The rise and fall of supervision in a project designed to strengthen supervision of Integrated Management of Childhood Illness in Benin

Rowe, Alexander K.; Onikpo, Faustin; Lama, Marcel; Deming, Michael S.

doi:10.1093/heapol/czp054

Cited by 64 publications

(57 citation statements)

References 16 publications

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“…A randomized control trial from Benin of health workers trained in Integrated Management of Childhood Illness (IMCI) conducted a per-protocol analysis using a pre-/post-design with non-randomized controls due to slow IMCI implementation (54, 69). Three years after implementation, they found a 27% point difference in children receiving recommended care in intervention compared to control areas with routine supervision and a smaller impact on the proportion of IMCI tasks performed (54, 69). In India, the effect of supportive supervision on immunization providers was measured using a before and after design.…”

Section: Resultsmentioning

confidence: 99%

Supervising community health workers in low-income countries – a review of impact and implementation issues

Hill

Dumbaugh

Benton

et al. 2014

Global Health Action

176

185

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BackgroundCommunity health workers (CHWs) are an increasingly important component of health systems and programs. Despite the recognized role of supervision in ensuring CHWs are effective, supervision is often weak and under-supported. Little is known about what constitutes adequate supervision and how different supervision strategies influence performance, motivation, and retention.ObjectiveTo determine the impact of supervision strategies used in low- and middle-income countries and discuss implementation and feasibility issues with a focus on CHWs.DesignA search of peer-reviewed, English language articles evaluating health provider supervision strategies was conducted through November 2013. Included articles evaluated the impact of supervision in low- or middle-income countries using a controlled, pre-/post- or observational design. Implementation and feasibility literature included both peer-reviewed and gray literature.ResultsA total of 22 impact papers were identified. Papers were from a range of low- and middle-income countries addressing the supervision of a variety of health care providers. We classified interventions as testing supervision frequency, the supportive/facilitative supervision package, supervision mode (peer, group, and community), tools (self-assessment and checklists), focus (quality assurance/problem solving), and training. Outcomes included coverage, performance, and perception of quality but were not uniform across studies. Evidence suggests that improving supervision quality has a greater impact than increasing frequency of supervision alone. Supportive supervision packages, community monitoring, and quality improvement/problem-solving approaches show the most promise; however, evaluation of all strategies was weak.ConclusionFew supervision strategies have been rigorously tested and data on CHW supervision is particularly sparse. This review highlights the diversity of supervision approaches that policy makers have to choose from and, while choices should be context specific, our findings suggest that high-quality supervision that focuses on supportive approaches, community monitoring, and/or quality assurance/problem solving may be most effective.

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Section: Resultsmentioning

confidence: 99%

Supervising community health workers in low-income countries – a review of impact and implementation issues

Hill

Dumbaugh

Benton

et al. 2014

Global Health Action

176

185

View full text Add to dashboard Cite

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“…This situation is amply illustrated in a detailed study in Tanzania, which demonstrated a number of problems, including failure to recognise and treat more than one illness in the same child and inadequate referral for severe illness. Although such can often be corrected with adequate supervision, the difficulties of maintaining regular and high quality supervision of service providers are numerous19: poor coordination, lack of skilled managers, competing priorities, lack of financial incentives and logistical difficulties.…”

Section: Imci Successes and Shortcomingsmentioning

confidence: 99%

Integrated management of childhood illness: what have we learned and how can it be improved?

Chopra

Binkin

Mason³

et al. 2012

Arch Dis Child

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Integrated management of childhood illness (IMCI) was developed by the WHO and UNICEF in the mid-1990s as a strategy to reduce under-five mortality. Aimed at countries with mortalities >40/1000 live births, it has been adopted by more than 100 countries. Repeated evaluations have demonstrated that IMCI can improve the quality of clinical care for sick children, but coverage has rarely reached high enough levels to achieve the expected reductions in mortality. In this paper, we discuss the reasons why IMCI has fallen short of its full potential, what has already been done to address some of these issues, and how it could be repositioned to achieve its original goals.

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“…The implementation and scale-up of the programme itself needs managerial supervision in which the roles and responsibilities of supervisors are integrated into the existing system. In lower-income countries, there are many challenges to sustain initial supervisory efforts at all levels of the health system [63].…”

Section: Supportive Supervisionmentioning

confidence: 99%

What is needed for taking emergency obstetric and neonatal programmes to scale?

Bergh

Allanson

Pattinson

2015

Best Practice & Research Clinical Obstetrics & Gynaecol

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Scaling up an emergency obstetric and neonatal care (EmONC) programme entails reaching a larger number of people in a potentially broader geographical area. Multiple strategies requiring simultaneous attention should be deployed. This paper provides a framework for understanding the implementation, scale up and sustainability of such programmes. We reviewed existing literature and drew on our experience in scaling up the Essential Steps in the Management of Obstetric Emergencies (ESMOE) programme in South Africa. We explore the non-linear change process and conditions to be met for taking an existing EmONC programme to scale. Important concepts cutting across all components of a programme are equity, quality and leadership. Conditions to be met include appropriate awareness across the board and a policy environment that leads to: commitment, healthsystems-strengthening actions, allocation of resources (human, financial, capital/material), dissemination and training, supportive supervision, and monitoring and evaluation.

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The rise and fall of supervision in a project designed to strengthen supervision of Integrated Management of Childhood Illness in Benin

Cited by 64 publications

References 16 publications

Supervising community health workers in low-income countries – a review of impact and implementation issues

Supervising community health workers in low-income countries – a review of impact and implementation issues

Integrated management of childhood illness: what have we learned and how can it be improved?

What is needed for taking emergency obstetric and neonatal programmes to scale?

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