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On-site mentoring to improve the quality of Emergency Maternal and Neonatal Care (EMONC) in Nepal V. Broch Alvarez, T. Bharati, P. R. Silwal, B. Rajbhandari,
ISQUA17-1789
GIZ Support to the Health Sector Programme, Lalitpur, Nepal
Introduction and Objective
Exit client interviews (N=31) demonstrated the effects of mentoring on improved quality of care at the HFs. Majority of exit clients noted improvements in health worker’s attitude and motivation to work (55%), health worker communication (55%), cleanliness of the health facility (64%) and their overall satisfaction with the service (73%).
The mentoring approach promotes individual personal and professional learning through a close and trustful relationship between a mentor and a mentee over an extended period of time. Strengthening the capacity of human resources for delivering quality of care has been priority of the MoH in Nepal1. The importance of a more personal and effective approach than simple off-site training has been acknowledged only recently2. An intervention was executed by the MoH, supported by GIZ and implemented by GFA Consulting Group in technical partnership with Jhpiego between July 2014 and July 2016 in 58 facilities in ten districts of the Far Western, Mid Western and Central regions of Nepal to improve the clinical and management capacity of health workers and the management committees thereby improving quality of care. Within the framework of the intervention, an operational study was conducted with the guiding questions; 1) Does mentoring improve the clinical skills of health workers and the management of MNC services? [Effectiveness] and 2) Is mentoring an appropriate model of capacity development to improve the quality of MNC in rural Nepal? [Feasibility].
2. Improved management capacity through management mentoring Figure 2: The change in management performance of intervention and control facilities at midline and endline in A (Tool 1 – Committee structure and function), B (Tool 3 – MNC facility management and support services) and C (Tool 6 – Hygiene, Infection prevention and Waste management)
Results 1. Improved clinical performance through clinical mentoring Figure 1: The change in performance (clinical mentees in intervention sites) and (health workers in the control sites) in Tool 4- Normal delivery and Immediate Newborn Care (25 standards), and Tool 7 - Complications during labor and Childbirth (14 standards related mainly to newborn resuscitation and postpartum hemorrhage) between midline and endline.
25 22
20
18
15 10
Conclusions
5 2
Methods and Materials
0
A quasi-experimental longitudinal study, both quantitative and qualitative, was designed to assess both the clinical and the management performance. Independent research organization Center for Molecular Dynamics Nepal (CMDN) implemented the study.
-5
The changes in performance were measured within an intervention group of mentees and compared to the changes in performance in a control group that did not receive mentoring. Of the 10 intervention districts, 23 health facilities of the five districts were purposefully sampled for the operation research(OR) study. The 10 health facility from control districts were selected. A total of 3 assessments for the interventions sites and 2 assessments for the control sites over the course of project implementation were conducted making midline and the endline data comparable to each others. Qualitative interviews such as client exit interviews and key informant interviews with the concerned stakeholders were conducted to supplement the quantitative results. Contact Tulasa Bharati GIZ Support to the Health Sector Programme (S2HSP) Email:[email protected] Website:www.giz.de Phone:+977 – 1- 5013090
Tool 4
Tool 7 -4
-10 Intervention
Control
Note: There was a significant improvement in performance between midline and endline (from an average of 64% to 80%). The mean improvements of the score was 18% of all clinical mentees over the midline scores (p
ISQUA17-1789
GIZ Support to the Health Sector Programme, Lalitpur, Nepal
Introduction and Objective
Exit client interviews (N=31) demonstrated the effects of mentoring on improved quality of care at the HFs. Majority of exit clients noted improvements in health worker’s attitude and motivation to work (55%), health worker communication (55%), cleanliness of the health facility (64%) and their overall satisfaction with the service (73%).
The mentoring approach promotes individual personal and professional learning through a close and trustful relationship between a mentor and a mentee over an extended period of time. Strengthening the capacity of human resources for delivering quality of care has been priority of the MoH in Nepal1. The importance of a more personal and effective approach than simple off-site training has been acknowledged only recently2. An intervention was executed by the MoH, supported by GIZ and implemented by GFA Consulting Group in technical partnership with Jhpiego between July 2014 and July 2016 in 58 facilities in ten districts of the Far Western, Mid Western and Central regions of Nepal to improve the clinical and management capacity of health workers and the management committees thereby improving quality of care. Within the framework of the intervention, an operational study was conducted with the guiding questions; 1) Does mentoring improve the clinical skills of health workers and the management of MNC services? [Effectiveness] and 2) Is mentoring an appropriate model of capacity development to improve the quality of MNC in rural Nepal? [Feasibility].
2. Improved management capacity through management mentoring Figure 2: The change in management performance of intervention and control facilities at midline and endline in A (Tool 1 – Committee structure and function), B (Tool 3 – MNC facility management and support services) and C (Tool 6 – Hygiene, Infection prevention and Waste management)
Results 1. Improved clinical performance through clinical mentoring Figure 1: The change in performance (clinical mentees in intervention sites) and (health workers in the control sites) in Tool 4- Normal delivery and Immediate Newborn Care (25 standards), and Tool 7 - Complications during labor and Childbirth (14 standards related mainly to newborn resuscitation and postpartum hemorrhage) between midline and endline.
25 22
20
18
15 10
Conclusions
5 2
Methods and Materials
0
A quasi-experimental longitudinal study, both quantitative and qualitative, was designed to assess both the clinical and the management performance. Independent research organization Center for Molecular Dynamics Nepal (CMDN) implemented the study.
-5
The changes in performance were measured within an intervention group of mentees and compared to the changes in performance in a control group that did not receive mentoring. Of the 10 intervention districts, 23 health facilities of the five districts were purposefully sampled for the operation research(OR) study. The 10 health facility from control districts were selected. A total of 3 assessments for the interventions sites and 2 assessments for the control sites over the course of project implementation were conducted making midline and the endline data comparable to each others. Qualitative interviews such as client exit interviews and key informant interviews with the concerned stakeholders were conducted to supplement the quantitative results. Contact Tulasa Bharati GIZ Support to the Health Sector Programme (S2HSP) Email:[email protected] Website:www.giz.de Phone:+977 – 1- 5013090
Tool 4
Tool 7 -4
-10 Intervention
Control
Note: There was a significant improvement in performance between midline and endline (from an average of 64% to 80%). The mean improvements of the score was 18% of all clinical mentees over the midline scores (p
