LMG & Community Engagement, Dr Gondi, MOPHS/Nyanza, LMG Health Conference 31Jan13
LMG and Community engagementThe 1st National Conference on Health Leadership, Management and Governance Dr. Gondi J. , MOPHS, Nyanza And: CHS TAG and JICA SEMAH project
Contents1. Background: CHS implementation2. LMG activities, roles and gaps of the various actors.3. Results from Nyanza CHS LMG study4. Conclusion and Recommendations.
Background CHS structure District CHS focal personReport submission Supportive Supervision CHEWs/CHCsReport submission Supportive Supervision CHWs HH visitation & Data collection Service provision Households
Background∗ Nyanza has 6 counties; Total C.Us = 633; 2 counties (Siaya and Homabay) have 100% CU coverage.∗ LMG trainings are conducted to DHMTs and health workers in the health facility. In Nyanza 100% DHMTs trained on LMG through SEMAH project.∗ For the CHS; LMG is included in the CHC and CHEW trainings.
Background: leadership issues on CHEW∗ LGM training components in standard CHEW training manual is inadequate in LMG∗ Standard Policy on performance enablers: Transport;∗ Diverse professional background of CHEWs ?
CHCs• Clear guideline on membership• LGM training for CHC members exists.• Overall Effective Participation in CHS challenged by: • Weak resource mobilization. • Expectations versus Voluntarism. • Complex and technical training manual
CHWs∗ Identified and Selected through a participatory community approach.∗ Trained through a basic and advanced package to improve quality and performance. LMG limited.∗ HH coverage target of 100 HH/month difficult to attain.∗ Enablers and motivation provided for effectiveness is diverse: ∗ CHW KIT, ∗ Transport Retention, ∗ Stipend? Satisfaction ∗ Recognition etc.
Nyanza CHS LMG study∗ So, We introduced a pilot study on refresher training with LMG components conducted in 4 district, Nyanza province∗
Background Reporting - CHS structure with gaps-monitoring tool District CHS focal person (checklist) Report submission Supportive Supervision Reporting CHEWs/CHCs Training monitoring tool Report submission Supportive Supervision CHWs Training HH visitation & Data collection Referral & Defaulter Service provide tracing mechanism Households
The results from baseline survey Even though these knowledge are minimum requirement for CHEW and CHWs, They had limited knowledge The cascade down from CHEW to CHWs and Household member is one of the issues. LGM skill and facilitation skill must be useful to solve.
Refresher CHEW & CHWs training components Case management 1. High impact interventionFacilitation skill 2. Risk factors in pregnancy1. Leadership management & Data management 3. Danger signs in pregnancygovernance 1. Data definition / collection 4. Danger signs in neonatal2. Coaching and Mentoring 2. Data cleaningsummarizing and childhood3. Overview of facilitation skill 3. Data analysis / 5. Case management for4. Time management/Effective presentation neonatal health andmeeting 4. Data interpretation nutrition4. Communication skill 6. Case management for5. Report/Proposal writing skill major diseases
CHEW&CHWs refresher training with LMG components∗ Participants: Community health extension workers (CHEWs) Community health workers (CHWs)∗ Schedule: This trainings were monthly based, one day intensive training. In total, 7 days trainings were conducted from Jan to July. The training consist of two phase. Step one: Refresher CHEW training by DCHSFP Step two: Cascade down training to CHWs by CHEWs
Study design Clustered Randomized Control Trial (cRCT) SY KW Gem Ugenya Target 64 CUs in 4 pilot district Base-line survey Cluster random samplingGroup 3 : 24 CU Group 2 20 Group 1 20 1.Facilitation skill CHEW & CHWs training 2.Case Management 3.Data management 1.Referral and defaulter Defaulter Tracing activity tracing card 2.Defaulter tracing model End-line survey Comparison of the three groups
Effectiveness of the community model-Results from cluster randomized control trial- P<0.001 ∗ Compared with control group, the health knowledge P<0.001 on HII, Danger sings etc of CHEW, CHWs and household member (mother with children aged 1-2 years) was significantly improved (p< 0.001). ∗ The Number of Household coverage by CHWs was also significantly increased, compared with control group (p< 0.001). (Increased by nearly 1.5 times)
Conclusion and Recommendations∗ Streamline the CHEW recruitment for effective performance. In addition, given the diverse backgrounds, the CHEW training, supervision and continuous support need to harmonized and strengthened.∗ It is important to conduct refresher training including LMG components to the existing CHEWs.∗ Integrate LMG components when a training on specific technical topics, so that the knowledge gap between CHEW, CHWs and HH member is reduced.
Recommendation cont..∗ STANDARDISE CHW stipend issue; from the study here, CHW performance improved without stipend???∗ Review HH Coverage target? focusing on Priority HHs such as HH with MNCH etc.∗ Feedback on the CHC training manual from the implementers.