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Management & Supervision
Meeting of MAQ Sub-committee on Management and Supervision
The MAQ sub-committee for Management and Supervision met at the offices of University Research Corporation from 10:00 until 3:00 on November 1. Participants included Wayne Stinson (MSH); Thada Bornstein, Diana Silimperi, Dawn Crosby, Edie Dupont and Linda Kean (URC); Jim Shelton (USAID); Chris Davis and Kama Garrison (JHPIEGO); Heidi Reynolds (FHI); Maj-Britt Dohlie (EngenderHealth/INTRAH), and Indira Narayana (BASICS).
There were four principal topics of discussion:
- PowerPoint module, prepared for the March 2002 MAQ Exchange in Nigeria
- Supervision "white paper," under preparation by consultant Linda Keane
- Proposed FHI/JHPIEGO research on internal supervision in Kenya
- Future topics for the M&S sub-committee.
Lunch was served, and a good time was had by all.
PowerPoint
The Nigeria MAQ Exchange will occur in Ibadan in March and involve 45 participants. M&S has been asked to prepare a PowerPoint presentation/discussion guide for use in a one hour session at Ibadan as well as for the MAQ website. The M&S co-chairs have been developing this presentation through a series of small meetings over the past 6 months, and have distributed it for wide review.
Wayne Stinson used the module, as it would be used in Nigeria, to stimulate audience participation. Showing themselves to be more knowledgeable and informed than expected, participants repeatedly answered questions before the presenter had the opportunity to ask them. There were few concerns about the material presented (however, see next paragraph), but participants did recommend that fewer slides be used and that text be reduced to a bare minimum.
The main technical concern about the presentation was that it focused too much on external supervision, rather than on supervision by the in-charge within the service delivery facility. Kama Garrison presented evidence from Kenya showing that high performing facilities, in contrast with weak sites, were ones in which internal supervision was strong. External supervision, by contrast, had little or no impact on performance. The group agreed that local responsibility and "ownership of problems," whether conveyed through some hierarchical process (e.g., internal supervision), or more "horizontal" peer review, self-assessment, or quality assurance, was indeed essential; the only disagreement concerned the role of external supervision in nurturing responsibility. We finally agreed that the "white paper," if not the PowerPoint presentation, should focus on desired outcomes at each level in the system rather than promote any single process for achieving it. Then, future inquiries can focus on identifying what is in place and what lacking, and the role of supervision in filling the gaps.
Jim Shelton invited the co-chairs to make two presentations of the module on November 29: to the Office of Population in the morning, and the MAQ Steering Committee in the afternoon.
Note: Linda Kean, Lynn Bakamjian and Wayne Stinson met in New York on November 19 to again review the PowerPoint presentation and white paper, in light of the November 1 meeting. We agreed on significant revisions in the PowerPoint, but these will not be ready until just before the 29th. We had hoped to attach them to these minutes, but will instead for ward them separately in early December.
Supervision white paper
Consultant Linda Kean has collected considerable material for this paper, but the current draft is not ready for broad review. There appear to be numerous innovations to report, but some are "strategic" and of wide applicability whereas others are tactical and may or may not work in any given setting. The paper also needs to be guided by the outcome focus discussed above.
Supervision research
Kama Garrison and Heidi Reynolds briefly described research being planned concerning internal supervision in Kenya. JHPIEGO will train in-charges in techniques for internal supervision, and FHI will study the impact of this training on quality of care. Since the study protocol was still in development, Kama and Heidi sought feedback on the following ideas: to train on-site, in-charge supervisors who supervise all reproductive health activities; to measure worker satisfaction; and to measure different client outcome measures. The main concerns articulated were that training of in-charges might not itself strengthen internal supervision and that measuring client outcomes is difficult. The group brainstormed quality of care measures that cross all areas of reproductive health. To better measure client satisfaction, it was suggested to follow-up with clients some time after their visit to measure whether they sought additional treatment, if they went to a different facility, and whether they were satisfied with the initial treatment.
Future directions for M&S
Focus on building CA consensus around a conceptual framework for supervision.
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