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ABSTRACT
Human resource insufficiency in the resource constraint countries like India insists that the existing human resources are optimally utilized. Supportive supervision is one such strategy to ensure retention of knowledge and skills of existing service providers for optimal implementation of any national health programme. The present study ascertained and documented various models of supportive supervision for implementation of Integrated Management of Neonatal and Childhood Illnesses (IMNCI) strategy, to reduce under 5 mortality, in terms of its feasibility, sustainability, effectiveness, success and limitation in selected districts of Rajasthan, Orissa and Bihar states in India. The comparison of IMNCI indicators one year after the initiation of supportive supervision had shown that three post natal visits by health workers within 10 days of birth increased by 11.3 %, 20.2% and 37.6% in the districts - Tonk in Rajasthan, Mayurbhanj in Orissa and Vaishali in Bihar, respectively. There was a marked increase in the referral rates for both young infants and sick children in these states. More focused and regular supervisory visits kept health workers motivated and led to better IMNCI indicators in Bihar as compared to Rajasthan and Orissa. Model of supportive supervision involving both internal and external agency was found to be more feasible, sustainable and successful.
INTRODUCTION
India aims to reduce the under five mortality rate by two thirds between 1990 and 2015 under the Millennium Development Goals (MDG-4). Hence one of the very important goals of family welfare programmes is to bring down the infant and child mortality rates for improving child health in India.' Although India witnessed a decline in Infant Mortality Rate (IMR) of 50 per 1000 live births in 2008 from 68 per 1000 live births in 1990 still there are certain programmatic issues which need attention.2·3 Improved child health is tried to be achieved through building knowledge and skills of health service providers as well as grass root level workers including anganwadi workers, auxiliary nurse midwives (ANMs), medical officers (MOs) and nurses by imparting training under Integrated Management of Neonatal and Childhood Illnesses (IMNCI) in India.4 However, these skills would be lost with time if not practiced and reiterated by
supportive supervision5. The aim of the present study was to document various models of supportive supervision for IMNCI...