Supportive supervision of routine immunization in Rajnandgaon district of Chhattisgarh

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Abstract

Background:

Immunization coverage in Chhattisgarh has never been abysmal but the improvement is rather insignificant over the years. Some more interventions are essential to strengthen different aspects of immunization services such as micro-planning, cold-chain and logistics management, monitoring/supportive supervision, and community mobilization. The present study was considered as a part of ongoing UNICEF funded Project on Supportive Supervision of Routine Immunization in Rajnandgaon district undertaken by the Department of Community Medicine, Government Medical College, and Rajnandgaon CG with the objectives to observe key quality parameters at Ice Lined Refrigerator (ILR) points and to assess knowledge and practice of Vaccine Cold Chain Handler (VCCH).

Methods:

A facility-based, cross-sectional study (repeat survey) was conducted from May 2017 to June 2018 in the Rajnandgaon district of Chhattisgarh. First phase of the study was conducted from May 2017 to November 2017 and repeat survey was conducted from December 2017 to June 2018. Structured questionnaires as a part of standard tool prescribed by Government of India was used for the collection of required data.

Results:

The cumulative score status out of all the 50 centres in Rajnandgaon district showed improvement in 35 centres. The score of important components such as vaccine management, equipment maintenance, temperature monitoring, and monitoring and supervision information improved, but that of background information and human resource component decreased.

Conclusion:

Supportive supervision strategy can be more beneficial in improving the cold chain maintenance process provided that components such as logistic, infrastructure, and manpower are in place to enhance service delivery. Supportive supervision is a continuous process, so regular follow-up and monitoring visits are essential to achieve the targets.

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Most cited references 17

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Support and performance improvement for primary health care workers in low- and middle-income countries: a scoping review of intervention design and methods

Ashwin Vasan, David C. Mabey, Simran Chaudhri … (2016)

Abstract Primary health care workers (HCWs) in low- and middle-income settings (LMIC) often work in challenging conditions in remote, rural areas, in isolation from the rest of the health system and particularly specialist care. Much attention has been given to implementation of interventions to support quality and performance improvement for workers in such settings. However, little is known about the design of such initiatives and which approaches predominate, let alone those that are most effective. We aimed for a broad understanding of what distinguishes different approaches to primary HCW support and performance improvement and to clarify the existing evidence as well as gaps in evidence in order to inform decision-making and design of programs intended to support and improve the performance of health workers in these settings. We systematically searched the literature for articles addressing this topic, and undertook a comparative review to document the principal approaches to performance and quality improvement for primary HCWs in LMIC settings. We identified 40 eligible papers reporting on interventions that we categorized into five different approaches: (1) supervision and supportive supervision; (2) mentoring; (3) tools and aids; (4) quality improvement methods, and (5) coaching. The variety of study designs and quality/performance indicators precluded a formal quantitative data synthesis. The most extensive literature was on supervision, but there was little clarity on what defines the most effective approach to the supervision activities themselves, let alone the design and implementation of supervision programs. The mentoring literature was limited, and largely focused on clinical skills building and educational strategies. Further research on how best to incorporate mentorship into pre-service clinical training, while maintaining its function within the routine health system, is needed. There is insufficient evidence to draw conclusions about coaching in this setting, however a review of the corporate and the business school literature is warranted to identify transferrable approaches. A substantial literature exists on tools, but significant variation in approaches makes comparison challenging. We found examples of effective individual projects and designs in specific settings, but there was a lack of comparative research on tools across approaches or across settings, and no systematic analysis within specific approaches to provide evidence with clear generalizability. Future research should prioritize comparative intervention trials to establish clear global standards for performance and quality improvement initiatives. Such standards will be critical to creating and sustaining a well-functioning health workforce and for global initiatives such as universal health coverage.

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Expanding immunization coverage in rural India: a review of evidence for the role of community health workers.

R. Patel, M Nowalk (2010)

Poor routine immunization coverage in India has led to a large burden of vaccine-preventable diseases borne by children under 5 years of age. Despite efforts to strengthen infrastructure and service delivery in the past decade, immunization coverage rates have reached a plateau. To meet the formidable needs of India's growing population and address the shortcomings of health services for rural populations, the country is now turning toward a new national community health worker (CHW) plan. This article reviews the effectiveness of CHWs in expanding immunization coverage in developing countries and examines the potential contribution of CHWs toward strengthening immunization services in rural India. While the limited number and quality of available studies make it difficult to directly compare CHW interventions to other strategies for improving immunization coverage, it is clear that CHWs make diverse contributions toward strengthening immunization programs. Incorporation of evidence-based strategies for CHW selection, retention, and training is critical for success of India's immunization program. In addition, there is growing need to develop efficient mechanisms for monitoring children's vaccination status to generate actionable feedback and identify cost-effective strategies.

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The role of supportive supervision on immunization program outcome - a randomized field trial from Georgia

Mamuka Djibuti, George Gotsadze, Akaki Zoidze … (2009)

Background One of the most common barriers to improving immunization coverage rates is human resources and its management. In the Republic of Georgia, a country where widespread health care reforms have taken place over the last decade, an intervention was recently implemented to strengthen performance of immunization programs. A range of measures were taken to ensure that immunization managers carry out their activities effectively through direct, personal contact on a regular basis to guide, support and assist designated health care facility staff to become more competent in their immunization work. The aim of this study was to document the effects of "supportive" supervision on the performance of the immunization program at the district(s) level in Georgia. Methods A pre-post experimental research design is used for the quantitative evaluation. Data come from baseline and follow-up surveys of health care providers and immunization managers in 15 intervention and 15 control districts. These data were supplemented by focus group discussions amongst Centre of Public Health and health facility staff. Results The results of the study suggest that the intervention package resulted in a number of expected improvements. Among immunization managers, the intervention independently contributed to improved knowledge of supportive supervision, and helped remove self-perceived barriers to supportive supervision such as availability of resources to supervisors, lack of a clear format for providing supportive supervision, and lack of recognition among providers of the importance of supportive supervision. The intervention independently contributed to relative improvements in district-level service delivery outcomes such as vaccine wastage factors and the DPT-3 immunization coverage rate. The clear positive improvement in all service delivery outcomes across both the intervention and control districts can be attributed to an overall improvement in the Georgian population's access to health care. Conclusion Provider-based interventions such as supportive supervision can have independent positive effects on immunization program indicators. Thus, it is recommended to implement supportive supervision within the framework of national immunization programs in Georgia and other countries in transition with similar institutional arrangements for health services organization. Abstract in Russian See the full article online for a translation of this abstract in Russian.

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Author and article information

Journal

Journal ID (nlm-ta): J Family Med Prim Care

Journal ID (iso-abbrev): J Family Med Prim Care

Journal ID (publisher-id): JFMPC

Title: Journal of Family Medicine and Primary Care

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2249-4863

ISSN (Electronic): 2278-7135

Publication date (Print): February 2019

Volume: 8

Issue: 2

Pages: 385-389

Affiliations

[1 ] Department of Community Medicine, Government Medical College, Rajnandgaon, Chhattisgarh, India

Author notes

Address for correspondence: Dr. Kiran G. Makade, Professor, Department of Community Medicine, Government Medical College, Rajnandgaon, Chhattisgarh, India. E-mail: kirangmak@ 123456gmail.com

Article

Publisher ID: JFMPC-8-385

DOI: 10.4103/jfmpc.jfmpc_429_18

PMC ID: 6436264

SO-VID: 749a4fbd-7148-4e4a-bcaf-ad9f5c4c8d4f

License:

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Supportive supervision of routine immunization in Rajnandgaon district of Chhattisgarh

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Abstract

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European Journal of Microbiology and Immunology

Most cited references 17

Support and performance improvement for primary health care workers in low- and middle-income countries: a scoping review of intervention design and methods

Expanding immunization coverage in rural India: a review of evidence for the role of community health workers.

The role of supportive supervision on immunization program outcome - a randomized field trial from Georgia

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