Kiribati is an Island nation with 33 atolls spread over an area of the Pacific Ocean the distance of New York to Los Angeles. Providing health services across this vast expanse is a challenge, as is supporting the primary health staff in these remote locations. WHO has been working with the Nursing division to develop a process of supportive supervision to improve the quality of service delivery in the Outer Islands. This technical assistance has included creation of policy, manuals, toolkits, evaluation and analysis methods and information sharing procedures to assist in the provision of ongoing supervisory visits to the Outer Islands.
The guidelines for supportive supervision were written to assist both the supervisors (the Principle Nursing Officers or PNOs) and the health care professionals working in the Outer Islands (Medical Assistants [MAs] and the nurses). The MAs are also expected to provide supportive supervision for the nurses on their island.
The basic idea of supportive supervision is to provide a supportive and developmental approach to the provision of the service. It is seen as an ongoing, inclusive and cyclic process. Its focus is on growth not discipline. It involves the MA/nurse in the process and requires commitment at all levels of the health service. It is supervision with, not supervision of. Its aims are:
- To find out what is being done well
- To help staff to identify and solve problems
- To motivate the staff
- To improve the skills of the staff
- To make sure that operational objectives are appropriate
The overall aim is to make sure that the health of the people improves.
Each PNO is responsible for an island and supervisory visits have been occurring since 2007, with some islands having now received their second visit. Both the PNOs and Outer Island staff are enthusiastic and supportive of this new delivery of services, and are confident that it will assist in the improvement of health services, and therefore the health of the community. WHO continues to support the programme with assistance to analyse the visit results and to review and modify the tool as new needs arise. A comprehensive evaluation of the programme will be undertaken in 2009.