The Visiting Supervisor Model
What’s the evidence?
Kinds of evidence• What we know• What’s in the literature
What do we know?• How many planned/actual
visits?• What usually happens
during a visit?• What helped to make it
effective?
What’s in the literature?• Do supervisors visit?• What happens during a visit?• What makes it effective?
Do supervisors visit?• DR Congo• Nepal• Niger• Sudan• Peru
DR Congo• Planned visits: 12/year
DR Congo• Planned visits: 12/year• Actual: 3-4/year
Nepal• Planned visits: 6 per 6
months
Nepal• Planned visits: 6 per 6
months• Actual: 1.5 per 6 months
Niger% scheduled visits completed
Niger
0102030405060708090100
1996 1997 1998 1999
% scheduled visits completed
?????????
Sudan• Proportion of sites receiving
1 or more visits per 6 months:
Sudan• Proportion of sites receiving
1 or more visits per 6 months: less than 50%
Peru• Average annual supervisory
visits:
Peru• Average annual supervisory
visits: 0.19
Effective supervision
Set Expectations
Identify problemsand opportunities
Take action Monitor and assessperformance
What happens-Congo• Overall error rate of 58.7%:
• Incomplete documentation• Lack of follow-up• Poor controls over equipment
and supplies
What happens-Botswana• Ask about problems: 65%• Examine clinic records:
50%• Observe service delivery:
43%• Make suggestions for
improvement: 38%
What happens-Sudan• Supervision book found:
26%• Supervision records found:
15%• Observation of case
management: 21%
What makes it effective?• Increasing freq or duration
of visits not effective• Relationship most
important for effect• Direct (on-site) supervision
works best
What’s in the literature?• Do supervisors visit?• What happens during a visit?• What makes it effective?