Models of Supportive Supervision for IMNCI Implementation in Selected Districts of Bihar, Orissa and Rajasthan in India

Human resource insufficiency in the resource constraint countries like India insists that the existing human resources are optimally utilized. Supportive supervision is one such strategy to ensure retention of knowledge and skills of existing service providers for optimal implementation of any national health programme. The present study ascertained and documented various models of supportive supervision for implementation of Integrated Management of Neonatal and Childhood Illnesses (IMNCI) strategy, to reduce under 5 mortality, in terms of its feasibility, sustainability, effectiveness, success and limitation in selected districts of Rajasthan, Orissa and Bihar states in India. The comparison of IMNCI indicators one year after the initiation of supportive supervision had shown that three post natal visits by health workers within 10 days of birth increased by 11.3%, 20.2% and 37.6% in the districts - Tonk in Rajasthan, Mayurbhanj in Orissa and Vaishali in Bihar, respectively. There was a marked increase in the referral rates for both young infants and sick children in these states. More focused and regular supervisory visits kept health workers motivated and led to better IMNCI indicators in Bihar as compared to Rajasthan and Orissa. Model of supportive supervision involving both internal and external agency was found to be more feasible, sustainable and successful.