Effectiveness of supportive supervision on the consistency of integrated community cases management skills of the health extension workers in 113 districts of Ethiopia

Ethiop Med J. 2014 Oct;52 Suppl 3:65-71.


Background: Consistency in the adherence to integrated Community Case Management (iCCM) protocols for common childhood illnesses provided by Ethiopia's Health Extension Program (HEP) frontline workers. One approach is to provide regular clinical mentoring to the frontline health workers of the HEP at their health posts (HP) through supportive supervision (SS) following the initial training.

Objective: To Assess the effectiveness of visits to improve the consistency of iCCM skills (CoS) of the HEWs in 113 districts in Ethiopia.

Methods: We analyzed data from 3,909 supportive supervision visits between January 2011 and June 2013 in 113 districts in Ethiopia. From case assessment registers, a health post was classified as consistent in managing pneumonia, malaria, or diarrhea cases if the disease classification, treatment, and follow-up of the last two cases managed at the health posts were consistent with the protocol. We used regression models to assess the effects of SS on CoS.

Results: All HPs (2,368) received at least one supportive supervision visit, 41% received two, and 15% received more than two. During the observation period, HP management consistency in pneumonia, malaria, and diarrhea increased by 3.0, 2.7 and 4.4-fold, respectively. After controlling for secular trend and other factors, significant dose-response relationships were observed between number of SS visits and CoS indicators.

Conclusions: The SS visits following the initial training were effective in improving the CoS.

MeSH terms

  • Case Management / organization & administration*
  • Case Management / standards
  • Child Health Services / organization & administration*
  • Child Health Services / standards
  • Child, Preschool
  • Clinical Competence*
  • Community Health Services / organization & administration*
  • Community Health Services / standards
  • Community Health Workers / education
  • Community Health Workers / organization & administration*
  • Community Health Workers / standards
  • Delivery of Health Care, Integrated
  • Diarrhea / diagnosis
  • Diarrhea / therapy
  • Ethiopia
  • Humans
  • Infant
  • Infant, Newborn
  • Inservice Training
  • Malaria / diagnosis
  • Malaria / therapy
  • Organization and Administration
  • Pneumonia / diagnosis
  • Pneumonia / therapy
  • Quality of Health Care*