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Empowering Health Workers_Ariel Higgins Steele_10.17.13

Empowering Health Workers_Ariel Higgins Steele_10.17.13






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  • Concern Innovations for Maternal, Newborn & Child Health (Innovations) - a collaboration between Concern Worldwide US, UNICEF and Ministries of Health - trialling several new innovative projects to explore the possibility of accelerating progress towards MDGs 4 and 5
  • Some of the world’s worst MNCH indicatorsMaternal mortality: 890out of 100,000 births (MMEIG 2012)Neonatal mortality: 50 out of 1,000 live births (2012, cited in APR 2013)Under-five mortality: 182out of 1,000 live births (2012, cited in APR 2013)A weak and under-resourced health systemNumber of health workers per 10,000 population: 2 (WHO 2011)WHO indicates that 23 HW (drs, nurses, midwives) per 10,000 is the critical threshold, below which is considered a shortageIn 2009, Innovations carried out a studyto better understand the biggest barriers to coverage of high impact MNCH interventionsBoth secondary and primary sources of data were collected Primary research was conducted in three districts with elevated mortality and low service coverage: Pujehun, Tonkolili and Western Area rural, and two urban slum areas in Freetown Consultations took place at district, health facility, community and household levels Data was collected using semi-structure instruments, FGDs, individual discussions and home inquiriesOur research teased out an aspect of quality improvement that could positively affect community perception of MNCH services and improve access, which was improving the quality of client/provider relationships.
  • Additionally,95% felt they “not at all” or “rarely” had positive relationships with patients95% felt they were “not at all” or “rarely” able to provide high quality care93% felt they were “not at all” or “rarely” able to manage their workload
  • While psycho-social techniques are used among frontline health workers in developed country settings, we found few examples in low resource settings. We therefore worked with a local organization and a psychosocial professional to develop a counseling method and training curriculum. [After the 10 weeks of group counselling was finished, there were original and then refresher trainings in Stress Management, Self Care, and Client Care (one training for each topic, so three in total for original trainings, and then the same thing for refresher trainings). Refresher trainings happened 10 months after original trainings. The refresher trainings have a slightly different content, as they also cover the pscho-educational topics which were taught in the group counselling.]
  • Conducted individual clinical assessments of health workers to determine the key stressors which lead to poor motivation, performance and relationships. Health workers, whose conditions were very traumatic and too sensitive for group therapy, were placed under individual counseling with frequent monitoring to follow up on their cases. 8 HWGroup counseling comprised 10 sessions and lasted for 3 monthsAll counseling is complemented with targeted training in key areas, including stress management, self-care and client-care. Three separate manuals were developed to ensure well tailored and well guided training execution. Training covers specific skills: counseling of clients, stress reduction techniques, communication skills, anger management and conflict resolution. Refresher trainingThis was a follow up intervention to reinforce health workers understanding in a holistic and comprehensive approach with regards overcoming the consequences of high stress and trauma in their work environment.
  • Preliminary analyses seem to indicate positive effects of intervention as compared to the group who did not receive

Empowering Health Workers_Ariel Higgins Steele_10.17.13 Empowering Health Workers_Ariel Higgins Steele_10.17.13 Presentation Transcript

  • Empowering Health Workers Through Psychosocial Support Techniques in Sierra Leone Ariel Higgins-Steele Policy & Knowledge Management Specialist Fall Meeting 2013 www.innovationsformnch.org
  • Innovations for Maternal, Newborn & Child Health, Concern Worldwide About this Initiative To identify and test innovative MNCH pilot projects that achieve transformative change, involve communities throughout the process, and capture learning related to outcomes as well as process www.innovationsformnch.org
  • The Context: Sierra Leone Some of the world’s worst MNCH indicators • Maternal mortality: 890 out of 100,000 births • Neonatal mortality: 50 out of 1,000 live births • Under-five mortality: 182 out of 1,000 live births A weak and under-resourced health system • Number of health workers per 10,000 population: 2 Continued barriers to accessing facility-based care • From Concern’s barrier research, women and caregivers perceived health workers to have low motivation, poor attitudes, and provide poor quality of care www.innovationsformnch.org
  • The Context: Health Worker Attitudes In Kono District, government health workers were assessed to understand their attitudes and perceptions prior to implementation (n=271) 96% felt not at all or rarely satisfied with their job 75% responded that they often felt stress on the job 65% responded that they were coping poorly with workplace stressors www.innovationsformnch.org
  • Theory of Change: Helping Health Workers Cope HWs unsatisfied and demotivated at work Improved knowledge and ability to apply coping skills Intervention www.innovationsformnch.org Improved well-being, job satisfaction and motivation Improved provider-client interaction Improved providerprovider interaction Greater client satisfaction (perception of quality of care) Improved MNCH outcomes
  • The Approach: Helping Health Workers Cope Objectives: • Improve coping techniques among health workers by addressing workplace stressors and introducing support services • Improve interpersonal relationships among health workers and with patients • Increase patient satisfaction • Increase facility-based care seeking Target population: 271 Health Care Workers in Kono District from 75 primary care facilities (catchment population of over 388,000 people) Timeframe: Aug. 2011 to May 2013 Implementing partner: Community Association for Psychosocial Services (CAPS) Scale: District-wide, with 12/14 Chiefdoms covered www.innovationsformnch.org
  • Intervention & Monitoring • Intake • • • Counseling – 10 weeks Training • • Clinical intake to assess group (263) or individual (8) counseling Client care, self-care, stress management Refresher www.innovationsformnch.org
  • Monitoring Data: Quantitative (1) Health workers report improvements across all categories: motivation, job satisfaction, relationships, etc. 100% 90% 80% Chart 1. Health workers feel motivated (n=271) 2% 13% 28% 70% 59% 60% 50% 40% 30% 72% 70% 31% 20% 10% 12% 0% Intake www.innovationsformnch.org 6% First follow-up Second Follow-up No FU Often Sometimes Rarely Not at all
  • Monitoring Data: Quantitative (2) 100% 90% 80% Chart 2. Health workers have positive relationships with their clients 4% 4% 7% 12% 32% 70% 59% 60% 50% 66% 40% 30% 63% 20% 31% 10% 16% 0% Intake www.innovationsformnch.org First follow-up Second Follow-up No FU Often Sometimes Rarely Not at all
  • Monitoring Data: Qualitative • Counselors collected stories/scenarios from health workers on how techniques were applied in real-life scenarios ranging from relationships (professional and personal) to informal support groups • Client interviews report improved health worker attitude and quality of care received at the health facilities. “There has been a dramatic change in her [health worker] attitude. Very few women used to come here [health center] but her new attitude to the community has encouraged us greatly.” - Theresa D., Client, Koakor Clinic, Kono District www.innovationsformnch.org
  • Evaluation Design Key questions: • What are the factors influencing active participation of HW? • What changes do HW perceive in themselves with regard to their knowledge levels and ability to apply/practice their skills, as well as the scope to do so? • How has participation in the project affected relationships at the workplace (provider-provider, as well as provider-client)? Mixed method evaluation comprised of • Health worker survey (against comparison group) • • • • Scale of job satisfaction and motivation (retrospective pre-tests) Anchoring vignettes FGDs for women of MNCH services Key informants www.innovationsformnch.org
  • Questions? Fall Meeting 2013 www.innovationsformnch.org