16 worker in front of others, it will undermine the local<sup>respect for her which</sup> is essential for her effectiveness. The only exception<sup>to this rule is if the</sup> worker is doing something dangerous, such<sup>as not sterilizing syringes properly</sup> in an AIDS-endemic area. Then you must ensure<sup>that she is taken aside by one</sup> of the local supervisors and quietly corrected<sup>immediately.</sup> 'ur findings about constraints and problems should<sup>be used at two</sup> distinct levels. Where the problem appears to<sup>be a local one and not generic</sup> to the program, it should be discussed<sup>at the end of the day with local health</sup> service managers, and they should be asked to suggest<sup>a solution for it.</sup> More important for you, as a supervisor<sup>from the foreign aid agency</sup> or national capital, is to focus on those problems<sup>which are systemic in the</sup> program. There is no point in correcting an individual<sup>worker when some bad</sup> practice is widespread, because the problem<sup>lies not with her but with the</sup> training system which has ill-equipped her, or the<sup>MIS and supervision system</sup> which is sending her the wrong kinds of signals.<sup>Nor do most regional health</sup> service managers, given the centralized nature<sup>of most public health programs,</sup> have the power to correct these problems themselves.

Therefore, systemic problems need to be addressed at<sup>the center or</sup> state level through redesign of aspects of the program's<sup>software, after</sup> discussion with regional and central health service<sup>managers. But use the</sup> opportunity of your field visit to ask health<sup>workers and supervisors about</sup> possible solutions to systemic problems; they<sup>often know what needs to be</sup> done, even if they can't do it.

An example of the way in which an aide-memoire might be<sup>drafted to</sup> focus on systemic problems found during field<sup>supervision visits is given in</sup> the annex to this paper.

# Using The Process

Most supervisors focus on finding out what is<sup>going wrong and</sup> correcting things on the spot, at the<sup>expense of using the supervison process</sup> to improve program quality. The process can be<sup>used in at least three</sup> positive ways.

Giving Rositive feedback. Most supervisors focus<sup>and comment in</sup> their field visits on what is going wrong.<sup>Instead, focus on what is wrong</sup> and store it away for future analysis; but<sup>comment on what is going right.</sup> Praise the worker and her supervisor where<sup>they are doing well. This not only</sup> improves health service morale and performance.<sup>It sends important signals to</sup> your counterparts that you are on their side<sup>and not just a fault-finder.</sup> What you spend time on. Workers and their supervisors<sup>will note</sup> very quickly what you are spending time on. If you<sup>and the health service</sup> managers with you spend most of your supervision<sup>visit looking at health</sup> center records, you can bet that is what<sup>will workers will focus on before the</sup> next visit. If on the other hand, your time<sup>is spent in the village asking</sup> about outreach and the feelings of local<sup>people about the health service, this</sup> sends important signals to workers about what<sup>is important to management.</sup>