ARTICLES JOURNALS & WEBCASTS

Enhanced Supervision Approaches: Landscape Analysis Findings Report USAID Self Reliance Initiative
Link to report & highlights USAID has provided details on their plan to operationalize their Journey to Self-Reliance Initiative since
the SCOPE Oct 2018 newsletter that highlighted their country road maps dashboard. USAID now has a
The landscape analysis reviews documented supervision approaches and analyzes the
published policy framework with associated learning agenda questions. The learning agenda questions
characteristics and factors associated with improving health worker performance,
health service quality, or system effectiveness based on white (published) and grey goals is to help inform USAID on their approach to building countries capacities to be self-reliant and
(not published) literature. The below bullets arethe key takeaways. remove the need for foreign assistance. The table shows the questions and how they link to the policy
framework. For the full fact sheet
 Using health management information system (HMIS) and performance data
click here to access it from the
to inform supervision priorities, whether across sites or service areas. Linking
SCOPE Dropbox folder.
human resource information systems (HRIS) with HMIS can help target
resource allocation to improve quality and equity, and promote continuity
despite high turnover or absenteeism of both supervisors and supervisees. From Fragile to Resilient Health
Systems: A Journey to Self-Reliance
 Incorporating QI methods such as group problem-solving or collaborative As part of USAID’s Journey to Self-
improvement initiatives to support supervisees so that they can understand
Reliance initiative, linked is a video
quality gaps, consider ways to address underlying factors, and use relevant data
of a forum convened by the USAID’s
to continuously monitor and adapt actions.
Office of Health Systems that
 Ensuring more timely, multi-level feedback loops, including to communities, discuss’ how to support fragile
supervisees, and facility teams, across health worker networks, and to districts health systems on the path to self-
and national programs. reliance. The panel featured a range
 Integrating digital data to promote efficiencies by making data available at of experts from USAID, the World
multiple levels, such as through district-level dashboards, and to reduce Health Organization, the U.S.
supervisory workload by automating some tasks. These supervision data should Department of State, the DRC
be integrated with the HMIS to further inform health system performance and USAID mission, the Gates
aggregated or disaggregated according to various decision-makers’ needs. Foundation, the World Bank,
 Use digital technologies to adapt and apply standardized checklists to capture UNICEF, Save the Children, World
health worker performance, including development of algorithms for Vision, International Rescue
customized feedback and automated data flows. Committee, Johnson & Johnson,
 Clinical mentoring effectively complements supervision, especially where pre- GlaxoSmithKline, Johns Hopkins
service education and training are inadequate and when health workers have University, Finland’s International
an enhanced scope or new skill to acquire, such as through task Affairs Ministry, Harvard University,
shifting/sharing. Carnegie Mellon University, and
 Applying a “whole of system” approach where health systems are inherently MEASURE Evaluation.
 weak may be necessary to strengthen not only support to supervisees, but also
build skills for supervisors themselves and improve health workers’ working
conditions, including ensuring the availability of medicines, supplies,
equipment, infrastructure, water and electricity.
 Engaging communities can enhance supervision by promoting feedback loops
with supervisors on service availability and quality, as well as by improving
communication and encouraging service utilization.
The group addressed multiple factors affecting how health systems are able to respond to both routine
health challenges and emergencies. For example, what percentage of the health burden is caused by
natural and man-made disasters? Or is resilience equally or differentially important at household,
community, and institutional or governmental levels? Other topics included consideration of which
non-health sectors should play a role in developing health system resilience and how to measure
progress.

Supervisor or mentor: is there a difference? Implications for paediatric practice.

Below and linked is an abstract on mentorship that asks the question if mentorship
should be a part of a supervisor’s role.
Abstract: The formal roles of educational and clinical supervisor focus on education
planning and goal setting against required training elements. Assessment of
performance is integral to these roles that necessarily involve some elements of
developmental support to trainees. Mentoring is increasingly seen as a desirable route
to support doctors in training. Definitions vary, but core expectations of mentors are
that they encourage personal development and offer psychosocial support to a trainee
within a longitudinal relationship. A key question is whether a supervisor is the
appropriate individual to act as a mentor to an individual trainee. The supervisor's role
as an assessor of performance can pose challenges and potential conflicts when
providing support relating to other personal needs of trainees along their career paths.
It is apparent from the literature that mentoring is a multifaceted role, with different
actions required of mentors and supervisors. There is evidence that mentorship can
affect specialty choice, academic output and commitment to organisations. Addressing
the challenges posed by an ideal of providing mentoring to all trainees is potentially as
important as ensuring supervisors of competence. The potential benefits for the
profession are of enhancing the development and retention of trainees of high calibre
within the paediatric discipline.

TOOLS
I-TECH Clinical Mentoring Toolkit
I-TECH has created a toolkit for organizations interested in the provision of clinical mentorship. The toolkit comprises of learning curriculums with associated PowerPoints, tools and resources
for mentors, as well as documentation of their successes using this specific clinical mentorship model. Below is their philosophy to clinical mentorship that is integrated throughout their
learning curriculums.
Clinical mentoring is a vital component of a comprehensive clinical training program, helping to bridge the gap between new skills, knowledge, and attitudes obtained in the classroom, and
effective application of these in the health care setting. This clinical mentoring toolkit is a comprehensive guide for developing, implementing, and evaluating clinical mentoring programs. This
updated edition of the toolkit contains many new documents, tools, and articles reflecting the rich diversity and depth of I-TECH’s program experience in clinical mentoring.
The I-TECH approach to mentoring includes five key components:
1. Relationship building. The establishment of a trusting, receptive relationship between the mentor and mentee(s) that evolves and grows over the course of mentorship is the foundation of effective
mentoring practice.
2. Identifying areas for improvement. Observation and assessment of existing systems, practices, and policies leads to the identifi cation of areas for improvement. I-TECH has developed a number of tools
for use during the assessment phase. Information obtained during an assessment helps to inform the establishment of goals and objectives for the mentorship.
3. Responsive coaching and modeling of best practices. Mentors must demonstrate proper techniques and model good clinical practice. Targeted activities with mentees may include demonstrating
appropriate examination techniques, modeling proper infection control measures, and setting examples for establishing good rapport with patients. Setting a good example and intervening directly to
improve mentee practice are equally important in mentorship.
4. Advocating for environments conducive to quality patient care and provider development. This component relates to technical assistance in support of systems-level changes at a site. Mentors work
with colleagues to enhance the development of clinical site infrastructure, systems, and approaches that can support the delivery of comprehensive HIV care. For example, mentors might provide
technical assistance in support of improved patient fl ow at a facility, advocate for provision of privacy for patients during examination, or help to promote a multidisciplinary approach to HIV care at a
site.
5. Data collection and reporting. Mentors support the utilization and integration of patient data into clinical practice by encouraging staff to adopt documentation practices that promote effective chronic
disease management. Mentors can help demonstrate the utility of data collection and reporting to mentees during mentorship. For example, data on patients who were lostto-follow-up was collected
and discussed with mentees in one I-TECH program. This led to an analysis of causes and solutions and, ultimately, a decrease in the cases lost-to-follow-up. A similar positive result occurred following
an analysis of the time of initiation of ART among TB-HIV coinfected patients.