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

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eceived from outside the rout<strong>in</strong>e public health system, such as from NGOs or<br />

community groups,<br />

monitored through a system that holds supervisors <strong>and</strong> those above them responsible<br />

<strong>and</strong> accountable (Intra<strong>Health</strong> 2008).<br />

The connection to education <strong>and</strong> tra<strong>in</strong><strong>in</strong>g is also reported by other studies. The comb<strong>in</strong>ation<br />

of on the job tra<strong>in</strong><strong>in</strong>g <strong>and</strong> supervision has been found to improve the confidence <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong><br />

the skills of auxiliary nurse midwives <strong>in</strong> a Prime II project <strong>in</strong> India (Intra<strong>Health</strong> 2001) <strong>and</strong><br />

CHWs engaged <strong>in</strong> a child health project <strong>in</strong> rural Boliva (Charleston 1994). In crisis contexts<br />

harness<strong>in</strong>g opportunities <strong>for</strong> supervisory activities <strong>in</strong>clude staff meet<strong>in</strong>gs, observations <strong>and</strong><br />

field visits, one-on-one meet<strong>in</strong>gs, <strong>and</strong> group supervision (Ehrlich 2004). In Samoa<br />

supervision is promoted by l<strong>in</strong>k<strong>in</strong>g it to accreditation required <strong>for</strong> all PHC health staff, so<br />

there is a strong imperative to be <strong>in</strong>volved <strong>in</strong> <strong>in</strong>-service tra<strong>in</strong><strong>in</strong>g (Burnet Institute 2007). Suh<br />

et al. found <strong>in</strong> Senegal that <strong>for</strong>mative supervision can improve the quality of reproductive<br />

health services, especially <strong>in</strong> areas where there is on-site skill build<strong>in</strong>g <strong>and</strong> refresher tra<strong>in</strong><strong>in</strong>g.<br />

This approach can also mobilize communities to participate <strong>in</strong> improv<strong>in</strong>g service quality.<br />

(2007). Supervisors themselves require tra<strong>in</strong><strong>in</strong>g <strong>in</strong> the provision of appropriate support <strong>and</strong><br />

guidance <strong>and</strong> the management of the per<strong>for</strong>mance system. Were states that CHW<br />

―supervisors should have tra<strong>in</strong><strong>in</strong>g on monitor<strong>in</strong>g processes, relationships, <strong>in</strong>puts (whether<br />

<strong>in</strong><strong>for</strong>mation or materials) as well as outputs <strong>in</strong>dicative of an improv<strong>in</strong>g situation‖ (2008).<br />

Clear criteria have been developed <strong>for</strong> the selection of supervisors of community level staff <strong>in</strong><br />

MNRH. The supervisors of lady health workers <strong>in</strong> Pakistan require at least an <strong>in</strong>termediate<br />

(Class 12) pass, however <strong>in</strong> practice most supervisors are considerably better qualified. More<br />

than half of the supervisors have graduated or completed higher degrees (Ox<strong>for</strong>d Policy<br />

Management 2002).<br />

The need <strong>for</strong> regular, on-go<strong>in</strong>g constructive feedback emerged from a Tanzanian study at<br />

PHC level. One auxiliary respondent stated:<br />

When the re-supervision is done <strong>for</strong> the second time, there should be feedback from the first<br />

supervision so that we can recognize where we went wrong <strong>and</strong> correct our mistakes. There<br />

should also be feedback of the problems identified from the previous supervision. It is not<br />

easy to th<strong>in</strong>k the supervisors are useful when reported problems rema<strong>in</strong> <strong>and</strong> no feedback is<br />

given (Manongi, Marchant et al. 2006)<br />

The recognition of good per<strong>for</strong>mance by supervisors dur<strong>in</strong>g feedback sessions contributes to<br />

health worker morale <strong>and</strong> motivation <strong>and</strong> is there<strong>for</strong>e critical (Willis-Shattuck, Bidwell et al.<br />

2008).<br />

P a g e | 72

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