For quality health care delivery, continuous supportive supervision is needed in order to be able to fill gaps that are experienced by health care providers at the lower health care level who for some reasons can not deliver what is expected from the community. Supervision is an excellent opportunity to provide follow-up training, improve performance, and solve other systemic problems that contribute to poor health care delivery.
Following a number of challenges experienced during ordinary supportive supervision, in the year 2010, Bahi District Council introduced cascade supervision to its health care facilities. The cascade supervision is all about empowering staffs at the health centers to be able to conduct supportive supervision to the dispensaries’ staffs who in then provide supervision to the communities within their catchment areas.
Prior to the introduction of cascade supervision, we conducted training to the people dealing with this system including all in-charges of health care facilities and health officers. The district was then divided into four zones (so called the cascade zones) and 31 nodes (so called cascades nodes).
In each cascade zones there was one health center while each node has one dispensary. Within its zone, each health center supervises an average of seven dispensaries and each dispensary, on the other hand, supervises communities within its catchment area. Upon implementation of cascade supervision we have been able to cut down costs by 25% which, would have otherwise, come from ordinary supportive supervision.
Bahi District Council with an area of 5948 sq km has a total of 35 health care facilities (4 health centers and 31 dispensaries). Nevertheless, process for construction of the district hospital is underway. Through the experience of Bahi District Council, cascade supportive supervision remains to be an option for effective delivery of quality health care for resource limited settings like Bahi District Council which has very diverse geography with some areas being difficult to reach especially during rainy seasons.
Bahi District Council represents many districts in Tanzania which experience difficulties in conducting cost effective supervision. Therefore cascade supervision proves to be a alternative choice for improving health care delivery in resource limited settings.
As we believe this is the high time, we urge other stakeholders in the health sector in other districts, to implement this strategy in order to improve the quality of health care delivery in their districts and in the whole country.
The Author is also the District Medical Officer of Bahi District, Dodoma, Tanzania