Supervision of Program Staff. A supervision system is in place to assess performance of health personnel, management of the information system, technical quality, equipment, supplies and infrastructure. Two types of supervision are done, one by the MOH District (every 6 months), and another by CSRA (each quarter). The three Area Health Centers supervise Health Posts (Sectors) on a quarterly basis. The Health Sector AN supervises HVs. The supervision system is adequate, however areas that need improvement include: completion of planned supervisory activities; greater emphasis on follow-up of the results; improved feedback to staff; ways to reduce barriers to effective supervision; update and review job descriptions and clarify roles, especially in the case of field supervisors; and improve supervision of health volunteers and link the results to capacity building. Since there are two supervision systems, it would be useful to assess how these could be joined into a single system. Although the supervision system is functioning, it should be streamlined and adopted by the MOH and MHBs in order to merit expansion to other MOH districts and municipalities.
Supervision of Program Staff. Internal institutional supervision improved notably in the second half of the project as supervision systems began to evolve to better suit the needs of the project and the institutions. For example, APROSAR simplified its supervision forms and process to make it less bureaucratic and more supportive of learning in the field. SC/B instituted annual performance reviews of its staff based on stated desired results and reviewed the progress of each trainer during monthly and quarterly quality circle meetings. The MOH benefited from the project vehicle and gasoline to make biannual supervisory visits to all health facilities. Additionally, to supervise field staff, SC/B and APROSAR supervisors reviewed a number of other project forms including workshop reports, “planning together” meeting and summary forms, training participant lists and monthly program reports. However, field staff mentioned that the recommendation from the MTE to provide more direct in-the-field supervision of their work was still lacking; in several cases trainers were never visited (see Capacity Building: Strengthening the PVO for more details). Supervision of Promoters was made more efficient when the project developed a “Guide to monthly evaluation of performance during home visits”. This is a checklist that the supervisor uses to ensure that the Promoter is covering the key topics effectively. XXX directors appreciated the value of the biannual supervisory visits and expressed interest in continuing them after the project ends. Their main concern is budget for gasoline for which they are advocating from the municipalities for next year’s budget.
Supervision of Program Staff. Strengths
Supervision of Program Staff. Supervision of CEPAC staff is conducted both indirectly through frequent staff meetings and review of reports, and field visits for direct supervision. CEPAC staff was comfortable with the level of support they received. A quality checklist for supervisors is used occasionally during supervision visits for evaluating the quality of the work being done by CEPAC Supervisors. The supervision of RPSs and RANs was discussed in previous sections.
Supervision of Program Staff. The MTE recommended that CARE strengthen the supervision system in order to improve the quality and efficiency of Child Survival personnel. CARE designed a plan for the accompaniment of Extensionists to improve the quality of their work. Each Monday the CS team meets to review of the previous week’s activities, analyze difficulties, and make plans for the coming week. CS team members take turns presenting a training topic and share best practices. The Project Manager and CS Specialist plan supervision visits based on needs identified at the weekly meetings, and spontaneous visits are also made. The CS Project Manager and the CS Specialist accompany the MOH in supervision visits to health posts every Wednesday, where the work of CARE Extensionists is also reviewed. CARE Extensionists and MOH personnel were taught how to supervise each community using checklists, observation and interviews with CHWs and mothers. Job descriptions were developed based on the DIP and have been revised periodically to reflect the actual responsibilities of CS Project staff. Performance evaluations were done every 6 months based on the key responsibilities of each staff member. Evaluations are performed as follows: The CS Project Manager is evaluated by the Health Sector Coordinator based in Managua. The CS Manager evaluates the CS Specialist, who in turn evaluates the Extensionists. Evaluation criteria include an assessment of results, personality, behavior, and skills demonstrated during the evaluation period. The supervision system is part of the CARE organizational structure and has been institutionalized for several years now. Although supervision was adequate, field staff feels that the results of the 6-month evaluations did not truly reflect the extent of their work and the sacrifices involved, such as working nights and weekends, and the degree of commitment to the communities. Extensionists indicated that more field visits on behalf of supervisors would have helped them improve their work. The TQM approach has helped the MOH to improve supervision systems. CARE sponsored a workshop which focused on the development of guides and forms to track indicators. The MOH has implemented improvements through weekly supervisory visits to Health Posts. The work of MSH, which was instrumental in developing the quality of care assessments, is helping to refine the supervision process by detecting areas of weakness and the development of action plans.
Supervision of Program Staff. The health supervisor supervised the assistant health supervisors. The assistant project coordinators supervised the health supervisors. The project coordinator supervised the assistant project coordinators. The national health supervisor and the program support manager supervised the project coordinator. The technical backstop from Plan USA provided ongoing technical support throughout the project. The supervisory system was logical given the structure of the project however it was not always responsive to the needs of the project staff. Many of the field staff stated that they were not routinely supervised in the field and that they would have felt much more supported had there been routine supportive supervisory visits for the community level work. While Plan has an institutionalized supervisory system that is fully functional, with checks and balances at all levels, the CS project staff did not feel that they had much recourse to effect change/decentralization of the project management structure. The supervisory system was felt to be inadequate for project management at all levels and for all project partners including the MOH and AAPPEC. • • Plan may wish to consider implementing routine organizational assessments at the program level to ensure that management systems are functional, effective and progressively addressing staff needs. Capacity building for supportive supervision should be built into each new project.
Supervision of Program Staff a. Supervisory system
b. Institutionalization of supervisory system
c. Evidence that the program’s approach to strengthening supervisory systems has been adopted beyond the program
