Effectiveness of Supportive Supervision in Improving the Performance of National Immunization Program in Georgia

The project was funded by Cida/IDRC (Canadian International Development Centre; The International Development Research Centre) and implemented by Curatio International Foundation in collaboration with Toronto University. The duration of the project was July 2004 – March 2006.

The study objective was to document the effects of “supportive supervision” on the performance of the immunization program at the district level in Georgia.

The intervention package included: development of supervisory guidelines, district-level training, continuous supervision and support, monitoring and evaluation, and funding for Centers of Public Health to carry out the package of interventions (travel and communication costs). Supportive supervision, which was the focal point of the package of interventions, was based on introducing updated job descriptions with documented lines of supervision; improving communication lines and skills; introducing guidelines and tools for supervision, performance review and monitoring, and evidence-based action planning, all of which help health workers to improve immunization service delivery.

The effectiveness of the intervention package was assessed with a pre/post-experimental research design. The package of interventions was uniformly implemented in 15 districts selected randomly out of the nation’s 67 districts. Another 15 districts were selected to serve as controls. Measurements were assessed at the baseline and end of the one-year intervention. Quantitative, qualitative and postal surveys were used to collect the information and derive conclusions. Study revealed that significant improvements in the performance of immunization program occurred after implementation of the intervention. In contrast to control districts, intervention districts experienced a significant increase in DPT-3 coverage, decrease in contraindications rate, decrease in refusals rate, and decrease in vaccine wastage between baseline and follow-up stages. The intervention did not appear to have independently contributed to the relative change in service delivery outcome indicators.