New Model of Formative Supervision to Improve Health Outcomes in Ukraine

Author(s) Martin Raab1, Nataliia Riabtseva2
Affiliation(s) 1Health Technology & Telemedicine Unit, Swiss Center for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland, 2Swiss Center for International Health, Swiss Tropical and Public Health Institute, Kyiv, Ukraine.
Country - ies of focus Ukraine
Relevant to the conference tracks Health Systems
Summary Swiss-Ukrainian Mother & Child Health Programmes aim to improve the quality of MCH care in Ukraine. One of the tools is formative supervision: regular structured visits to hospitals. The visits are provided by a trained team according to developed guideline. The following results are observed: improved clinical skills and practices of personnel, more comfortable, friendly & safe conditions for patients, enhanced collaboration with local authorities, etc. The approach is evaluated highly by regional management who provide logistical & financial support for the team.
What challenges does your project address and why is it of importance? The overall objective of the programme is to reform perinatal health services in the Ukraine. Historically, health services staff are hierarchically governed and directed by decrees and narrow guidelines. This human resources management scheme had been impeding continuous education based on evidence based knowledge. At the same time, health care administrations had inadequate access to information about factors leading to positive or negative health services outcomes, while the rates of maternal and infant mortality and morbidity in the country are 2-3 times higher comparing to EU averages.
How have you addressed these challenges? Do you see a solution? The special focus is on antenatal, delivery and postnatal care provision in antenatal clinics and maternity hospitals.
Key interventions are regular, structured visits to health facilities and round table discussions with managerial and service personnel. Supervisors (obstetricians, neonatologists, managerial officers) had been trained and are guided by a manual elaborated by the programme. The supervision guideline is composed of a methodology section and by assessment tools ensuring the information and data capture according to a unified format. This allows the evaluation of field information and thus allows the comparison of data across different services regions and across time. On the basis of the information obtained, gaps analysis is performed and further improvement interventions are planned and implemented.
The formative supervision is based on principles of peer support and the identification and dissemination of good practice encountered in different Ukrainian regions and facilities. Personnel of particular service regions have been assessed by supervision teams from other regions (peer exchange approach). The overall supervision approach developed for Ukraine contains key findings and elements from the WHO and leading international professional associations.
The manual for formative supervision is actively promoted throughout the country and is available under the following address:
http://motherandchild.org.ua/eng/resource/245
How do you know whether you have made a difference? The development of the perinatal health services are monitored by an M&E information system which collects quantitative and qualitative information. Special interviews with personnel in the frame of the M&E scheme provide information on central changes targeted by the programme (e.g. the availability of an adequate building and devices infrastructure according to a set standard or the diagnosis and treatment according to new evidence based guidelines, etc.). Qualitative evaluation revealed an increased staff satisfaction and motivation as a result of the supervision interventions.
Concrete improvement outcomes: successful reorganization of obstetric and neonatal services according to perinatal concepts, renovations to assure thermo stability for women and newborns, improved psycho-social conditions for women and partners, the improvement of clinical skills (e.g., urgent care for woman with pre-eclampsia, correct assessment of newborn’s status, breathing support for newborn), better collaboration with local authorities for financial and policy support and improved contact with mass media to deliver health promotion messages.
Have you or the project mobilized others and if so, who, why and how? The Project mobilized:
1) Regional authorities: via regular meetings and reporting on the results – to assure their ‘political goodwill’ and support for the teams;
2) Regional team: via trainings, provision and training of manual, supervision from national consultants – so they actually perform the visits and ‘keep an eye’ on what’s going on in their regions and what is to be improved.
3) Chief / Head doctors of the partner hospitals: via special training “Why monitoring / supervision is needed? How could it be useful for managers?” – to assure their support and performance of the recommendations which occurs as a result of the visits.
When your donor funding runs out how will your idea continue to live? The regional authorities and teams will continue this activity as the positive outcome is palpable and widely promoted through national events. For this reason, authorities provide additional financial and logistical support (e.g. assuring the transportation for the team to the hospital).

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