Emphasizing Supportive Supervision in Health
Sector Reform
Using the Performance Improvement approach to determine the root causes of gaps in prenatal care and family planning services in the Olancho region, PRIME II assisted the Ministry of Health (MOH) in implementing and evaluating a supportive supervision intervention for primary providers. PRIME trained more than 120 providers and their supervisors in peer support and using a Quality Measurement Tool to assess their delivery of services. The program encouraged visits among auxiliary nurses working alone in remote health posts and meeting infrequently with their formal supervisors.

Key Results: A regional census of health facilities and service delivery needs in Olancho conducted by PRIME and the MOH in 2000 as a baseline study for the supervision intervention served as a pilot that the MOH expanded nationwide as part of its plan to license health facilities. The MOH used PRIME’s instruments to standardize facility inventories and train facility inspectors in all regions of the country. The Quality Measurement Tool was implemented in work sites by 122 providers and supervisors, and supervisors began holding regular monthly meetings to focus on strengthening factors that affect provider performance. Although qualitative data indicated improvements in the quality of supervision, quantitative data generally showed no change in provider skills and practices or client utilization of services deriving from either supervision methodology (traditional external supervision or peer support). The PRIME team believes the primary reason for this was the project’s short intervention period, compounded by delays including strikes, vaccination campaigns and elections.