Supportive supervision as an effective intervention in improving water, sanitation and hygiene facilities in government health facilities of Tamil Nadu

Sudharshini Subramaniam, T. S. Selvavinayagam


Background: Water, sanitation and hygiene (WASH) is one of the important components of Sustainable Development Goals which is essential for achieving any global health-related goals. WASH in health care facilities is prioritized as a necessary input to achieve health goals. Supportive Supervision has been established as an effective intervention in improving the performance of health care workers. This paper evaluates the role of supportive supervision in improving WASH facilities in the health care facilities of high priority districts of Tamil Nadu.

Methods: The effectiveness of supportive supervision in improving WASH facilities was assessed through a pre-post experimental research design. World Health Organization proposed steps were followed while planning for the supportive supervision. Supervisory visits were made using checklists in all secondary level public health facilities in 7 High Priority Districts which were chosen based on the preliminary WASH survey conducted by UNICEF. The same health facilities were revisited after 3 months and supervised using the same checklist.

Results: In the first supervisory visit, 41.6% of the health facilities (57 out of 137 facilities) were non- functional in terms of WASH score, while only 5.8% (8 out of 137 facilities) were fully functional. In the second visit, proportion of non- functional facilities had dropped from 41.6% to 7.3% and there has been an increase in the partially functional (52.6% to 71.5%) and fully functional facilities (5.8% to 21.2%) which was found to be statistically significant.

Conclusions: Supportive supervision was able to show a significant improvement in the WASH facilities in all types of facilities. 


Supportive Supervision, WASH

Full Text:



United Nations. Clean Water and Sanitation: Why It Matters. 2016. Available at: sustainabledevelopment/wp-content/uploads/2016/ 08/6_Why-it-Matters_Sanitation_2p.pdf. Accessed on 16 August 2017.

Benova L, Cumming O, Campbell OMR. Systematic review and meta-analysis: association between water and sanitation environment and maternal mortality. Trop Med Int Health. 2014;19(4):368–87.

Blencowe H, Cousens S, Mullany LC, Lee AC, Kerber K, Wall S, et al. Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect. BMC Public Health. 2011;11(Suppl 3):S11.

Tobergte DR, Curtis S. Water, sanitation and hygiene in health care facilities: Status in low- and middle-income countries and way forward. J Chem Information Modeling. 2013;53(9):1689–99.

World Health Organization (WHO). Water and Sanitation for Health Facility Improvement Tool (WASH FIT) A practical guide for improving quality of care through water, sanitation and hygiene in health care facilities. 2017. Available at: Accessed on 16 August 2017.

Crigler L, Gergen J, Perry H. Supervision of Community Health Workers. 2013.

World Health Organization. Training for mid-level managers (MLM) 4. Supportive supervision. 2008;(Mlm):1–34; Module 4.

Children’s Vaccine Program at PATH. Guidelines for Implementing Supportive Supervision: A step-by-step guide with tools to support immunization. 2003;

Djibuti M, Gotsadze G, Zoidze A, Mataradze G, Esmail LC, Kohler J. The role of supportive supervision on immunization program outcome - a randomized field trial from Georgia. BMC Int Health Human Rights. 2009;9(Suppl 1):S11.

RAISE. Guidelines for implementing supportive supervision for family planning and post- abortion care services in crisis settings. 2012.

Ryman T, MacAuley R, Nshimirimana D, Taylor P, Shimp L, Wilkins K. Reaching every district (RED) approach to strengthen routine immunization services: Evaluation in the African region, 2005. J Public Health. 2010;32(1):18–25.

Suh S, Moreira P, Ly M. Improving quality of reproductive health care in Senegal through formative supervision: results from four districts. Human Resources for Health. 2007;5(1):26.

Som M, Panda B, Pati S, Nallala S, Anasuya A, Chauhan AS, et al. Effect of supportive supervision on routine immunization service delivery-a randomized post-test study in Odisha. Global J Health Sci. 2014;6(6):61–7.

Ameha A, Karim AM, Erbo A, Ashenafi A, Hailu M, Hailu B, et al. Effectiveness of supportive supervision on the consistency of integrated community cases management skills of the health extension workers in 113 districts of Ethiopia. Ethiopian Med J. 2014;52 Suppl 3:65–71.

Frimpong JA, Helleringer S, Awoonor-Williams JK, Yeji F, Phillips JF. Does supervision improve health worker productivity? Evidence from the Upper East Region of Ghana. Tropical Medicine and International Health. 2011;16(10):1225–33.

McAuliffe E, Daly M, Kamwendo F, Masanja H, Sidat M, de Pinho H. The Critical Role of Supervision in Retaining Staff in Obstetric Services: A Three Country Study. PLoS ONE. 2013;8(3):1.

Hernández AR, Hurtig A-K, Dahlblom K, San Sebastián M. More than a checklist: a realist evaluation of supervision of mid-level health workers in rural Guatemala. BMC Health Services Res. 2014;14:112.

Vasan A, Mabey DC, Chaudhri S, Brown Epstein H-A, Lawn SD. Support and performance improvement for primary health care workers in low- and middle-income countries: a scoping review of intervention design and methods. Health Policy and Planning. 2016;2016:czw144.

World Health Organization. Standards for improving quality of maternal and newborn care in health facilities. 2016;73. Available at: Accessed on 18 August 2017.

SRS. Maternal Mortality Ratio (MMR), Maternal Mortality Rate and Life Time Risk; India, EAG & Assam, South and Other states. Census of India. 2013: 1–2. Available at: http://www.censusindia. Accessed on 16 August 2017.

Montgomery AL, Ram U, Kumar R, Jha P. Maternal Mortality in India: Causes and Healthcare Service Use Based on a Nationally Representative Survey for The Million Death Study. 2014;9(1):1-11.

Sankar M, Neogi S, Sharma J, Chauhan M, Srivastava R, Prabhakar P, et al. State of newborn health in India. Journal of Perinatology. 2016;36:S3-S8.

Ministry of Health and Family Welfare Govt of India. Swachhta Guidelines for Public Health Facilities. New Delhi; 2015.

Ministry of Health and Family Welfare Govt of India. Table of Contents. Vol. 43. New Delhi; 2015 May. Available at: retrieve/pii/S0196655315001984 Accessed on 3 April 2017.

Mohan P, Kishore B, Singh S, Bahl R, Puri A, Kumar R. Assessment of implementation of integrated management of neonatal and childhood illness in India. J Health, Population Nutrition. 2011;29(6):629–38.

Mogasale V, Wi TC, Das A, Kane S, Singh AK, George B, et al. Quality assurance and quality improvement using supportive supervision in a large-scale STI intervention with sex workers, men who have sex with men/transgenders and injecting-drug users in India. Sexually Transmitted Infections. 2010;86(Suppl 1):i83–8.

Ross MW, Williams ML. Effective targeted and community HIV/STD prevention programs. J Sex Res. 2002;39(1):58–62.