1. IDSR SUPPORTIVE SUPERVISION IN CENTRAL MONROVIA & CAREYSBURG DISTRICTS, MONTSERRADO COUNTY By: Interns from Tubman University and SDA University, April 25-May 1,2018

2. The IDSR supportive supervision was done by:
Emmanuel Dwalu(NPHIL),
Yolaine K. Waka (NPHIL),
Kadiatou Balde(NPHIL),
Sackor B. Toe(Tubman University),
Comfort Smith(Tubman University),
Lawrence T. Tanwone (Tubman University)
, Henrietta Morgan(SDA University)
Rhoda Moore(NPHIL)
,Zinnah Luther Koenig(Intern),
Alexlyn S. Monlue(NPHIL),
Rosemary H. Lott (Intern), Patrick Woi (Intern),Wonbin Surzue(NPHIL), Beatrice E. Gibson(Intern

3. Table of Contents Background Objective Methods
Key Findings: (Achievements, & Constraints)
District
Health Facility
Community
Next step

4. Background & Methods

5. Background
Public health surveillance and public health action functions are fundamental for national and global health security but this requires sustained hands on technical and managerial capacity for all at service delivery and leadership levels.
In so doing, NPHIL continues to work towards strengthening the national disease surveillance system guided by the Integrated Disease Surveillance and Response(IDSR)
With this, Interns from the Adventist and Tubman Universities, participated in a supportive supervision inorder to gain practical field experience as it relates to public health activities.

6. Supervision Objectives
To motivate and expose interns to practical field activities in Public health
To ensure data quality, identify implementation gaps and health system barriers that constraint IDSR delivery at sub-national levels.
Validate and harmonize Health Facilities data with national
Identify health system/operational challenges that constraint IDSR program
Improve health staff skills and knowledge through onsite mentorship

7. Why a Supportive Supervision?
Validate and Harmonize reported data
Improve staff skills to reflect acceptable standards
inform programs on key findings of on- going plans to address operational needs
Ensured accountability and quality assurance

8. Distribution of Health Facility(s)
Methodology1/2
Distribution of Health Facility(s)
Purposive sampling
Sample size of 2 health districts (rural and urban)
Respondents: DSOs, HF, surveillance Focal Persons and CHVs
District
Total Facility(s)
Hosp
H/C
Clinics
Comm.
Careysburg 8 1 7  2
Central Monrovia 15 2 3 10  0
Total
23(100)
3(13%)
17(74%)
Purposive because of accessibility and performance (Selective/subjective based on program objectives).
Clinics randomly based on HMIS data

9. Methodology 2/2 The tools used for data collection were:
IDSR Checklist as primary data collection tool:
Administration (Competency)
Data Collection, reporting Analysis
Investigation and Confirmation of Cases
Epidemic Preparedness and Response
Supervision and Feedback; Safe and Dignified Burial
Community Event-Based Surveillance (Perceptions, knowledge and attitudes)
Secondary data:
Past 3 months IDSR data report
( Jan.- March 2018)

10. Key Findings

11. District Level Facility level Community level
Key Achievements/Strength
Both District surveillance officers are trained in frontline Field Epidemiology and IDSR modular training
Both districts have office space for surveillance activities (Central Monrovia)
One out of two Districts have functional computers used for surveillance activities (Central Monrovia)
96% (n=22) of the health facilities visited have SFP
90% (n=21) of the health facilities have community simplified case definition pined on the wall.
73% (n=17) of the health facilities have means of communicating to the district
65% (n=15) of the health facilities visited have IDSR weekly ledger
Effective team work between HFs and Community Volunteers
Improved information sharing among health facilities, districts and communities
Good community engagement by CHAs/CHVs
improved community involvement with surveillance activities

12. District Level Facility level Community level
Areas Need Improvement/Constraint
Intensify supervisory visit to all facilities
(Central Monrovia)
Posting of updated line graphs, IDSR indicators and catchment map on the walls of the office
Proper filling in of the weekly IDSR ledger (central Monrovia)
Need to do more follow ups for feedback on lab results
Availability of transport for DSO
DSO was not interviewed due to inaccessibility to his office (Careysburg)
All health facilities visited do not have specimen collection kits
84% (n=19) of the HF do not have functional triage and isolation
83% (n=19) of the health facilities reported of not receiving feed back
57% (n=13) of the health facilities visited do not have IDSR standard case definition and alert epidemic threshold charts updated within the past one month
52% (n=12) of the health facilities do not have IPC supplies
Referral system
Feedback mechanism from health facility to community
CHAs/CHVs regular meetings with community

13. Actions taken District Level Facility level Community level
Case investigation forms of AFP were given to Hydro Merci Clinic
Mentorship on IDSR reportable diseases to SFPs
Health facilities were mentored in proper filling of IDSR weekly ledgers

14. NPHIL to provide districts with IDSR materials (ledger, etc)
District Level
Facility level
Community level
Recommendation
Encourage central Monrovia district DSO to visit health facilities for supervision
NPHIL to provide districts with IDSR materials (ledger, etc)
NPHIL to print and supply Districts with laminated case definitions to be pined on the walls of each health facility
Districts should have updated catchment map for health facilities and population
Provision of transport for central Monrovia DSO
MOH/NPHIL supply specimen collection kits to HFs
CHT and partners to ensure improvement in triage and isolation
Improve feedback at all levels
Train SFPs in IDSR (Hydro Merci, Soniwein, Kingsville, Slemp, Crozieville clinics)
Encourage DSOs to do more visits to investigate zero reports In health facility.
Improve accessibility of data
Develop mechanism to ensure IDSR feedback from health facility to community
CHAs/CHVs schedule regular meetings with community
Improve referral system

15. Data verified by National Supervisors in two Districts
In Central Monrovia there were cases seen but not reported:
4 suspected cases of ABD at Ahmadiyya Clinic
2 suspected cases of measles at SDA Cooper Hospital,
In Careysburg, there were cases seen but not reported:
3 suspected cases of ABD,
3 suspected cases of Human Rabbies
10 suspected cases of Measles(Bensonville Hospital)
2 suspected cases of Measles (Kingsville Clinic)
1 suspected case of Human Rabbies ( White Plains Clinic)

16. Photos from supervision

17. Acknowledgement National Public Health Institute of Liberia
National supervisors
Montserrado County Health Team
SFPs
DSOs
ZSOs
CHAs

18. Thanks