The Role of Intensive Mentorship in EmONC Improved Quality of Care

The MCHIP Approach in Mansa Zambia

Saving Mothers, Giving Life

Martha Ndhlovu January 2013

What is mentorship?
Mentorship is the process where-by an experienced, highly regarded and empathetic person (mentor) guides another individual (mentee) in the development and reexamination of their own ideas, learning and personal and professional development.

What is mentorship?
Mentoring is a challenging task that requires flexibility, excellent communication and relationship-building skills and the ability to cope with rapid change of direction, in addition to possessing up-to-date clinical knowledge and teaching skills Different from traditional supervision

How do facility staff react to the arrival of traditional supervisors?

LETS RUN, THOSE GUYS ARE HERE AGAIN

TS RURAL HEALTH CENTRE

THE TRADITIONAL SUPERVISORS

How do staff react to the supportive mentors?

SUPPORTIVE MENTOR PARADISE HEALTH CENTRE
HI ! EVERYONE MIKE, WELCOME ! WE ARE GLAD TO SEE YOU

Target Providers for Mentorship Visits

Health care workers who have received inservice EmONC and HBB training Other health care workers, who have not received any specific in-service training but are working in specific focus areas (e.g., child health, obstetrics and gynaecology)

Mentorship Design
1) Trained team of 16 Mansa District mentors in:
Mentoring skills IRH Supervisory Tool & EmONC Skills Checklists Anatomic models to guide on-site clinical simulations Data collection and support Reporting

2) Team of 2-3 mentors visiting every delivering facility on a monthly basis

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Mentorship Visits
At each visit, mentors:
1) Set objectives for the mentorship visit 2) Assist the health center to service any back-up of clients in order that the providers have time to sit with the mentor 3) Review the SM Register, delivery client files and partographs and discuss with the providers what is going well and challenges experienced

Mentorship Visits (contd)

At each visit, mentors:
4) Observe client care (if there are active cases), using IRH Supervisory Tool as standards-based guide 5) Review basic EmONC skills on anatomic models, using skills checklist 6) At visit conclusion, together with the mentee:
Review objectives to determine if they were met If objectives not met, identify reason Deter interventions to address objectives Agree on timeline to meet objectives Agree on responsible person to meet objectives
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Mentorship in Action
Mentor demonstrates HBB Mentee conducts return demo

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Quarterly Recognition Meetings

Quarterly Recognition/Clinical Update Meetings held with staff representatives of all facilities High-performing facilities are recognized and presented with plaque by DMO; all facility staff receive recognition certificate Recognized staff are highly motivated and staff from other facilities return to their facilities with motivation to improve service delivery

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Quarterly Recognition Meetings

Receiving certificates Plaques for deserving centers

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Impact of Mentorship
Immediate & sustained application of skills learned during EmONC training Improved provider confidence and morale HCs now managing complications which previously were referred (e.g., manual removal of placenta, MVA)
Improved outcomes for pregnant women Reduced pressure on emergency transport systems

and referral facilities

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Impact (contd)
Increased use of the partograph (0.06% to 29%). 78% correctly filled Improved documentation in service delivery registers AMTSL applied in 88% of deliveries, even with 3-fold increase in number of facility deliveries since October 2011.
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Keys to Success
Strong ownership by Mansa DHO Involvement and collaboration of many district partners DHO, PHO, Mansa GH, ZPCT II, ZISSP and UNFPA Proper training in mentorship skills Use of anatomic models for on-site clinical simulations
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