支持性监督如何影响免疫接种点的实践：印度奥里萨邦的一项准实验研究。
How supportive supervision influences immunization session site practices: a quasi-experimental study in Odisha, India.
作者信息
Panda Bhuputra, Pati Sanghamitra, Nallala Srinivas, Chauhan Abhimanyu S, Anasuya Anita, Som Meena, Zodpey Sanjay
机构信息
Indian Institute of Public Health, Bhubaneswar, India;
Indian Institute of Public Health, Bhubaneswar, India.
出版信息
Glob Health Action. 2015 Jan 14;8:25772. doi: 10.3402/gha.v8.25772. eCollection 2015.
BACKGROUND
Routine immunization (RI) is a key child survival intervention. Ensuring acceptable standards of RI service delivery is critical for optimal outcomes. Accumulated evidences suggest that 'supportive supervision' improves the quality of health care services in general. During 2009-2010, the Government of Odisha and UNICEF jointly piloted this strategy in four districts to improve RI program outcomes. The present study aims to assess the effect of this strategy on improvement of skills and practices at immunization session sites.
DESIGN
A quasi-experimental 'post-test only' study design was adopted to compare the opinion and practices of frontline health workers and their supervisors in four intervention districts (IDs) with two control districts (CDs). Altogether, we interviewed 111 supervisor-supervisee (health worker) pairs using semi-structured interview schedules and case vignettes. We also directly observed health workers' practices during immunization sessions at 111 sites. Data were analyzed with SPSS version 16.0.
RESULTS
The mean knowledge score of supervisors in CDs was significantly higher than in intervention groups. Variegated responses were obtained on case vignettes. The control group performed better in solving certain hypothetically asked problems, whereas the intervention group scored better in others. Health workers in IDs gave a lower rating to their respective supervisors' knowledge, skill, and frequency of supervision. Logistics and vaccine availability were better in CDs.
CONCLUSION
Notwithstanding other limitations, supportive supervision may not have independent effects on improving the quality of immunization services. Addressing systemic issues, such as the availability of essential logistics, supply chain management, timely indenting, and financial resources, could complement the supportive supervision strategy in improving immunization service delivery.
背景
常规免疫接种是一项关键的儿童生存干预措施。确保常规免疫接种服务达到可接受的标准对于实现最佳效果至关重要。越来越多的证据表明，“支持性监督”总体上可提高医疗服务质量。2009年至2010年期间，奥里萨邦政府和联合国儿童基金会在四个地区联合试点了这一战略，以改善常规免疫接种计划的成果。本研究旨在评估该战略对提高免疫接种现场技能和操作的效果。
设计
采用准实验性“仅后测”研究设计，比较四个干预地区（IDs）和两个对照地区（CDs）的一线卫生工作者及其上级的意见和操作。我们总共使用半结构化访谈提纲和案例 vignettes 对111对上级-被监督者（卫生工作者）进行了访谈。我们还在111个地点直接观察了免疫接种期间卫生工作者的操作。使用SPSS 16.0版对数据进行分析。
结果
对照地区上级的平均知识得分显著高于干预组。对案例 vignettes 获得了多样化的回答。对照组在解决某些假设性问题方面表现更好，而干预组在其他方面得分更高。干预地区的卫生工作者对其各自上级的知识、技能和监督频率的评价较低。对照地区的后勤和疫苗供应情况更好。
结论
尽管存在其他局限性，但支持性监督可能对提高免疫接种服务质量没有独立影响。解决系统性问题，如基本后勤的可用性、供应链管理、及时订货和财政资源等，可在改善免疫接种服务提供方面补充支持性监督战略。
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