KENYA MEDICAL TRAINING COLLEGE

MONITORING, EVALUATION AND REPORTING MODULE

TEACHING MANUAL

DEPARTMENT OF HEALTH PROMOTION AND COMMUNITY HEALTH

MAY, 2022
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Table of Contents
UNIT 1: Concepts in Community Health Information System.........................................................................................5
1.1 Introduction.............................................................................................................................................................5
1.2 Definition of terms used in M&E............................................................................................................................5
1.5 Concepts in Community Health Information System..............................................................................................6
1.5.1 Importance of monitoring..............................................................................................................................6
1.5.2 Players involved in Monitoring Community health work...........................................................................7
1.5.3 Monitoring cycle.............................................................................................................................................7
1.5.4 Indicators of community health....................................................................................................................8
UNIT 2: Data collection and reporting in the community.................................................................................................8
2.1 Introduction.............................................................................................................................................................8
2.2 Sources of data........................................................................................................................................................8
2.3 Kenya Health Information System (KHIS).............................................................................................................8
2.3.1 Attributes of KHIS.........................................................................................................................................9
2.3.2 Electronic Community Health Information System....................................................................................9
2.3.2 Master Facility List (MFL)............................................................................................................................9
2.3.2 Master Community Health Unit List (MCHUL)................................................................................................9
2.4 Community Health Information System (CHIS)...................................................................................................10
2.4.1 Community Referral Register - MOH 100.................................................................................................10
2.4.2 Community Health Volunteer Household Register – MOH 513...................................................................10
2.4.3 Community Health Volunteer Service Delivery Logbook – MOH 514....................................................10
2.4.4 Community Health Assistants Summary Register – MOH 515.....................................................................10
2.4.5 Chalk Board – MOH 516................................................................................................................................10
2.4.6 Community Treatment and Tracking Register..........................................................................................10
2.4.6 Inventory Control Card...............................................................................................................................10
2.5 Data Visualization.................................................................................................................................................11
2.6 Data Collection.....................................................................................................................................................11
2.7 Data Flow and Reporting Responsibility...............................................................................................................11
Importance of reporting to the community.............................................................................................................11
Mechanisms of reporting to the community...........................................................................................................11
Data validation..........................................................................................................................................................11
UNIT 3: Monitoring, Evaluation health and reporting community health performance..................................................12
3.1 Definitions............................................................................................................................................................12
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 3.2 Reasons/Purpose/Importance of Monitoring and Evaluation................................................................................12
3.2.1 Key benefits of Monitoring and Evaluation...............................................................................................12
3.2.2 Characteristics of monitoring and evaluation...............................................................................................13
3.2.2.3 Evaluating and reporting community activities and projects...........................................................................13
3.4.2 Monitoring and Evaluation Frameworks...................................................................................................15
3.5. Role of CHA/CHEW in reporting........................................................................................................................17
3.6 Evaluation.............................................................................................................................................................18
3.6.4 Types of evaluation......................................................................................................................................19
UNIT 4: Facilitative Supervision in the Community.......................................................................................................19
4.1 Definitions............................................................................................................................................................19
4.2 Concepts and principles in facilitative supervision...............................................................................................20
4.2.1 Concepts in supervision...............................................................................................................................20
Benefits of Facilitative Supervision..........................................................................................................................22
National Level...........................................................................................................................................................22
Regional/ County/ City Level...................................................................................................................................22
4.2.2 Principles of supervision..............................................................................................................................23
4.3 Differences between facilitative and traditional supervision.................................................................................23
4.4.1 Qualities of a good facilitative supervisor...................................................................................................23
4.4.2 Task of supervision......................................................................................................................................25
4.5 Mentorship for Community Health Services.........................................................................................................26
4.5.1 Introduction to mentorship.........................................................................................................................27
Figure 1. Benefits to all parties...................................................................................................................................29
Figure 2. Differences between Coaching & Mentoring...............................................................................................30
4.5.2 Mentorship skills & characteristics of mentors in tier ones.........................................................................31
4.5.3 Mentorship stages and methods..................................................................................................................32
4.6 Coaching for Community Health Services............................................................................................................36
4.6.1 Introduction to coaching in the community...............................................................................................36
4.6.2 Characteristics of coaching..........................................................................................................................37
4.6.3 Benefits of coaching and how to effectively coach after facilitative supervision session.........................37
4.6.4 Steps in coaching during facilitative supervision.......................................................................................39
4.7 Counseling for Community Health Services.........................................................................................................41
4.7.1 Define counseling..........................................................................................................................................41
4.7.2 Principles of counseling...............................................................................................................................41
4.7.3 Use of basic counseling skills.......................................................................................................................42

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 4.7.3 Benefits of counseling...................................................................................................................................42
4.7.4 Key elements in counseling..........................................................................................................................42
4.8 Conflict resolution.................................................................................................................................................43
4.8.1 Definitions.....................................................................................................................................................43
4.8.2 Principles of conflict resolution.....................................................................................................................43
4.8.3 Conflict resolution options............................................................................................................................43
4.8.4 Steps in conflict resolution...........................................................................................................................45
4.8.5 Effects on health in the community.............................................................................................................46

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Module Outcome:

By the end of this module, the learner should be able to:

1. Define, the concepts in monitoring, evaluation and reporting
2. Discuss the various approaches and types of monitoring and evaluation
3. Describe CHIS tools used in monitoring and evaluation
4. Discuss the importance of monitoring, evaluation and reporting to the stakeholders in
community health
5. Demonstrate skills in monitoring, evaluation and reporting
Module competence

This module is designed to enable the learner to manage community health data for decision making

UNIT 1: Concepts in Community Health Information System

1.1 Introduction
1.2 Definition of terms used in M&E

Monitoring: This is a systematic and continuous process for data collection and assessment of activity
progress over time. It is the regular collection and analysis of information to assist timely decision making,
ensure accountability and provide the basis for evaluation and learning

Evaluation: this is systematic and objective assessment of an ongoing or completed project or programme,
its design, implementation and results in order to improve planning and implementation of current and future
activities

Reporting: an account presented in detail, a formal account of the proceedings or transactions of a group

Process: That which is accomplished using inputs e.g. training, conducting home visits

Inputs: Resources availed to implement the projector program e.g., finance, human resource,
commodities and supplies (CHEW kit/CHV kit), tools

Output: the direct products or deliverables of the project-people trained, materials distributed

Outcome: Results of the programme, or changes that occur both immediately or sometime after e.g.
change in knowledge

Impact: The wider effect of program on long term results, changes in death rate and disease burden

Information: specific data which has been processed, organized for a given purpose and presented within
a context that gives it meaning and relevance

Indicator: these are qualitative or quantitative criteria used to check whether the planned changes have
taken place as intended

Indicator: They are variables with which we can measure changes either directly or indirectly. They are
performance standards that allow project outputs to be verified and eventual impacts measured

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Sustainability: The extent to which the desired impact of a project will continue to generate
advantages after finalization of the program

1.5 Concepts in Community Health Information System

1.5.1 Importance of monitoring
M&E results in better transparency and accountability: Because organizations track, analyze, and report
on a project during the monitoring phase, there’s more transparency. Information is freely circulated and
available to stakeholders, which gives them more input on the project. A good monitoring system ensures no
one is left in the dark. This transparency leads to better accountability. With information so available,
organizations need to keep everything above board. It’s also much harder to deceive stakeholders.

M&E helps organizations catch problems early: Projects never go perfectly according to plan, but a well-
designed M&E helps the project stay on track and perform well. M&E plans help define a project’s scope,
establish interventions when things go wrong, and give everyone an idea of how those interventions affect the
rest of the project. This way, when problems inevitably arise, a quick and effective solution can be
implemented.

M&E helps ensure resources are used efficiently: Every project needs resources. How much cash is on
hand determines things like how many people work on a project, the project’s scope, and what solutions are
available if things get off course. The information collected through monitoring reveals gaps or issues, which
require resources to address. Without M&E, it wouldn’t be clear what areas need to be a priority. Resources
could easily be wasted in one area that isn’t the source of the issue. Monitoring and evaluation helps prevent
that waste.

M&E helps organizations learn from their mistakes: Mistakes and failures are part of every organization.
M&E provides a detailed blueprint of everything that went right and everything that went wrong during a
project. Thorough M&E documents allow organizations to pinpoint specific failures, as opposed to just
guessing what caused problems. Often, organizations can learn more from their mistakes than from their
successes.

M&E improves decision-making: Data should drive decisions. M&E processes provide the essential
information needed to see the big picture. After a project wraps up, an organization with good M&E can
identify mistakes, successes, and things that can be adapted and replicated for future projects. Decision-
making is then influenced by what was learned through past monitoring and evaluation.

M&E helps organizations stay organized: Developing a good M&E plan requires a lot of organization.
That process in itself is very helpful to an organization. It has to develop methods to collect, distribute, and
analyze information. Developing M&E plans also requires organizations to decide on desired outcomes, how
to measure success, and how to adapt as the project goes on, so those outcomes become a reality. Good
organizational skills benefit every area of an organization.

M&E helps organizations replicate the best projects/programs: Organizations don’t like to waste time on
projects or programs that go nowhere or fail to meet certain standards. The benefits of M&E that we’ve

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described above – such as catching problems early, good resource management, and informed decisions – all
result in information that ensures organizations replicate what’s working and let go of what’s not.

M&E encourages innovation: Monitoring and evaluation can help fuel innovative thinking and methods for
data collection. While some fields require specific methods, others are open to more unique ideas. As an
example, fields that have traditionally relied on standardized tools like questionnaires, focus groups,
interviews, and so on can branch out to video and photo documentation, storytelling, and even fine
arts. Innovative tools provide new perspectives on data and new ways to measure success.

M&E encourages diversity of thought and opinions: With monitoring and evaluation, the more
information the better. Every team member offers an important perspective on how a project or program is
doing. Encouraging diversity of thought and exploring new ways of obtaining feedback enhance the benefits
of M&E. With M&E tools like surveys, they’re only truly useful if they include a wide range of people and
responses. In good monitoring and evaluation plans, all voices are important.

Every organization benefits from M&E: While certain organizations can use more unique M&E tools, all
organizations need some kind of monitoring and evaluation system. Whether it’s a small business,
corporation, or government agency, all organizations need a way to monitor their projects and determine if
they’re successful. Without strong M&E, organizations aren’t sustainable, they’re more vulnerable to failure,
and they can lose the trust of stakeholders.

Fosters internal and external accountability of the resources used and results obtained
Provides opportunity for reassessment, realigning and redesigning
Provides information for decision making
Helps to promote project ownership and sustainability
Enhances efficiency and effective use of resources
Enhances relationships between project stakeholders

1.5.2 Players involved in Monitoring Community health work

Community health workers (CHCs, CHEWs, CHVs)
Household members,
Individuals,
Communities,
Health teams,
Development partners,
Government
Officials and communities

1.5.3 Monitoring cycle

The monitoring process entails:
 Recording data on key indicators
 Analysing and processing data
 Storing and retrieving information
 Reporting activity results
 Providing feedback to appropriate managers and stakeholders
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 1.5.4 Indicators of community health
Indicators should be SMART; Specific, Measurable, achievable, Realistic and Time bound.

They should also have technical merit, usable, balanced and coherent. Examples of indicators in
community health include:

Examples of indicators in community health include:

 Number of women of reproductive age receiving family planning commodities
 Number of pregnant women referred for ANC
 Number of household sleeping under ITN
 Number of children receiving immunization

UNIT 2: Data collection and reporting in the community

2.1 Introduction
Health information was also identified as a key investment area in the Kenya Health Strategic and Investment
Plan 2014-2018 and the Kenya Health Policy 2014-2030 also has one of its objectives in line with
strengthening health information systems. The District Health Information System (DHIS-2) software was
implemented in 2010 to address challenges of its predecessor, the File Protocol Transfer System. DHIS-2 is a
cloud-based software that captures and stores individual facility information.

2.2 Sources of data

 Reports
 Check in meetings
 Activity report forms, records and registers
 Surveys and interviews
 Focused group discussions
 Field supervisory visits
 Observation
 Quarterly meetings

2.3 Kenya Health Information System (KHIS)

The health information system is a comprehensive and integrated structure that collects, collates,
analyses, evaluates, stores, disseminates, health and health-related data and information for use by
all.

The HIS, like any system, consists of parts which are interrelated, interdependent and work
towards a common goal.

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 The malfunctioning of any part affects other parts of the system.

In general the system is a combination of Health Information and Management Information.

The system collects information on health (Morbidity and mortality statistics, Service statistics)
and on management (human resources, financial, fixed assets and infrastructure, drugs and
supplies logistics) and performs comparative analysis with population- based data from various
surveys.

The HIS is a powerful tool for making health care delivery more effective and efficient

The DHIS is the integrated Health Information System in Kenya, and is run and maintained by the
Health Managers at various levels.

The DHIS is found online at www.hiskenya.org and is composed of permanent and semi-
permanent data elements.

2.3.1 Attributes of KHIS

Has data entry for all dataset by levels and structure of government.

Up-to-date data. As soon as the Health Managers , facility in charge or designated person who
has right entered data per data element it save automatically, the details should be updated in
the DHIS.

ALL Health facilities, community unit are the system– MOH, FBO, Private

The DHIS will be the single source of facility permanent and service data for the MOH,
partners. • The data should be accessible on the website

2.3.2 Electronic Community Health Information System

2.3.2 Master Facility List (MFL)

There exists a master facility list where the MCHUL is linked.
It’s a web-based list of facility which encompasses the different facility types under public,
faith-based, private, NGO among others.
It also has services offered in each facility.
MFL gives the name of facility, geo-codes, owner of facility, list of services offered, in-charge
details and contact address. MFL data is available at www.ehealth.or.ke

2.3.2 Master Community Health Unit List (MCHUL)

This is a web-based system extension of master facility list with similar data, modeling and
functionality.

MCHUL is linked to MFL through use of CHUs codes for integration into the national HMIS.
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 2.4 Community Health Information System (CHIS)

2.4.1 Community Referral Register - MOH 100

Referral form (MoH 100) - Used to refer patients from community who require further
management at a health facility.
The form is then received at the facility by the officer attending the patient/client.
The form is then filled and given back to the client with instructions regarding further
management, if any, to be undertaken at the community by the CHV.
It acts as a feedback to the referring CHV.

2.4.2 Community Health Volunteer Household Register – MOH 513

This is a tool to determine overall health status in the community.
The first reports serve as a base line data for community strategy activities at the community.
It is updated every six months and submitted to the CHEWs.
It summarizes the status of the households within the community unit for further action.
It contains basic information on members of a household with their health status, health promotion
practices and education.
It should also have records of the births and deaths.

2.4.3 Community Health Volunteer Service Delivery Logbook – MOH 514

This is a diary used by CHVs to record information from the households during their visits as they
give messages and services.
It records factual information on what was done or identified in the household served.
The logbook should be submitted to the CHEW for summary at the end of every month.

2.4.4 Community Health Assistants Summary Register – MOH 515

The CHEW summary is filled monthly by the CHEW using the information from the community log
books and household registers

2.4.5 Chalk Board – MOH 516

The information captured on the CHEW summary is also replicated in the chalk board for sharing
with the community during community dialogue

2.4.6 Community Treatment and Tracking Register

This is a tool in which details of sick children less than five years who are seen and treated at the
community is recorded.
The register contains basic information, assessment for treatment, referrals, management and
treatment outcomes.

2.4.6 Inventory Control Card

This is a tool used to record items/equipment received and issued at the community. It contains
their batch numbers, quantities and remarks

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 2.5 Data Visualization

2.6 Data Collection

2.7 Data Flow and Reporting Responsibility

Collecting household health data for analysis
Maintaining and updating health data using registers
Collating community health data
Distribution of data collection tools
Train CHVs on data collection, management
Ensuring data from the community is credible
Compiling periodic reports (monthly, quarterly, annually) for dissemination 8. Utilize data for
decision making

Importance of reporting to the community

To establish records for future reference
Helps with resource mobilization based on known priorities
Promotes accountability and transparency
Informs planning and decision making
Offers feedback to stakeholders
Shares lessons learnt and challenges for better future results

Mechanisms of reporting to the community

Community gatherings
Written reports
Word of mouth
Using mobile phones
Use of community boards
Community newsletters and briefs

Data validation
Data can be validated manually and electronically.
The manual validation should be done at the point of collection by the CHC and facilitated by the
CHEW while electronic validation is done monthly by sub-county focal person and quarterly by
the Sub County Health Management Team.
The aim of validation is to ensure that the data going into reports and the HMIS is of quality and
can be verified.
The CHU details to be validated shall include the specific data variable and data source to ensure
quality and reliability.

UNIT 3: Monitoring, Evaluation health and reporting community health performance

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 3.1 Definitions
Monitoring and Evaluation is a process of continued gathering of information and its analysis, in order to
determine whether progress is being made towards pre-specified goals and objectives, and highlight whether
there are any unintended (positive or negative) effects from a project/programme and its activities.

What is a Monitoring?
Monitoring is a continuous process of collecting, analyzing, documenting, and reporting information on
progress to achieve set project objectives. It helps identify trends and patterns, adapt strategies and inform
decisions for project or programme management.

3.2 Reasons/Purpose/Importance of Monitoring and Evaluation

Timely and reliable M&E provides information to:

Support project/programme implementation with accurate, evidence-based reporting that informs
management and decision-making to guide and improve project/programme performance.
Contribute to organizational learning and knowledge sharing by reflecting upon and sharing
experiences and lessons.
Uphold accountability and compliance by demonstrating whether or not our work has been carried out
as agreed and in compliance with established standards and with any other stakeholder requirements
Provide opportunities for stakeholder feedback,.
Promote and celebrate project/program work by highlighting accomplishments and achievements,
building morale and contributing to resource mobilization.
Strategic management in provision of information to inform setting and adjustment of objectives and
strategies.
Build the capacity, self-reliance and confidence stakeholders, especially beneficiaries and
implementing staff and partners to effectively initiate and implement development initiatives.

3.2.1 Key benefits of Monitoring and Evaluation

Provide regular feedback on project performance and show any need for ‘midcourse’ corrections
Identify problems early and propose solutions
Monitor access to project services and outcomes by the target population;
Evaluate achievement of project objectives, enabling the tracking of progress towards achievement of
the desired goals
Incorporate stakeholder views and promote participation, ownership and accountability
Improve project and programme design through feedback provided from baseline, mid-term, terminal
and ex-post evaluations
Inform and influence organizations through analysis of the outcomes and impact of interventions, and
the strengths and weaknesses of their implementation, enabling development of a knowledge base of
the types of interventions that are successful (i.e. what works, what does not and why.
Provide the evidence basis for building consensus between stakeholders

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3.2.2 Characteristics of monitoring and evaluation
Monitoring tracks changes in program performance or key outcomes over time. It has the following
characteristics:
Conducted continuously
Keeps track and maintains oversight
Documents and analyzes progress against planned program activities
Focuses on program inputs, activities and outputs
Looks at processes of program implementation
Considers program results at output level
Considers continued relevance of program activities to resolving the health problem
Reports on program activities that have been implemented
Reports on immediate results that have been achieved

3.2.2.3 Evaluating and reporting community activities and projects

Evaluation is a systematic approach to attribute changes in specific outcomes to program activities. It has the
following characteristics:
Conducted at important program milestones
Provides in-depth analysis
Compares planned with actual achievements
Looks at processes used to achieve results
Considers results at outcome level and in relation to cost
Considers overall relevance of program activities for resolving health problems
References implemented activities
Reports on how and why results were achieved
Contributes to building theories and models for change
Attributes program inputs and outputs to observed changes in program outcomes and/or impact

3.3 Ways of monitoring community health work

3.3.1 Monitoring and Evaluation Plans

Every project or intervention should have a monitoring and evaluation (M&E) plan. This is the fundamental
document that details a program’s objectives and the interventions developed to achieve these objectives, and
describes the procedures that will be implemented to determine whether or not the objectives are met.

It shows how the expected results of a program relate to its goals and objectives and describes the data
needed, how these data will be collected and analyzed, how this information will be used, the resources that
will be needed, and how the program will be accountable to stakeholders.

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M&E plans should be created during the design phase of a program and can be organized in a variety of
ways.

Typically, these plans include:

The underlying assumptions on which the achievement of program goals depend

The anticipated relationships between activities, outputs, and outcomes
Well-defined conceptual measures and definitions, along with baseline values
The monitoring schedule
A list of data sources to be used
Cost estimates for the M&E activities
A list of the partnerships and collaborations that will help achieve the desired results
A plan for the dissemination and utilization of the information gained

M&E plans:

State how a program will measure its achievements and therefore provide accountability
Document consensus and provide transparency
Guide the implementation of M&E activities in a standardized and coordinated way
Preserve institutional memory

Typically, the components of an M&E plan are:

The introduction
The program description and framework
A detailed description of the plan indicators
The data collection plan
A plan for monitoring
A plan for evaluation
A plan for the utilization of the information gained
A mechanism for updating the plan

The introduction to the M&E plan should include:

Information about the purpose of the program, the specific M&E activities that are needed, and why
they are important
A development history that provides information about the motivations of the internal and external
stakeholders and the extent of their interest, commitment, and participation.

The program description should include:

A problem statement that identifies the specific problem to be addressed (This concise statement
provides information about the situation that needs changing, whom the situation affects, and the
situation’s causes, magnitude, and impact on society.)

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The program goal and objectives:

The goal is a broad statement about a desired long-term outcome of the program. For example,
improvement in the reproductive health of adolescents or a reduction in unwanted pregnancies in X
population would be goals.
Objectives are statements of desired specific and measurable program results. Examples of objectives
would be to reduce the total fertility rate to 4.0 births by year X or to increase contraceptive
prevalence over the life of the program.
Descriptions of the specific interventions to be implemented and their duration, geographic scope, and
target population

The list of resources needed: financial, human, and those related to the infrastructure (office space,
equipment, and supplies)

The conceptual framework, which is a graphic depiction of the factors thought to influence the problem of
interest and how these factors relate to one another. The logical framework or results framework that links the
goal and objectives to the interventions

3.4.2 Monitoring and Evaluation Frameworks

Frameworks are key elements of M&E plans that depict the components of a project and the sequence of
steps needed to achieve the desired outcomes. They help increase understanding of the program’s goals and
objectives, define the relationships between factors key to implementation, and delineate the internal and
external elements that could affect its success. They are crucial for understanding and analyzing how a
program is supposed to work.

There is no one perfect framework and no single framework is appropriate for all situations, but several
common types will be discussed here:

Conceptual framework
Results framework
Logic model

A conceptual framework—sometimes called a “research framework”— is useful for identifying and

illustrating the factors and relationships that influence the outcome of a program or intervention

Results frameworks—sometimes called “strategic frameworks”— diagram the direct causal relationships
between the incremental results of the key activities all the way up to the overall objective and goal of the
intervention. This clarifies the points in an intervention at which results can be monitored and evaluated.

A logic model, sometimes called an “M&E framework,” provides a streamlined, linear interpretation of a
project’s planned use of resources and its desired ends.

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Logic models have five essential components:

Inputs: The resources invested in a program—for example, technical assistance, computers,

condoms, or training
Processes: The activities carried out to achieve the program’s objectives
Outputs: The immediate results achieved at the program level through the execution of activities
Outcomes: The set of short-term or intermediate results at the population level achieved by the
program through the execution of activities
Impacts: The long-term effects or end results, of the program—for example, changes in health status.
In this context, the term “impact” refers to the health status or conditions that the program is intended
ultimately to influence (mortality, morbidity, fertility, etc.), as measured by appropriate indicators.
Measuring “impact” in this way, however, should be distinguished from impact evaluation, which is a
specific type of evaluation activity that focuses on examining how much of an observed change in
outcomes or “impact” can be attributed to the program.

3.4 Indicators of community health

An indicator is defined as a quantitative measurement of an objective to be achieved, a resource

mobilised, an output accomplished, an effect obtained or a context variable (economic, social or
environmental)”.
Precise information needed to assess whether intended changes have occurred.
Indicators can be either quantitative (numeric) or qualitative (descriptive observations).
Indicators are typically taken directly from the log frame, but should be checked in the process to ensure
they are SMART (specific, measurable, achievable, relevant and time-bound).

The methods/sources- identifies sources of information and data collection methods and tools, such as
the use of secondary data, regular monitoring or periodic evaluation, baseline or endline surveys, and
interviews.

The frequency/schedules -how often the data for each indicator will be collected, such as weekly,
monthly, quarterly, annually, etc.

The person(s) responsible- lists the people responsible and accountable for the data collection and
analysis, e.g. community volunteers, field staff, project/programme managers, local partner(s) and
external consultants.

The information use/audience - identifies the primary use of the information and its intended audience.
Some examples of information use for indicators include:
Monitoring project/programme implementation for decision-making
Evaluating impact to justify intervention
Identifying lessons for organizational learning and knowledge-sharing
Assessing compliance with donor or legal requirements
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 Reporting to senior management, policy-makers or donors for strategic planning
Accountability to beneficiaries, donors and partners
Advocacy and resource mobilization.

3.4.1 Types of indicators

Context indicators - measures economic, social or environmental variables concerning an entire

region, sector, or group and the project location. Context indicators also measure relevant national
and regional policies and programs. The situation before the project starts, the (baseline) data,
primarily from official statistics.
Input indicators include indicators that measure the human and financial resources, physical
facilities, equipment and supplies that enable implementation of a program
Process indicators reflect whether a program is being carried out as planned and how well
program activities are being carried out.
Output indicators which relate to activities, measured in physical or monetary units/results of
program efforts (inputs and processes/activities) at the program level.
Outcome indicators measure the program’s level of success in improving service accessibility,
utilization or quality.
Result indicators- direct and immediate effect arising from the project activities that provide
information on changes of the direct project beneficiaries.
Impact indicators refer to the long-term, cumulative effects of programs over time,
beyond the immediate and direct effects on beneficiaries
Exogenous indicators are those that cover factors outside the control of the project but which
might affect its outcome.
Proxy indicators – an indirect way to measure the subject of interest

3.4.2 Key performance indicators, calculations, interpretation & basic analytics

3.5. Role of CHA/CHEW in reporting

Collecting household health data for analysis
Maintaining and updating health data using registers
Collating community health data
Distribution of data collection tools
Train CHVs on data collection, management
Ensuring data from the community is credible
Compiling periodic reports (monthly, quarterly, annually) for dissemination
Utilize data for decision making

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 3.6 Evaluation

Evaluation is a periodic assessment, as systematic and objective as possible, of an ongoing or completed

project, programme or policy, its design, implementation and results. It involves gathering, analysing,
interpreting and reporting information based on credible data. The aim is to determine the relevance and
fulfilment of objectives, developmental efficiency, effectiveness, impact and sustainability.

Evaluations are critical for evidence based decision making on the following attributes:
Performance
Efficiency and effectiveness
Impact
Sustainability
Institutional learning

3.4.3 Mechanisms used for monitoring, evaluation & reporting

3.4.4 Purpose of evaluation

Evaluation helps to check if the objectives have been achieved
It improves planning and management
Promotes institutional learning and informs policy

3.4.5 Evaluation approaches

There are several approaches to evaluation

Results chain approach - designed to address a range of interventions and strategies
taking a systematic view of wider developmental environment and outcomes to which
such interventions contribute. It depicts logical relationships between inputs, activities,
outputs, outcomes and impacts of a given program or initiative.

Expert-driven approach – one or more outside evaluators are given full responsibility for
conducting the evaluation.

Participatory approach - an evaluation coordinator, often from outside the program or

organization, works in partnership with program stakeholders in all phases of the
evaluation process.

Peer approach - professional or teams assess each other

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3.6.4 Types of evaluation

Baseline/formative: conducted before implementation to assess needs and potentials. It

also helps in determining feasibility of the plan

Midterm evaluation: Conducted during implementation to identify areas for change or

modifications, to detect deficiencies and ensure immediate redesign of intervention
strategies

Summative/end term evaluation: Conducted at the end of programme to assess outcomes

Ex-post evaluation: Conducted to measure the programme sustainability after the

programme closure/end

UNIT 4: Facilitative Supervision in the Community

By end of this module, the participants will be able to:

1. Differentiate traditional supervision and supportive supervision

2. Describe the qualities of a good supervisor
3. Discuss the functions of supervision-educative, supportive and administrative
4. Outline the roles/tasks of a good supervisor

4.1 Definitions

Supervisors are those having authority to exercise independent judgement in hiring, discharging,
disciplining, rewarding and taking other actions of a similar nature with respect to employees’.

‘Supervision’ comprises two words, namely ‘super’, that is, superior or extra, and ‘vision’, that is, sight or
perspective. The literal meaning of the term ‘supervision’ is to ‘oversee’ or ‘to inspect the work of other
persons’.

Thus, ‘supervision’ refers to an act by which any person inspects or supervises the work of other people, that
is, whether they are working properly or not

Supervision is direction, guidance and control of working force with a view to see that they are working
according to plan and are keeping time schedule.

Traditional supervision

Traditional supervision is superficial. It only looks at the face value of the problem and not the root
cause.
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 It is often punitive, fault-finding and critical and therefore does not offer solution.

It focuses on individuals rather than processes therefore do not endeavor to strengthen systems and
processes that may cause disconnect between current outputs of health care to the expected standards.

Traditional supervision emphasizes the past rather than the future. Further it’s not continuous but it’s
rather intermittent and usually it creates resentment, suspicion, disintegration between team members
rather than focusing on strengthening team work for quality service delivery.

Facilitative supervision

Facilitative supervision can be defined as ‘a process of guiding, monitoring and coaching workers to
promote compliance with standards of practice and assure the delivery of quality care services.

The supervisory process permits supervisors and supervisees the opportunity to work as a team to
meet common goals and objectives.

4.2 Concepts and principles in facilitative supervision

4.2.1 Concepts in supervision

Historically, and across professions, supervision has been an endeavor of task oversight and punitive, critical
corrective actions. However, alternative modes of supervision have recently emerged, including supportive
supervision.

Facilitative supervision is considered a best practice for CHW supervision in international settings and
includes collaborative reviews, observations, monitoring, constructive feedback, participation, problem-
solving, and training and education.

Such a comprehensive supervisory strategy is of particular importance to the success of CHW programs and
facilitates the empowerment of CHWs across disparate health care settings.

Supervision refers to the direct and immediate guidance and control of subordinates in the performance of
their task.” Thus, the supervision is concerned with three main functions of management, i.e., direction,
immediate guidance and control with a view —
To see, they are working, according to plans, policies, programmes, instructions and the time
schedule,
To guide them at the work if they are doing something inconsistent to directions given and
need help so as to let them able to accomplish their assigned task, and

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 To give them directions to get the work done, if necessary.

It is about ‘empowerment and not control, emphasizing building confidence and self-esteem through
supportive feedback’. It is facilitated through an encouraging and respectful relationship with community
health service provider.

It sets expectations, monitors and assesses performance, identifies problems and opportunities in which the
supervisor remains an intermediary promoting collaboration in problem solving and linking to external
resources.

The concept of facilitative supervision is to place within the health system individuals whose purpose is to
coordinate the aspects of the health system which support community health service providers in service
delivery.

A facilitative supervisor’s job is to identify everything that his/her community health service providers need
to succeed – including continued training, supply of medicines, easy mobility, emotional support etc. and
ensure that these supports are in place.

Good quality supervision is crucial for community health service providers to remain motivated and active in
their jobs and to feel valued in their work. Community health service providers always feel a ‘value-add’ for
participating in a supervision exercise, and not come to fear or avoid it. It should an opportunity to share their
concerns, help them to overcome the challenges they have experienced in their work, and to learn more about
the work that they are carrying out through the knowledge sharing and coaching of the supervisor.

For many, supervision also means ‘line-management’ and therefore CHWs may feel reluctant to report the
difficulties they have. This attitude will limit the effectiveness of the supervision in improving work quality
and eventually lead to supervisees becoming demoralized.

Creating and open dialogue and a mentoring relationship will be most effective in helping them to report,
identify and resolve the problems they have and will lead to genuine improvements competencies
improvement over time.

Facilitative supervision is a major component of continuous quality improvement in health services.

It has 2 goals
Learn what is going on
Improve knowledge, skills, and abilities in areas needing improvement

It emphasizes
Mentoring
Joint problem solving
2-way communication between supervisor
Those being supervised
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Benefits of Facilitative Supervision

Facilitative supervision requires an initial time investment. However, you will find you have free up time to
devote to other responsibilities

As staff learns to solve their own problems, you will find fewer routine, low-level problems to solve

As supervisors under your authority learn to supervise in a facilitative manner, you will need to
provide them with less technical assistance
You will gain a reputation as a leader, an effective supervisor, and an enabler
You will welcome at sites because you help staff solve their problems, rather than criticize them for
their faults
You will have satisfaction of working as a team member, watching staff learn and grow and watching
quality improve
Your job will become more fulfilling as your staff's motivation and commitment increase
Staff will openly share problems

The Following is an example of Facilitative Supervision using the EPI Hierarchical Structure:

National Level

The National EPI Coordinator is responsible for the following supervisory roles
Definition of quality standards and norms as well development of technical guidelines for the
implementation of EPI policies.
Dissemination of these policies and guidelines to reach to the sub-national levels for implementation
Training of staff the policy and policy implementation guidelines to facilitate proper application of
standards and norms
Development of supervisory checklist for national and sub-national level supervisors to ensure
uniformity of policy interpretation and its correct application throughout the country
Giving feedback on the results of supervision individually and through supervisory reports and
circulars
The National EPI Coordinator ensures that the national EPI standards are observed at all levels.

Regional/ County/ City Level

The role of the sub-national EPI coordinator is to assist to health workers at field level at provide quality
services.

Implementors need assistance in

Planning their work
Technical advice
In-service training
Support in handling grievances
Disciplinary problems
Good leadership
Motivation

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The supervision at this level entails
Ensuring objectives at lower levels are consistent with the national objectives and goals
Determining what is being done well and encouraging staff to continue good work
Observing immunization procedures at immunization sites to see if the target population is vaccinated
according to the EPI guidelines
Helping staff identify and solve problems using in-service training approach
Giving feedback in person or through letters and records

4.2.2 Principles of supervision

Right intensity: Lesser the weight of supervision higher the output. So a supervisor must be given
optimum work.
Personal interest: The supervisors should take personal interest in the welfare of the workers
under them. They must be willing to listen to the personal problems of workers.
Consultations: A good supervisor must consult people under him. He can afford opportunities for
free and frank discussion of issues and problems.
Loyalty: He must exhibit his loyalty to his subordinates by safeguarding their interests. He should
not offend the dignity of workers
Informal assessment: Informal appraisal of the performance of the subordinates and pointing out
their shortcomings with a view to improve.
Broader interest: Supervisors are expected to take interest in management functions like
planning, organizing, directing and controlling.
Work climate: He can create better work climate for successful achievements. Any strain in work
climate will spoil the whole organisation.

4.3 Differences between facilitative and traditional supervision

Facilitative supervision is different from traditional supervision because it:

Focuses on helping staff solve problems through using quality-improvement tools
Focuses on processes rather than on individuals
Assists staff in planning for future quality-improvement goals
Is continuous and builds on past gains while setting higher quality-improvement goals

4.4.1 Qualities of a good facilitative supervisor

Good listener
More knowledgeable in technical issues than the community health service providers (It is ok for
the supervisor not to know everything, but they can enquire)

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 Resourceful e.g. being able to make things happen when confronted by obstacles. This may be
referred as having problem solving skills but it’s also about being innovative and thinking ‘out of
the box’-being creative
Have good communication skills
Be a role model-be respect, able to give community health service providers space to air their
issues, able to show interest by the way they listen, acknowledging the strength of others
Able to observe confidentiality
Being respectful – it’s more than being courteous and polite. Being able to treat people as
individuals, acknowledging their individual needs and aspirations
Supportive e.g. being attentive to the community health service providers personal and
professional needs; absence of a superiority complex; assistance with challenging aspects of the
community health service providers work, being flexible like having flexible working hours
Be a mentor and coach the community health service providers for good performance
Knowing and being able to use the community health service provider’s strengths
Allowing the community health service providers to manage their own time and workload
Fostering a relationship between the community health service provider and the clinic and
hospital, to help integrate them into the local health system
Ability to motivate community health service providers to continue to improve their skills
Taking the time to give frequent, constructive feedback on the community health service
providers’ performance
It may require that you as the supervisor start to think differently about what it means to be
‘incharge’. Though supportive supervision will take some practice, in the end we believe it will
produce better results and ultimately help save lives.

4.4.2 Functions of supervision

Support supervision has three main functions;

1. Educative (formative) — professional development of the supervisee
2. Supportive (restorative) — welfare of the supervisee
3. Administrative (normative)—quality assurance

1. Educative (formative)
In supervision, knowledge and information (theory base), personal development and skills training is carried
out. Supervision is also of learning by doing, allowing supervisees to reflect on their work with in the
presence of an experienced person who enables that reflection. Supervisors inevitably fill in gaps in
knowledge, increase skills, make practical what was only abstract knowledge but what must now become
working knowledge. A link is established between theory and practice. This function has been called the
‘formative’ function of supervision. Supervision is directive in the behavioural approaches; in the humanistic
it is more informal. The facilitative role of the supervisor enables learning in the interaction.

2. Supportive (restorative)

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The supportive role of supervision is emphasized more in the person-centred approach. It involves offering
supervisees a forum where they are encouraged to look at their own issues and ask for or be given the
encouragement they need to explore their way of working with clients. It is this function that provides the
‘containment’ side of supervision. Supporting supervisees as they struggle to work, as they deal with other’s
or the community members difficulties, as they engage emotionally with community members, takes place
throughout all aspects of supervision. This function of supervision has been called the ‘restorative’ function.

2. Administrative (normative)
The administrative function has an eye on all aspects of the work that contain accountability and
responsibility of the supervisee and the welfare of the client. Called the ‘normative’ function of supervision,
it pays heed to the ethical and professional aspects of client work. It enables supervisees to monitor their own
work as professionals. It is here that supervisors become advocates, making sure that quality service is
rendered and that ethical and professional dimensions are maintained at a high level.

4.4.2 Task of supervision

1. Relationship between the supervisor and the community health service provider
There is little agreement on the ‘kind’ of relationship involved.
The relationship changes as supervision progresses.
Supervisors feel able to combine other roles with supervisees.
There is an element of power within supervision.
The supervision relationship is characterized by choice: self-disclosure, transference, counter-
transference and contract for example self-disclosure of the supervisor and the supervisee – how
much personal issues do people share? Is it appropriate for supervisors to share their own issues?
Transference and counter-transference for example where the community health service provider
may become dependent, or the supervisor may project issues or displace or where the supervisor
sees the other as helpless and takes responsibility rather than helping them know how to solve the
problem. As a supervisor you are not supposed to take over a job of the other but to give guidance
which is not the case- how do you do that without becoming manipulative.

2. Monitoring the professional and ethical aspects of supervision

Monitoring the professional and ethical aspects is seen as an essential task of supervision.
There are different opinions on how to monitor.
Supervisors need to assure themselves that their supervisees are working ethically.
Some issues emerge around this for supervisors.
Supervisors have worked out strategies for dealing with supervisees when they are anxious about
the ethical or professional side of their work.
Supervisors have several options when there is serious doubt about a supervisee.

3. The supportive task of supervision

Supervisors expect personal issues to arise from supervision.
Supervisors are concerned that the supervisee’s personal issues might interfere with work.
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 Supervision deals with personal issues as they emerge from work but not personal issues per se.
Some supervisors work with personal issues only when they throw light on work with client.
Some supervisors give limited space to deal with personal issues.
Some supervisors demand action if they are worried about client work.

4. The teaching task of supervision

Teaching is an essential task of supervision.
Teaching is individualized within supervision.
Teaching within supervision is more informal than formal.
Modeling is seen as an important teaching method.
Teaching recedes as the supervisee becomes more experienced.
Teaching methods are used within supervision mostly determined by the supervisor.
Some supervisors react negatively to formal teaching in supervision.
Some teaching methods are used such as demonstration, role play, taping etc

5. The evaluation task of supervision

Evaluation is seen as a key task within supervision.
Ongoing feedback evaluation ought to be built into the supervisory contract.
Evaluation is the responsibility of the supervisors; it inevitably affects supervisory relations.
In evaluation the power issues are very clear.
Supervisors tend to give methods of formal evaluation.
There are different stances on the use of taped material for evaluation purposes.

6. Consultation task of supervision

The consultation task is described in various ways by supervisors.
There is different emphasis on different systems.
Supervisors want to know what is happening to clients.
Parallel process must be used with caution.
Developmental stages are connected to the consultation task.
The consultation task is widely seen as the underlying key task of supervision. Includes consulting
with management, partners, donors, and even volunteers, what do they want changed? Learning
from each other, this is the situation in my unit and the problem stems from beyond the unit, so
need to consult for others, and ask advice.

7. The administrative task of supervision

Provide support to community health service providers around logistical challenges (such as
transportation) and difficulties with service delivery such as commodity supply. This may also
include challenges that occur during household visits.
Conduct spot-checks to ensure that community health service providers have visited and are
providing all required services to the community.
Accompany individual community health service providers on household visits to assess
performance. Look for areas where community health service providers are strong, and where

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 they are weak. Coordinate with central health management to provide incentives for strong
performance OR further assessment, refresher trainings, and mentorship for poor performance.
Improve cooperation between the community health service providers and the health facilities by
being a link between them.
Compile reports
Provide mentorship to the community health service providers through on-the-job training • Meet
with individual community health service providers to discuss performance and provide
constructive feedback and one-on-one
Ensure quality assurance in service delivery

4.5 Mentorship for Community Health Services

4.5.1 Introduction to mentorship

Mentoring is a process of deploying experienced individual to provide guidance and advice that will
help to develop the careers of mentees allocated to them.

For the purpose of this programme, mentoring will defined as:

“A process of deploying experienced individuals to provide guidance and advice that will help to develop the
careers of mentees allocated to them. Mentoring is defined in a number of ways:

A mentoring relationship is a relationship between two or more people, (whether formalised or not)
where the relationship has a specific purpose. The relationship is reciprocal and both parties benefit,
albeit in different ways. The mentor-mentee relationship is dynamic with different stages or phases.
Each mentor-mentee relationship is unique although there may be certain general characteristics in
all mentor-mentee relationships. This relationship transcends duty and obligation and often involves
coaching, networking, sponsoring and career counselling”. (Meyer, M 2006).

From the above definition it is evident that mentoring is a learning partnership that is co-created by
two parties, namely the mentor and the mentee.

This definition highlights the following very important characteristics:

The mentoring relationship is dynamic, i.e. as it is focused on growth and knowledge transfer.
It is a reciprocal relationship which suggests that commitment to the relationship comes from
both sides as does the growth. It is a learning partnership in which both parties are learning
and growing.
The relationship takes place within the context of the work environment.
The mentor is the wise career incumbent.

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 The mentor is focused on helping the mentee develop his or her potential.
The mentee is the less experienced but has development potential.
The mentor is not the direct supervisor of the mentee, but a third party such as a manager in a
different department.
The mentee is developed in some specified capacity in other words there must be a clear
purpose and focus for development through mentoring.
Mentoring is not about being sponsored for promotion.

The role of the mentor is not merely to provide guidance and advice on how to accomplish certain
tasks skillfully.

The mentor’s primary role is twofold:

 To provide career development behaviors such as coaching, providing challenging

assignments and fostering the mentee’s visibility.
 To provide psychosocial support such as counseling, support and role modelling.

The role of the mentee is to assume responsibility for his or her own growth and to see feedback
from the mentor as an opportunity to grow and improve their skills.

For mentoring to work the mentor co-creates a learning partnership with a mentee. Goodman
(2004) defines a mentee as:
“A person who takes charge of their own development and sees real value in learning from
others”

Thus Mentoring is the transfer and exchange of information between a mentor and a mentee as they
develop a long-term relationship. Clearly the focus of mentoring is the transfer of knowledge
throughout the organisation

Benefits of Mentoring

Mentoring is a very powerful tool and can have many benefits, as an intervention in delivery of
community health services. For this reason it requires much planning, effort and energy which
should all be directed towards attaining specific benefits for your organisation.

Some typical benefits of implementing a mentoring programme are:

It can be used for leadership and management development. Jack Walsch, as one of the most
influential CEO’s and the world of leadership has on many occasion stated that his most
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 important role as a leader is to mentor talent and that this consumes about 70% of his time.
It supports and reinforces training and skills development interventions
Mentoring, when combined with training increases a manager’s productivity by 88%
according to the American society for Training & Development.
It facilitates learnerships by appointing workplace mentors and coaches to support learners
with the application of skills after training
It aids in the induction and orientation of new employees or managers
It assists with career development
It promotes succession planning and skills transfer
It promotes teamwork and sound working relationships
It assists with the implementation of performance management
It contributes to job satisfaction
It accelerates employment equity
It builds competence within the organisation
It contributes to employee retention. Business week reports that over 35% of employees who
are not mentored within the first 12 months after they are hired are actively looking for a job!
(career systems internationals, 2003). According to Louis Harris & associates only 16% of
those with mentors expect to seek other employment (Sukiennik,2004)
It harnesses the full potential and talents of employees
It promotes a learning culture in an organisation
It helps a company to achieve its business objectives

Figure 1. Benefits to all parties

Mentors Mentees Organisation

Get more opportunities to apply Learn from
experienced Pool of talent for professional
leadership skills people & management jobs is
increased
Develop leadership Skills Acquire skills for career Effective skills transfer
progression
Self-fulfillment to see mentees Disadvantage Employees are Future leaders of Organization are
perform empowered shaped
Learn from mentees Adapt quicker in new jobs & Supports fast tracking
roles
Improved credibility Develop networks Image of organization is enhanced
Expand opportunities for Enhanced More co-operation between
dialogue at all levels of the Interpersonal skills staff & departments
Organization
Enhance professional
Development

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Difference between Mentoring and Coaching?

According to Meyer & Fourie (2006), Coaching can be defined as:

“The systematically planned and direct guidance of an individual or group of individuals by a coach to learn and
develop specific skills that are applied and implemented in the workplace, and therefore translates directly to clearly
defined performance outcomes that are achieved over a short period of time” .

From this definition it is clear that coaching is a form of on-the-job training. In order to be a good mentor,
one must already be a good coach.

Figure 2. Differences between Coaching & Mentoring

COACHING MENTORING
Provides day to day skills to be used Provides medium to long-term
skills
on the job
development
2 parties are involved, i.e. the 3 parties are involved, i.e.
manager,
manager and the employee
employee & mentor
Coach is usually the direct line The mentor is an independent third party
Manager
Maintained by performance Maintained by development agreement
Appraisals
Driven by individual coaches Driven by steering committee
Usually no policy framework for Guided by policy framework
Coaching
Coaches are appointed Mentors are nominated or are volunteers
Occurs on the job Occurs off the job
Is training focused Is development focused
Relationships are formed sue to Relationships are formed via matching
supervisory role
Goals, objectives & tasks are Goals, objectives & tasks are documented
normally not documented (informal)

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 Job outputs are measured Developmental outputs & the
overall mentoring process can be measured
Used to develop individual Used for a variety of reasons, e.g. career
Competence management, fast-tracking, equity
The relationship continues as long Once goals are achieved, the formal
as there is a supervisory-employee relationship is terminated
relationship

From this list of differences one can summarise the core difference between mentoring and
coaching in the following:
“Coaching aims to achieve and empower performance today whereas mentoring aims to achieve
performance and empowerment tomorrow”

Objectives of the Mentoring Relationship

To drive a high performance organisation: To ensure a learning environment, which drives

a high performance culture within the Public Finance Management (PFM) sector, is created, a
climate of being supportive needs to be embedded
To promote skills and knowledge transfer: Creating the capacity for the duplication of
knowledge and skills is paramount to the longevity of the PFM sector and is considered part
and parcel of the strategic thinking of the organisation.
To enhance leadership capabilities: Mentoring is a core competence of any leader’s profile
and as such should be used to provide PFM with a platform to enhance and leverage
leadership capabilities of existing and potential leaders
To embed transformation which encourages a diverse workforce: To foster relationships
within PFM that encourages the acceptance of diversity whilst promoting personal
development and growth
To reinforce learning and development: Mentoring combined with training increases
application of knowledge and skills within the workplace
Driving organization change within PFM: To ensure that the change is reflected deeply
within the way people both internally and externally perceive the change to be rooted in the
culture.

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4.5.2 Mentorship skills & characteristics of mentors in tier ones

Mentees/coachees need to…

Understand the programme objectives/purpose and process

Be self motivated
Be able to articulate expectations and own objectives
Meet commitments
Accept feedback and act on it
Listen
Be self-aware
Have the ability to reflect
Be open Willing to engage in meaningful feedback
Trustworthy
Receptive to and able to benefit from legitimate challenges
Not a passive receiver but an active partner in the process
Ambitious with aspirations to go further
Realistically ambitious about their expectations of the programme
Strong interpersonal skills
Prepared to take responsibility for their own actions
Able to approach the relationship with respect, good humour and openness
High belief in their ability to influence events in their favour

4.5.3 Mentorship stages and methods

Any relationship, regardless of the context in which it is formed, is a complex exchange, driven
by interactional patterns from both parties. As such relationships are characterised by their
unique dynamics.
Mentoring relationships can span anything from a few months to 24 months in duration and is
characterised by four phases.
Each phase has a specific focus that can elicit many relationship dynamics. More importantly,
the same mentor can mentor two different mentees and each of these people can have very
different relationship dynamics which are elicited in the same phase of the mentoring
relationship.
The four phases or stages through which the mentoring relationship will pass are as follows:

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 PHASE 1: PHASE 2:
CONNECTION REALTIONSHIP
BUILDING &
IMPLEMENTATIO N

PHASE 4: PHASE 3:
SEPARATION ASSESSMENT

Phase 1: Connection

This phase is characterised by getting to know each other. Typically mentor’s and
mentees alike explore their interests, motivations, needs, concerns and expectations.

Of critical importance in this phase is your ability as a pair to build rapport and you
might have to meet quite often to achieve this.

In this phase the mentor should have a personal development discussion with the mentee
which should broadly cover the following areas which help to establish the initial

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boundaries of the relationship:
The mentees strengths, development interests and areas needing enrichment
The specific skills the mentee will need to develop.
The development plan.
The roles and responsibilities of both parties.

What the mentee can expect during this phase

Coaching: The mentee will have a skills gap and be unsure and uncertain of
him/herself. So they will require more coaching.
Feedback: Mentees are there to learn and grow so they will require a lot of
feedback at this stage.
Role modelling: As this is new to them, they will require a greater degree of
role modelling during this stage.
Acceptance & Confirmation: They will have a greater need for acceptance
and confirmation than when they are more adept at the necessary skills they
wish to develop.
Challenges: The mentee will need challenging assignments and other
learning opportunities, which in turn could make them more anxious and
uncertain of themselves. Remember that mentors will have to normalise these
feelings and reassure them that the path to doing a task automatically and
effectively starts with a single step and many attempts! So predict initial failure
as a sign of courage, tenacity and a journey towards excellence!

Phase 2: Relationship-building & Implementation

This phase of the process focuses on working at the relationship at a deeper level. This is
reflected in the increased interaction and level of self-disclosure, between the pair.

Through these processes, there is a definite shift on the continuum from dependence to
interdependence and usually both parties are willing to demonstrate greater levels of
commitment to the mentoring space through increased efforts and time being spent on
the relationship, as well as its core purpose.

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What the mentee can expect during this phase:

Guidance & Support: This may go beyond the technical context and learning of
new skills that was initially contracted between mentor and mentee. When people
are put into a growth process it usually elicits many unconscious expectations, feelings
and fears within both parties. For this reason, it is important to normalise these fears and
feelings and provide an accepting and safe space in which the mentee can be guided
through these experiences.
Instruction: Providing the mentee with clear instructions which are
communicated clearly, is vitally important during this phase, as it helps reduce
fears, anxieties and frustrations that could arise if this is not done correctly.
Feedback: A mentor acts as a mirror in which the mentee’s growth, learning and
strengths and weaknesses should be reflected. Mirroring to mentees what the
mentor sees and witnesses is a very powerful form of communication and
feedback that empowers the mentee to respond to those reflections, so that he or
she can choose to grow.
From the start mentors should prepare the mentee for the ritual of giving and
receiving feedback as a mechanism for growth and development.
NB: Growth in the mentoring relationship is a choice and if a mentee chooses not to
accept the mentor’s feedback and grow from it, the mentor should reflect that choice
back to the mentee and address the possible lack of commitment to self-development, a
core role of the mentee, or a lack of readiness for the process.
 Encouragement: A mentor should always speak to the mentee in the language
of possibility, especially when mentees attempt to learn a new skill.

Phase 3: Assessment

As the end of the relationship draws nearer a comprehensive assessment of the

mentoring journey and the mentee will take place.

This assessment is to determine whether the objectives of the relationship have actually
been met as well as the level of competence and growth that you have both reached.

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To ascertain this information, the following crucial questions need to be explored:
To what extent have the goals been met?
Is the mentee competent?
What have the mentors and mentees learnt?
What unforeseen outcomes have occurred?
How, if at all, has the mentorship journey affected the organisation?
What obstacles were encountered in the process?

Phase 4: Separation

At this stage of the relationship, the mentee requires less guidance from the mentor due
to an increase in levels of confidence and competence.

The mentor begins to play a less directive role in the mentee’s ability to make decisions
and the latter initiates actions to further his or her growth and development.

Termination is evident and during this time opportunities should be leveraged to

publicise achievements in these mentoring relationships. Such publicity should form part
of the feedback given by the participants and should be included in the organisation’s
internal communication channels.

The latter usually motivates others who have yet to enter into the mentoring partnership.

4.6 Coaching for Community Health Services

4.6.1 Introduction to coaching in the community

Coaching is a developmental approach to working and interacting with other people. It can help
people develop their personal capabilities, interpersonal skills and capacity to understand and
empathise with others. In turn, this can help people understand more about their own challenges
and make informed choices about their future. It can strengthen their ability to use a range of
influencing and leadership styles. Coaching can help people feel more empowered to make a
difference and improve their own effectiveness.

‘Coaching is the process whereby one individual helps another; to unlock their natural ability; to
perform, learn and achieve; to increase awareness of factors which determine performance; to
increase their sense of self responsibility and ownership of their performance; to self-coach; to
identify and remove internal barriers to achievement.’ MacLennan (1999)

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‘Coaching is the art of facilitating the performance, learning and development of another.’
Downey (2003)

‘Unlocking a person’s potential to maximize their own performance. It is helping them to learn
rather than teaching them.’ Whitmore (2003)
‘Ultimately coaching aims to bring out the best in an individual to enable the team to work better
as a whole.

Different types of coaching

Personal/Life Coaching – ‘A collaborative solution-focused, results-orientated and systematic

process in which the coach facilitates the enhancement of work performance, life experience,
self-directed learning and personal growth of the coachee.’

Executive Coaching - ‘As for personal coaching, but it is specifically focused at senior
management level where there is an expectation for the coach to feel as comfortable exploring
business related topics, as personal development topics with the client in order to improve their
personal performance.’

Corporate/Business Coaching - ‘As for personal coaching, but the specific remit of a corporate
coach is to focus on supporting an employee, either as an individual, as part of a team and/or
organization to achieve improved business performance and operational effectiveness.’

Speciality/Niche Coaching - ‘As for personal coaching, but the coach is expert in addressing
one particular aspect of a person’s life e.g. stress, career, or the coach is focused on enhancing a
particular section of the population e.g. doctors, youths.’

Group Coaching – ‘As for personal coaching, but the coach is working with a number or
individuals either to achieve a common goal within the group, or create an environment where
individuals can co-coach each other.

4.6.2 Characteristics of coaching

4.6.3 Benefits of coaching and how to effectively coach after facilitative supervision session

The benefits for the coachee/mentee/student/colleagues:

A chance to discuss issues, blockages and/or concerns in your career development
Having someone (other than friends/colleagues/tutors) available to share difficult
situations

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 Having someone to believe in you and your ability
Being given help to work out what it is you want from life and work
Being given help to develop a greater confidence
Learning to cope with the informal and formal structure of your future
Working through tactics to manage relationships with other people
Becoming more comfortable in dealing with people from unfamiliar backgrounds
Learning how to communicate with others in more senior positions
Making sense of feedback from others and deciding how to deal with it
Being given the opportunity to challenge thinking and be challenged in return
Being given the opportunity to receive career advice (and possible enhancement)
Gaining an insight into management processes
Having someone else to act as a ‘conscience and a guide’
Obtaining opportunities to network, visibility (access to senior management thinking)

The benefits for the coach/mentor:

A chance to discover and work with colleagues/students from a different viewpoint
An opportunity to share their knowledge, skills and experience
The satisfaction of knowing that they have made a difference to someone else
The huge amount of personal learning that can be taken from the experience
The opportunity to create some reflective space in a hectic daily work schedule
The intellectual challenge of working on issues that they do not have direct personal
responsibility and that may take them into unfamiliar territory
An increased skills base, credibility and reputation
A chance for them to re-assess their own views and leadership style
A chance to become more aware of other’s views/a source of challenge to one’s own
thinking
The chance to broaden their perspective/collect others views – an opportunity to view the
world with fresh eyes, to understand what others are going through
By explaining/sharing/exploring best practice concepts to others, may help to reinforce
them once more for themselves
A chance to challenge and be challenged - mutuality
Taking pride in the mentees/coachees/students/colleagues achievements
Learning new ways to support and develop others

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4.6.4 Steps in coaching during facilitative supervision

No matter what approach is taken towards mentoring/coaching, the relationship progresses

through similar stages as shown here in the Megginson et al’s (2006) European model of
mentoring/coaching and Zachary (2000) US Model of mentoring/coaching
.
Stage One - Rapport Building Stage. Here the mentor/coach and mentee/coachee explore
whether they can work together. They focus on building rapport through exploring their
perceptions and alignment of values (especially on a personal level), how to build mutual
respect, agreement about the purpose of the mentoring/ coaching relationship and alignment of
expectations of their roles and behaviour.

Stage Two - Setting Direction Stage. Although the initiation of the relationship involves
discussing the purpose, at this stage mentor/ coach and mentee/coachee clarify and refine what
the relationship should achieve on both sides. They begin the process of linking the medium to
long term goals with what happens on a day to day basis. The process of rapport building
continues as they explore tactical responses to some of the issues raised.

Stage Three - Core Stage/ Progression. While rapport building and goal setting can be
accomplished in a few meetings, the progression stage typically lasts longer. Mentor/coach and
mentee/coachee become more relaxed about challenging each other, exploring issues more
deeply and experience mutual learning. The mentee/coachee takes more of the lead in managing
the relationship and the process.

Stage Four - Winding up. This occurs when the mentee/coachee has achieved a large part of
their goals or feels equipped with the confidence, plans and insight to continue the journey under
their own steam. Planning for a good ending is critical if both parties are to emerge from the
process with a positive perception of the experience.

Stage Five– Moving on. This stage is about reformulating the relationship, typically into a
friendship in which both parties can meet each other on an ad hoc basis as a sounding board or a
source of networking contacts.

Zachary (2000) US Model of mentoring/coaching

Preparation - It is important that mentors/coaches prepare themselves for their relationships.

This should include considering where they mentor/coach, what behaviours they demonstrate,
the skills they will use, the beliefs and values they have that may enable or hinder the mentoring
relationship, their personal identity and their identity as a mentor/coach, and how being a
mentor/coach impacts on their wider world.
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Negotiation – This is the discussion the mentor/coach and mentee/coachee have about the aim of
the mentoring relationship, the ground rules/contract laying out how the relationship will happen,
the mentoring/coaching goals, benchmarks and review, and the strategy for exiting the
mentoring/coaching relationship.

Enabling – This is the doing stage where the mentee/coachee does the work they need to do to
achieve the development they have identified. The mentor/coach enables this process through
providing support, information and challenge when necessary. It is important that your
mentee/coachee becomes autonomous through developing confidence and independence from
the support provided by the mentor/coach.

Closure - This stage can be difficult, even when the end of the relationship is mutually agreed.
Closure is an inevitable part of relationships, which usually end once specific goals have been
achieved, or particular work experiences completed.

Mentors/coaches approaching closure may experience feelings of separation or loss. People who
have difficulty ending relationships should be aware this might cause them difficulties. An exit
plan should be developed to help both parties to understand the closure process.

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 4.7 Counseling for Community Health Services

4.7.1 Define counseling

Counseling is a face to face communication process in which one person tries to help another to
understand a problem and identify a solution to that problem.

Counseling is the act of working with a client to help him/her to clarify personal goals and find
ways of overcoming their problems. The aim of counseling is to assist an individual to change
behaviors that are interfering with normal life situations

Counseling involves providing the client with necessary information to enable them to solve
their problems or make a decision on the way forward.
4.7.2 Principles of counseling
Acceptance
Individualization
Privacy
Confidentiality
Accepting limitations
Recording

Other Principles of Counselling

Counselling is based on n number of principles. These principles are:

1. Counselling is a process. It is necessary for the counsellor to understand that

counselling is a process and a slow process. Failure to understand this will result in
annoyance and disappointment.
2. Counselling is for all. Especially in the school/college situation counselling is meant for
all the students and not only for those who art: facing problems or other exceptional I
students. As we have already discussed in the school situation counselling is more
3. Counselling is based on certain fundamental assumptions.
4. Every individual in this world is capable of taking responsibilities for him/her.
5. Every individual has a right to choose his/her own path, based on the principles of
democracy.
6. Counsellor does not deprive the right of self-choice but simply facilitates choice. That
counsellor should give due respect to the individual and accept him/her as he/she is.
7. Counselling is not advice giving.
8. Counselling is not thinking for the client, but thinking with the client. Counselling is
for enabling the client to do judicious thinking.
9. Counselling is not problem- solving. The counsellor simply assists the person to find
solution on his/her own.

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 10. Counselling is not interviewing but conversing with the client in order to help Him/her
developing self-understanding,
11. The counsellor should determine individual differences and provide for them.
12. The counsellor has to prepare the client to open to criticism including self- criticism.
13. The counsellor acts as a facilitator or catalyst only. He creates an atmosphere which
is permissive and non -threatening, through his war111 and accepting relationship with
the client which helps the client to explore himself/herself and understand
himself/herself better.

4.7.3 Use of basic counseling skills

Several skills need to be brought into a one-to-one counselling session. These include:
1. Attitudinal skills;
2. Listening skills;
3. Verbal communication skills; and
4. Giving leads.

4.7.3 Benefits of counseling

Why do people need counseling?

Help them understand the problems they are experiencing.
Give them information they are lacking to solve problems
Assist them to understand alternative approaches to solving the problems
facing them.
Help them to explore the problems and clarify conflicting issues
Assist them to adjust to the problem or find better ways to coping living with
the problem
Assist others who may be experiencing similar problems

4.7.4 Key elements in counseling

The key elements in counseling are:

1. Building rapport and understanding
2. Gathering data
3. Finding out the problem
4. Establishing personal involvement
5. Giving hope
6. Giving homework
7. Terminating the counselling

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The following elements are the first things to be learned in any successful counseling session.

Rapport
Communication
Counsellor’s experience
Counsellor’s change to positive feelings
Structured counselling interview

4.8 Conflict resolution

4.8.1 Definitions

Conflict: A state of opposition or disharmony between ideas and interests.

Conflict resolution: The process of resolving a dispute or conflict by meeting at least some of
each sides need and addressing their interest.

4.8.1.1 Sources of conflicts

Misunderstanding and communication failure
Values in goal differences
Differences in methods and approaches to work
Conflict in job roles and responsibilities
Lack of cooperation
Authority issues
Non- compliance issues
Differences in the interpretation of rules, policies on standards

4.8.2 Principles of conflict resolution

Clarify the conflict situation-look beneath the conflict, determine facts, be
sensitive to perspectives
Define interests-separate issues and emotions
Invoke overriding interest
Focus on an exchange
Emphasize legitimacy
Keep issue and power proportional
Display commitment
Consider creating distance
Resist aggression

4.8.3 Conflict resolution options

Adjudication-This is a legal way of solving disputes, a judge listens to the views of
both sides and makes a judgment that brings an end to the conflict the parties
involved do not have much choice over who listens to the case. The judge has the

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 authority to state the cause of action to be taken by the parties involved in the
conflict.
Arbitration-The parties in conflict agree on a third party who listen to each side and
then makes a decision. Both parties must agree on the third party before the conflict
resolutions proceed. They must agree to participate in the process and abide by the
verdict.
Mediation- It is a process in which the parties in conflict involve a third person
whom they both consider to be impartial to help them reach an agreement. The
mediation only facilitates discussions between the two parties.
Negotiation-It is the process through which the parties in conflict hold discussions
in order to come to an agreement it involves marking offers and comprises by both
parties until a common agreement is reached.
Resolution-In this method of conflict resolution discussion are held to establish the
cause of conflicts the parties concerned then agree on a specific cause of action
which is called
Reconciliation-This method (reconciliation) of conflict resolution places emphasis
on abolishing or reestablishing good relation between those who are in conflict. This
is done by encouraging conversation by violators and forgiveness by victims. It is
the basis for the formation of the reconciliation commissions
Transformation-Conflict transformation involves changing various aspects of
society in order to solve conflicts and to prevent such conflicts from reoccurring. It
involves going to the roots of the conflict and carrying out radical changes
transforming relationships that led to the occurrence of the conflict of the first place

4.8.3.1 Conflict resolutions skills

Win -win approach
Creative response
Empathy
Appropriate assertiveness
Cooperative power
Managing emotions
Willingness to resolve

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4.8.4 Steps in conflict resolution

There are eight steps to effective conflict resolution;

Conflict is a regular part of life. How you handle it affects the outcome of your
negotiations and the community work.
Dealing with conflict in constructive ways will help you maintain and enhance
productivity, and achieve professional results in a fair, open and transparent manner.
They include:
1) Be aware: Conflict can rise at any time. Knowing this enables you to take steps to
effective conflict management. Approaching conflict as normal occurrence helps you to
turn potential disagreements into clear communication and improved processes.
2) Be proactive: prevention and early resolution are the most effective. When issues arise,
listen and reflect on what is happening. Consider hoe you can address difficult issues
before they escalate to conflicts.
3) Seek to understand all sides of the issue - there is always more than one way to
interpret an issue. Reflect on what this issue means to you, to the others involved, and
what is at stake for everyone.
4) Initiative dialogue - initiate dialogue by listening and asking questions. This will help
you gain a greater understanding of what is hindering progress, and will help you better
address the central issue.
5) Know when to ask for help - enlisting the help of a neutral third party can assist you to
clarify communication and prevent conflict escalation. When early awareness and
response measures uncover issues that need greater attention, consult others, including a
practitioner for assistance.
6) Assess your options - there are a variety of ways to handle a conflict, such as
negotiation, conflict coaching, facilitated discussions, mediation, arbitration and
litigation. A practitioner can help you assess your options so you can decide the best
possible way to manage the situation.
7) Take action - use your knowledge and resources to take action. This could mean
developing or fine tuning your conflict management skills through conflict coaching,
taking time to prepare for a difficult meeting, or preparing for a facilitated discussion.
8) Reflect on the situation - reflecting on the situation is a key element in maintaining and
enhancing productivity. What have you learned? What has this situation shown you about
yourself, others, and/ or procedures? What can you change in the future to prevent similar
situations?

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4.8.5 Effects on health in the community

Negative effects

The effects of conflicts can either be positive or negative. The negative effects unresolved
conflicts will include the following-

Strained relationship-people in relationships will not relate well with each other. We
avoid talking or interacting.
Physical confrontation:-i.e. increase in the possibility of violent conflict. People may
engage in disruptive/destructive behavior i.e. riots, fights and demonstrations.
Violence:-people can lose their lives, suffer, injuries, lose property.
Displacement of people:-People may leave their homes and forced to settle in other
areas.
Fear and insecurity:-When people are involved in conflict they are fearful and
suspicious of each other and may not feel safe in the presence of the other. There may be
also attacks on each other leading to insecurity in the area.

Positive effects

A conflict gives positive effects if handled constructively. They include the following:-

Positive change in society.

Opportunities for new ideas or new possibilities.

Renewal in relationships.

Increase in productivity of all sectors.

Change that will aid in the development of the society.

4.8.5.1 Benefits of conflict resolution

Better results
Group harmony
Stress and management
Knowledge management

4.9 Planning and conducting supervision visit

4.9.1 Developing the annual supervision visit plan
4.9.2 After the supervision visit

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