2.5 GIZ presentation on training successes, D. Wanyama, Enzaro Health Centre, LMG Health Conference 30Jan13
Leaders Drive the Health SystemResults of Mentorship Approach in GIZ Focal districts National LMG Conference Intercontinental Hotel, Nairobi January 2013
Background German Development Cooperation supports the Government of Kenya to improve equitable access to quality healthcare with a focus on Reproductive Health GIZ Target areas: Bondo, Butere, Gucha, Kisumu East & Vihiga Limited management competencies and limitations in translating theoretical technical skills in resource poor settings were identified as key challenges in health service delivery in the GIZ focal districts in the year 2009. With the participation of district partners, GIZ designed a two pronged capacity building initiative
Mentorship-Management ApproachIn 2012 the capacity building initiatives on leadershipfocused on three areas. These were jointly agreed betweenGIZ and participating district teams:1.The integration and scaling up of the management andmentorship approach.2.Ensuring sustainability of the initiative by strengtheningthe mentorship component and having the training offeredby a recognized training institution3.Strengthening management competencies at both DHMTand facility level.
Training Components The trainings were run as three distinct courses: Management for Effective Health (MEH) Plus Management Basics for Effective (MEH) 2012 Supervisory Skills for Effective Health (SSEH) The first phase of the training, facilitated by trainers from Kenya School of Government, consisted of face to face lectures. The second phase of the training, facilitated by a clinical mentor in close collaboration with trainers from KSG, involved implementation of a transfer project.
Indicators Targeted for Transfer Project• Increasing number of women attending the fourth ANC visit• Increasing uptake of FP services• Improving capacity of health providers on cervical cancer Screening and increasing number of eligible population screened.• Improving number of women accessing skilled birth attendance
Key Activities• Regular supervision and review meetings between mentors and mentees applying skills learnt during MEH and SSEH• Capacity building of staff on FANC, EOC,PAC,AMSTIL,FP, comprehensive RH, neonatal care and cervical cancer screening• HIS- strengthening use of diaries and phones in defaulter tracing; strengthening and upscaling CHW inventory of ANC clients• Health education-Advocacy targeting male involvement; community dialogues.• Community mobilization- through use of community health workers• Conducting outreaches• Rapid Results Initiative (RRI)• Collaboration with stakeholders
Impact of Intervention Improved quality of RH services in the district. Improved indicators in all three facilities targeted. Improved customer satisfaction
Got Agulu Sub-District Hospital th4 ANC Visit Facility Deliveries ANC attendance improved from 38 percent to 53 percent; Hospital deliveries increased from 90 percent to 102 percent
Nyangoma Dispensary th4 ANC Visit Attendance of fourth ANC visit increased from 45.6 percent to 70 percent.
Customers Perception on Services Offered at Supported Facilities Staff have become more friendly Improvement in quality of services offered Waiting time has reduced immensely Facilities are more sensitive to clients’ needs Infrastructure has improved Facilities are cleaner
Lessons Learnt Team development and leadership skills have a big influence on health service delivery outcomes Functional teams with effective leaders produced better results compared to teams that were struggling and had no clear leadership Selection of mentors should be based on demonstrable capacity to mentor/coach Improving on existing structures vis a vis adopting new ones is more cost effective in improving health service delivery Stakeholder involvement is important in achieving desired objectives
Facility ExperienceProject title: Increasing skilled delivery at Enzaro Health Centre.
Project FocusEnzaro Health Centre recorded low rates of facilitydeliveries (8.7 percent).This arose from a number of issuesincluding:•Existence of certified TBAs in the catchment population•Poor facility-community linkage•Poor infrastructure•Lack of a proper referral system in the community formothers in labour•Inadequate knowledge and skills among the technicalstaff particularly on management of labour, FANC andcustomer careThus the purpose of the project was to increase facilitydeliveries at the health centre from 9 percent to 43 percent
Key Activities• Refurbished maternity ward• Updated 10 skilled health providers on AMSTL, use of partograph, FANC and customer care• Introduced customer care desk• Collaboration with key stakeholders• Re-orientated TBAs to refer pregnant women to health facility for skilled attendance• Used TBAs as birth companions• Conducted regular home visits to expectant mothers• Used motorcycles to refer mothers in labor to facility• Introduced hot drink and warm water for bathing after delivery• Strengthened maternal data collection and utilization at the facility
Results: Skilled Birth Attendance at Enzaro Health Centre Deliveries increased from 9% to 52%
Lessons Learnt Training health providers on management and mentoring them to improve technical skills is effective in improving of health service delivery Community participation contributes immensely towards uptake of RH services Team work and commitment to change are key in improving services A facility can move to greater heights by using its own resources