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Home Care - 5.9 Supervision
5.9 Supervision
Supervision is provided at two levels in the Home Care programme in Phnom Penh. The Team Co-ordinators are responsible for day-to-day supervision of their own HCTs, as well as communicating information between the HCTs and the Home Care Network Co-ordinator. The Team Co-ordinators were initially selected by the Project committee, but are now elected by their own teams.
Initially, two medical doctors visited the teams once each month, to supervise team activities and provide clinical assistance to difficult cases. After the 6-month review, supervision was split into one visit for medical consultation, and one to supervise team management. Simple forms are used to assist the supervisors to give feedback on each aspect, and these are collated by the Home Care Network Co-ordinator and included in the monthly reports to the HCNG.
At present, management supervision is provided by some members of the HCNG and some of the Health Centre Managers. Medical supervision is provided by doctors on a rota basis drawn up each month by the Home Care Network Co-ordinator. However, it is becoming increasingly difficult to find doctors who are willing to provide medical supervision, even with the provision of a small honorarium to cover travel expenses.
Discussions with the HCTs clearly indicate that the HCTs place great value on supervision, and visits by supervisors are welcomed. All the HCTs were emphatic that they would like more medical supervision to assist them in dealing with difficult medical cases and to help them improve their clinical and diagnostic skills, especially for TB. Enhanced management supervision would help to address issues of reporting and planning discussed earlier.
Lesson learned: supportive supervision is a key component of the home care programme and is highly valued by the home care teams
Given the present difficulties of finding supervisors, it is difficult to see how the demands for more supervision can be met using the existing system. Policy changes to integrate home care provision into the MoH system may help to facilitate the allocation of medical supervisors. However, the supervisory needs of the HCTs are for more facilitative and supportive supervision, rather than just more frequent supervision. Earlier sections of this report identified needs of the HCTs for refresher training and a supportive approach to supervision in a number of areas:- assessment of symptoms; analysis of needs; dispensing medication; reporting; prioritising; planning visits.
Following an earlier recommendation (Section 4.6) that each HCT is “attached” to an existing referral hospital, it is further recommended that each hospital is responsible for providing supervisory support to their HCTs. In order to provide good supervision, the supervisors themselves must be resourced and trained in supportive approaches to supervision. A set of tools and approaches has been developed by AVSC International which may help to address this issue.
It is recommended that the referral hospitals provide supportive medical supervision to their partner HCTs. The supervisors must be resourced and trained in facilitative supervision.
There is also a possible pool of resources within the international and local NGO communities which could be drawn upon to provide supervision to the HCTs and which could be resourced through the Home Care Network.
It is recommended that the Home Care Network identifies and resources a pool of supervisors from government and NGOs to provide facilitative supervision to the HCTs.
Supervision is provided at two levels in the Home Care programme in Phnom Penh. The Team Co-ordinators are responsible for day-to-day supervision of their own HCTs, as well as communicating information between the HCTs and the Home Care Network Co-ordinator. The Team Co-ordinators were initially selected by the Project committee, but are now elected by their own teams.
Initially, two medical doctors visited the teams once each month, to supervise team activities and provide clinical assistance to difficult cases. After the 6-month review, supervision was split into one visit for medical consultation, and one to supervise team management. Simple forms are used to assist the supervisors to give feedback on each aspect, and these are collated by the Home Care Network Co-ordinator and included in the monthly reports to the HCNG.
At present, management supervision is provided by some members of the HCNG and some of the Health Centre Managers. Medical supervision is provided by doctors on a rota basis drawn up each month by the Home Care Network Co-ordinator. However, it is becoming increasingly difficult to find doctors who are willing to provide medical supervision, even with the provision of a small honorarium to cover travel expenses.
Discussions with the HCTs clearly indicate that the HCTs place great value on supervision, and visits by supervisors are welcomed. All the HCTs were emphatic that they would like more medical supervision to assist them in dealing with difficult medical cases and to help them improve their clinical and diagnostic skills, especially for TB. Enhanced management supervision would help to address issues of reporting and planning discussed earlier.
Lesson learned: supportive supervision is a key component of the home care programme and is highly valued by the home care teams
Given the present difficulties of finding supervisors, it is difficult to see how the demands for more supervision can be met using the existing system. Policy changes to integrate home care provision into the MoH system may help to facilitate the allocation of medical supervisors. However, the supervisory needs of the HCTs are for more facilitative and supportive supervision, rather than just more frequent supervision. Earlier sections of this report identified needs of the HCTs for refresher training and a supportive approach to supervision in a number of areas:- assessment of symptoms; analysis of needs; dispensing medication; reporting; prioritising; planning visits.
Following an earlier recommendation (Section 4.6) that each HCT is “attached” to an existing referral hospital, it is further recommended that each hospital is responsible for providing supervisory support to their HCTs. In order to provide good supervision, the supervisors themselves must be resourced and trained in supportive approaches to supervision. A set of tools and approaches has been developed by AVSC International which may help to address this issue.
It is recommended that the referral hospitals provide supportive medical supervision to their partner HCTs. The supervisors must be resourced and trained in facilitative supervision.
There is also a possible pool of resources within the international and local NGO communities which could be drawn upon to provide supervision to the HCTs and which could be resourced through the Home Care Network.
It is recommended that the Home Care Network identifies and resources a pool of supervisors from government and NGOs to provide facilitative supervision to the HCTs.