Peer-driven quality improvement among health workers and traditional birth attendants in Sierra Leone: linkages between providers’ organizational skills and relationships

Abstract

BackgroundSierra Leone has among the poorest maternal and child health indicators in the world and investments in public health have been predominately to increase demand for services, with fewer initiatives targeting supply side factors that influence health workers’ work environment. This paper uses data from the Quality Circles project in a rural district of Sierra Leone to achieve three objectives. First, we examine the effect of the intervention on organizational skills and relationships among coworkers as well as between health workers and traditional birth attendants. Second, we examine whether changes in organizational skills are associated with changes in relationships among and between formal and informal health providers and between health providers and clients. Third, we aim to further understand these changes through the perspectives of health workers and traditional birth attendants.MethodsThe Quality Circles project was implemented in Kailahun District in the Eastern province of Sierra Leone from August 2011 to June 2013, with adjacent Tonkolili District serving as the control site. Using a mixed-methods approach, the evaluation included a quantitative survey, in-depth interviews and focus group discussions with health workers and traditional birth attendants. Mean values of the variables of interest were compared across sub-populations, and correlation analyses were performed between changes in organizational skills and changes in relationships.ResultsThe results demonstrate that the Quality Circles intervention had positive effects on organizational skills and relationships. Furthermore, improvements in all organizational skill variables – problem-solving, strategizing and negotiation skills – were strongly associated with a change in the overall relationship variable.ConclusionsThe Quality Circles approach has the potential to support health workers to improve their organizational skills and relationships, which in turn can contribute to improving the interpersonal dimensions of the quality of care in low-resource contexts. This method brings together peers in a structured process for constructive group work and individual skill development, which are important in low-resource contexts where active participation and resourcefulness of health workers can also contribute to better health service delivery.

Improving inpatient provider-initiated HIV testing and counseling in Sierra Leone

“…These findings are consistent with studies showing that the use of QI methods and the QIC approach can empower health facility teams to identify and address process and management barriers to attaining high quality health services [19,20,23,27]. Contexts in which national guidelines and standards exist and quality challenges can be addressed at the facility level are optimal settings for QI interventions, which have been used successfully to address other quality challenges in Sierra Leone [28,29,30]. To our knowledge, this is the only study of QIC methodology to improve inpatient PITC coverage, but other PITC implementation projects report similar challenges, such as non-standardized workflows, suboptimal staffing and test kit shortages [10,11,31].…”

“…The four QI learning sessions were well-attended, with an average of 50 participants attending each of the quarterly meetings. The initial training increased participant knowledge, as shown by improved performance on a multiple-choice test, from a median of 41% (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47) at the pretest to 73% (60-85) at the post-test (p < 0.0001). ICAP and MoHS provided twice-monthly supportive supervision, making a total of 188 site visits to the ten sites between October 2017 and August 2018.…”

Examining domains of community health nurse satisfaction and motivation: results from a mixed-methods baseline evaluation in rural Ghana

“…It has been theorized that improved supervision and better relationships among the CHNs may have an impact on job satisfaction and motivation [ 7 , 8 ], as well as clinical knowledge and performance [ 9 ]. Some studies have found that collaborative skill-building can improve both performance and inter-personal relationships among health workers [ 10 , 11 ]. These questions are especially relevant to Ghanaian CHNs, given that these health workers live in environments of professional isolation and limited support.…”

Status of the Latest 2016 World Health Organization Recommended Frequency of Antenatal Care Contacts in Sierra Leone: a Nationally Representative Survey

“…Globally, about 295,000 maternal deaths were registered in 2017 and majority of these deaths occurred in low-income countries [1]. Sub-Saharan Africa accounts for 66% of maternal deaths globally (196 000) [1].…”

“…Globally, about 295,000 maternal deaths were registered in 2017 and majority of these deaths occurred in low-income countries [1]. Sub-Saharan Africa accounts for 66% of maternal deaths globally (196 000) [1]. Three sub-Sahara African countries; South Sudan, Chad and Sierra Leone have the highest maternal mortality ratios globally [1].…”