Defining a Performance Improvement
Intervention |
Prepared by
Lydia Chege, KRN/M, KRPHN, DAN, TOT
Rikka Trangsrud, MA
November 1999
As partners under the USAID AIDS, Population and Health Integrated Assistance project, the Kenya Ministry of Health and JHPIEGO have developed an integrated clinical training system for both preservice education and inservice family planning (FP) training that utilizes a network of Decentralized Training Centers. The competency-based approach used in JHPIEGO-supported training improves performance by ensuring that trainees go back to their worksites with the knowledge and skills required to provide FP services. Once back at the workplace, however, participants often face constraints that limit their ability to provide quality services. Factors that can affect the performance of the healthcare provider include: job expectations, performance feedback, supplies and equipment, motivation, possessing the knowledge and skills to provide services, and supervision. For these participants—and their colleagues in clinical settings—to perform well, it is essential that they have regular and supportive personal contact from supervisors.
JHPIEGO proposes to address training-related supervision problems through the development of a supervision learning package. Before embarking on the development of the supervision learning package, JHPIEGO carried out a performance analysis that focused on reproductive health (RH) supervisors. In addition, a stakeholders meeting was held. Supervision topics identified by the supervisors, the health providers they supervise and other stakeholders will help shape the content of the package.
During the course of this performance analysis, it was determined that most health professionals charged with supervision responsibilities in Kenya lack the full range of knowledge and skills to perform their job effectively. Most supervisors are limited in this capacity because they have received neither training in this area nor any support or reference materials on supervision. In conjunction with the development of the supervision learning package, group-based and structured on-the-job training courses will be conducted as an intervention to improve supervisor performance. It is clear from the performance analysis that training is viewed as vital for improved supervisor performance. Supervisors and healthcare providers at all levels of the health system welcome the development of a supervision learning package and training courses. All are agreed, however, that the focus of the learning package should be where supervision has the most direct impact on the quality of services—namely, on-site supervision.
In addition to a lack of knowledge and skills, other causes of poor performance include: insufficient funds for transportation, lack of supervision tools (to be addressed in part through the development of the supervision learning package), infrequent supervision visits and inadequate national supervision guidelines. To maximize the effect of the training interventions, it is essential that these other causes of poor performance be addressed concurrently with the training of supervisors. During the performance analysis, the major responsibilities for a supervisor were identified and individual tasks were outlined that will specifically target these causes of poor performance. These duty categories include: planning, staffing, training, information, logistics, problem-solving, communication and finances. For each duty category, a summary of key issues was formulated and recommendations were made for the development of the supervision learning package.
Supervision is an essential intervention to maintain the performance of the healthcare provider, and improved supervision is unanimously recognized as important for the delivery of quality RH services in Kenya. The supervisor plays a critical role in ensuring that members of the community receive quality reproductive healthcare services. To perform effectively, the supervisor not only needs to acquire the knowledge and skills to do the job, but needs to work in an environment that will allow the supervisor to have a positive effect on the quality of services.
CREDITS
Editors: Kathleen Hines, Jane Zadlo Sudbrink
Copyright © 1999, 2000 by JHPIEGO Corporation. All rights reserved.
JHPIEGO, an affiliate of Johns Hopkins University, is a nonprofit corporation dedicated to improving the health of women and families throughout the world. JHPIEGO works to increase the number of qualified health professionals trained in modern reproductive healthcare, especially family planning.
ACKNOWLEDGEMENTS
We thank the participants of the stakeholders meeting for sharing their ideas and experience in the area of supervision. We also express appreciation to the health professionals interviewed at Kakamega, Siaya and Machakos districts, members of the Ministry of Health (central level), and the various other experts represented from donor agencies, implementing agencies and professional organizations.
We also thank the JHPIEGO/Kenya staff for their support.
At JHPIEGO, we thank Sue Brechin, Rick Sullivan, Nancy Caiola and Pamela Lynam for their input and support.
Financial support was provided by the Office of Population, Center for Population, Health and Nutrition/Global Programs, Field Support and Research Bureau/CMT Division, US Agency for International Development, under the terms of Award No. HRN-A-00-98-00041-00. The opinions expressed in this report are those of JHPIEGO and do not necessarily reflect the views of the US Agency for International Development.