The role of supportive supervision on immunization program outcome - a randomized field trial from Georgia

Abstract

BackgroundOne of the most common barriers to improving immunization coverage rates is human resources and its management. In the Republic of Georgia, a country where widespread health care reforms have taken place over the last decade, an intervention was recently implemented to strengthen performance of immunization programs. A range of measures were taken to ensure that immunization managers carry out their activities effectively through direct, personal contact on a regular basis to guide, support and assist designated health care facility staff to become more competent in their immunization work. The aim of this study was to document the effects of "supportive" supervision on the performance of the immunization program at the district(s) level in Georgia.MethodsA pre-post experimental research design is used for the quantitative evaluation. Data come from baseline and follow-up surveys of health care providers and immunization managers in 15 intervention and 15 control districts. These data were supplemented by focus group discussions amongst Centre of Public Health and health facility staff.ResultsThe results of the study suggest that the intervention package resulted in a number of expected improvements. Among immunization managers, the intervention independently contributed to improved knowledge of supportive supervision, and helped remove self-perceived barriers to supportive supervision such as availability of resources to supervisors, lack of a clear format for providing supportive supervision, and lack of recognition among providers of the importance of supportive supervision. The intervention independently contributed to relative improvements in district-level service delivery outcomes such as vaccine wastage factors and the DPT-3 immunization coverage rate. The clear positive improvement in all service delivery outcomes across both the intervention and control districts can be attributed to an overall improvement in the Georgian population's access to health care.ConclusionProvider-based interventions such as supportive supervision can have independent positive effects on immunization program indicators. Thus, it is recommended to implement supportive supervision within the framework of national immunization programs in Georgia and other countries in transition with similar institutional arrangements for health services organization.Abstract in RussianSee the full article online for a translation of this abstract in Russian.

Effect of support supervision on maternal and newborn health services and practices in Rural Eastern Uganda

“…The MANIFEST approach demonstrated that it is possible to have positive and collegial relationships between health workers and supervisors. The changes in the use of support supervision in improving the quality of maternal and newborn care services has also been reported by other studies conducted in low-income countries [10,12–14]. …”

“…Support supervision also provides opportunities for regular feedback and therefore promotes skill building through appropriate strategies, such as training and mentorships [12,13]. Inadequate support supervision has been cited as a key contributor to health worker shortages in low- and middle-income countries.…”

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].…”

The role of supportive supervision in enhancing and sustaining health education in home management and prevention of malaria among mothers of under-five children

“…This may contribute beneficially to sustenance of health education and training that might have been provided for the patients/clients. Djibuti et al (2009) defined supportive supervision as "range of measures to ensure that personnel carry out their activities effectively through direct personal contact on a regular basis to guide, support and assist designated staff to become more competent in their work." This type of supervision can also be adapted for guiding, supporting and assisting the health care consumers to develop selfefficiency in their self-care in the spirit of promoting good health and preventing diseases.…”