Abstract
BackgroundOne of the most common barriers to improving immunization coverage rates is human resources and its management. In the Republic of Georgia, a country where widespread health care reforms have taken place over the last decade, an intervention was recently implemented to strengthen performance of immunization programs. A range of measures were taken to ensure that immunization managers carry out their activities effectively through direct, personal contact on a regular basis to guide, support and assist designated health care facility staff to become more competent in their immunization work. The aim of this study was to document the effects of "supportive" supervision on the performance of the immunization program at the district(s) level in Georgia.MethodsA pre-post experimental research design is used for the quantitative evaluation. Data come from baseline and follow-up surveys of health care providers and immunization managers in 15 intervention and 15 control districts. These data were supplemented by focus group discussions amongst Centre of Public Health and health facility staff.ResultsThe results of the study suggest that the intervention package resulted in a number of expected improvements. Among immunization managers, the intervention independently contributed to improved knowledge of supportive supervision, and helped remove self-perceived barriers to supportive supervision such as availability of resources to supervisors, lack of a clear format for providing supportive supervision, and lack of recognition among providers of the importance of supportive supervision. The intervention independently contributed to relative improvements in district-level service delivery outcomes such as vaccine wastage factors and the DPT-3 immunization coverage rate. The clear positive improvement in all service delivery outcomes across both the intervention and control districts can be attributed to an overall improvement in the Georgian population's access to health care.ConclusionProvider-based interventions such as supportive supervision can have independent positive effects on immunization program indicators. Thus, it is recommended to implement supportive supervision within the framework of national immunization programs in Georgia and other countries in transition with similar institutional arrangements for health services organization. in RussianSee the full article online for a translation of this abstract in Russian.
Highlights
One of the most common barriers to improving immunization coverage rates is human resources and its management
The decentralization of health care financing and service supply responsibilities to the municipal level caused fragmentation and the delegation of powers was unclear and created unclear lines of responsibility [6]. These reforms affected much of the health care sector, including the National Immunization Program (NIP)
Demographic and employment characteristics Demographic and employment characteristics were similar among Centre of Public Health (CPH) staff respondents in the intervention and control groups, both at baseline and follow up (Table 1)
Summary
One of the most common barriers to improving immunization coverage rates is human resources and its management. Alongside many variables that can cause poor coverage, such as inadequate financing, poor vaccine quality, poor vaccination practices, and weak health care systems [1], one of the most common barriers to improving immunization coverage rates is human resources and its management [2]. The decentralization of health care financing and service supply responsibilities to the municipal level caused fragmentation and the delegation of powers was unclear and created unclear lines of responsibility [6] These reforms affected much of the health care sector, including the National Immunization Program (NIP). While recognizing the role of many factors that can influence low coverage rates, an important factor which has caused a negative effect has been weak human resource management within the NIP, namely weak organizational structure and processes and a lack of knowledge and skills in management and supervision, especially at peripheral levels [7]
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