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In a country as geographically and culturally diverse as India, frontline workers act as
important and sometimes last mile delivery points of services to people. The auxiliary
nurse midwife (ANM), accredited social health activist (ASHA) and anganwadi worker
(AWW) along with a range of community volunteers, reach out directly to families as
part of government implementation mechanisms providing advice, referrals, linkages,
diagnosis and information.
Various monitoring and evaluation tools have been formulated under the National
Rural Health Mission and other government programmes to strengthen hands of these
community volunteers. The need for Supportive Supervision has been felt in recent
times, given the increasing workload and expectations which this cadre is faced with.
As a process, it promotes quality at all levels of the health system by strengthening
relationships within the system, focusing on identification and resolution of problems,
optimising allocation of resources, promoting high standards, team work and better twoway
communication (Marquez and Kean 2002). While many approaches have been
proposed to improve quality of health services (quality assurance, continuous quality
improvement, client-centered services, district team problem-solving, fully functional
service delivery points), the Supportive Supervision approach improves services by
focusing on meeting staff needs for management support, logistics, and training and
continuing education.
Goals of Supportive Supervision
• y To promote efficient, effective, and equitable health care.
• y To work with health staff to establish goals, monitor performance, identify and
correct problems, and proactively improve quality of service.
• y To build confidence, motivation, negotiation and leadership skills and
competencies of workers.
• y To recognise good practices and help health workers maintain high performance
levels.
Examples of Supportive Supervision
An analysis of Supportive Supervision and mentoring in Tanzania’s National AIDS
Control Programme in 2009, showed positive results such as timely reporting, improved
supplies management, improved patient management and adherence to national
guidelines. Healthcare professionals interviewed for the study, specifically perceived it
to be helpful in building capacity, motivating and improving confidence.
The Global Alliance for Vaccines and Immunization (GAVI) partners identified it as a
high priority and critical gap in immunization. It has also been used in the education
sector, where it was embedded in implementation plans of both government and NGO
programmes. Government structures such as Block Resource Centres and Cluster
Resource Centres provide ongoing supervision and support to teachers. A combination
of pre and in-service training, classroom observations, monthly workshops and
teachers’ forums provide ample space for a supportive structure of supervision.
3
MSH Occasional Paper No. 2, 2006
4
A Manual for Comprehensive Supportive Supervision and Mentoring on HIV and AIDS Health Services, 2009
10
Consultation on Supportive Supervision to Strengthen
Capacity of Frontline Workers and Service Providers