Teaching and supervision of health team members

TEACHING AND SUPERVISION OF HEALTH TEAM
MEMBERS
MS. KANCHAN MEHRA
M.SC. (N) I YR
PCNMS, HALDWANI

INTRODUCTION
Teaching and Supervision have, in all places, been a vital aspect of higher
education. One of the purpose of teaching and supervision is to help the
individual in becoming a useful member of society.

TEAM
Team is a group of two or more persons who works together for common
purpose. In short we can say:
• Team has objective
• Team follow rules
• Team members organize to achieve their objective
• Team member cooperate with each other

TEACHING
According to Gage, "Teaching is a form of interpersonal influence aimed at
changing the behavior potential of another person.“

SUPERVISION
It means observing the subordinates at work to see that they are working
according to plans and policies of the organization and keeping the time
schedule , and to help them in solving their works problems.

OBJECTIVE OF TEACHING AND SUPERVISION OF
TEAM
• To help the staff to do skillfully and effectively to give maximum output with minimum
resources - cost effectiveness
• To help the staff develop the individual capacity
• To Guide or assist in meeting predetermined work objectives or targets.
• To promote effectiveness of the subordinates / staff ensuring that the subordinates staff or
supervise does what he/ she supposed to do.
• To motivate subordinates to maintain high morale.

TEACHING AND SUPERVISION OF HEALTH TEAM
MEMBERS:
1) COMMUNITY HEALTH WORKER:- The Indian government introduced a
community health worker scheme across the country in 1977 for “provision of
health services at the doorsteps of villagers”. However the names of the worker
and the scheme changes over time- from community health worker in 1977 to
community health volunteer in 1980 and villages health guides in 1981.

VILLAGE HEALTH GUIDE: The village health guides are mostly women and this
scheme was started on 2nd October. 1977. They are chosen by the community in which
they work.
Be permanent resident of the local community Have minimum formal education(VI
Class)
• Training:- training is conducted every month. Selected by criteria: a woman of the village
who will visit everyone, represent every one by village communities themselves.
After selection, they undergo training in nearest PHC for 200 hours in 3 months. 1for
each village per 1000 rural population.

LOCAL DAIS:- They are expected to play vital role in propagating small
family norms, emphasis is given on asepsis so that home deliveries are
conducted under safe hygiene to reduce maternal and child mortality.
• Training:- The training is for 30 working days. She is paid a stipend of
Rs.300 during her training period. Training is given at the PHC, sub‐center
or MCH center for 2days in a week, and on the remaining four days of the
week they accompany the health worker.
After successful completion of training, each dai is provided with a
delivery kit and a certificate.

ANGANWADI WORKER:- Under the ICDS (Integrated Child Development Services)
scheme, there is an anganwadi for a population of 1000, there are about 100 such
workers in each ICDS Project.
• Training:- Training in various aspects of health, nutrition, and child development for 4
months. She is a part‐time worker and is paid an honorarium of RS.200‐250 per month
for the services rendered, which include health check‐up, immunization, supplementary
nutrition, health education, non‐formal pre‐school education and referral services. The
beneficiaries are especially nursing mothers, other women (15‐45years) and children
below the age of 6 years

ANM WORKER:- She plays a vital role in maternal & child health as well as in family welfare
services in rural areas. Therefore it is essential that the proper training to be given to them so that
quality services to provided to the rural population.
• Training:-
• The training institutions are sub-centre, PHC, rural family welfare centre & other health centre in the
community.
• The duration of training program of ANM is 2year years and qualification to this course is 12th passed.
• Senior ANM with 5yrs of experience is given 6mnth promotional training to become
LHV/HEALTHASSISTANT (f).

MULTIPURPOSE HEALTH WORKER:- The basic training of multipurpose health worker
(male) scheme was approved during 6th and 5th five year plan & taken up since 1984 as a
100% centrally sponsored scheme.
• The training is provided through 56 training centre through health and family welfare training
centre
• The training is of 1yr duration, on successful completion of training, the male health workers
is posted at the sub centre along with ANM/HEALTHWORKER (Female).
• The main function of the male multipurpose health workers are in the areas of national health
program like malaria, leprosy, TB & limited involvement in diarrhea control program & in
family welfare services.

ASHA:- ASHA must be a woman resident of the village married/ widowed/ divorced, preferably in the age
group of 25 to 45 years. She should be a literate woman qualified up to 10 standard. ASHA will be chosen
through community groups, self- help groups, Anganwadi Institutions,tvillage Health Committee and the
Gram Sabha.
• At the village level it is recognized that ASHA cannot function without adequate institutional support.
Women's committees, village Health & Sanitation Committee of the Gram Panchayat, peripheral health
workers especially ANMs and Anganwadi workers.
• She will counsel women on birth preparedness, importance of safe delivery, breast-feeding and
complementary feeding, immunization, contraception and prevention of common infections including
Reproductive Tract Infection/Sexually Transmitted Infections (RTIs/STIs)

II) HOSPITAL TEAM WORKERS
DOCTORS :- Doctors, or physicians, are key members of the healthcare team. They have
years of education and training. They may be primary care doctors or specialists.
• Primary care doctors :-. Primary care doctors may be family practitioners, internal
medicine or Osteopathic Doctors (OD's). Pediatricians also provide primary care for
babies, children and teenagers. Primary care pediatricians treat day-to-day illnesses and
provide preventive care such as minor injuries, viral infections, immunizations and check-
ups.

• Specialists:- Specialists diagnose and treat conditions that require a special
area of knowledge. Patients may see a specialist to diagnose or treat a specific
short-term condition or, if they have a chronic disease, they may see a specialist
on an ongoing basis. Examples of specialties include: dermatology and
obstetrics.

PHYSICIAN ASSISTANTS (PA'S):- Physician's Assistants are licensed
to practice medicine and are supervised by a doctor. Their training is
similar to a doctor's but they do not complete an internship or residency.
Like a medical doctor, a physician's assistant can perform physical exams,
order tests, diagnose illnesses and prescribe medicine, assist in surgery,
provide preventive Healthcare counseling. Education for PA's includes a 4-
year degree plus a 2-year Physician Assistant program.

NURSES:-Nurses work closely with patients. A nurse’s job duties depend on their education,
area of specialty and work setting. Types of nurses include:
• Licensed Practical Nurses (LPN) are also called Licensed Vocation Nurses. They train for
about one year at a community college or vocational school and are licensed by their state.
• Registered Nurses (RN’s) are licensed by their state. They may have completed a diploma
program, an associate’s (2-year) degree or a bachelor’s (4-year) degree.
• Advanced Practice Nurses are nurses who have more education and experience than RN’s.
Examples of advanced practice nurses are clinical nurse specialists, nurse anesthetist, nurse
midwife and nurse practitioner.

PHARMACISTS:- Pharmacists give patients medicines that are prescribed, or
recommended, by a doctor. Sometimes pharmacists help doctors choose which medicines to
give patients and let doctors know if combinations of medicines may interact and harm
patients.
• Pharmacists have a Pharma degree and are licensed by the state. Pharma education may take
five or six years and is a combination of college courses and pharmacy school.

Technologists and Technicians:-Technologists and technicians have a technical role in diagnosing or
treating disease. They work in a variety of settings. Examples of technologists and technicians include:
• Laboratory Technologists help providers diagnose and treat disease by analyzing body fluids and cells.
Most lab tech positions require a 4-year bachelors’ degree and some states require a license.
• Radiology Technologists, also called radiographers, help providers diagnose and treat disease by taking x-
rays. Radiology technologists are can specialize in computed tomography (CT scans), Magnetic Resonance
Imaging (MRI’s) Most radiology technologists complete a 2-year an associate degree, but some have a 4-
year bachelor's degree or a certificate, which takes 21-24 months. Licensing requirements vary by state.

THERAPISTS AND REHABILITATION SPECIALISTS:-Therapists and
rehabilitation specialists help people recover from physical changes caused by a medical
condition, chronic disease or injury. Types of rehabilitation specialists include physical
therapists, occupational therapists and speech therapists.
• Occupational Therapists help patients perform tasks needed for every-day living or
working. They work with patients who have physical, mental or developmental
disabilities. Occupational therapists help clients find new ways to dress, cook, eat or work.
They may visit patients in their home or workplace to find adaptive equipment or teach
patients new ways to do things. Occupational therapists have a master's or doctoral degree
and are licensed by their state.

• Physical Therapists (PT's) help patients when they have an injury, disability or medical
condition that limits their ability to move or function. The goal of treatment is to improve
mobility, reduce pain, restore function or prevent further disability. PT's are required to
have a license and may have a 2-year master's or a 3-year doctoral degree.
• Respiratory Therapists treat and care for patients with breathing problems. They work
with all types of patients including premature babies, older people with lung disease, or
patients with asthma or emphysema. Respiratory therapists require an associate's degree,
but many have a bachelor's degree. A license is required in most states.

• Speech Therapists are also called speech-language pathologists. They
work with patients who have problems related to speech, communication
or swallowing.. Most states license speech-language pathologists and
require a master's degree.

EMOTIONAL, SOCIAL AND SPIRITUAL SUPPORT:- The team members we have talked
about so far provide physical support. There are many healthcare team members who provide
emotional, social and spiritual support.
• Psychiatrists are medical doctors (MD's) who diagnose and treat mental, emotional and
behavioral disorders.
• Psychologists deal with mental processes, especially during times of stress. They are not
medical doctors, but have a Doctor of Psychology (PsyD) or a doctor of philosophy degree
(PhD). Most psychologists do not prescribe medicine, but treat patients with counseling and
psychotherapy ("talk" therapy).

SUPERVISION OF HEALTH TEAM MEMBERS:-
SUPERVISION
MODEL
Objectives Prerequisites Optimal
Frequency
Implementation
Considerations
Key Scale-Up
Considerations
1) EXTERNAL
SUPERVISION:-
Health worker from
health center or
supervisor from
district health
office..
• Provides –
a direct link
between
Community
health worker and
the health system
• supplies drugs,
and equipment
• collection of
information, and
• one-to-one
support for the
Community
health worker.
• A functioning
health center
within a
reasonable
distance from the
community.
• Travel resources
(vehicle, fuel, per
diem).
• Adequate
numbers of
supervisors.
• Supervision
tools.
Monthly to
quarterly
Strength of formal
health system
Travel resources
(means, fuel, per
diem). Method to
measure success;
evaluate
supervisors and
system
Success at district
or regional level.

SUPERVISION
MODEL
Frequency
Implementation
Considerations
Key Scale-Up
Considerations
2)GROUP
SUPERVISION:
Health worker
supervises group
of Community
health worker
Provides –
• a direct link
between
Community health
worker and the
health system
• supplies, drugs,
and equipment,
• collection of
information, and
group support for
the Community
health worker
•A functioning
health center
within a
reasonable
distance from the
community.
•Travel resources
(means, fuel, per
diem).
•Supervision tools.
Monthly to
quarterly
Easiest model to
implement. PHC
staff time to plan
meetings, Method
to support and
measure success of
individual
Community health
worker
Success at district
or regional level.

SUPERVISION
MODEL
Frequency
Implementation
Considerations
Key Scale-Up
Considerations
3)COMMUNITY
SUPERVISION:
Community plays
a role in defining
expectations,
providing
feedback, tracking
Community health
worker activity.
•Community
helps define
and manage
quality.
•Community
plays a role in
providing
incentives for
good
performance,
and sanctions
for poor
performance.
•A culture of
community
involvement.
•Agreement on
the role of the
Community
health worker.
•Strong
community
leaders
•Training in
supervision,
problem solving.
Monthly
meetings
Challenges in
measuring
success or
impact.
Community-
based training,.
Strong
community-
based
organizations.
Community by
community;
difficult to scale
quickly.

SUPERVISION
MODEL
Frequency
Implementation
Considerations
Key Scale-Up
Considerations
4) PEER
SUPERVISION:
Peers play a major
role in supervising
each other.
Emphasis is on
joint problem-
solving, skills
development, and
peer support
arising from
understanding
what the other is
experiencing.
•Multiple cadres
of Community
health worker or
villages that are
near each other.
•Oversight from
the health system
for supplies,
skills, and
training.
•Travel resources
(means, fuel, per
diem).
•Meeting
resources for
Community health
worker.
Quarterly
meetings, in
between if
possible
Types and
numbers of
Community health
workers in
proximity. Peer-
based training and
materials.
Facilitation skills.
Success at district
or regional level.

SUMMARY
Teaching and Supervision have, in all places, been a vital aspect of higher education. One of
the purpose of teaching and supervision is to help the individual in becoming a useful
member of society and the team is a group of two or more persons who works together for
common purpose. Teaching is a form of interpersonal influence aimed at changing the
behavior potential of another person, and the Supervision of overseeing the employee at
work it has been defined as authoritative direction of work of one’s subordinates. It means
observing the subordinates at work to see that they are working according to plans and
policies of the organization and keeping the time schedule , and to help them in solving their
works problems.

ABSTRACT
Oathokwa Nkomazana, Robert Mash, Silvia Wojczewski, Ruth Kutalek & Nthabiseng Phaladze,
conducted a study on How to create more supportive supervision for primary healthcare in 2016 at
Ngamiland district of Botswana. The objective of the study was to explore how district health managers
can change their practice to create a more supportive environment for primary healthcare providers. A
facilitated co-operative inquiry group (CIG) was formed, CIG belongs to the participatory action
research paradigm. The CIG went through three cycles between March 2013 and March 2014. Twelve
district health managers participated in the inquiry group. The major insights and learning that emerged
from the inquiry process included inadequate supervisory practice, perceptions of healthcare workers’
experiences, change in the managers supervision paradigm, recognition of the supervisors’ inadequate
supervisory skills, and barriers to supportive supervision.

REFERENCE
• Bhaskar Nima, Midwifery and Obstetrical Nursing. 2nd Eddition 2017, EMMESS Medical
Publisher, 715- 718
• Lauren Crigler, Jessica Gergen, and Henry Perry, Supervision of Community Health Workers 2013,
9-23, [cited on 15 April 2019] , available at www.mchip.net/sites/default/files/mchipfiles
• Nkomazana Oathokwa, Mash Robert, Wojczewski Silvia, Kutalek Ruth & Phaladze
Nthabiseng (2016) How to create more supportive supervision for primary healthcare: lessons from
Ngamiland district of Botswana: co-operative inquiry group, Global Health Action Journal[cited
on 15 April 2017],9:1, DOI: 10.3402/gha.v9.31263, available at:
https://doi.org/10.3402/gha.v9.31263

Teaching and supervision of health team members

Teaching and supervision of health team members

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