Service Delivery Supervision Strategy

To meet the objectives of the project, in particular those in quality of care, SFPS has given priority in Year Three to setting up a supervision system for SFPS service delivery sites. One reason that supervision has become a priority is that the lack of efficient and permanent supervision during the first two years of the project prevented the project from addressing site-level issues and constraints. As long as these issues are not brought to the attention of the project managers, the project managers are unable to work with service providers to identify appropriate solutions. By setting up a supervision system with a tested supervisory approach, the project hopes to improve performance of the SFPS service delivery sites.

The objectives of the SFPS supervision system are as follows:

• To strengthen the capacity and efficiency of SFPS Country Offices to monitor the program through dynamic technical supervision teams in each target country.

• To improve performance at the sites through an improvement in working conditions and in skills of service providers.

• To develop the capacity of health teams to identify management problems in the sites and to find adequate solutions.

• To ensure quick collection and processing of statistical data on-site, and ensure use of this data for decision-making purposes.

What supervision approach will be used?

To ensure efficiency of the SFPS

supervision system, it is designed to be facilitative, decentralized and participatory. Supervision will be conducted at the sites on a team basis and will use a formative/developmental approach so that staff at sites are encouraged and supported to correct weaknesses noted at the site level. To avoid any duplication of effort or conflict with the traditional supervision systems already in operating in the target countries, the SFPS supervisory approach will attempt to integrate members of existing supervision teams. This will also necessitate the use of tools that already exists in conjunction with supervision tools being developed for SFPS.

Who will conduct the supervision?

There will be four levels of supervision, hence four different types of supervisors. These are :

• At the international level, SFPS will use experienced supervisors (consultants or SFPS staff). These supervisors will supplement national supervisors, if necessary, on the basis of resources available .

• At the "SFPS" national level, the project will use freelance national consultants to conduct supervision and monitoring. The number of these consultants used in each target country will vary between one and three, depending on the number of sites in the country and on financial resources available. These supervisors, along with local staff, will make up the core of the technical supervision team in each country.

• At the "Partners" national level, SFPS partners will provide one to three supervisors in each country to work with SFPS supervisors. The partner supervisors will be selected on the basis of their responsibilities and skills within the structure which appoints them.

• At the "service delivery" national level, depending on the local situations, team members will work in close collaboration with local supervisors or with supervision teams operational in the sites.

Each supervision team will be made up of two to five persons competent and experienced in the area of reproductive health (medical doctors, midwives, medical auxiliaries, nurses or any other social worker with experience). Supervisors on the team will be selected based on their dynamism and motivation to meet project objectives. The team will be responsible for supporting SFPS Resident Advisors in monitoring and supervising project activities. On average, one supervisor will cover 12 to 15 sites.

The supervision team in each country will undergo training to standardize their skills in facilitatory supervision, as well as to orient them to the project objectives. They will also participate in the adaptation and development of supervision tools specific to their countries. Initially, site supervision will be conducted in pairs or by the whole team. Eventually, when all of the team members understand and follow the same approach, supervisors will conduct visits on a one-man team basis.

How frequently will supervision visits be conducted?

Supervisors will conduct visits on a monthly basis for the first six months, then on a bi-monthly basis. Nonetheless, sites with particular issues or difficulties may benefit from more frequent visits to boost their performance.

What will supervisors look for?

Supervision visits will investigate the following elements/issues at the sites: infrastructure and equipment, service delivery activities, client records and files, management and data support, client flow, reference documents and their use, infection prevention measures, and specific SFPS elements of quality of care. Supervision visits will take one to three days, depending on the needs and immediate corrective measures to be taken (on-the-job training, information gathering, etc.), with initial visits tending to take longer than subsequent ones.

What tools will supervisors use?

The SFPS supervision system will make use of several tools to help identify weaknesses in the organization of services, service provision, access to contraceptives and service delivery supplies, infection prevention practices, client-provider interaction, and collection and use of statistical data. In each country, teams will use a supervision record file form which includes guides to assess competency and performance of service providers, to analyze and assess working conditions, and to assess the quality of care.

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