Download the complete report - Unicef

In the State immunisation team, state EPI officer will be in charge and will be supported
by State Immunisation Manager, Coordinator and State Immunisation Coordinator and
Distirct Support team, depending on number of districts the state has. Also, for vaccine
and logistics, there will be dedicated people supported by supportive staff. Similar
model will be followed at district level on smaller scale where District Immunization
Officer will be supported by a team to run the programme and at block level the Block
Medical Officer will be duly supported. In the next phase, there will be more clarity on
how to implement the SS model.
Programmes need to be designed keeping local context in mind. MCHIP had brought
out a small model which was a short-term duration process for fault-finding. If provided
quantitative status, it would involve state, district, block and field staff. The model did
not involve anyone from outside the district. Involvement was only at the inter-block
level. Issues were identified and discussed within 3-4 days and all discussions were in
quantitative manner. It was like a regular appraisal programme in the district and could
apply to any programme.
Implementation
The programme followed the RED strategy which had two components. RAPID helped
undertake regular views of the RI programme in the areas of programme management;
cold chain, vaccine and logistics management; injection safety and immunization
waste disposal; records, reports and use of data for action. By improving quality of
immunization programme, it hoped to improve vaccination coverage.
The project helped undertake periodic assessment of all facilities and select session
sites, ensuring on-site correction and providing on-site capacity building through
demonstrations. It also used data for action and follow-up. The programme was
conducted on a 6-monthly basis and could be further customised. It was completed
in 3-4 days, providing feedback to all cadres of health functionaries; informing gaps;
and facilitating corrective actions at each level. It helped scale-up the RAPID process
and was led by results. The Government of Jharkhand scaled up RAPID in all 24
districts through NRHM funds (2011-12 & 2012-13). In UP, it was rolled-out in 32 poor
performing districts (out of 75) along with UNICEF. Government of Haryana is scaling
up RAPID in all districts. It was also piloted by State Governments of MP and Odisha.
Key elements of RAPID included the 3 ‘R’s, namely right supervisor, right tools and right
resources. The 3 ‘W’s were addressing issues related to where, when and what. Team
approach aimed for capacity building of health system staff; which was further facilitated
by external supervisors with full participation of the District and Block Medical Officers.
Results of 5 rounds of RAPID conducted in focus districts of Jharkhand in all the cold
chain points saw facilities graduating from 36% poor, 55% average and only 9% good
(during round 1) to 0% poor, 25% average and 75% good (at fifth round).For effective
RAPID round it was important to inform facilities about supervisory visits in advance;
follow-up on recommendations made during previous visits; collect latest materials,
and supplies for the health centre; spend sufficient time; schedule return visit before
leaving the health centre; and ensure each visit was useful to health centre staff.
44
Consultation on Supportive Supervision to Strengthen
Capacity of Frontline Workers and Service Providers