Supportive supervision to health facilities by WHO-EPI/surveillance officers to improve health system support, Ethiopia June –October 2009

Abstract

Introduction: one of the high impact and cost effective intervention to improve child survival is IMNCI. Ethiopia initiated IMNCI in 1997 and the coverage of trained IMNCI health workers is improving gradually and steadily in the country. The WHO employed EPI/ surveillance officers monitoring the performance of EPI and surveillance can integrate monitoring of IMNCI support functions with their routine activity and this is an opportunity to be exploited.
Objective: identify problems that the IMNCI trained health worker face when they go to their work place after training, fix identified problems, communicate challenges to higher bodies and suggest way of improving perforce and supply.
Method : officers trained on health facilities on the health system support on IMNCI and EPI , prepared check list and included it on the already prepared check list for EPI and surveillance , using the check list data was collected using PDA. The data analysed every month for monitoring of performance and evaluated at the end of the 5 month for trend of support and supply availability at the health facilities through time
Results
1086 health facility visits on 433 health center and hospitals were conducted during the five months of the project (June –October 2009). 300 /433(69%) of the health facilities visits have one or more IMNCI trained health workers. The health facility support for EPI is very good but not optimal.
The health system support: availability of vaccines, EPI supplies, management and handling of vaccines and injection safety doesn’t show significant change through time. Other IMNCI system support: like availability of important oral drugs (ORS, cortimoxazole, amoxicillin, Coartum, paracetamol) and ORT corner and Job Aids improve with time from June to October 2009. But IMNCI health workers managing children decreased with time.
Conclusion
The findings related to health system support on IMNCI and EPI are very good. Though there is occasions of stock out, key health facility supports like vaccine and essential drugs are available, though very early WHO supervisors brought only little change on the health system support, as supervisors without decision making power have limited capacity to change the existing situation but provide information to those who need it for action. Supervision with observation of case management by the supervisors is very poor. Training is one component of IMNCI it is not the only component. Unless those trained people are assigned to work in child survival programmes, receive supportive supervision, quickly after training and regularly, and supplied with the necessary logistic support; their training will be in vain