Currently, supervision of routine immunization is being done by the regional and Woreda (District) health officers and mainly focuses on data collection rather than supporting the health workers skills and knowledge. Supervision varied across different areas in terms of frequency, level of training of supervisors, location of the supervisor, and use of supervisory tools, such as checklists. The report showed that the average number of regional supervision to each district is twice per year. Often, supervisors themselves lack skills, tools, and resources and are over-burdened with other administrative duties on a daily basis and hence the supervision is mostly for evaluation and facility inspection purpose rather than capacity building. In Ethiopia, with the massive investment of the government, the number of health science colleges is increasing exponentially almost one in each of the districts of the country. The health science colleges are academic center where highly skilled and experience physicians and nurses are working and practicing. In this project, we are proposing an innovation to introduce medical and health science colleges to continuously build and monitor the capacity of nearby facilities through continuous supportive supervision and mentorship.
The primary implementation hypothesis is that Introducing Capacity building and Mentorship Program (CBMPI) by medical and health science colleges is feasible, acceptable and effective. We plan to develop appropriate implementation strategy that results in fidelity, adoption and penetration of the health workers in service training program and increases the reach of routine immunization services to every household and test the effectiveness of the program by randomized filed trail with a hybrid design. Data will be collected at baseline and after the intervention by independent data collectors. Data analysis will be using the implementation science framework and effectiveness will be quantitatively evaluated.
This research will be done in selected health facilities in Wogera Woreda. And the study participants are health workers at the selected health facilities, Woreda health office and immunization focal persons from health centers.
The package of activities includes development of supportive supervision and mentorship guidelines, training in continuous supportive supervision and mentoring, monitoring and evaluation of performance. Training supervisors on supportive supervision and mentoring, which will be the focal point of the package of interventions, will be based on updating supervisors on current policies, new immunization practices, techniques, and management skills, training them on how to coach, mentor, effectively communicate, and conduct performance planning. We will also be introduced with guidelines and tools for supervision. Guidelines and tools for supervision include detailed instructions for conducting supervision and mentoring, namely, sequence for conducting supervision meeting, checklist for supervisory visit, self-assessment for providers, work planning action sheets, do’s and don’ts of supervision, supervisor competencies, giving feedback, resolving conflict, and conducting difficult conversations.
In doing this implementation research of introducing the CBMPI, we expect to produce essential data regarding the level and quality of capacity building and mentorship given by staffs of the medical college and its impact on the knowledge and skill of primary health care providers. It also provides data on the reaching every child using the previous approach of supervision and our new additional CBMPI program. With the intervention we would generate data regarding the effectiveness and feasibility of CBMPI implemented by local medical colleges which could be scalable. We expected to look into enablers and barriers for such new program to scale it into large geographic areas in the country. We will also evaluate its impact on the quality of care and skill of health workers by analyzing our pre and post data. We will also document the experience of college staffs when they provide this capacity building and mentorship support to nearby facilities to use it as an input when we design the scale-up guidance document to ministry of health.