1. Making supervision supportive and sustainable
Enwereji, E.E.
College of medicine
Abia State University
Uturu, Abia State, Nigeria

2.   Introduction
The benefit of supervision in managing human resources in Primary Health Care is often not achieved in developing countries including Nigeria.
Supervision service has emphasized administrative issues such as
inspection of facilities(hours of operation, maintenance ),

3. review of records and communication of information from higher to lower levels without regard to :
use of resources(financial, material, human),
supply of logistics( quantity, and qaulity)

4. Supervisors usually blame individuals rather than look for root causes in deficient processes.
For this reason, supervision systems have not sufficiently ‘empowered staff to engage in problem solving
or to take initiative in improving service quality and access to clients.

5. The paper aims to provide framework for feasible supportive supervision in Primary Health Care practice
to identify key lessons and gaps learnt in supervision.
The paper identifies supervision approaches that are sustainable.

6. Materials and method:
The study observed supervision styles in primary health care centres
noted feasible strategies to enhance and sustain supervision.
Data were generated by review of relevant literature and work experiences.
study emphasized joint problem-solving,

7. encouraged monitoring and mentoring through two-way communication (supervisor and supervisee)
organized a two-day on the job training for the supervisees.
The training emphasized self-assessment, peer assessment, community input as vital components of result-oriented, supportive supervision

8. focus of supervision from inspecting facilities and gathering service statistics to concentrating on the performance of clinical tasks and resolution of problems. Increased feedback from supervisors to health workers was initiated. Analysis of the findings was done qualitatively.

9. Result
There were:
systemic problems that plague effective supervision in primary health care centres.
-lack of planning and /or training of staff
-failure to define priorities in services provided
-shortage of resources (man, materials and finance)

10. -episodic visits of supervisors
-non-adherence to work ethics
-diversion of resources
-lack of financial stability
-lack of accountability
-low morale among health workers due to punitive measures

11. Observations: The study noted that: facilitating on the job learning promoted quality health care , high standard teamwork increased health workers’ problem –solving techniques

12. supervisors showed up at the health facility, as ongoing performance monitoring and quality improvement
routine part of health workers’ jobs took place on the job

13. both formally and informally one-on-one meetings and peer discussions in meetings outside the work place enabled health workers to review their performances against standards.
Based on the findings, the followings are suggested as mechanisms for supportive supervision

14. Suggested mechanism for supportive supervision
self and peer supervision
 External supervision internal supervision

15. interventions suggested for implementation of supportive supervision
expected results
Lessons to be learned
Construction of checklists and guidelines for quality performance
Regular feedback from health workers , adherence to standard treatment schedules, for example there will be improvement in history taking, disease classification, treatment and counseling
Joint identification of opportunities for staff improvement, better communication and provision of information to patients,
Training of supervisors ( workshops and seminars)
Better time management, problem –solving technical/clinical updates, increased capacity building
Better problem identification, increased coaching and mentoring
Data collection and analysis,
Improved documentation, clearer standards of care
Clearer feedback on strengthens and weaknesses,

16. Pictures of areas noted as faulty supervision: