Transcription
SUPPORTIVE SUPERVISION TOOL DMPA-SC SELF-INJECTIONREMOTE SUPPORTIVE SUPERVISION INSTRUCTIONSInstructions for the remote supportive supervision tool for family planninghealth workers offering DMPA-SC self-injectionWho should use the remote supportive supervision formThis form is designed to be used by ministry of health and program implementation partners to prepare andconduct remote/virtual supervision to assess and support health workers who have recently been trained inoffering subcutaneous DMPA (DMPA-SC) self-injection to clients. Guidance on conducting supportivesupervision is available in a companion document at www.FPoptions.org/supervision-toolkit. Remotesupervision can be a useful way to support health workers and ensure quality of services when in-personsupervision is not possible. When possible, conduct a role play of self-injection counseling (Section 3 below)using live video to enable the most comprehensive assessment of health worker skill and allow for accuratefeedback.Recommended platforms for conducting live video supervision WhatsApp video, Zoom, Skype, or other live video platforms.If local bandwidth supports it, supervisors and health workers should use live video where visualobservation is indicated below (i.e., Section 3 Self-injection role play of self-injection counseling).HOW TO USE THIS SUPERVISION TOOLSection 1: FAMILY PLANNING COUNSELING (No videorequired)Section 2: SELF-INJECTION COUNSELING (No videorequired)Section 3: SELF-INJECTION ROLE PLAYHealth worker turns on video function. If internet is weak, thesupervisor can keep their video off while the health worker’svideo remains on for demonstration.Section 4: CLIENT FOLLOW-UP Ask each question aswritten. Select theappropriate box based onthe health worker’sresponse. Take notes in the“Observations” column onaspects that the healthworker does very well,and areas forimprovement.Select the appropriate box. (No video required)Section 5: PRODUCTS AND DATA MANAGEMENT (No videorequired)Select the appropriate box.Section 6: REVIEW OF REMOTE SUPERVISION VISIT(No video required) Share your observationswith the health worker.Praise things the healthworker did well andprovide suggestions forimprovement whereneeded.Remote supportive supervision www.FPoptions.org/supervision-toolkit Page 1 of 9
Steps to prepare for conducting remote supervision1. Orient district supervisors Schedule a virtual meeting (using WhatsApp video, Zoom, Skype, or other video platformthat will be used for the later supervision session) to orient district health teams orsupervisors on how to use a remote/virtual approach. This will be an opportunity to reviewthe remote supportive supervision tool with them. Review or orient health workers on how to record self-injection information in the familyplanning registry.2. Contact family planning health workers who will be supervised After completing orientation, supervisors should contact health workers at the facilitiesneeding supervision to plan the date and time of remote supervision. Supervisors shouldexplain that health workers will receive a supervision visit conducted through a videoplatform, and that:o The estimated time to complete the visit will be an hour.o The visit will include a series of questions asked by the supervisor, along with asimulation exercise or role play in which the supervisor will pretend to be a client whohas decided to self-inject DMPA-SC. The health worker will play their role as the familyplanning health worker.o The health worker will role play counseling the supervisor as the “client” on self-injection.The phone or computer video will need to be turned on for a portion of this section. It isrecommended that the health worker bring someone who can serve as a “videoassistant” to hold and operate the device for ease of capturing the live video.o The supervisor will confirm that the health worker knows how to record self-injectioninformation in the family planning registry. The supervisor should ask health workers to make themselves and their video assistantavailable for at least one hour on the scheduled date and time. They should bring allsupplies and documents they will need to counsel a client on self-injection.3. Send text/SMS reminders to health workers in advance of the remote visit One day before the remote monitoring visit, the supervisor should send a text/SMS messageto the health worker(s) to confirm the date and time of the planned supervision call. The supervisor should remind health workers to have their phones or computers wellcharged for the call and to have their video assistant and all necessary self-injection suppliesand documents available.4. Plan administrative aspects in advance Ministry of health and program implementation partners using this tool should ensure thathealth teams or supervisors are provided with all necessary information in advance:o How to access the video platform to be used.o The method to be used for any payment of internet/phone credits.o Allowances if applicable.o Any documents they may be responsible for sharing before or after the supervision visit.Remote supportive supervision www.FPoptions.org/supervision-toolkit Page 2 of 9
SUPERVISION TOOL DMPA-SC SELF-INJECTIONREMOTE SUPPORTIVE SUPERVISION FOR SELF-INJECTIONTool for remote supportive supervision of family planning health workersoffering DMPA-SC self-injectionGeneral demographic informationHealth worker name:Supervisor name:Health facility th facility type: (select all that apply) Public Private Hospital Health center/clinic Health post Pharmacy Drug shop Other (specify):Health center level: (select or adapt as relevant to country health system) IV III IIWhere does the health worker perform most duties? (select one) Facility CommunityWhat function/role does the health care worker hold? (select the most appropriate response) District chief medical officerDistrict health team memberIn-chargeFamily planning (FP) focal personHead nursePrimary health care supervisor Health worker Community health worker (e.g., village healthteam [VHT], accredited social health activist[ASHA], relais.) FP counselor Other (specify):What DMPA-SC training has the health worker completed? (select one) Online training: eLearning course onDMPA-SC self-injection Online training: eLearning course on healthworker administration of DMPA-SC and selfinjection On-job training only (no eLearning) Off-site training only (e.g., classroom-basedtraining)When did the health worker receive the above training (most recent experience)?/ /Remote supportive supervision www.FPoptions.org/supervision-toolkit Page 3 of 9
Section 1: FAMILY PLANNING COUNSELINGObservationsDirections: The supervisor should ask each question as written. Select the appropriate box based on thehealth worker’s response. The supervisor should take notes in the “Observations” column on aspects thatthe health worker does very well, and areas for improvement.Do you do FP education/ awarenessactivities at this facility (i.e., groupeducation sessions for clients)? Yes NoHow often? Frequency per month:Do you talk about self-injection of DMPASC with any client considering usinginjectable contraception? Yes NoWhich family planning products do you counsel women on?Male condoms Yes NoFemale condoms Yes NoIntrauterine devices (hormonal ornonhormonal IUDs) Yes NoInjectables: DMPA-IM(Depo-Provera or other brand) Yes NoInjectables: DMPA-SC (Sayana Press) Yes NoImplants (Jadelle, Implanon, other) Yes NoOral contraceptive pills (combinedestrogen-progestin oral contraceptives[COCs] or progestin-only pills [POPs]) Yes NoEmergency contraception pills Yes NoWhich of the below print materials do you provide to DMPA-SC self-injection clients?DMPA-SC self-injection job aids (DMPASC) Yes NoDMPA-SC self-injection calendar (DMPASC) Yes NoNotes: (For example, note any products or methods that are not offered in the facility or notable issuesrelated to demand or supply as the health worker reports.)Remote supportive supervision www.FPoptions.org/supervision-toolkit Page 4 of 9
Section 2: SELF-INJECTION COUNSELINGObservationsDirections: The supervisor should ask each question as written. Select the appropriate box based on thehealth worker’s response. The supervisor should take notes in the “Observations” column on aspects thatthe health worker does very well, and areas for improvement.Since your training,approximately how manytimes have you counseled aclient on self-injection? Never Fewer than 10 times Fewer than 20 times More than 20 timesFor clients interested in selfinjection, do you invite themto attend a self-injectioncounseling session? Yes NoFor women who are ready toproceed with self-injection, doyou conduct individualcounseling, group counseling,or both? Individual GroupDo you offer self-injection toall women who are interestedand eligible? If no, why? Yes NoWhen you have counseledclients to self-inject, have anyclients successfullyadministered their first selfinjection in front of you whileyou observed? Yes NoSince you began counselingclients to self-inject, have anyclients returned used devicesto you? Yes NoIf yes, how many ingroups?If yes, what have you donewith the used devices?Remote supportive supervision www.FPoptions.org/supervision-toolkit Page 5 of 9
Section 3: SELF-INJECTION COUNSELING ROLE PLAYObservationsDirections: The health worker should turn ON the video at this point and display the supplies and materialsthey use to counsel a client on self-injection.Question to be asked by the supervisor to the health worker: “Can you tell me what supplies andmaterials you have prepared in front of you for today’s counseling simulation? Remember to turn on yourvideo.”There are six key supplies and materials the health worker needs to train clients on self-injection, listedbelow. Do not prompt for all the possible supplies and materials listed—instead, let the health workerprovide the answers. For anything that is mentioned spontaneously (unprompted by supervisor), select the“Mentioned” box. If the health worker does not mention specific supplies and materials, ask “What about[insert supply item here]?” Select the “Mentioned after verbal prompt” box to indicate the answer wasreceived after the supervisor prompted verbally. If the health worker does not have the supplies on hand,indicate this in the Observations column.Supplies gathered in preparationfor role playObservationsDMPA-SC devices Mentioned Mentioned afterverbal promptDMPA-SC self-injection instructionsheet/job aid for clients Mentioned Mentioned afterverbal promptCalendar to be given to clients Mentioned Mentioned afterverbal promptSafety box Mentioned Mentioned afterverbal promptExample of appropriate storagecontainer to keep in the house forplacing used devices Mentioned Mentioned afterverbal promptCondom filled with salt to use as amodel Mentioned Mentioned afterverbal promptTraining video (optional) Mentioned Mentioned afterverbal promptRemote supportive supervision www.FPoptions.org/supervision-toolkit Page 6 of 9
Directions: The supervisor should say to the health worker: “Now let us simulate a client’s selfinjection counseling through a role play. I will be the client who chose to self-inject. Step by step, proceedas if you are counseling the client to initiate self-injection.”During the simulation/role play, note whether the health worker provides adequate advice to the client onthe topics listed below. If the answer is “no” for a given topic, indicate the findings in the “Observations”column.Praise the health worker for elements of client counseling they presented clearly and comprehensively.Note and discuss any aspects that can be improved and make suggestions for how the health worker cancounsel clients more effectively.Comprehensive and correctexplanation of self-injection isgiven. Yes NoHighlights the four criticalinjection steps: Yes NoM Mix the solution by shakingdevice for 30 seconds; check forleakage.A Activate device by closingthe gap (push needle cap andport together).P Pinch the skin gently tocreate a tent; insert needle atdownward angle.S Slowly press reservoir forabout 5 to 7 seconds to inject.Correct information is given to the Yesclient on common possible side Noeffects of DMPA-SC.Correct explanation given to theclient on how to calculate thereinjection dates using thecalendar. Yes NoInstructions n given to the client onhow to check the resupply dateafter she has used all her DMPASC devices. Yes NoConfirms the client correctlycalculates future reinjectiondates. Yes NoDiscusses how to store theproduct at home and how todispose of it properly after use. Yes NoDiscusses follow-up options withthe client. Yes NoRemote supportive supervision www.FPoptions.org/supervision-toolkit Page 7 of 9
Section 4: CLIENT FOLLOW-UPObservationsDirections: The supervisor should say to the health worker: “Now let us do a role play in which I willplay the role of a client coming for resupply of DMPA-SC for self-injection. Please proceed as if you are ahealth worker receiving a self-injection client who is coming for resupply.”During the role play, note whether the health worker correctly addresses the following topics. If the answeris “no” for a given topic, indicate the observations in the “Observations” column.At the end of the role play, review any aspects not covered by the health worker.Client satisfaction with the method Yes NoAny challenges with home storage Yes NoAny challenges with wastemanagement Yes NoAny challenges with home selfinjection Yes NoAny side effects or questionsabout side effects Yes NoReviews the four critical injectionsteps (MAPS) Yes NoClient confirms desire to continuewith self-injection or not Yes NoAsks about and listens to theclient’s questions Yes NoSection 5: PRODUCTS AND DATAObservationsMANAGEMENTDirections: The supervisor should ask each question as written. Select the appropriate box based on thehealth worker’s response. The supervisor should take notes in the “Observations” column.Are you currently stocked out ofDMPA-SC? (optional) Yes NoIf “yes,” how long has it beenstocked out? (optional)DaysMonth(s)If stocked out, have you placed anorder? When? (optional) Yes NoDate order placed:/ /How do you note self-injectioninformation in the FP clientregistry?Indicate health worker’s response here:Remote supportive supervision www.FPoptions.org/supervision-toolkit Page 8 of 9
Section 6: REVIEW OF REMOTE SUPERVISION VISITDirections: Share your observations from the remote supervision session with the health worker. Praisethings they did well and cover areas where they can make improvements. List the top three highlights andthree opportunities to improve service provision.Performance highlightsOpportunities for improvementFollow-up needed or requestedRemote supportive supervision www.FPoptions.org/supervision-toolkit Page 9 of 9
Which of the below print materials do you provide to DMPA-SC self-injection clients? DMPA-SC self-injection job aids (DMPA-SC) Yes No DMPA-SC self-injection calendar (DMPA-SC) Yes No Notes: (For example, note any products or methods that are not offered in the facility or notable issues
