Human Resources for Health in Maternal, Neonatal and - HRH ...

as a guide to mentoring, delegation, encouraging teamwork and leadership. Documentation
detailing experiences using this tool were not found in this study.
Supervision
The role of a supervisor is to motivate staff to achieve goals and support them through a
process of change in order to realize quality care and services and meet client‘s needs. This
supportive approach to supervision is ―a process that promotes quality at all levels of the
health system by strengthening relationships within the system, focusing on the identification
and resolution of problems, and helping to optimize the allocation of resources promoting
high standards, teamwork, and better two-way communication‖ (Marquez and Kean 2002).
There are a number of general reviews of supervision in International health contexts but few
of them focus at community level or include research studies indicating a need for more
rigorous studies in this area. A comprehensive overview by Marquez at al reviews the
function, process, barriers and approaches to improving supervision (2002). Another review
highlights methods of supportive supervision at PHC level and the need for flexible
supervisory materials that address the participatory nature of PHC (Rohdes 2006).
PHC and services in MNRH are generally managed from the district level and supervision
may involve visits to PHC facilities and community sites. Were (2008) describes the
optimum structure for CHWs supervision in the public system involving mid level cadres
who are attached to the first referral facility in order to ensure CHW access to support and
guidance and links for referral. On site supervision is not always possible at community level
however for those attached to community health facilities this may be required depending on
the services offered. An evaluation of reproductive health services in Kenya found that
supervision was considered to be adequate if there was an on-site supervisor actively
overseeing family planning and reproductive health service delivery and the site had received
an external supervision visit in the last year (Rawlins 2003).
The supervisory structure in the non state sector may be very different. A Pathfinder report
describes an NGO approach in Kenya where an NGO employs a small cadre of CHW
supervisors, most of whom started as CHWs themselves. Each supervisor oversees from 10 to
20 CHWs, accompanying them on home visits or in groups during public events and
facilitating monthly oversight meetings, in which progress is reviewed, reports are compiled,
plans are developed and refresher training is provided as needed. The Project Coordinator or
Director for each NGO often joins the supervision meetings and visits, in addition to
conducting periodic, direct supervision of CHWs. Additionally, the Coordinator/ Director
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