[Evaluation of a supervision program of health centers at the district level in Madagascar]

Poor supervision and follow-up have long been recognized as major weaknesses in the development of primary health care in many countries. A program has therefore been specifically developed to strengthen the supervision activities of 18 rural health centers in Madagascar. District health officers were appropriately trained and then conducted two-monthly supervision visits. The emphasis of the training program was on problem solving, program integration and on-site training. The effects of the supervision program was assessed quantitatively and objectively. Various activities of each health center were scored before intervention, and one year after implementation of the supervision program. The improvement in most health centers was substantial, both in quantitative coverage and qualitative practice. Nevertheless, some centers appear to have been resistant to change.