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Supervision, Training, and Quality Assurance

Supervision, Training, and Quality Assurance

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Supervision, Training, and Quality Assurance

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  1. Supervision, Training, and Quality Assurance Lonny Born TA Hserv/Epi 544 W’ 07 University of Washington February 1, 2007

  2. Part I – Supervision

  3. Supervision (1)Supervising MCH WorkersRole Play Nurse: Nursing student: Supervisor: Provincial Direction: Patients:

  4. Organization Flowchart

  5. Supervision (2)Failure of Supervision Systems? Personnel shortages 2. Transport 3. Qualified and/or inappropriate supervisors 4. Power, status, and control Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981

  6. Supervision (3)What is the role of the supervisor? In community health? Setting the conditions of employment? Amount of personal training? Qualified? Maintaining and improving structure and capacity Fund raising and budgeting? Training and support Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981

  7. Supervision (4)Four Principal Tasks Ranking the most important elements for a given program 1. Legitimation 2. Protecting role integrity 3. Motivation 4. Education and guidance 5. Technical assistance 6. Linkage 7. Monitoring and control 8. Evaluation Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981

  8. Supervision (5)Four Principal Tasks II. Identify available mechanisms which might be used for supervision and specify to what extent each might contribute to the objectives 1. Intermediate level personnel 2. Community supervision 3. Communication media Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981

  9. Supervision (6)Four Principal Tasks III. Mobilize training and related resources for the mechanisms used in supervision. 1. Who to plan with? Provide frontline workers with a continuous support system - Formalized? - Accountability - Include policy-making evident at all levels Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981

  10. Supervision (7)What can be done to overcome obstacles? Change from the idea of “supervision” with emphasis on one-directional monitoring to the idea of a two-way exchange involving support and evaluation of the system. Reevaluate the mechanisms for supervision and support. Plan and train using different mechanisms for different supervision tasks according to the context. Establish health system commitment to supporting those in the field Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981

  11. Part II – Training

  12. Evaluating Training ProgramsTraining for effective performance

  13. Tools and Techniques (1)Decision Tree

  14. Tools and Techniques (2) Training Needs Assessment • Analysis of job descriptions and work plans • Skills needed? • Fit with organizational objectives? • Task Analysis • List skills needed • Group those with similar training needs • Transform into training objectives • On-the-job supervision, observations and interviews • Watch for gaps in understanding, attitude, performance • Client surveys • Exit interviews from point of service • Focus group surveys

  15. Preparing a training program • Develop a general plan for training with overall course objectives • Write objectives for each training session • Determine the training approach, methods, and techniques • Develop training session plans • Prepare evaluation plan and forms • Determine resource requirements and budget • Prepare a summary of the training program plan/proposal

  16. General Plan for Training (1) Overview

  17. General Plan for Training (2):Overall objectives

  18. General Plan for Training (3): Individual Session objectives

  19. Training Methodology and TechniquesTraining Plan: Individual Session

  20. Final Evaluation Plan and Forms

  21. The MCH Training Budget • Facilitator(s) – training program design and training implementation (salaries/honoraria; per diems; travel) • Materials, equipment, facilities (purchase and shipping of materials; duplication; supplies; refreshments; equipment rental; facility rental) • Participants (travel to and from training; per diems) • Secretarial, clerical, logistics (typing; reproduction of materials during training; communication; transport of supplies and workshop participants • Post-training activities (reproducing reports; follow-up visits and evaluation)

  22. Training Summary • Write a report summarizing the training. Be sure to include all stakeholders, participants and clients. • Follow-up the summary report.

  23. ANOTHER APPROACH:Integrated Management of Childhood Illnesses (IMCI) • integrated approach • aims to reduce death, illness and disability, and to promote improved growth and development • includes both preventive and curative elements • implemented by families, communities and health facilities Adapted from previous guest speakers Donna Denno and Sally Stansfield

  24. Pneumonia Diarrhea Measles Malaria Malnutrition Sepsis Meningitis Dehydration Anemia Ear infection HIV/AIDS Wheezing Sore throat IMCI Addresses Most Causes of Death Adapted from previous guest speakers Donna Denno and Sally Stansfield

  25. Three Components of IMCI • Improves health worker skills • Improves health systems • Improves family and community practices Adapted from previous guest speakers Donna Denno and Sally Stansfield

  26. Improves Family and Community Practices • Community participation • Preventive care • Immunization • Breast-feeding and other nutritional counseling • Home care of sick children • Recognition of severe illness • Care-seeking behavior Adapted from previous guest speakers Donna Denno and Sally Stansfield

  27. Improves Health Worker Skills • Targets first level health facilities • Addresses causes of at least 70% of deaths • Case management guidelines • Training • Supervision • Monitoring Adapted from previous guest speakers Donna Denno and Sally Stansfield

  28. Improves Health Systems • Planning and Management • Availability of drugs and supplies • Organization of work • Monitoring and supervision • Referral pathways and systems • Health information systems Adapted from previous guest speakers Donna Denno and Sally Stansfield

  29. IMCI Multicountry Evaluation • Training health workersimproved performance • Difficult to maintain & expand existing IMCI sites • District and national health systems lack sufficient management structure, funding, coordination, supervision, and manpower • Low utilization rates of health servicesIMCI cannot impact child mortality. Adapted from previous guest speakers Donna Denno and Sally Stansfield

  30. Clinical Assessment and treatment by health workers Knowledge, Beliefs and skills caretakers Capacity, structure and functions of health system Improving Health Worker Skills, Community Care, and Health Systems Adapted from previous guest speakers Donna Denno and Sally Stansfield

  31. Part III – Quality Assurance (QA)

  32. Four Principles of QA • Focus on client perspective and needs • View work in terms of systems and processes • Make data-based decisions • Teamwork USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

  33. What is Quality? • Technical performance • Access to services • Effectiveness of care • Efficiency of service delivery • Interpersonal relations • Continuity of services • Safety • Physical infrastructure and comfort • Choice USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

  34. 3 components of QA (1) Defining Quality (QD) • Minimum • Ideal • Optimal and achievable STANDARDS? USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

  35. 3 components of QA (2) Measuring Quality (QM) • Baseline • Monitoring • Evaluation • Programmatic evaluationvariation USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

  36. 3 components of QA (3) Improving Quality (QI) • Identify  • Analyze  • Develop  • Test and implement USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

  37. USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

  38. View work in terms of systems and processes USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

  39. Maturity QA is formally, philosophically integrated into the structure and function of the organization or health system Consolidation Expansion Experimental Awareness Pre-existing - Organization has no formal or deliberate QA Implementing QA USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005

  40. Happy Supervising and Training