(PHN 003) Finding time for reflective supervision, and the availability of supervision following a difficult visit were additional limiting factors.
The skills needed to perform these tasks could be enhanced through clinical supervision, the limited availability of which appears to be a major barrier to involving relatives.
Strengthening supervision and assuring the availability of essential drugs need to precede the initiation of IMCI Clinical training.
In Niger, quality assurance measures to strengthen supervision and improve the availability of child survival drugs resulted in better preparation of the target districts for IMCI.
It starts with strengthening district level supervision and improving the availability of child survival drugs through cost recovery well before the beginning of IMCI clinical training.
This paper presents the results of the evaluation carried out by the authors of Niger's experience in introducing IMCI after applying interventions to strengthen supervision and improve the availability of child survival drugs through cost recovery system.
It indicates the need for regular supervision and ensuring the availability of essential resources and skills, particularly at sub urban health facilities and health centres differing form the DOTS centres in order to ascertain their proper functionality and level of quality of available services.
The merging of the two projects in 1997 allowed benefitting from quality assurance interventions to ensure the effectiveness and regularity of district supervision system and improve the availability of essential drug supply before the beginning of IMCI clinical training.
Health personnel in both Bangladesh and Uganda responded to a questionnaire covering questions on the effects of reforms regarding issues such as management, supervision, training, promotion, salaries, the availability of drugs and supplies and incentives for remote deployment (see Table 5).
Our study revealed a number of important community- and provider-related operational and cultural barriers that have resulted in program adaptations such as the introduction of obstetric audit on a regular basis, enhanced provision of on-the-job training, increased ward supervision and improvements in the availability of human and material resources in a number of health clinics [ 15, 16].
