Abstract
Background: Based on in-country consultations, capacity to provide high-quality TB/TBHIV services is sub-optimal and not unrelated to weak supervision. Within the National TB Program (NTP) in Nigeria, supervision is entirely paper based; time consuming and structured in a way that rapid review of results is neither available nor timely resolution of problems. Objective: Describe the value of smart phones in improving quality of supervision. Methods: This is a descriptive study. With the NTP open to exploring innovative ways of strengthening supervision, Health Systems 20/20 in collaboration with the NTP proposed a pilot use of smart phones for supervision at health facilities, with focus in Abia state. The State was purposively selected for the study. A stake-holders meeting was convened to fully engage all key TB partners. Situation analysis was conducted in Abia state, a south-east state selected for the pilot, out of which 4 facilities were identified. National and state supervisory checklists were reviewed, programmed & uploaded unto the smart phones. The State TB teams were trained on the use of the smart phone & 6 supervisory visits were conducted within 4 consecutive quarters in Abia state for each facility. Results: Within the pilot sites, the smart phones were noted to be user friendly with rapid review of results done at each visit. Immediate feedback and corrective action for identified challenges were made. However, the record of previous findings and recommendations could not be retrieved on the spot during subsequent visits due to storage capacity of the phone. The time spent on supervision was reduced to 2 hrs per facility using the smart phones compared to 4 hrs when using the paper based at other sites. With scale up from 4 to 45 DOT centers, the treatment success rate in the state TB program increased from 76% in 2011 to 85% in 2012 reporting year, for cases registered in the previous year. Conclusions: NTP through support of other partners should adopt and scale up the use of smart phones for supervision nationwide.
Highlights
Tuberculosis is still a public health challenge especially in low income countries
The quality of human resources is pre-requisites and vital to achieving sustained organizational performance; this was coined as “organizational performance is a function of these components: selecting the right people for the job, appraising their performance; rewarding them for good performance and developing their skills to improve performance in the future” [3]
Abia state is in south eastern part of Nigeria and occupies 5834 square kilometer with a population of 3.9 million according to 2006 population
Summary
Tuberculosis is still a public health challenge especially in low income countries. Nigeria is ranked 4th among 22 high burden countries [1]. Democratic method allows employees to influence and share in organizational decision making, relies on the supervisor conveying to employees what, how and why something is to be accomplished while lassie 'fare, delegates virtually all authority to employees to decide and act without the supervisor’s involvement This type of supervision reduces efficiency and affects productivity. A paradigm shift from paper based questionnaire to improved electronic documentation and reporting This was succinctly coined as “Supervisors have indicated that the system is enabling them to monitor and assess performance of the TB health delivery system, identify problems and opportunities, and in many cases take immediate action for improvements” [4]. The tool is expected to automatically generate reports at the end of each supervision process This was tersely coined as “the automated checklist allowed for on the spot calculation and analysis, resulting in the improvement of supervision, assessment and creation of action plans” [5]. The global and national TB target is to detect at least 70% of TB cases and achieve 85% treatment success rate
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