Facilitative Supervision: A Vital Link in Quality Reproductive Health Service Delivery
Figures 1-6


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Figure 1:
AVSC Quality-Improvement Approaches and Tools

Issues Approaches Tools
Problem identification and solution * COPE (including self-assessment, client interviews, client-flow analysis, and action plan development)

* Facilitative supervision

* Medical monitoring
* COPE: Client-Oriented, Provider-Efficient Services

* Supervisor's program evaluation tools (draft)

* AVSC Medical Monitoring Handbook


Access to services; linkages between services * Inreach (including orientations, updates, and establishing referral systems)

* COPE
* Orientation handbook (draft)

* COPE: Client-Oriented, Provider-Efficient Services

* IEC materials


Technical competence; quality assurance * Whole-site training (including orientations, updates, and skills training)

* Medical monitoring
* Orientation handbook (draft)

* Guidelines (female sterilization, vasectomy, postpartum IUD, informed consent, etc.)

* Curricula for clinical skills training (minilaparotomy, no-scalpel vasectomy, etc.)

* Family Planning Counseling: A Curriculum Prototype

* On-the-job training certification guides (draft)


Involvement of all levels of staff; ownership; meeting provider needs * Facilitative supervision

* COPE

* Site assessment and evaluation

* Medical monitoring

* Provider interviews

* Whole-site training
* COPE: Client-Oriented, Provider-Efficient Services

* Supervisor's program evaluation tools (draft)

* Orientation handbook (draft)

* Guidelines

* Curricula for clinical skills training

* AVSC Medical Monitoring Handbook

* Cost-Analysis Methodology for Clinic-Based Family Planning Methods

* MIS review (from Management Sciences for Health's Family Planning Manager)


Note: With the exception of the MIS review and national standards and guidelines, all handbooks, questionnaires, curricula, and other materials listed here were developed by AVSC International. Materials described as "draft" may not be available for distribution.




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Figure 2:
Inspection: Process and Results

SUPERVISION BY INSPECTION

The process
  • Establish targets
  • Wait to see what happens
  • Deal with what goes wrong

The results
  • Staff feel threatened
  • Failures and problems reach clients
  • Costs increase, other problems arise



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Figure 3:
Conventional versus Facilitative Approach to Management

MANAGING QUALITY SERVICES

Conventional approach
  • External review
  • Inspection of end result
  • Heavy investment in monitoring

Facilitative approach
  • Involves all staff at all stages
  • Gives staff tools for on-going assessment
  • Is an ongoing, continuous process



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Figure 5:
Rights of the Client, Needs of the Provider

QUALITY SERVICES

Clients Have the Right To:
  • Information
  • Access
  • Choice
  • Safety
  • Privacy and confidentiality
  • Dignity, opinion, and comfort
  • Continuity

Providers Have a Need For:
  • Good supplies and site infrastructure
  • Good management and supervision
  • Information, training, and development

Source: This figure is adapted from the wall chart "The Rights of the Client," produced by the International Planned Parenthood Federation, and from Huezo, C. and Diaz, S., 1993, Quality of care in family planning: Clients' rights and providers' needs, Advances in Contraception 9:129-139.




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Figure 6:
Three-Stage Introduction of Facilitative Supervision

STAGE I
Focus: Orientation
  • Introducing the concept of facilitating continuous quality improvement
  • Becoming aware of the importance of having communications skills
  • Understanding linkage between supervision and training
  • Discussing the roles and needs of supervisors
  • Introducing the AVSC quality-improvement tools (such as COPE and inreach)

STAGE II
Focus: Assessing the Quality-Improvement Process
  • Setting objectives using tools introduced in Stage I
  • Developing and prioritizing training plans
  • Understanding the mentoring process

STAGE III
Focus: Developing Complex Supervisory Skills
  • Designing long-term training plans for the site
  • Using measurable indicators for evaluation
  • Introducing key concepts of training-of-trainers design