1. Supervision, Training, and Quality Assurance Lonny Born TA Hserv/Epi 544 W’ 07 University of Washington February 1, 2007

2. Part I – Supervision

3. Supervision (1) Supervising MCH Workers Role Play Nurse: Nursing student: Supervisor: Provincial Direction: Patients:

4. Organization Flowchart

5. Supervision (2) Failure of Supervision Systems? 1.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

6. Supervision (3) What is the role of the supervisor? a.In community health? b.Setting the conditions of employment? c.Amount of personal training? d.Qualified? e.Maintaining and improving structure and capacity f.Fund raising and budgeting? g.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

7. Supervision (4) Four Principal Tasks I.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

8. 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

9. Supervision (6) Four Principal Tasks III.Mobilize training and related resources for the mechanisms used in supervision. 1. Who to plan with? IV.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

10. Supervision (7) What can be done to overcome obstacles? 1.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. 2.Reevaluate the mechanisms for supervision and support. 3.Plan and train using different mechanisms for different supervision tasks according to the context. 4.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

11. Part II – Training

12. Evaluating Training Programs Training for effective performance

13. Tools and Techniques (1) Decision Tree

14. Tools and Techniques (2) Training Needs Assessment 1.Analysis of job descriptions and work plans Skills needed? Fit with organizational objectives? 2.Task Analysis List skills needed Group those with similar training needs Transform into training objectives 3.On-the-job supervision, observations and interviews Watch for gaps in understanding, attitude, performance 4.Client surveys Exit interviews from point of service Focus group surveys

15. 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

16. General Plan for Training (1) Overview

17. General Plan for Training (2): Overall objectives

18. General Plan for Training (3): Individual Session objectives

19. Training Methodology and Techniques Training Plan: Individual Session

20. Final Evaluation Plan and Forms

21. 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)

22. Training Summary Write a report summarizing the training. Be sure to include all stakeholders, participants and clients. Follow-up the summary report.

23. 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

24. IMCI Addresses Most Causes of Death Pneumonia Diarrhea Measles Malaria Malnutrition Sepsis Meningitis Dehydration Anemia Ear infection HIV/AIDS Wheezing Sore throat Adapted from previous guest speakers Donna Denno and Sally Stansfield

25. 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

26. 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

27. 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

28. 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

29. 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

30. Improving Health Worker Skills, Community Care, and Health Systems Capacity, structure and functions of health system Knowledge, Beliefs and skills caretakers Clinical Assessment and treatment by health workers Adapted from previous guest speakers Donna Denno and Sally Stansfield

31. Part III – Quality Assurance (QA)

32. 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

33. 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

34. 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

35. 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

36. 3 components of QA (3) Improving Quality (QI) 1)Identify  2)Analyze  3)Develop  4)Test and implement USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

38. View work in terms of systems and processes USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

39. Implementing QA USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005 - Pre-existing Awareness Experimental Expansion Consolidation Maturity QA is formally, philosophically integrated into the structure and function of the organization or health system Organization has no formal or deliberate QA

40. Happy Supervising and Training