Executive SummaryBackgroundThe provision of health care is "human resource intensive," making it particularly important that a health care system has the right providers in the right places, with the right skills. Good supervision should be a critical part of achieving the objective of excellent health care provision. However, there is a growing body of experience and evidence from developing countries showing that the traditional visiting (or distance) supervisor model is not very effective. There is also growing evidence about the merits of alternate supervision models (such as site based self-assessment and peer review). This led the Capacity Project to sponsor a workshop with a number of experts in this area to review the evidence and think creatively about how to improve supervision in the health sector. Participants from the United States Agency for International Development (USAID), USAID collaborating agencies, the Health Resources and Services Administration (HRSA), the Pan American Health Organization (PAHO) and universities attended this workshop on Tuesday, October 25, 2005, at the Ronald Reagan Building in Washington, DC. This CD documents highlights from the presentations and discussions and is intended to capture the ideas and recommendations that emerged from this workshop and to encourage, inform and support further innovation in the area of supervision. What is good supervision?Experience has shown that to deliver high-quality health care, certain factors must be in place for providers. These factors are: 1) clear performance expectations; 2) regular feedback on performance; 3) adequate motivation and incentives; 4) needed supplies and equipment; and 5) appropriate knowledge and skills. It is generally accepted that a supervisor should ensure these factors are in place, and this performance-nurturing approach is called supportive supervision. However, for a variety of reasons, many supervisors do not focus on trying to provide these important performance factors nor do they build a positive, supportive relationship between the supervisor and service provision team. Unfortunately, many take a controlling or punitive approach. Most health systems also rely on a supervisor who is distant from the actual service delivery site (the visiting supervisor), which results in very infrequent and brief visits. Despite significant evidence that the common model of the visiting supervisor is ineffective, most developing country health programs continue to use it, at times making minor adjustments hoping that they can make it more effective. However, the workshop participants felt that there is a clear need to explore alternative models and approaches. A new paradigm for performance supportCompelling presentations by experts (including some from outside of the international development and health sectors) and energetic group discussion resulted in the general notion that those who are working to improve health care provision should test and promote more supportive approaches. The workshop discussions generated elements for an improved approach that could include empowerment of the on-site service providers and support staff, use of a team approach, more reliance on self-assessment using established standards and involvement of the supervisor more as a coach or mentor to assist with problem solving. A summary of some of the contrasts between the dominant visiting-supervisor model and an improved approach is presented below.
The Capacity Project is committed to working to develop, test and promote such improved performance support models. |
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