1. Facilitative Supervision for Improving the Quality of FP/RH Services
Anna Kaniauskene, MS, Betty Farrell, CNM, MPH, Erin Mielke, MPH, Henry Kakande, MD, Nizamul Haque, MD, Mizanur Rahman, MD, Mahboob-E Alam
NOTE: I’ve been asked to keep the presentation to 15 minutes rather than 20 to allow for more Q&A time.
APHA, Washington D.C., 2007
Facilitative Supervision for Improving Quality of FP/RH

2. Session Objectives Define facilitative supervision
List the fundamentals of care
Describe ACQUIRE’s approach to strengthening supervision systems
Describe the benefits of facilitative supervision

3. Facilitative Supervision (FS)
Emphasizes mentoring, joint problem-solving, constructive feedback and two-way communication between supervisors and supervisees

4. Fundamentals of Care CHOICE
Ensuring informed and voluntary decision making
SAFETY
Assuring safety for clinical techniques and procedures
QUALITY
Mechanism for ongoing quality assurance and management

5. Strengthening Supervision Systems: ACQUIRE’s Approach
Developed, tested, and adapted curriculum to different services and settings (FP/RH, Integrated FP/HIV services)
Incorporated FS in pre-service training curricula
Conducted leadership workshops
Training for all levels of supervisors (off- & on-site, medical & non-medical)
There is widespread agreement among those in the international health community that supervision is a critical part of human resource management for the delivery basic health services. Supervision is one of the key approaches to improving the quality of health care and the performance of health care providers.
NEED to describe what leadership workshops means vs. FS training
Facilitative Supervision for Improving Quality of FP/RH

6. Strengthening Supervision Systems: ACQUIRE’s Approach (2)
Build local training capacity in FS
Develop tools & establish mechanisms for monitoring & evaluation (M&E)
Introduce related tools & approaches to improve quality of care and provider performance
Advocate for supportive policy changes
There is widespread agreement among those in the international health community that supervision is a critical part of human resource management for the delivery basic health services. Supervision is one of the key approaches to improving the quality of health care and the performance of health care providers.
Facilitative Supervision for Improving Quality of FP/RH

7. FS Curriculum (Selected Topics)
Quality of care
Data for decision-making
Leadership and communication skills
Links between supervision and other support systems
Practice supervisory visits
There is widespread agreement among those in the international health community that supervision is a critical part of human resource management for the delivery basic health services. Supervision is one of the key approaches to improving the quality of health care and the performance of health care providers.
Facilitative Supervision for Improving Quality of FP/RH

8. Results and Benefits of FS
Azerbaijan
Bolivia
Bangladesh
Cameroon
Uganda
The facilitative supervisor realizes that staff cannot provide quality services unless their needs are met. A facilitative supervisor works to ensure that staff work within an environment that enables them to perform well. They help make sure staff have clear job expectations, receive feedback on their performance, are motivated, have sufficient equipment and supplies, and have necessary knowledge and skills.
Facilitative Supervision for Improving Quality of FP/RH

9. Teambuilding in Bolivia

10. Action Plans in Azerbaijan
Facilitative Supervision for Improving Quality of FP/RH

11. Supervisors’ New Attitudes and Practices
Inform staff about upcoming supervisory visits
Provide constructive feedback
Participate in COPE® exercises & support staff in their QI efforts
Conduct regular staff meetings to discuss issues for improvement
Consider staff as internal customers
Cameroon: after two COPE exercises at a FP center in Douala, the Manager said: “I was the biggest problem for my staff. I did not understand what do they want and why they want to change something. Now I know what QI means and what can we do together. I support my staff and help them to find additional resources to improve services”
Facilitative Supervision for Improving Quality of FP/RH

12. Supervisors’ New Attitudes and Practices (2)
At the end of the supervisory visit, meet with the staff to discuss findings and to help develop an action plan
“My attitude towards service providers has changed. It has enabled me to focus on systems….I have become creative in using available resources to ensure clients are served…. It has helped me to be able to give constructive feedback without hurting anybody…”
Manager, TASO Mbale Center, Uganda
Cameroon: after two COPE exercises at a FP center in Douala, the Manager said: “I was the biggest problem for my staff. I did not understand what do they want and why they want to change something. Now I know what QI means and what can we do together. I support my staff and help them to find additional resources to improve services”
Facilitative Supervision for Improving Quality of FP/RH

13. Manager, Douala FP Center, Cameroon
“I was the biggest problem to my staff. Now I am different. I support my staff in their QI efforts”
Manager, Douala FP Center, Cameroon
Facilitative Supervision for Improving Quality of FP/RH

14. Changes in Organization of Work
Off-site supervisors conduct regular supervisory visits
On-site supervisors apply medical monitoring checklists to assess quality of services
Supervisors provide coaching
Supervisors organized visiting surgeons to provide weekly access to sterilization services
Discuss and analyze service statistics with the staff
The facilitative supervisor realizes that staff cannot provide quality services unless their needs are met. A facilitative supervisor works to ensure that staff work within an environment that enables them to perform well. They help make sure staff have clear job expectations, receive feedback on their performance, are motivated, have sufficient equipment and supplies, and have necessary knowledge and skills.
Facilitative Supervision for Improving Quality of FP/RH

15. Uganda – Plans from Medical Monitoring

16. Changes in Organization of Work (2)
Redistributed contraceptive supplies based on local demand
Conduct educational sessions for clients in 3 languages (vs. just one language)
Rearranged facility to ensure privacy and confidentiality during counseling
Use medical monitoring assessment to identify staff’s learning needs
The facilitative supervisor realizes that staff cannot provide quality services unless their needs are met. A facilitative supervisor works to ensure that staff work within an environment that enables them to perform well. They help make sure staff have clear job expectations, receive feedback on their performance, are motivated, have sufficient equipment and supplies, and have necessary knowledge and skills.
Facilitative Supervision for Improving Quality of FP/RH

17. Facilitated Use of QI and PI tools and Approaches
Medical monitoring is being conducted
Supervisors support COPE® activities and participate in exercises
QI activities institutionalized
Community COPE® will be introduced this year
FS skills trainings for national level MOH staff
The facilitative supervisor realizes that staff cannot provide quality services unless their needs are met. A facilitative supervisor works to ensure that staff work within an environment that enables them to perform well. They help make sure staff have clear job expectations, receive feedback on their performance, are motivated, have sufficient equipment and supplies, and have necessary knowledge and skills.
Facilitative Supervision for Improving Quality of FP/RH

18. Facilitated Policy Changes
Supervision Guidelines being updated/developed
National Strategy for FP/RH developed
Infection Prevention Guidelines adapted and institutionalized by NGOs
National Strategy for Quality under development
The facilitative supervisor realizes that staff cannot provide quality services unless their needs are met. A facilitative supervisor works to ensure that staff work within an environment that enables them to perform well. They help make sure staff have clear job expectations, receive feedback on their performance, are motivated, have sufficient equipment and supplies, and have necessary knowledge and skills.
Facilitative Supervision for Improving Quality of FP/RH

19. Improved & Integrated Health Systems
Human Resources – job descriptions revised
Training - providers are linked with training resources based on needs
Finance – advocacy among communities for funding of health services
The facilitative supervisor realizes that staff cannot provide quality services unless their needs are met. A facilitative supervisor works to ensure that staff work within an environment that enables them to perform well. They help make sure staff have clear job expectations, receive feedback on their performance, are motivated, have sufficient equipment and supplies, and have necessary knowledge and skills.
Facilitative Supervision for Improving Quality of FP/RH

20. Improved & Integrated Health Systems (2)
Logistics – contraceptive supplies ensured; improved inventory systems
M&E – medical monitoring checklists adapted and used, findings analyzed and action plans developed, service statistics forms adapted/updated
The facilitative supervisor realizes that staff cannot provide quality services unless their needs are met. A facilitative supervisor works to ensure that staff work within an environment that enables them to perform well. They help make sure staff have clear job expectations, receive feedback on their performance, are motivated, have sufficient equipment and supplies, and have necessary knowledge and skills.
Facilitative Supervision for Improving Quality of FP/RH

21. Analyzing Areas for Improvement in Bangladesh

22. Benefits to Supervisors
Feel more welcomed by staff because they help staff to solve their problems, rather than criticize them for their faults
They have the satisfaction of working as a team member, watching staff learn and grow and seeing quality improve
Facilitative supervisors gain a reputation as leaders and enablers
Expected results of implementing facilitative approach to supervision:
Service delivery sites provide access to quality services that clients want and need
Service providers and institutions continuously seek ways to improve the quality of their services
Service providers and institutions are responsive to client rights and needs
Service providers and supervisors continuously improving their own performance, have opportunities for increased job satisfaction, and see their work as part of a larger picture, Supervisors provide support and encouragement to providers in continuously improving the quality of services
Supervisors are able to help sites translate institutional goals into services, help to bring additional resources needed for quality service provision, able to influence policies
Supervisors are able to provide management with information about the quality of services being provided and help identify constraints to improving quality
There is a reduction in the cost of poor quality
“Facilitative Supervision: A Vital Link in Quality Reproductive Health Service Delivery”, AVSC Working Paper #10, 1996
Facilitative Supervision for Improving Quality of FP/RH

23. Benefits to Staff & Clients
Staff feel empowered to solve routine and simple problems
“Supervision is more humanized” – provider in Bolivia
“The doctor was very good. She said: ‘I will take care of everything. You are all my patients and I have a lot of love for my patients’” – client in Bolivia
Tell that facilitative approach to supervision may seem to them like a lot more work than when traditional approach to supervision is used. While this approach requires an initial investment of extra time, after starting using FS approach, they will find that it benefit them and may actually free up time to devote to other, more appropriate responsibilities.
Facilitative Supervision for Improving Quality of FP/RH