On a busy OPD day, a surprise visit by the supervisor was least expected. Pushing away all the regular responsibilities of the day, the Primary Health Centre Medical Officer [PHC MO], for the next few hours had to devote all his time and attention answering queries of the supervisor. What followed next was an interrogation process, grilling the medical officer on issues of his absenteeism, corruption, complaints against his attitude, incompetence in his skills and knowledge and inefficiency in maintaining registers and submitting reports. The medical officer was never given an opportunity to explain his actions, clarify his doubts or vocalise his problems. At the end of the visit, the patients were furious for the long wait, the supervisor had got an opportunity to vent out his frustration and the PHC MO was depressed, angry and highly de motivated.
A leaf out of a PHC MO diary, this episode is not a standalone case. Often, across all levels within our health system, supervision is perceived to be identical to inspection, policing and fault finding. The infrequent, unplanned supervisory visits often do not lend ears to the practical problems, do not respect regular duties of the staff at the health facility, do not provide feedback, do not believe in joint action plan and completely follows authoritative style of leadership.
The key challenge we encountered during field visits in Tumkur was to find ways to transform this practice of traditional supervision into adopting and advocating supportive supervision by all health care providers in the District.
To address this challenge, a contact session on supportive supervision was planned. The idea was to introduce Swasthya Karnataka [SK] District Health management [DHM] participants to the concept of supportive supervision with a final objective of ensuring its implementation at the grass root level. The most significant component to achieve this objective was to bring in the attitude change amidst this diverse group of clinicians, program managers, administrators and medical officers who had believed and practised traditional supervision from the commencement of their career in the government services.
Lectures, role play, facilitated discussion and group work were employed to explain the concepts and principles of supportive supervision. The practical component of the session comprised of a field visit by the teams to conduct supportive supervision of an auxiliary nurse midwife at a sub centre, a medical officer at a primary health centre and a block program manager at the Taluka health office. At the end of the 2 day contact session, with the background of principles of supportive supervision, a platform was provided for the teams to share, discuss and criticise each other’s observations from these field visits.
Few months later many participants shared their success stories of adopting supportive supervision.
Dr Asma Tabassum, District Tuberculosis officer articulated that supportive supervision had decreased the barriers of communication with her staff, the quality of testing and reporting at health facilities had improved to a great extent and she had found newer ways to motivate her staff to surpass.
Dr Rajani, the Reproductive child health officer vocalised that by practising supportive supervision she had found that her subordinates had started relating to her and would understand her viewpoints much better. The participatory decision making process had created a sense of ownership in her staff and the improvement in interpersonal relationships had brought about a positive change in their performances. For us, it was a new beginning …..
