As the Regional Quality Improvement Officer for Morogoro, Rwenyagira is responsible for conducting supportive supervision and mentorship to nine councils. Every Monday, he sits down with 23 other members of the Regional Health Management Team to map out their schedule for the week. Together, they determine the status and quality of health services, the current burden of disease, and related determinants before determining how best to mitigate the situation. They also decide what facilities they will visit, who will conduct the assessments, and what the previous week’s evaluations revealed about the performance of health facilities in the region.
Despite this planning, conducting these visits used to be a complicated, uncoordinated, and time-consuming process.
“We were forced to print a lot of papers—different checklists—and we faced a lot of challenges, like [stocking the right] stationary and transporting them manually,” remembers Rwenyagira. “Service delivery was challenging, and it was not cost-effective.”
Supervisory visits are a critical part of strengthening health system performance. They provide insights into how health facilities are performing against regional targets, where more resourcing or training may be needed, and how health trends may be shifting and new needs emerging. They can also improve the motivation of health workers and the quality of care. But the process often differs by actor and health area, creating a dizzying number of paper feedback forms that can be difficult to reconcile between visits and health areas. For example, the checklist for reviewing a health facility’s maternal and newborn health programming may differ from the checklist for immunization.
It was common for supervisors to miss visits or for Rwenyagira to struggle to make sense of an evaluator’s notes. Without that continuity of feedback, health workers didn’t stand a chance—they couldn’t improve upon what they didn’t know.
Johanes N. Rwenyagira, Regional Quality Improvement Focal Personnel, Morogoro Region, was one of the earliest adopters of the new digital health system to streamline the supportive supervision process under the Data Use Partnership (DUP). Photo: PATH
“AfyaSS has reduced a lot of work on my part. With AfyaSS, tools like smartphones and tablets help to view previous visits and plan accordingly. This brings about continuous support to areas that need attention.”— Johanes N. Rwenyagira, Regional Quality Improvement Focal Personnel
When PATH and the government of Tanzania introduced a new digital health system to streamline and standardize the supportive supervision process under the Data Use Partnership (DUP), Rwenyagira became one of its earliest adopters.
The AfyaSS digitalizes the process, using a single dashboard to consolidate supervisory checklists, feedback forms, and action plans.
“AfyaSS has reduced a lot of work on my part,” explained Johanes. “With AfyaSS, tools like smartphones and tablets help to view previous visits and plan accordingly. This brings about continuous support to areas that need attention.”
The results are night and day. Johanes doesn’t need to print and carry stacks of feedback forms because they are integrated into the system. Supervisors are no longer randomly assigned to far-off councils because AfyaSS assigns upcoming visits to the right coordinator. Health care workers know to expect upcoming visits because of the systems scheduling features. And Johanes and his team can make meaningful use of the data collected during supervisory visits.
“This function was impossible prior to AfyaSS. One checklist for a hospital had 564 papers to print. It was too time-consuming to sit down and analyze this data,” he said. “With AfyaSS, we are able to develop action plans quickly and easily while on site, because the system is scoring [the health facility] as you are carrying out the supervision.”
Maybe most importantly, the new AfyaSS system is contributing to a data-driven culture of care. Johanes and his team are able to analyze health facility data to deliver constructive feedback to health care workers that issues clear recommendations and outlines an action plan for improvement.
It’s also contributing to more ambitious data analyses and quality improvement efforts. Johanes recently used data from the system to develop a presentation about infection prevention and control and other supportive supervision findings for a quarterly maternal and perinatal death surveillance and review meeting in Morogoro. Because of the ease of navigating AfyaSS, health care workers had access to the same datasets, so he could share which areas had struggled with high maternal and perinatal mortality and better pinpoint trends. Johanes has also helped to introduce an award system for high-performing councils in the region. He hopes that this will further contribute to a culture of performance-based care.
In the meantime, Johanes is encouraging health actors across Tanzania to adopt AfyaSS for themselves.
