EFFECTIVENESS OF SUPPORTIVE SUPERVISION TOWARDS THE IMPROVEMENT OF HEALTH CENTER’S PERFORMANCE: THE CASE OF INTRAHEALTH/CPMTCT PROJECT IN ADDIS ABABA

Abstract

Supportive supervision is a process of guiding, helping and encouraging staff to improve their work performance, provide better quality services, and meet the needs of their clients according to the defined standards of performance of their employer. This paper presents a case study of IntraHealth/ CPMTCT project that can serve as an example for other health programs wishing to use PQI-based supportive supervision in improving service quality and coverage. The regression discontinuity design or the cutoff design was used. All 22 CPMTCT supported health centers in Addis Ababa were covered in the study. It base primarily on examination of completed JSS checklists and facility monthly MNCH/PMTCT service delivery reports. Besides, an in-depth interview was conducted with health centers’ managers. Quantitative data were analyzed using SPSS and qualitative data were examined using a content analysis methodology. The study reveals that a significant difference was observed in group of HCs with higher number of ARV coverage and group of health centers with relatively less ARV coverage. The more JSS conducted in health centers, the more will be its ARV coverage. Besides, in all HCs where JSS has been conducted, an improvement was observed in quality of service provision and coverage; although no difference was observed between the two groups of HCs in flow of clients for ANC, C&T and L&D services. The health center managers overwhelmingly reported that they found the quarterly joint supportive supervision visits using a checklist helpful. Particularly valued elements of JSS included: early identification of service delivery and other gaps, utilization of action plans, clarifying the roles and responsibilities of individual staff, and self-assessments serving as added motivation for staff. The major challenge in implementing JSS for the health facilities was that there were not enough financial and other resources to address many of the gaps that they identified during the JSS exercise. Supportive supervision is a promising approach to improve service quality and coverage. Programs that wish to use this approach can adapt best practices from CPMTCT project. Specifically, programs should involve all stakeholders, establish feedback mechanism, encourage facilities to conduct regular self-assessment, and have regular schedule and adequate budget for joint supportive supervision. Moreover, supervisors should be trained health care workers themselves, who are able to provide mentoring to health workers, modeling best practices, rather than just relying on observation and telling workers how to improve their work.