What is the “state of the art?”

About effectiveness of supervision in stable contexts… •  Tools need to be simple •  Competence, accuracy, supervision of SUPERVISORS

is key •  Direct observation is a promising practice

•  Planned but poorly executed supervision is worse than

none at all

November 23, 2015

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What “difficult contexts/”

•  Program goal – Increase women’s access to family planning and post-abortion care in difficult contexts

•  Program content– training and supervision to front-line primary care providers in family planning and post-abortion care initiative (also demands-side, supply chain, etc)

•  Program context: Chad, eastern DRC, Mali, Pakistan, Djibouti; affected by natural disaster, active conflict, fragile state

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What does success look like?

•  # family planning users •  # post-abortion care cases

•  % FP clients choosing long-acting family planning •  %PAC clients accepting PAC •  Infection prevention score from supervision

checklist

•  NOTE – respectful care and clinical skills should be included – in a perfect world November 23, 2015

3

What were the key elements of effective supervision?

•  Community involvement in quality improvement

•  Data-driven front-line management

•  Regular supervisory visits

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Regular visits

November 23, 2015

5

2011 2014 Going forward

Mon

ths

= Facilities

Data-Driven front line management

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Community engagement, as essential supervision step

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Quality Improvement – Method Mix

November 23, 2015

8

-40%

-20%

0%

20%

40%

60%

80%

100%

11Q3 11Q4 12Q1 12Q2 12Q3 12Q4 13Q1 13Q2 13Q3 13Q4 14Q1 14Q2 14Q3 14Q4 15Q1 15Q2

% Long Acting and Permanent Methods of All New Users

CHD

DJI

DRC.

MAL

PAK

Quality Improvement – FP among PAC

November 23, 2015

9

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

11Q3 11Q4 12Q1 12Q2 12Q3 12Q4 13Q1 13Q2 13Q3 13Q4 14Q1 14Q2 14Q3 14Q4 15Q1 15Q2

% Post-Abortion Care Clients who Accepted Family Planning

CHD.

DJI.

DRC..

MAL.

PAK.

Quality Improvement – Infection Prevention scores

November 23, 2015

10

5.00

5.50

6.00

6.50

7.00

7.50

8.00

8.50

9.00

9.50

10.00

2014_02

2014_03

2014_04

2014_05

2014_06

2014_07

2014_08

2014_09

2014_10

2014_11

2014_12

Chad

DRC

The numbers to prove it

•  128,518 new FP users PAC services to 7,341 women, between July 2011 and December 2014

•  68% FP users chose LAPM (Up from virtually 0%)

•  59% PAC clients accepted FP

•  Infection prevention scores (on a 1 – 10 scale) improved from below 8 to above 9.5

•  Plus, data quality errors were virtually eliminated, and stock-outs reduced significantly in all countries.

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In summary •  Regularly (not necessarily frequency) matters

•  Include communities for mutual accountability

•  Data motivates - Positive competition among stakeholders fuels emulation of effective techniques

•  Supervision is a building block across health areas

•  Supervision is “high investment” but front-line health workers without it wastes potential

•  KISS

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Thank you

November 23, 2015

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