Quality assurance and quality improvement using supportive supervision in a large-scale STI intervention with sex workers, men who have sex with men/transgenders and injecting-drug users in India

Abstract

BackgroundDocumentation of the long-term impact of supportive supervision using a monitoring tool in STI intervention with sex workers, men who have sex with men and injection-drug users is limited. The authors report methods and results of continued quality monitoring in a large-scale STI services provided as a part of a broader HIV-prevention package in six Indian states under Avahan, the India AIDS Initiative.MethodologyGuidelines and standards for STI services, and a supportive supervisory tool to monitor the quality were developed for providing technical support to STI component of large-scale HIV-prevention intervention through 372 project-supported STI clinics. The tool contained 80 questions to track the quality of STI services provided on a five-point scoring scale in five performance areas: coverage, quality of clinic and services, referral networks, community involvement and technical support.ResultsThe tool was applied to different STI clinics during supportive supervision visits conducted once in every 3 months to assess quality, give immediate feedback and develop a quality score. A total of 292 clinics managed by seven lead implementing partners in six Indian states were covered in 15 quarters over 45 months. Overall quality indicators for the five performance areas showed a three- to sevenfold improvement over the period.ConclusionIt was possible to improve quality over the long-term in STI interventions for sex workers, men who have sex with men and injection-drug users using an interactive and comprehensive supportive supervision tool which gives on-the-spot feedback. However, such an effort is time-consuming and resource-intensive, and needs a structured approach.

Strengthening Malaria Service Delivery through Supportive Supervision and Community Mobilization in an Endemic Indian Setting: An Evaluation of Nested Delivery Models

“…The supportive supervision by NGO workers through semi-monthly visits provided them with a structured learning process. Similar to other low-and middle-income country settings, more hands-on support through supportive supervision imparted more confidence, knowledge and skills in CHWs and thereby improved their motivation to perform [13][14][15][16]. Further, the supervisors provided the conduit for efficient communication between the CHWs and the formal health system to maintain an uninterrupted supply of commodities.…”

“…Communities should be empowered to regularly monitor and evaluate the effectiveness of interventions [8]. In terms of the involvement of CHW, the global evidence suggests that regular and systematic supervision with clearly defined objectives can improve the performance of community health workers involved in primary health care [13][14][15][16]. Such evidence for India, however, is lacking and insufficient community capacity, trust, and coordination may keep the new malaria control strategies from meeting expected outcomes [9,17,18].…”

Rolling out new biomedical HIV prevention tools: what can be learned from Avahan, the India AIDS initiative?

“…Microplanning tools were developed for their use, coupled with clear targets, and they were given authority and responsibility for meeting the targets, resulting in a marked increase in the number of KPs contacted monthly by KP peer outreach workers, a narrowing in the condom distribution gap (the difference between the estimated number of condoms needed by sex workers, based on reported client numbers, and the number of condoms distributed) and increased clinic utilisation. 22,[31][32][33][34] This indicator was used to gauge the extent to which KP peer outreach workers were acting as role models. Other efforts were undertaken to ensure that STI testing and treatment were not coercive, mandatory or incentivised in any way.…”

Scale-up and coverage of Avahan: a large-scale HIV-prevention programme among female sex workers and men who have sex with men in four Indian states

“…Acceptability of services was maximised by involving FSWs and HR-MSM as part of the outreach and facilities (drop-in centre (DIC) and STI clinics) management teams 5 7 9. Companion papers in this supplement address the question of quality of Avahan's STI clinical services and condom social marketing 15 16…”