In this section, communication and logistics are combined because the proper distribution and administration of resources — ensuring that people and materials are where they are needed and when they are needed — inevitably depend on a second communications system. Proper planning is the first essential step in every well-managed program. In terms of resource allocation and supply distribution, poor planning can lead to disastrous results.
It may mean that the necessary personnel or vaccines are not in the right place at the right time. If these problems occur on vaccination days at dispensaries or outreach posts, the activities will have to be affected. People who walked long distances and lost time in order to bring their children for vaccination may not return another day. Public response will suffer considerably if such problems occur more than once.
Functions of a Logistics System
Together with a communications system, an effective and efficient transport system is indispensable for the distribution of vaccines and supplies and for supervisory visits. In short, supply and supervision are the two main uses of vehicles.
Supply: In order for health centers to function properly and provide services continuously over a certain period, medicines, materials and vaccines must be supplied regularly and without interruption. The use of a sufficient number of safe vehicles, maintained regularly and appropriate for the type of terrain, is an essential factor.
Supervision: The lack of regular supportive supervision tends to make employees become complacent. Supervision, when carried out properly and periodically, supports the continuation of quality services for the public seeking immunization, among other primary healthcare services.
In this regard, vehicles serve a dual purpose. When procedural problems or equipment failures arise, health personnel can rely on the regularly scheduled supervisory visit to solve those problems. A radio communications system can also be used when problems arise.
The lack of a reliable communications system can wreak havoc on any program. Depending on communications systems such as those that currently exist in most developing countries means continuing to deal with a high degree of uncertainty. These uncertainties cannot be tolerated when the shipment of perishable vaccines and fixed immunization dates and locations are involved.
A reliable and constant communications system can help prevent shortages of medicines, vaccines and supplies; loss of life in medical emergencies; missed meetings; last-minute corrections and discussions regarding supply orders, accounting or healthcare procedures; and delays in repairing stalled vehicles.
A radio communications network will help improve program coordination, administration, supervision and reporting, as well as consultation and continuing education.
Other Management Considerations
Administrative Aspects
An effective administrative organization includes the delegation of authority and the assignment of responsibilities to properly trained personnel. Supervisory activities and lines of communication must be clearly delineated.
Problems often arise when people are unsure of what they must do, when it needs to be done, and why or for what purpose a given activity is required. Complete job descriptions, including duties and responsibilities, must be formulated on the basis of what it is feasible for a given individual to carry out within the limited time available.
Each person must be held responsible for the execution of their work. Supportive supervision carried out systematically should serve to strengthen administration. A management information system must be established to allow information to circulate rapidly through the different levels of the organization.
Administrative paperwork should be simplified in order to provide the minimum amount of information needed for the upper level to monitor and evaluate activities. Useful feedback should be supplied through forms sent to all levels, but especially to the local level.
Supervision of Personnel
Supervisory visits to local health services provide a good opportunity to evaluate how well immunization activity is being carried out. The vaccination supervisor evaluates vaccine conservation, sterilization techniques, technical knowledge about immunization, and the collection, recording and communication of data obtained through surveillance. The supervisor may also provide supplies needed by the healthcare service.
The supervisor has the opportunity to erase the feeling experienced by many people working in remote health facilities of being isolated, separated and not an important part of the overall primary healthcare structure.
These supervisory visits also provide the opportunity to work with health personnel, motivate them, resolve questions or problems they may raise, and introduce needed improvements. Continuing education may be carried out through the introduction of new concepts or methods of application.
Therefore, supervisory visits are of fundamental importance for improving the quality of primary healthcare services and should be scheduled as a systematic part of immunization activities.
Supervisory activities must be carried out at all levels. Within the primary healthcare system, a mechanism must be formalized to collect, summarize and act on the information obtained through supervision.
The number of personnel carrying out supervisory activities will vary according to the size of the primary healthcare system and the extent to which immunization activities are part of that system. Most managerial positions include supervisory responsibilities. Very few positions, if any, are exclusively supervisory.
Competent supervision can help ensure that certain tasks are properly performed. Not everyone involved in supervisory activities can take an EPI training course. However, there are two important supervisory techniques that should be included in training courses:
a) Observe and reinforce correct performance. If field personnel are carrying out their work correctly, they should be personally praised. Recognition of a “job well done” encourages them to continue performing well.
b) Identify and correct inadequate performance before it becomes a major problem. If field personnel are not carrying out their work properly, the supervisor must take responsibility for helping them improve.
Perhaps the most important aspect of supportive supervision is the identification of problems and their correction before they become widespread. It is essential to offer immediate solutions to these problems: solutions that can be explained simply, are easy to understand and, when put into practice, produce better results.
Supervised personnel should receive the benefits derived from participating in self-evaluation, identifying problems and offering solutions to them. They should be made to feel that what they do is important and has an effect on the whole of immunization activities and, specifically, on the community they serve.
