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

The isolated nature of much community health work has resulted in some innovative
approaches to supervision involving peers. A peer support project in Honduras was designed
to encourage visits among nurses who were working alone in remote health posts and
meeting infrequently with their formal supervisors. Rural nurses came together every so often
to review their performance, solve problems, and mutually reinforce their knowledge and
skills in family planning and reproductive health (IntraHealth 2003). The Extending Service
Delivery (ESD) Project has documented the Kenya Private Nurse Midwives Networks as a
promising practice in the delivery of sustainable RH services to underserved communities
(Extended Service Delivery Project 2007). The midwives networks are formally organized
groups of private clinics and nursing homes operated by nurse midwives. They are grouped
together in a given locality for the purposes of facilitating peer support supervision for quality
service provision. Networks have a governance system which are managed by an elected
executive committee and membership to the network is by application. In terms of peer
supervision members consult one another in the management of complicated or challenging
cases. The nurse midwives evaluate one another‘s facilities using set standards and provide
feedback and recommendations for action and follow-up on the implementation of
recommendations. In some networks, non-compliance is penalized. The report suggests that
this initiative has contributed to an increase in the use of RH services.
There is a paucity of research studies that provide insight into cost effective approaches to
supervision that ensure quality care and service delivery. Loevinsohn et al (1995) found in
the Philippines that systematic supervision using clearly defined and quantifiable indicators
can improve service delivery considerably, at modest cost. It is also difficult to gauge the
appropriate level of supervision including the number of required visits to the field. A study
in Piaui State in northern Brazil found that regular quarterly supervision of community based
reproductive health distribution workers was cost effective and did not compromise quality of
the service (Foreit 1984).
Tools for supervision
The following tools and guides outlined in the table below have relevance for the supervision
of individual and teams of staff at community level in MNRH although they were not all
developed specifically for this context.
P a g e | 74