Reinforcement of clinical practice is defined as the supervisor either directly observing case management practices in the field or clinic or presenting case scenarios to the HSA.
More general supervision activities such as protocol reviews or supply replenishing are not considered reinforcement of clinical practice.
Supervision and/or mentorship rates with reinforcement of clinical practice varied by district, with a high of 96.0% in Kasungu and a low of 21.7% in Chitipa.
Over half of HSAs (57.6%) reported receiving field-based supervision and/or mentorship with reinforcement of clinical practice in the previous 3 months.
Six districts (Kasungu, Blantyre, Mulanje, Phalombe, Dowa, and Mchinji) achieved the MOH target of 80% or higher coverage of TWG indicator 5 (supervised in the last 3 months with reinforcement of clinical practice).
To distinguish supervision episodes that included reinforcement of clinical practice, HSAs were asked about the specific activities that occurred during their most recent supervision and mentorship experiences in the previous 3 months.
Without a ready supply of MgSO4, an easily accessible treatment protocol, supervision, and reinforcement of best practices after training, providers may not change established prescribing habits and switch from diazepam to MgSO4.
They provide training and socialization opportunities (e.g., reinforcement of cultural practices), offer a fresh set of eyes with the potential of averting or recovering from the sequelae of adverse events, and can impact on team cohesion.
The proportion of HSAs with an uninterrupted stock in the previous 3 months was 11% for ORS, 40% for LA, and 82% for cotrimoxazole 16; 53% of HSAs had received supervision in the previous 3 months, 29% of HSAs had supervision at their VHC, and 40% of HSAs reported receiving iCCM-specific supervision with reinforcement of clinical practices in the health center or at their VHC.
We can now redefine routinization: this involves the sustenance of the organizational routine(s) for a work practice through the mutual reinforcement of principles and practices.
