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that the ministry should come up with comprehensive schemes offering honoraria for basic health care in villages by any AYUSH doctor. These interventions will strengthen supportive supervision and bring about better health outcomes. Outlining Expectations of the Consultation Dr. Ajay Khera, Deputy Commissioner, Child Health and Immunization, Ministry of Health & Family Welfare, reiterated need for Supportive Supervision. In the context of NRHM, he said substantial investment had been made to improve Maternal and Child Health (MCH) outcomes. Much ground had been covered (India was polio free for over 22 months) but the country was still lagging on its Millennium Development Goals (MDG). Making investments alone would not be enough, unless backed by out-of-thebox thinking. Reports, state reviews and field notes had to be looked into and priority areas identified (equipment and supply, capacity building, programme management. He said supervision was not an altogether new concept, but a crucial missing link, which if addressed correctly, could enhance programme outputs greatly. Concerted effort had to be made to examine the current scenario and see how existing protocols and practices could be revived and strengthened and a blueprint drawn for new interventions. He recalled presence of Lady Health Supervisor and Male Health Worker who existed in the form of Leprosy Officers etc but who had vanished over the last decade. These positions had to be revived. Outlining expectations from the Consultation, he suggested: • y Specifying the kind of human resource element needed to do Supportive Supervision. • y Different models in thematic areas of continuum of care, immunization, family planning (FP), neo natal health, and Reproductive Maternal Newborn and Child Health (RMNCH) A-Plus strategy document. • y Unified team with unified structure needed with manuals, guidelines, HR and capacity building to come up with complete range of RCH activities. • y Institutionalising the system and having an integrated RCH Supportive Supervision model. 18 Consultation on Supportive Supervision to Strengthen Capacity of Frontline Workers and Service Providers
“I have been to the field and found the supervisor in many places saying he has to supervise the ANM but does not know what exactly to supervise. There has to be more clarity around all aspects of Supportive Supervision.” Dr. Khera was hopeful of a roadmap developing at the end of the Consultation, defining essential parameters for the way forward along with costing to enable make projections, that would be sustainable in the long term. The initiative will involve the Health department, along with AYUSH, members of civil society, academia and other partners. SESSION 2: Theoretical Framework for Supportive Supervision Jon E. Rohde, Former Representative of UNICEF in India in his presentation through a skype call from South Africa, outlined a theoretical framework for Supportive Supervision which could be effectively implemented in India. He enumerated that South Africa had undergone similar challenges which were addressed through the initiatives taken when a Supportive Supervision Policy was formulated. He updated the audience on the primary healthcare scenario in South Africa, where district hospitals were smaller than India’s, catering to a population of 0.5 to 1 million. Also, health centres or small 20- bedded hospitals/doctors received many referrals, but had little access to supervision per se. The country had 3500 nurse-run clinics catering to 1 to 10-15,000 population with 2-5 professional nurses/clinic plus aides. Add to this, the district was a major administrative unit, implementing all priority programmes and supply of drugs while overseeing these health centres. Supervisors were drawn from vertical programmes and they visited the centres sporadically, usually for only one programme, be it TB, Family Planning, HIV or EPI. They neither had a structure nor regularity of supervision visits. Also there was no recording or regular follow-up. However, this scenario went through transformative change – for the better - once the country adopted a special policy on Supportive Supervision with detailed guidelines and tools. Seeing the success of the South Africa experience and Jon’s own stint in India, he felt that the model could be adapted to suit India’s own healthcare system. The paras below outline some of his relevant thoughts around this: Formulating a Supervision Policy Advocating for the need to be guided by a Supervision Policy, Jon outlined a practical framework within the Indian context. The Policy could cover appointment of a single generalist supervisor who made regular scheduled visits. To facilitate the process, reliable transport for physical commuting could be provided. The supervisor would have to be up-to-date with information sharing and dissemination to enable him/her be informed about ground realities, government programmes and updates in facilities. Jon was of the view that the supervisor had to be vested with enough authority to mobilise support from higher levels. Having to revert to superiors for every decision on the field would lead to delays. By empowering supervisors to take spot decisions, community would have stronger faith and confidence in the supervisor. He suggested the need to have objective measures of success as key indicators which could further be guided by a comprehensive but flexible Supervisors Manual. Consultation on Supportive Supervision to Strengthen Capacity of Frontline Workers and Service Providers 19
Page 1: Consultation on Supportive Supervis
Page 5 and 6: Acknowledgments UNICEF is grateful
Page 7: RI : Routine Immunization SHRC : Sy
Page 11 and 12: Introduction & Background Defining
Page 13 and 14: In the corporate world, this approa
Page 15 and 16: Proceedings of the Consultation The
Page 17 and 18: Key Features of ICDS ICDS was a wel
Page 19: AWC. This included representation f
Page 23 and 24: These supervisory checklists should
Page 25 and 26: Title of Project: Mitanin Programme
Page 27 and 28: District Coordinators: They are app
Page 29 and 30: Medical Officers. They aimed to inc
Page 31 and 32: Results “If ASHAs could not fill
Page 33 and 34: Learnings • y Functional overlap
Page 35 and 36: Key Incentives to Support Supervisi
Page 37 and 38: Leveraging Support through Communit
Page 39 and 40: contributed to slowing down of the
Page 41 and 42: • y Absence of performance benchm
Page 43 and 44: Discussion • y When the process w
Page 45 and 46: UNICEF operates in Karnataka, West
Page 47 and 48: SESSION 6: Supportive Supervision f
Page 49 and 50: ecords and data collection); assess
Page 51 and 52: There were things that did not impr
Page 53 and 54: • y Joint supervision of Block He
Page 55 and 56: Key challenges in providing support
Page 57 and 58: Annexure 1: Programme Agenda Consul
Page 59 and 60: DAY 2 - 23 nd Nov 2012 Time Topic F
Page 61 and 62: 31. Anagha Khot, Project Management
Page 63 and 64: Importantly, supportive supervision
Page 65: Participants The workshop participa

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