WORKSHOP - 16th International Leprosy Congress

Salvador, Bahia Brazil - August 5, 2002


Prevention of Impairment and Disability (POID)

  Effective Supervision is the Key to Success




Linda Faye Lehman, OTR MPH C.Ped – Regional POID Consultant for Latin America & Africa for American Leprosy Missions


Priscila Leiko Fuzikawa, TO – Coordinator of Betim, Minas Gerais – Brazil Municipal Leprosy Control Program








The participant will be able to:

1.      Identify the need for POID within their setting.

2.      Develop an appreciation of supervision styles which facilitate or impede development of POID and differentiate between positive and negative supervision styles.

3.      Recognize the benefits which arise from positive supervision.

4.      Identify specific activities which prevent or minimize impairments and disability in Hansen’s Disease (HD) / Leprosy.

5.      Develop criteria needed to supervise POID within HD/Leprosy control programs.

6.      Identify and plan effective and appropriate methods and materials for supervision.




·        What is Supervision?

·        Why do you Supervise and what results do you expect?

·        Who makes the best Supervisor?

·        What do you do during Supervision? 

·        How do you Supervise and what makes it a  positive or negative experience?

·        How often should Supervision be done?



The Role of the Supervisor is to achieve results through people



Uses leadership, guidance, motivation, personal example and develops personal qualities of the persons he/she supervises.   RESULTS:  The individual desires to improve and is more confident

·        Understands personalities, differing needs and interest.

·        Recognizes potential ability and helps to develop it. (learning materials, learning opportunities / training, promotion, etc)

·        Provides regular opportunities to meet and share.

·        Gives opportunity for individual to control his/her own work. (objectives & methods to measure progress)

·        Realistic decision-making and planning, according to need, priorities and available resources.

·        Concentrates on key areas.

·        Avoids excessive close supervision and fault-finding over minor details.

·        Anticipates cases of problems and takes preventive action before they become unmanageable.

·        Sets standards of performance with the team.  (achieves desired results, be attainable, measurable and clearly understood by all)

·        Encourages the team to participate in establishing guidelines for ensuring that standards are maintained. (few, simple, reasonable & practical, enforceable, and understood by all)

·        Takes immediate corrective action when performance falls below the standards. (collect all the facts, Call individual to a private interview, listen to his side of the story, establish the extent of the deviation, decide the action to be taken and explain the reasons, take action, advise any others who could be affected and try to establish a normal relationships as soon as possible after the interview)

·        Ensures all the team understands the standards and reason for any corrective action.

·        Makes criticism of performance in a constructive manner, stressing the  correct way versus emphasizing the mistakes made.




Uses threats of disciplinary action, fault-finding and destructive criticism.   

RESULTS:  The individual is poorly motivated and feels as though he/she is a failure.



Some Definitions:

·        A guide, support and assist to the team at all levels to accomplish their tasks in the best way possible.  It is not only to assure the efficiency of the program but to also maintain the motivation and dedication of the health team to do their job.

·        The process of overseeing the performance or carrying out of specific actions and/or responsibilities.

·        The process of encouraging the members of a work unit to contribute positively toward accomplishing the organization goals.

·        The act of seeing that the work is completed satisfactorily and on schedule.  All work activities are related to stated objectives

·        The act of making sure that staff perform their duties effectively.   Guides and trains workers as necessary to help them become more competent in their work.

·        The effective monitoring enabling one to watch the progress and standards of the work in a program.  Monitoring is done by check-list, interviews, discussions and studying records and reports.  A program is redirected as a result of monitored information.

·        The act of achieving results through people.



·        Autocratic:  The health worker is told what to do with no choices to make and no influence on the type of work that is to be done (Do what I say!)

·        Anarchic:  The health worker can do whatever he likes.  (Do what you like!)

·        Democratic/Consultative:  The health worker is told about the job to be done and the desired results to be achieved.  Together the health worker and supervisor agree how best to do it.  (Let us agree on what we are to do!)



·        Persons who are able to clearly identify objectives and point all group efforts toward their achievement.

·        Those who trained the health-worker (trust & friendship)

·        Primary school teachers (knowledge and teaching skills)

·        Experienced worker (knows realities and problems of the work)

·        Workers expect their supervisor to be technically competent.



·        Inability or unwillingness to delegate work (skills, relationships, administrative)

·        Improper use of authority

·        Trying to be “one of the gang”

·        Setting a poor example

·        A lack of desire for the job



·        Understands and Recognizes the Workers as Individuals

·        Allows Staff to Control Their Own Activities

·        Concentrates on the Key Result Areas

·        Avoidance of Excessive Close Supervision

·        Anticipates Problems Before They Give Way to Crisis

·        Sets Standard of Work and Behavior

·        Encourages Staff to Participates in Drawing up Rules for Conduct

·        Takes Corrective Action

·        Makes Criticism Constructive

·        Thinks of Self as a Guide and a Leader




·        Job Factors (complexity, difficulty, need for quick decision, need for consistent results, need for creative work or new ideas)

·        Personal Factor (skill, reliability, experience, willingness to accept responsibility and make decisions)

·        Support available from community, team or other workers

·        Distance and cost

·        Reimbursement of costs

·        Seasonal Factors

·        Length of Visit

·        Normal workload



1.      What must be done (objectives)?

2.      Why must it be done?

3.      When should it be done?

4.      Where should it be done?

5.      How should it be done?




1.      Abbatt F and McMahon R.  Teaching Health-care Workers – A practical Guide, London, MacMillan Education Ltd., reprinted 1989.

2.      Feuerstein, Marie-Thérèse.  Partners in Evaluation:  Evaluating Development and Community Programmes with Participation, London, MacMillan Press Ltd., 1992.

3.      Fodor JT and Dalis GT.  Health Instruction:  Theory & Application (4th edition), Philadelphia, Lea and Febiger, 1989.

4.      Kanani S, Maneno J and Schluter.  Health Service Management – Learning Materials, Volume I, Kenya, African Medical and Research Foundation, Ministry of Health, Government of Kenya, 1991.

5.      Lankester T.  Setting Up Community Health Programmes – A practical manual for use in developing countries, London, MacMillan Education Ltd., reprint 1995.

6.      Mager Robert F.  Preparing Instructional Objectives (3rd edition), Atlanta, The Center for Effective Performance, Inc., 1997.

7.      McMahon R, Barton E and Piot M.  On Being in Charge - A guide for Middle-level Management in primary Health Care, Geneva, World Health Organization, 1980.

8.      Silva Joana Azevedo.  Capacitação Pedagógica para Instrutor/Supervisor Área da Saúde, Brasília, Secretaria de Modernização Administrativa e Recursos Humans, Secretário-Geral, Ministro de Saúde, 1989.

9.      Terry GR and Rue LW.  Programmed Leaning Aid for Supervision.  Illinois, Learning Systems Company, 1982.

10.  Wolff  JA, Suttenfield LF and Binzen SC.  The Family Planning Manager’s Handbook: basic skills and tools for managing family planning programs, In English West Hartford Connecticut, Kumarian Press, Inc 1991 and Portuguese Edition (Gerenciando Serviços de Saúde Reprodutiva), Boston, Management Sciences for Health / FPMD, 1999.