Ethiopia has approximately 428,000 people with tuberculosis (TB) and 1,480,000 people with HIV. While properly evaluating and supervising the health care workers supporting these people can improve service delivery, the vast size of the country and still-developing infrastructure make the process difficult. The Private Sector Program (PSP-One, through which IntraHealth contributed supportive supervision implementation) introduced the use of hand-held computers, or PDAs, to improve TB testing and HIV counseling and testing services.

In December 2007, an assessment of 20 pilot sites revealed issues with staffing, drugs and logistics, case detection and treatment outcomes, laboratory quality, general infrastructure, and monitoring and evaluation and data quality. While there was a paper-based supportive supervision checklist, it inadequately addressed these problems.

PSP replaced the paper checklist with a PDA-based tool at 91underperforming facilities. This tool allowed for immediate site-level analysis and priority setting. Not only could it record the initial data, it also quickly aggregated all data at the program level.  By analyzing this data, the PDAs could identify any problems. Once the problems were identified and prioritized, PSP program staff worked with health care focal people to develop an action plan which:

• Briefly described the problems identified
• Identified possible causes
• Selected a solution
• Outlined specific actions
• Assigned a responsible person and a deadline.

This action plan was kept by the facility and by PSP.  In the next supervisory visit, the action plan was reviewed to check completion.

 Problems addressed included manpower gaps—such as staff loss and training needs—and issues with accuracy and completion of facility reporting.  PSP found that using the PDA-based tool dramatically reduced data reporting errors, made the diagnosis of problems clearer, enabled cross-facility sharing to reduce drug shortages, and helped improve service quality by leading to concrete, specific action plans.

PSP-One is led by Abt Associates and funded by USAID.