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Many CHMTs plan a monthly supervision schedule, often found posted on their notice boards, but find it difficult to keep to it (personal observations and communications with District Medical Officers in rural districts).
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Participants completed at least 180 h of supervised clinical time at HUM. Supervision schedules were designed to minimize participant travel, assure oversight, and avoid ED overstaffing.
In practice, security issues (bombings, checkpoints and road closures) and problems with the phone or internet sometimes interfered with supervision schedules in both conditions, and supervision phone calls did not always occur weekly.
Factors that received attention include: setting KMC policy and service guidelines; developing clinical training materials, supervision schedules and tools; integrating recordkeeping and reporting on KMC into routine monitoring and evaluation systems; documenting implementation; and costing KMC services [ 7- 10].
The sessions with supervision were scheduled with assistance from the respective departments to fit into daily working routines.
Subsequently, monthly group supervisions were scheduled with one of the authors (PS) in order to discuss cases, to ensure the intervention's consistency.
Similarly, PHNs reported a 'disconnect' between emerging needs and their capacity to schedule supervision meetings [ 55].
To assure data validity, establishing a checking system, such as data audit, would be desirable at the following points: protocol design, supervision of study schedule, definition of data, data collection, choice of tests and procedures, verification, data checking, data recording, data handling, data analysis, and data validation.
Even when supervisory staff are available, there are challenges to carrying out scheduled supervision visits.
In addition, supervisors had other duties (e.g., academic responsibilities) that occasionally led to scheduled supervision sessions being missed.
These observations can be best achieved by carrying out additional visits to newborns rather than relying on supervision coinciding with scheduled home visits, as these do not happen on a regular basis.
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