Since 1995, JHPIEGO has been working under the USAID AIDS, Population and Health Integrated Assistance project with the Kenya Division of Primary Health Care (DPHC), the Nursing Council of Kenya (NCK) and the Division of Nursing (DON) to pioneer the development of an integrated clinical training system for preservice education and inservice family planning (FP) training that utilizes a network of Decentralized Training Centers (DTCs). The competency-based approach used in JHPIEGO-supported training improves performance by ensuring that participants go back to their worksites with the knowledge and skills required to provide FP services. Once back at the workplace, however, participants often cannot perform their tasks in the manner required for the delivery of quality services.

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. As stated in the Family Planning Manager’s Handbook (Wolff, Suttenfield and Binzen 1991), the purpose of supervision is to guide, support and assist staff to improve performance in carrying out their assigned tasks. In Kenya, a common understanding and definition of the word supervision does not exist, much less a common approach applied to supervision activities. Few, if any supervisors have received training in supervision, and they lack standardized tools to assist them in their supervision activities. The supervision system needs to be strengthened if improved performance of service providers is to be maximized. USAID has endorsed this strategy in its recommendation to support skills training for supervisors.

A number of reference manuals developed by JHPIEGO and other organizations address supervision. These documents, however, are seldom used and have not had a visible effect on service delivery in Kenya. The challenge facing the Ministry of Health (MOH), JHPIEGO and other partners is how to operationalize the key features of these manuals in Kenya. Recognizing that training (e.g., group-based courses, structured on-the-job training [OJT]) and non-training (e.g., funding, transportation) interventions will be required to strengthen the supervision system, JHPIEGO proposes to address training-related supervision problems through the development of a supervision learning package. Learning through this package will be problem-based and may occur in a group-based course or in a self-paced, OJT course. Supervision training is designed to support the supervision system and will translate into improved provider performance and the delivery of quality services.

Before embarking on the development of the supervision learning package, JHPIEGO conducted a needs assessment (performance analysis) that focused on the roles and responsibilities of reproductive health (RH) supervisors. During this assessment, supervision topics were identified by the supervisors, the health providers they supervise and other stakeholders and will be used to shape the content of the learning package. Key stakeholders will be made aware of causes of poor performance that need to be addressed through non-training interventions. Decisions will need to be made regarding the strategy for designing and implementing these interventions to maximize their impact.

Assessment Objectives

The performance analysis was designed to guide the development of the supervision learning package by providing a better understanding of the challenges RH supervisors encounter. The specific objectives were:

• To provide a basic description of the existing RH supervision system including a list of supervision tools and definitions of supervision

• To identify essential knowledge, skills and tools for RH supervision that will form the basis of the supervision learning package

Methodology

The performance analysis was carried out from August through September 1999 and consisted of a desk review, a supervisor questionnaire, key informant interviews and a key informant questionnaire.

Desk Review: Existing materials that address supervision (e.g., Family Planning Manager’s Handbook [Management Sciences for Health], Facilitative Supervision [AVSC]) were reviewed and sections that deal with clinical supervision were identified.

In addition, existing tools or instruments for RH supervision were collected during the assessment. Although the assessment did not include a technical review of the tools, they are listed as resources for the supervision learning package. They will be used before and during the supervision learning package workshop to ensure that participants do not, in effect, duplicate existing resources.

Supervisor Questionnaire: RH supervisors were asked to indicate the topics they felt should be included in a supervisor’s training course. A convenience sample of supervisors from 3 districts (Kakamega, Siaya and Machakos) was used. It included members of the District Health Management Team (DHMT) (e.g., the Medical Officer of Health), the District Public Health Nurse (DPHN) and the Matron In-Charge of maternal and child health (MCH) at the district hospital, as well as representatives from the DTC, where available. This questionnaire was self-administered with a total sample size of 17. (See Appendix for the results of the questionnaire.)

Key Informant Interviews: Interviews with a number of key informants were carried out using a semi-structured questionnaire. The interviewees were asked to describe the existing supervision system and identify several of the system’s key strengths and weaknesses. A number of the key informants were also asked to complete the Supervisor Questionnaire to solicit their ideas regarding topics to include in the learning package. Key informants included relevant members of the public health sector (e.g., DHMT, facility in-charges, service providers) as well as donors and USAID cooperating agencies that have an interest in training and supervision for RH.

Key Informant Questionnaire: A targeted questionnaire was used to elicit very specific information from several key informants about supervision training priorities. Questions directed to this group were very focused and were intended to encourage support for the recommendations to come from the assessment.

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