1. The Visiting Supervisor Model What’s the evidence?

2. Kinds of evidence What we know What’s in the literature

3. What do we know? How many planned/actual visits? What usually happens during a visit? What helped to make it effective?

4. What’s in the literature? Do supervisors visit? What happens during a visit? What makes it effective?

5. Do supervisors visit? DR Congo Nepal Niger Sudan Peru

6. DR Congo Planned visits: 12/year

7. DR Congo Planned visits: 12/year Actual: 3-4/year

8. Nepal Planned visits: 6 per 6 months

9. Nepal Planned visits: 6 per 6 months Actual: 1.5 per 6 months

10. Niger % scheduled visits completed

11. Niger % scheduled visits completed ?????????

12. Sudan Proportion of sites receiving 1 or more visits per 6 months:

13. Sudan Proportion of sites receiving 1 or more visits per 6 months: less than 50%

14. Peru Average annual supervisory visits:

15. Peru Average annual supervisory visits: 0.19

16. Effective supervision Set Expectations Identify problems and opportunities Take action Monitor and assess performance

17. What happens-Congo Overall error rate of 58.7%: Incomplete documentation Lack of follow-up Poor controls over equipment and supplies

18. What happens-Botswana Ask about problems: 65% Examine clinic records: 50% Observe service delivery: 43% Make suggestions for improvement: 38%

19. What happens-Sudan Supervision book found: 26% Supervision records found: 15% Observation of case management: 21%

20. What makes it effective? Increasing freq or duration of visits not effective Relationship most important for effect Direct (on-site) supervision works best

21. What’s in the literature? Do supervisors visit? What happens during a visit? What makes it effective?