Outreach training and supportive supervision for malaria case management in Zambia: the effects of focused capacity building on indicators of diagnostic and clinical performance

Abstract

BackgroundAccurate diagnosis of malaria and reduced reliance on presumptive treatment are crucial components of quality case management. From 2008 to 2012, the Improving Malaria Diagnostics project, in collaboration with the Zambia National Malaria Control Centre, implemented an external quality assurance scheme partially comprised of outreach training and supportive supervision (OTSS) in an effort to improve malaria case management across a spectrum of health facilities performing laboratory-based malaria diagnostics. OTSS assessments were conducted by project-trained laboratory and clinical supervisors on a regular basis and measured changes in health facility staff performance over time. Standardized supervision tools were used for data collection and guided OTSS teams to assess health facility infrastructure, record keeping practices, stores of supplies and consumables, good laboratory practices, and staff adherence to guidelines for the case management and diagnosis of suspected malaria cases via direct observations or record reviews. The structure of OTSS also allowed supervisors to provide ongoing support to clinicians and laboratory staff through regular mentoring and on-the-job training.ResultsThis analysis included 88 laboratories and 64 clinics each with four repeated supervisory assessments. Over the course of the project there were significant declines in the number of laboratories experiencing stock-outs of microscopy reagents/consumables (p < 0.001) and significant increases in the number of laboratories instituting the use of microscopy positive controls (p < 0.01), conducting parasite counting (p < 0.05), and converting from a semi-quantitative to a quantitative parasite counting methodology (p < 0.001). Performance in malaria diagnostic and clinical practices [i.e. RDT use (mean(diff) = 14.3%, p < 0.001), blood slide preparation (mean(diff) = 14.7%, p < 0.001), blood slide staining and reading (mean(diff) = 14.0%, p < 0.001), fever case management (mean(diff) = 7.3%, p < 0.01)] and prescriber adherence to negative diagnostic test results (mean(diff) = 7.2%, p < 0.05) showed modest, but significant gains from assessment 1 to assessment 4.ConclusionThe external quality assurance scheme provided periodic representations of clinical and laboratory staff performance. OTSS-enrolled health facilities demonstrated improvements to malaria diagnostic skills, adoption of laboratory best practices, strengthened fever case management practices, and improved prescriber adherence to negative malaria test results.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2589-6) contains supplementary material, which is available to authorized users.

Adherence to malaria management guidelines by health care workers in the Busoga sub-region, eastern Uganda

“…Additionally, the study findings lend credence to the importance of availing all health care workers with guidelines relevant to malaria case management promoting adherence to guidelines. Effective supervision systems for HCW at both public and private facilities should be emphasized as these realign practice to standards [ 53 ]. For the private sector, challenges are unique, driven by lack of knowledge, the desire to profit, and lack of incentive to adhere to guidelines calling for regulation and innovative and sustainable strategies that promote adherence to guidelines.…”

Evaluation of malaria microscopy diagnostic performance at private health facilities in Tanzania

“…More efforts are required to strengthen the capacity of health workers in both public and private sectors. Studies have shown that this can be achieved through on job training programs, supportive supervision, and reliable supplies of quality reagents, electricity and establishment of an external quality assurance scheme [4, 9, 13, 15–17, 36, 38].…”

“…Some studies report 30–96% of parasite negative patients being treated for malaria [10–12]. Therefore, there is a need for training of microscopists and supportive supervision to improve malaria microscopy competencies in health facilities [4, 14–17].…”

“…Governments and other stakeholders have been working to improve quality of microscopy in public health facilities, including methods for quality accreditation of national experienced microscopists and routine validation of slide examination [4, 17–19]. There has been a sizeable effort on the part of the non-governmental organizations (NGO) community to improve malaria case management and diagnostics in Tanzania, including the work done by the MalariaCare project in partnership with the National Malaria Control Programme.…”

The supervisory relationships of community health workers in primary health care: social network analysis of ward-based outreach teams in Ngaka Modiri Molema District, South Africa

“…Such a holistic conception requires viewing supervision not just as a dyadic relationship between a supervisee and their immediate line supervisor,10–14 but rather as a system operating at several levels with a range of functions involving different actors and relationships and forms of interaction, for example, one-on-one, group and peer supervision, and so on, simultaneously 7 9. In this sense, supervision can be thought of as a set of relationships embedded in the wider context of social and professional relationships and hierarchies within the health system.…”