Strengthening Implementation of RMNCH+A Health Strategies in UP

Altering perspective by making supervision supportive and sustainable

Supervision provides critical support for the delivery of public health services. Despite recognition of the importance of supervision in managing human resources for health care, supervision in public health programs has traditionally emphasized 'inspection and control' rather than facilitation. Moreover, many line supervisors often lack the requisite technical and managerial skills or have limited authority to resolve service delivery problems at the local level. Numerous projects and studies have been attempted to inform and improve supervision of primary health care and health programs in developing countries. The WHO delineates three main 'Rs' in setting up an effective supportive supervision system and they are: right skills for supervisors, right supervisory tools and right resources.

Global evidence favors a different approach to making supervision more conducive to improvement in health workers' performance. Supportive supervision therefore expands the scope of supervisory methods by incorporating self-assessment and peer assessment, as well as community inputs. Supportive supervision shifts the locus of supervisory activity from a single official to the broader workforce. A key concept in supportive supervision is that, it is a process implemented by many parties, including officially designated supervisors, informal supervisors, peers, and health providers themselves. Supportive supervision promotes quality outcomes by strengthening communication, focusing on problem-solving, facilitating teamwork, and providing leadership and support to empower health providers to monitor and improve their own performance.

Committed to strengthening its program on RMNCH+A catering to all age groups for improvement in health, life style, morbidity and mortality status of people in the state, the National Health Mission in Uttar Pradesh has recently introduced the concept of supportive supervision, a facilitative approach that promotes mentorship, joint problem-solving and communication between supervisors and supervisees. RMNCH+A concept has been brought up with an idea of life cycle approach for the better health outcomes for community. Complete care during reproductive period, complete antenatal, intra-partum and immediate post partum and post natal care, care of the newborn, promoting small family norms, growth monitoring of infants and development during childhood, improvement in nutritional status, care of the adolescents and post menopausal care are the key areas covered under RMNCH+A strategy. Though there are different programs for implementation of various strategies, concerted efforts are being made for effective outcomes through regular and intensive monitoring & review of the programs which includes identifying gaps, solving problems and improving service delivery, grievance redressal and regular feedback for better implementation and impact.

The onus of strengthening supportive supervision for RMNCH+A in the state is shared by SIFPSA and UPTSU. While the UPTSU focuses on 25 high priority districts (HPDs) SIFPSA has taken the lead in the remaining 50 districts in financial year 2016-17. The supportive supervision is conducted through detailed supervisory tools and checklist which contain minute details of important processes and activities in terms of infrastructure, logistics, human resource and their knowledge and skills.

Since supportive supervision is a comparatively newer area for the government functionaries, SIFPSA is playing an instrumental role in extending comprehensive training and handholding support for enhancing the capacity of field based supervisors to use the checklist for supportive supervision at the state, division, district and block levels. SIFPSA, following a comprehensive, cascade based training approach, successfully trained 223 division and district level officers as master trainers, against 236 proposed, in 5 batches in a 2-day curriculum at the state level. In turn, these master trainers are undertaking district TOTs for block level officers (MoIC, HEO, BCPM and BPM), 4 officers from each block, at the district level from 820 blocks, training 3280 block level officers, who will be extending training to the field level supervisors at the block level. The trained supervisors are expected to handhold the functionaries while visiting the facilities and outreach sessions for different activities. The supervisors are also expected to visit the beneficiaries at home to understand their level of satisfaction regarding health services. The strategy of Supportive Supervision will definitely help the state in improving the quality of service delivery and impact on outcomes.

Facilitating comprehensive review of RMNCH+A program on critical parameters, captured through the supportive supervision, done periodically at district and state level, is an important approach to sustain the gains from supportive supervision. Though District Health Societies under NHM often meet, there remains insufficient focus on RMNCH+A issues due to the overwhelming issues on the agenda in these meetings. Efforts are being made to ensure focus on RMNCH+A issues by introducing quarterly meetings at division level and six monthly state level meetings.

Another important aspect of supportive supervision is encouraging data based decision making. Efforts are being made for systematic collection and collation of digitalized data using supportive supervision formats at various levels facilitating easy analysis and use of the data for review and course correction at all levels. A detailed supportive supervision roaster is being introduced with minimum number of SS visits by district and block level program managers/officers every month. The information captured in the SS formats filled during such visits will be digitalized for easy analysis and use of data for further review and program strengthening.

The comprehensive and sustainable mechanism of Supportive Supervision is sure to go a long way in improving the RMNCH+A health service delivery in Uttar Pradesh.

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