Supportive Supervision (SS) mechanisms are regarded as an effective measure to improve and strengthen health systems. Outcomes of multiple public health intervention measures usually get compromised due to inadequate and poorly structured SS mechanisms. Jharkhand has taken many steps to institutionalize and implement various SS mechanisms aimed at Health System Strengthening (HSS) and improving coverage and quality of service delivery of specific programme interventions. This included formation of State Review Mission (SRM) Teams, District Monitoring Teams and designing and implementation of RAPID model of SS for Routine Immunization.
To strengthen RMNCH+A outcomes the State has institutionalized the recently launched Government of India's SS checklist, which provides an opportunity to harmonize and consolidate SS visits by looking at the critical impact indicators. All the State and District officials use the SS checklist during their field visits.
To further streamline the use and implementation of the checklist the last SRM round conducted in November - December2014 utilized the checklist to assess the availability of logistics and practices at the health facilities. Prior to the initiation of the round an orientation on the SS checklist was conducted for all SRM team members and data was analyzed using an excel based tool developed by the technical team of the USAID/Scale up RMNCH+A Project The tool helps analyze data district and facility wise thereby providing an opportunity to the State officials and district officials to identify and address the gaps existing at the health facilities.
The SRM round covered 26 Community Health Centers across 8 districts and accounted for nearly one third of the total facilities in the visited districts. Significant observations during the round were presented in form of information using the data collected through SS checklists. For example, BP was recorded in only 50% of the facilities while Partographs were used to monitor progress of labour in 73% CHCs. Injection VitK1 was available in 58%, bag and mask in 62% and clean linens/towel for receiving newborns in 54% facilities visited.
Technical support provided by the USAID/Scale Up RMNCH+A Project (State RMNCH+A Unit).
Similar mechanisms can be adopted during future review & monitoring visits. State is in the process of institutionalizing an external RMNCH+A Monitoring and Evaluation system for the High Priority Districts of the State through Medical Colleges on similar lines.
A limiting factor in earlier SS models in the State had been the lack of a comprehensive data management and analysis system. The data analysis tool developed for the current checklist helps identify critical parameters and components which need to be addressed at the State, district and facility levels. This mechanism should therefore be able to develop an integrated action plan for strengthening service delivery mechanisms in Jharkhand.
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