A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

Abstract

Background: There is increasing demand for trainers to shift from traditional didactic training to innovative approaches that are more results-oriented. Mentorship is one such approach that could bridge the clinical knowledge gap among health workers. Objectives: This paper describes the experiences of an attempt to improve health-worker performance in maternal and newborn health in three rural districts through a mentoring process using the cascade model. The paper further highlights achievements and lessons learnt during implementation of the cascade model. Methods: The cascade model started with initial training of health workers from three districts of Pallisa, Kibuku and Kamuli from where potential local mentors were selected for further training and mentorship by central mentors. These local mentors then went on to conduct mentorship visits supported by the external mentors. The mentorship process concentrated on partograph use, newborn resuscitation, prevention and management of Post-Partum Haemorrhage (PPH), including active management of third stage of labour, preeclampsia management and management of the sick newborn. Data for this paper was obtained from key informant interviews with district-level managers and local mentors. Results: Mentorship improved several aspects of health-care delivery, ranging from improved competencies and responsiveness to emergencies and health-worker professionalism. In addition, due to better district leadership for Maternal and Newborn Health (MNH), there were improved supplies/medicine availability, team work and innovative local problem-solving approaches. Health workers were ultimately empowered to perform better. Conclusions: The study demonstrated that it is possible to improve the competencies of frontline health workers through performance enhancement for MNH services using locally built capacity in clinical mentorship for Emergency Obstetric and Newborn Care (EmONC). The cascade mentoring process needed strong external mentorship support at the start to ensure improved capacity among local mentors to provide mentorship among local district staff.

On-site clinical mentoring as a maternal and new-born care quality improvement method: evidence from a nurse cohort study in Nepal

“…This difficulty is inherent to QI programs in EmONC. Emergencies in maternity settings are often unpredictable and rare in places with low caseloads [26]. Moreover, the data we collected did not allow us to identify the potential impact of the program on maternal and new-born outcomes.…”

“…A higher score at the end indicated that the mentee improved her knowledge or clinical skill a Significance was assessed using the Wilcoxon matched-pair signed-rank test; P was estimated for two-sided test, testing for both positive and negative increases at the end of the programme. The test showed that none of the loss in performance score was statistically significant b For skilled birth attendants only mentors further trained and mentored by provincial mentors, as successfully implemented in Uganda in the area of MNC [26]. Nepal has, however, taken a very promising step forward by launching a midwifery education program [27][28][29].…”

“…This finding may be due to one innovative feature of this mentoring program: the bundle approach linking clinical and management mentoring. Given that high-quality clinical services strongly depend on management support for the provision of basic infrastructure, water, power, equipment and supplies, as well as regular cleaning and maintenance, all clinical mentoring activities were organized jointly with the management mentors, promoting synergy, interaction and collaboration between the clinical and management teams, as seen elsewhere [26]. At the facility level, clinical and management teams developed the habit of discussing context-specific needs and of developing and effectively implementing gap-closing plans.…”

Perspectives on External Support to Low Level Private Health Facilities in Management of Childhood Infections in Mbarara District, Uganda: A Qualitative Study With Health Workers and Policy Makers

“…While the support needed by the LLPHF is contextual and may vary from simple materials to use in the health facilities to funding for infrastructural improvement, both policy makers and health care providers agreed that all the facilities need capacity building by training and technical supportive supervision. Other studies carried out in Uganda and other LMICs have demonstrated improvement in quality of care when support is given to lower level facilities [28][29][30][31][32] while Hill et al demonstrated that a supervision strategy with a supportive approach was most effective in getting good results, even though these studies mainly considered community health workers [33]. Some LLPHF lack basic items for provision of rst line lifesaving services and therefore, material support is also crucial.…”

Addressing barriers to quality of underutilized commodities and services for prevention and management of pre-eclampsia and eclampsia in Kenya

“…High provider attrition and redeployment affects practice and results, due to repeated retraining. Innovative MNH training approaches, especially with high staff turnover and need re-train staff on site, have been proven to work 39,40,41 . Evidence shows that PHC workers, with training, can offer MgS04, especially if supported with functional referral systems 38 .…”