Supportive supervision training; a video based training approach.

Training curriculum

Training objectives

Overall objective

The training intends to build the capacity of the Medicine Management Supervisors (MMS) to effectively supervise medicines management and effectively motivate and change the behavior of health workers.

Specific objectives

Specifically, the objectives of the training are to provide MMS with skills and attitudes relevant to;

  1. Effectively supervise health care workers to improve medicine management
  2. Creatively develop and implement tailored interventions
  3. Develop realistic performance improvement plans with health facility workers.
  4. Motivate and change the behavior of health workers

Training modules

A total of six (6) modules are covered in this training. These include;

Module one: Introduction to supportive supervision.

This modules aims at improving participants’ practice of planning and conducting an effective supportive supervision. It covers the process and key characteristics of supportive supervision, challenges of supportive supervision, planning for a supervision visit, establishing purpose during supervision visit and sustaining an effective supportive supervision.

Module two: effective communication

The purpose of the module is to improve Medicine Management Supervisor’s (MMS) ability to communicate effectively during supportive supervision. During this module, the MMS are required to demonstrate practical skills of effective communication during conduct of supportive supervision.

Module three: behavior change and motivational interviewing

The purpose of this module is to equip MMS with techniques of enabling behavioral change among health facility staff during support supervision. In this module, the stages of behavior change, strategies of behavior change, sustaining behavior and application of motivational interviewing as a technique of changing behavior were covered.

Module four: Problem identification, analysis and prioritization

This module empowers participants’ with skills in the process of problem identification, analysis and prioritization so that participants are able to identify root causes of problems and prioritize the problems that they are able to address during supportive supervision.

Module five: Intervention selection

This module focuses on building participants’ skills to support a health facility team in identifying effective solutions to identified problem (s) from SPARS data collection tool. It focuses on determination, selection and implementation of effective solutions to identified problem (s).

Module six: Feedback and improvement targets

This module aims at reinforcing the MMS’ skills in organizing an effective feedback session during supportive supervision practice. In addition the module is meant to enable MMS to effectively work with the Health Facility staff to develop realistic improvement targets necessary to address performance improvement gaps, and be able to document these appropriately in a SPARS Supervision Book.

 

Training method

The facilitation methods include;

Videos and Role plays

 

Use of video to provide feedback

Increasingly videos have become very useful as tools to enhance training. They can cover topics in a simple and concise way with “need to-know” information. The team produced video on scenarios of MMS interaction with health workers at the health units. This is used to stimulate participants to notice where things were right/wrong and appreciate how it could be done better, particularly to demonstrate motivational interviewing so that participants could appreciate the principles and techniques of strengthening and enlisting motivation and behavioral change.

 

Use of video as vignettes

Here brief vignettes to “bring alive” support supervision principles and skills required for effective supportive supervision are used.  These ready-made videos (5/8 minutes long) introduce and demonstrate concepts and skills of problem solving, behavioral change, motivational interviewing and effective communication skills. These are followed by discussions.

 

Role plays:

MMS play parts in role plays depicting interactions between health worker (s) and MMS on the topics previously considered problematic during assessment.

The MMS perform role plays on establishing purpose during supportive supervision, effective communication, motivational interviewing, problem identification, analysis and prioritization and provision of constructive feedback. Videos of participants’ role plays are taken and used to give them feedback on areas they have done well and areas that require improvement. MMS create simple posters and make presentations (including role-plays) illustrating the problem, sharing their personal connection to it, listing potential solutions, and choosing which one they think is best and why. The use of video helps MMS to learn through questioning and criticizing their own behavior at the health units so as to appreciate the different styles (negative/positive) and hence could learn together and provide the solution together.

Group work and practical exercises/activities

The participants are divided into groups and given activities to discuss in their different groups and present to the plenary. Then, discussions follow with pertinent questions that would lead MMS through a process of thinking, sharing in small groups and writing and drawing using this questioning sequence. The participants take lead in the discussions and most of the learning centered on the participants. This is mainly problem based learning.

Limited theory and Participatory approach

Most of the answers, comments and views come from the participants. The facilitators only guide the discussions, reinforced some of the issues raised by the participants and summarize the modules with key points at the end of the discussions.

Training assessment

Pre and Post evaluations

A pre-and post-tests are conducted at the beginning and end of the course respectively. The tests consists of six (7) multiple choice questions which assess areas of problem solving, communication skills and setting of improvement targets and three (3) true/false questions which assess mainly the strategies to change behavior of health facility staff.

Final exam/assessment

The exam consists of three questions, short answer and multiple choice questions. The examination assess participants’ understanding of establishing purpose during supervision visit, active listening and rapport building, planning for supervision, effective feedback, techniques of motivational interviewing, strategies of behavior change and indicators of behavior change.

Developers of training curriculum

The training curriculum and materials were developed by a team from Makerere University College of Health Sciences, Department of pharmacy with support from team from Harvard Medical School and Harvard Pilgrim Health Care Institute, Division of Health Policy and Insurance Research (HPI) Department of Population Medicine

Makerere University team

  1. Prof. Richard Odoi Adome, rodoiadome@gmail.com rodoi@gmail.com
  2. Hussein Oria, husmoyi@yahoo.co.uk
  3. Kalidi Rajab, rkalidi@chs.mak.ac.ug rkalidi@gmail.com
  4. Munanura Edson, wizedson@gmail.com
  5. Balikuna Sulah, bsulah@yahoo.com
  6. Aguma Bush Herbert, herbagum@gmail.com  

Harvard team

  1. Dennis Ross-Degnan, dennis_ross-degnan@hms.harvard.edu
  2. Anita Katharina Wagner, awagner@hms.harvard.edu

Funder

The project is funded by USAID through MSH-UHSC Project.

Training materials

Each module has trainers guide, participants guide and PowerPoint presentation. In addition, modules on communication skills, behaviour change and problem identification, analysis and prioritization have recorded videos.

For details on the training modules, please contact Prof. Richard Odoi, rodoiadome@gmail.com , rodoi@chs.mak.ac.ug or Hussein Oria, husmoyi@yahoo.co.uk