIVES

DEFINE

DESIRED

PERFORMANCE

FIND ROOT

CAUSES

Why does the

performance

gap exist?

SELECT

INTERVENTIONS

What can be done

to close the

performance gap?

IMPLEMENT

INTERVENTIONS

GAP

DESCRIBE

ACTUAL

PERFORMANCE

MONITOR AND EVALUATE PERFORMANCE

methodology contd
Methodology contd.
  • Reinforced the course with
    • 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
Components of the training
  • Overview of supervision
  • Working with people
  • Defining desired performance
  • Assessing performance
  • Finding root causes
  • Selecting and implementing interventions
  • Monitoring and evaluating performance
results

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
  • Improved Infection Prevention practicese.g.:
      • Improvised hand washing containers where no running water
      • Purchased containers for decontamination
results contd
Results contd.
  • Standards Developed:
    • Performance standards set and posted on the wall
results contd11

Suggestion Box at Ikutha Health Centre introduced by the supervisor (pictured right) as a way of getting feedback from the community

Results contd.
  • Community feedback on services:
      • Suggestion boxes introduced
      • Client Exit Interviews done by staff
results contd12

Meeting Agenda at Ekwanda Health Centre

Results contd.
  • Meetingsimproved
      • Invitation & agenda posted on the notice board
      • Minutes filed
results contd13

Curtains bought to provide privacy in one of the health facilities – MCH/FP Clinic

Results contd.
  • Privacyimproved:
    • Curtains purchased andput up
results contd14
Results contd.

Shared visions with other stakeholders (staff and community ) led to:

  • 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….”
  • Reduced client waiting time
results contd15
Results contd.

Staff Motivation: Supervisors developed new ways to motivate staff, e.g.:

  • 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 contd16
Results contd..
  • Supervisors enthusiastic about the materials and tools,e.g.:
      • Supervisory skills
      • Infection Prevention manual
      • Laminated Supervisors guide
      • Laminated hand washing tools
what next
What next?
  • Since the evaluation, the program has continued to evolve:
  • Trained further cadres:
    • Health Inspectors
    • Hospital Matrons
    • DPHNs
  • Employed more self assessment
  • Used a cross-cutting quality issue (infection prevention)
lessons learned
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
recommendations
Recommendations
  • Evaluate the further part of the program (training of Health Inspectors and Hospital Matrons)
  • Use this approach to train other cadres:
    • MOHs
    • Med Sups
    • DRH staff
    • Provincial T&S team
    • Health Administrators
recommendations contd
Recommendations contd.
  • 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 on-site supervisors.
  • Include a practicum day for visits to the clinic for participants to have “hands on” before implementation.
quotes from the field
Quotes from the field

Some of the quotes from providers as they filled the supervisory skills ratings questionnaire were:

  • “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.”