What Makes Supervision Work: Reflections from Kenya Experiences in QI Cycle 1

REACHOUT Consortium MeetingDhaka, Bangladesh

12th June 2016

Presentation Overview

1. Background2. REACHOUT in Kenya3. Reflections: What makes supervision work in Kenya

Kenya…who we are..

Government Structure

National Government

8 Provinces

Districts

Divisions

National Government

47 County Governments

Sub-County Level

Community Level

• Policy Formulation

• Standards and Guidelines

• Capacity Building

• Technical Support

• Human Resource

Management

• Procurement and Supplies

• Planning and financing

AFTE

R DE

VOLU

TIO

N

BEFO

RE D

EVO

LUTI

ON

REACHOUT in Kenya

Context analysis

Quality improvement

Quality embedded

•Inadequate supervision – frequency and approach

•Worked with four community sites in two counties

•Trained community level supervisors in supportive

supervision

•Provided supervision tools

•Mentored supervisors on supervision

Key Findings

SUPERVISORS CHANGED APPROACH

“…when you are supervising you are like a mentor. You also mentor those you are supervising...”

TRAINING WAS HELPFUL “That training was good because it

taught us supervision. This is something we didn’t understand

before…”

SUPERVISORS WERE MORE SUPPORTIVE

“…..so she encouraged me to continue doing the things that I had done the right way and also corrected me..”

SUPERVISION TOOLS WERE USEFUL “The supervision tool is systematic it has a way of reminding me what to take when am in the process of…”

Lesson 1: Leadership

• Leadership is required to drive supervision – Supervision is not just a job– Supervision has to be part of QI agenda

• Leadership needed in Human Resource Management– Staff motivation– Staff development Community leaders engaging with

community about their health priorities

Lesson 2: Investment

• Evidence shows supervision improves health outcomes

• Supervision works when there is investment in: – Supervision tools– Logistical support– Building capacity of supervisors

Supervisors’ require logistical support

Lesson 3: Engage all Health System Actors

• Engage senior managers in the health systems for:– Accountability– Work planning– Resource allocation

• Identify champions at all levels– National – County – Community

Prof. Miriam WereCommunity Health Service Goodwill Ambassador, Kenya

Next steps (QI cycle 2)

• Embed Quality Improvement (QI) approaches in Health system• Activities:

1. Building QI capacity of community level supervisors2. Formation of QI teams at community and sub-County level3. Measure embedment, supervision, data quality

In summary…

• Community Health systems are complex and in flux

• For supportive supervision to work, its important to:– Provide leadership in the health system– Invest in Capacity and operations support– Engage stakeholders at all levels

Dhonno baadAsante sana

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