GMHC 2013, Arusha Tanzanie

Improvements in Quality of services through 6mely post-training support

Jean Pierre Rakotovao, MCHIP Chief of Party Marc Eric Razakariasy, MCHIP Training Advisor Claudine Ramiandrazafy, MCHIP Training Advisor Fanja Ralaiarifenina, MCHIP Monitoring Evaluation Responsible

Introduction Strategy

Background Results

Goals/objectives Lessons learned

To achieve the Millennium Development Goal # 4 and 5, one of the strategies being implemented is competency building of service providers with regard to maternal and neonatal health issues. However, these trainings have little impact without the establishment of an effective system of post-training follow-up and supervision

Introduction Strategy

Background Results

Goals/objectives

Lessons learned
Maternal Mortality
MMR: 498 per 100,000 live births (DHS) Ranked 141 out of 181 countries (Hogan 2010 Lancet) Major causes of maternal death (EmONC survey 2010):
Hemorrhage: 39% Prolonged labor: 22% Infection: 20% PE/E: 15%

Maternal and Reproductive Health

Population: 20 millions Total fertility rate: 4.8 (per DHS IV 2008) Contraceptive prevalence: 40% (modern methods: 29%) Antenatal care: 86% for 1+ visit Home delivery is high: 64% (has remained high)

We improve providers competency to take care of these main causes of maternal and neonatal deaths 3

Introduction Strategy

Background Results

Goals/objectives Lessons learned

Our strategy is to improve the competencies of providers posttraining by supporting them to maintain their level of acquired skills and thus offer a better quality of services. The approach consists of performing at least 2 post-training follow-up visits on a monthly basis after the training.

Introduction Strategy

Background Results

Goals/objectives Lessons learned

Historically in Madagascar, trainings of service providers has had unsuccessful results in building competency and increasing the use of new essential skills. Despite training evaluation results showing the acquisition of new skills by providers, in many cases these newly acquired skills were not appropriately applied. The MCHIP project explored the factors leading to the training failures and found that one reason has been the absence of adequate follow-up by the trainer or the coach in the workplace
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Introduction Strategy

Background Results

Goals/objectives Lessons learned

Established standard : conduct a followup or supervisory visit after 3 months of training. MCHIP found that this follow-up was not held for various reasons such as the lack of resources (no budgeting) and availability of coaches. Even in cases where the follow-up took place, the newly trained provider was not readily capable of applying the skills because he could not convince his direct supervisor to allow him to do so, or did not yet feel safe to perform the skills by himself.
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Introduction Strategy

Background Results

Goals/objectives Lessons learned

MCHIP's innovative approach was to introduce two post-training follow up visits on a monthly basis after the training. These visits offer an opportunity to reinforce skills and to follow-up on the trainee's action plan for mentoring. This approach allows for a rapid appraisal of any challenges or problems with the new skills as well as the opportunity to remedy them and build confidence and maintain competency in the provider

Introduction Strategy

Background Results
Miarinarivo
95.2

Goals/objectives Lessons learned

96 94 92 87.9 90 88 86 84 Training Follow up 1

93.95

Training Follow up 1 Follow up 2

Follow up 2

The space of one month is respected and the result shows a loss of 7.3 points on the first follow up and 1.25 points on the second.
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Introduction Strategy

Background Results
95

Goals/objectives Lessons learned

Ambatondrazaka
95 94 93 92 91 90 89 88 87 Training Follow up 1 Follow up 2 90 Training Follow up 1 Follow up 2 93.67

The space is two months : the result shows a loss of 1.33 points on the first follow up and 5 points on the second
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Introduction Strategy

Background Results
Toamasina
92

Goals/objectives Lessons learned

100 80 60 40 20 0 Training Follow up 1 58

83

Training Follow up 1 Follow up 2

Follow up 2

The space is more than three months between the training and the first follow up and 1 month between first and second follow up: the result show a loss of 34 points on the first follow up and 9 points on the second follow up. 10

Introduction Strategy

Background Results

Goals/objectives Lessons learned

Mean of competency score

95.2 100 90 80 70 60 50 40 30 20 10 0 Training Miarinarivo Follow up 1 Ambatondrazaka Toamasina Follow up 2 58 95 92 87.9 93.67 93.95 90 83

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Introduction Strategy

Background Results

Goals/objectives Lessons learned

Other organizations working in Madagascar have taken notice of these results and have begun budgeting and implementing timely post-training follow-ups. Providers who have benefitted from this new approach report high numbers of skills application, and report feeling more motivated and competent to apply effectively what they have learned.
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Introduction Strategy

Background Results

Goals/objectives Lessons learned

To maintain the level of competency Provide site anatomical models Provide job aids

Always involve the direct supervisor in the training and follow up

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Mer ci !

Misaotra !
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