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Supervision, Training, and Quality Assurance. Lonny Born TA Hserv/Epi 544 W’ 07 University of Washington February 1, 2007. Part I – Supervision. Supervision (1) Supervising MCH Workers Role Play. Nurse: Nursing student: Supervisor: Provincial Direction: Patients:.

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Supervision, Training, and Quality Assurance


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supervision training and quality assurance

Supervision, Training, and Quality Assurance

Lonny Born

TA Hserv/Epi 544 W’ 07

University of Washington

February 1, 2007

supervision 1 supervising mch workers role play

Supervision (1)Supervising MCH WorkersRole Play

Nurse:

Nursing student:

Supervisor:

Provincial Direction:

Patients:

supervision 2 failure of supervision systems

Supervision (2)Failure of Supervision Systems?

Personnel shortages

2. Transport

3. Qualified and/or inappropriate supervisors

4. Power, status, and control

Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981

supervision 3 what is the role of the supervisor

Supervision (3)What is the role of the supervisor?

In community health?

Setting the conditions of employment?

Amount of personal training?

Qualified?

Maintaining and improving structure and capacity

Fund raising and budgeting?

Training and support

Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981

supervision 4 four principal tasks

Supervision (4)Four Principal Tasks

Ranking the most important elements for a given program

1. Legitimation

2. Protecting role integrity

3. Motivation

4. Education and guidance

5. Technical assistance

6. Linkage

7. Monitoring and control

8. Evaluation

Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981

supervision 5 four principal tasks

Supervision (5)Four Principal Tasks

II. Identify available mechanisms which might be used for supervision and specify to what extent each might contribute to the objectives

1. Intermediate level personnel

2. Community supervision

3. Communication media

Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981

supervision 6 four principal tasks

Supervision (6)Four Principal Tasks

III. Mobilize training and related resources for the mechanisms used in supervision.

1. Who to plan with?

Provide frontline workers with a continuous support system

- Formalized?

- Accountability

- Include policy-making evident at all levels

Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981

supervision 7 what can be done to overcome obstacles

Supervision (7)What can be done to overcome obstacles?

Change from the idea of “supervision” with emphasis on one-directional monitoring to the idea of a two-way exchange involving support and evaluation of the system.

Reevaluate the mechanisms for supervision and support.

Plan and train using different mechanisms for different supervision tasks according to the context.

Establish health system commitment to supporting those in the field

Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981

tools and techniques 2 training needs assessment
Tools and Techniques (2) Training Needs Assessment
  • Analysis of job descriptions and work plans
    • Skills needed?
    • Fit with organizational objectives?
  • Task Analysis
    • List skills needed
    • Group those with similar training needs
    • Transform into training objectives
  • On-the-job supervision, observations and interviews
    • Watch for gaps in understanding, attitude, performance
  • Client surveys
    • Exit interviews from point of service
    • Focus group surveys
preparing a training program
Preparing a training program
  • Develop a general plan for training with overall course objectives
  • Write objectives for each training session
  • Determine the training approach, methods, and techniques
  • Develop training session plans
  • Prepare evaluation plan and forms
  • Determine resource requirements and budget
  • Prepare a summary of the training program plan/proposal
the mch training budget
The MCH Training Budget
  • Facilitator(s) – training program design and training implementation (salaries/honoraria; per diems; travel)
  • Materials, equipment, facilities (purchase and shipping of materials; duplication; supplies; refreshments; equipment rental; facility rental)
  • Participants (travel to and from training; per diems)
  • Secretarial, clerical, logistics (typing; reproduction of materials during training; communication; transport of supplies and workshop participants
  • Post-training activities (reproducing reports; follow-up visits and evaluation)
training summary
Training Summary
  • Write a report summarizing the training. Be sure to include all stakeholders, participants and clients.
  • Follow-up the summary report.
another approach integrated management of childhood illnesses imci
ANOTHER APPROACH:Integrated Management of Childhood Illnesses (IMCI)
  • integrated approach
  • aims to reduce death, illness and disability, and to promote improved growth and development
  • includes both preventive and curative elements
  • implemented by families, communities and health facilities

Adapted from previous guest speakers Donna Denno and Sally Stansfield

imci addresses most causes of death
Pneumonia

Diarrhea

Measles

Malaria

Malnutrition

Sepsis

Meningitis

Dehydration

Anemia

Ear infection

HIV/AIDS

Wheezing

Sore throat

IMCI Addresses Most Causes of Death

Adapted from previous guest speakers Donna Denno and Sally Stansfield

three components of imci
Three Components of IMCI
  • Improves health worker skills
  • Improves health systems
  • Improves family and community practices

Adapted from previous guest speakers Donna Denno and Sally Stansfield

improves family and community practices
Improves Family and Community Practices
  • Community participation
  • Preventive care
    • Immunization
    • Breast-feeding and other nutritional counseling
  • Home care of sick children
  • Recognition of severe illness
  • Care-seeking behavior

Adapted from previous guest speakers Donna Denno and Sally Stansfield

improves health worker skills
Improves Health Worker Skills
  • Targets first level health facilities
  • Addresses causes of at least 70% of deaths
  • Case management guidelines
  • Training
  • Supervision
  • Monitoring

Adapted from previous guest speakers Donna Denno and Sally Stansfield

improves health systems
Improves Health Systems
  • Planning and Management
  • Availability of drugs and supplies
  • Organization of work
  • Monitoring and supervision
  • Referral pathways and systems
  • Health information systems

Adapted from previous guest speakers Donna Denno and Sally Stansfield

imci multicountry evaluation
IMCI Multicountry Evaluation
  • Training health workersimproved performance
  • Difficult to maintain & expand existing IMCI sites
  • District and national health systems lack sufficient management structure, funding, coordination, supervision, and manpower
  • Low utilization rates of health servicesIMCI cannot impact child mortality.

Adapted from previous guest speakers Donna Denno and Sally Stansfield

improving health worker skills community care and health systems

Clinical

Assessment

and treatment by health workers

Knowledge,

Beliefs

and skills

caretakers

Capacity, structure

and functions of

health system

Improving Health Worker Skills, Community Care, and Health Systems

Adapted from previous guest speakers Donna Denno and Sally Stansfield

four principles of qa
Four Principles of QA
  • Focus on client perspective and needs
  • View work in terms of systems and processes
  • Make data-based decisions
  • Teamwork

USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

what is quality
What is Quality?
  • Technical performance
  • Access to services
  • Effectiveness of care
  • Efficiency of service delivery
  • Interpersonal relations
  • Continuity of services
  • Safety
  • Physical infrastructure and comfort
  • Choice

USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

3 components of qa 1
3 components of QA (1)

Defining Quality (QD)

  • Minimum
  • Ideal
  • Optimal and achievable

STANDARDS?

USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

3 components of qa 2
3 components of QA (2)

Measuring Quality (QM)

  • Baseline
  • Monitoring
  • Evaluation
  • Programmatic evaluationvariation

USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

3 components of qa 3
3 components of QA (3)

Improving Quality (QI)

  • Identify 
  • Analyze 
  • Develop 
  • Test and implement

USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

slide37

USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

view work in terms of systems and processes
View work in terms of systems and processes

USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

implementing qa

Maturity

QA is formally, philosophically integrated into the structure and function of the organization or health system

Consolidation

Expansion

Experimental

Awareness

Pre-existing

-

Organization has no formal or deliberate QA

Implementing QA

USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005