Education & Performance

In Francophone West Africa, 3,000 More Nursing and Midwifery Students Are Benefitting from Competency-Based Training Matching Local Needs

cbales — Mon, 20 Nov 2023 16:19:57 +0000

In Francophone West Africa, 3,000 More Nursing and Midwifery Students Are Benefitting from Competency-Based Training Matching Local Needs cbales November 20, 2023 November 20, 2023

IntraHealth is partnering with Takeda Pharmaceutical Company Limited to improve maternal and child health in Mali, Senegal, and Niger by sustainably increasing the number of skilled nurses and midwives ready to serve rural communities.

Through the Classroom to Care (C2C) project, funded by Takeda's Global Corporate Social Responsibility (CSR) Program, IntraHealth International is improving access to high-quality maternal and child health care in Mali, Niger, and Senegal by strengthening the preservice training of nurses and midwives in 12 private health schools. Now at the end of the second year of the project, more than 3,000 nursing and midwifery students—75% of whom are women—are benefiting from updated curricula adapted to local clinical practice.

The project is responding to several pressing issues. There is a critical shortage of health workers (nurses, midwives, and doctors) available in the three countries, with only 6.1 health workers in Mali, 3.9 health workers in Niger, and 4.3 health workers in Senegal for every 10,000 people. The shortage is even more acute in rural areas. Currently, traditional preservice education curricula have not prepared health workers for real-life work conditions, and many health training institutions are inadequately equipped and unaccredited. Furthermore, women are disproportionally disadvantaged when it comes to enrollment and graduation due to a variety of factors, such as family responsibilities. Discrimination against women and gender inequalities directly impede development of the health workforce to provide equitable and accessible health services.

Meanwhile the maternal mortality rate remains very high in the three countries, with 315 deaths per 100,000 live births in Senegal, and more than 500 deaths per 100,000 live births in Mali and Niger. And in Mali and Niger, approximately 10% of children die before their fifth birthday.

Competency-Based Approach

Competency-focused preservice education is critical for the provision of high-quality maternal and child health services that meet local needs. Since 2006, the West African Health Organization (WAHO) has pushed to harmonize training curricula for nurses and midwives in the Economic Community of West African States (ECOWAS) region that addresses current disease patterns as well as intra-regional migration. The curricula use a competency-based approach (CBA) that considers population and student needs to replace classic training. Many health schools in the region, however, have still not started the process of implementing the WAHO standardized curricula or been able to train a critical mass of teachers on CBA.

From 2017-2020, the USAID/Mali Human Resources for Health Strengthening Activity, led by IntraHealth, supported the use of competency-based curricula in 10 schools and strengthened policies and practices related to recruitment and retention of students, leading to improved performance of health workers.

The five-year C2C project builds on this work and supports four private schools in each country to strengthen preservice education of nurses and midwives through enhanced competency-based curricula; train teachers and others in the CBA, achieve the appropriate accreditations; and promote diversity, equity, and inclusion (DEI) to increase the number of nursing and midwifery graduates, particularly women from marginalized communities and vulnerable groups.

C2C partners with a diverse set of stakeholders, including WAHO, government bodies including the ministries of health and education in each country, government units such as the Human Resources Division and the Division for Mother and Child Health, private school associations, health professional associations, and Empower School of Health.

Preliminary results

C2C conducted an in-depth needs assessment to identify the baseline for each school, then developed capacity-building plans for all 12 schools to address gaps in national accreditation standards, purchased essential teaching equipment for competency labs, and digitized eLearning modules harmonized with the WAHO curricula.

At the end of Year 2, the project has:

Supported the development and validation of CBA teacher training documents at the national level, including a reference manual, trainer’s guide, and participant workbook.
Through updated CBA training programs, improved the skills and knowledge of 3,721 students, teachers, and school management staff:
- 398 teachers acquired skills and knowledge in adult teaching techniques.
- 250 teachers and clinical supervisors received training on competency-based curricula.
- 3,073 students (2,361 women) benefited from updated curriculum content with tools adapted to clinical practice.
Developed an Accreditation and Quality Assurance Roadmap for all three countries, established internal quality assurance and accreditation units in each school, and oriented 62 educational advisors on quality assurance—laying the groundwork for the accreditation process.
Digitized 33 maternal and child health teaching modules and developed an eLearning platform in collaboration with Empower School of Health. This platform is a comprehensive learning management system tailored to each country, and the modules cover topics such as pediatrics, anatomy, community health, and obstetrics. The eLearning platform incorporates DEI considerations in its design, audio and visual features, and mobile and offline options.
Established inter-ministerial technical working groups in the three countries and initiated a regional private sector community of peers and a community of practice on medical sciences training.

What’s next

C2C is currently conducting DEI situational analyses in all three countries, and in the next year will use them to develop school-specific DEI plans that apply DEI best practices, such as providing nurseries and lactation rooms, to make partner schools more inclusive for women students and boost well-being and academic performance.

C2C will launch the eLearning platform and over the next three years will expand the platform to also include management and leadership courses and solidify it as the standard in health care education across West Africa. C2C will ensure each partner school receives the necessary equipment and technical support to set up competency and computer laboratories. C2C will deepen engagement with stakeholders, from government bodies to local communities, ensuring that the project's impact is sustainable and far-reaching.

The project will also continue its Private Sector Community of Practice, strengthen public-private partnerships through the technical working groups, and oversee implementation of action plans in each school.

By the end of the project, C2C aims to have 580 teachers trained on the CBA, 9,720 students benefiting from quality training, and all 12 private health schools accredited.

Learn more about the Classroom to Care project in three short videos produced by IntraHealth’s Mali team for a virtual visit this month with Takeda.

Mali Niger Senegal Maternal, Newborn, & Child Health Education & Performance eLearning Private-Sector Approaches Midwives NursesPhoto by Amadou Iam Diallo for IntraHealth InternationalClassroom to Care: Training to Expand Access to Maternal and Child Health

Three Steps NGO Leaders Can Take toward a Future of Inclusive, Locally Led Development

ihadmin — Mon, 01 May 2023 12:43:36 +0000

Three Steps NGO Leaders Can Take toward a Future of Inclusive, Locally Led Development ihadmin May 01, 2023

April 27, 2023

Lessons in localization with global health CEOs Maqsoda Maqsodi and Pape Gaye.

If you ask the head of any international or regional NGO what is on their mind lately, chances are it’s the same thing that’s on ours: the localization debate.

And it truly is a debate—opinions vary on every aspect of it, from what we should call it to how to do it, and how to help your organization survive it. Those of us who follow such things have seen an onslaught of opinion pieces on this topic lately, most of which highlight northern perspectives and the points of view of implementers and donors.

Shifting power is the right thing to do.

It seems there are two things on which we all generally agree: 1) that shifting power and resources to local organizations that know their communities’ needs and contexts best is the right thing to do, and 2) that doing so will fundamentally change our businesses.

Adaptation is not optional. But how?

Many organizations are passively resisting this shift, acquiring one another or creating subsidiaries that call themselves local but are in fact not. Others have long recognized that localizing programs has always been the end game, and so they’ve invested in creating local organizations that eventually become independent entities.

As we embark on adapting our two organizations—IntraHealth International and the Baobab Institute—we are asking ourselves some tough questions. How do we leverage the progress we’ve made as a global community over the last 50 years? How do we safeguard the partnerships and collaborations that have made that progress possible? And what steps must we as NGO leaders take to avoid sustaining the very systems we’re trying to change?

In short, how do we avoid being the colonizers?

As two CEOs who are not white, were not born in the United States, and are leaders of organizations that work to expand access to health care in low- and middle-income countries like the ones in which we were born, we want to share three steps we and other global health leaders can take to build a future of inclusive, locally-led development—and expand our impact at the same time.

1. Advocate for the local point of view.

So far, the conversation about localization has focused on shifting resources—but it should instead be about shifting power.

To do this, we must hear and listen to more local voices. As NGO leaders, we must do all we can to make sure the local point of view is prominent in conversations where decisions are made, to create safe spaces for representatives of local communities to speak and be heard, and to amplify their messages through our own platforms.

Here are just a few examples of how we’ve seen this done effectively:

Giving local voices center stage at global conferences. Amref’s Africa Health Agenda International Conference, the Africa Health Business Symposium, and IntraHealth’s SwitchPoint event series are all great examples of global events that prioritize local issues and amplify local voices. The Frontline Health Workers Coalition and the Community Health Impact Coalition ensure their events at major fora feature local experts—including health workers—as speakers.
Supporting coalitions that are—or can eventually be—locally owned. The Ouagadougou Partnership is a fantastic example. In 2020, these nine governments in francophone West African countries registered more than 3.8 million additional users of modern family planning methods in the region, in part by catalyzing indigenous young people’s voices. The partnership’s coordination unit was managed by IntraHealth during 2011-2021 and funded by the William and Flora Hewlett Foundation and the Bill & Melinda Gates Foundation. In 2021, IntraHealth transferred leadership of the coordination unit to Dakar-based Speak Up Africa.
Training local health workers to advocate for themselves and their clients. When IntraHealth, the Frontline Health Workers Coalition, and Medtronic Foundation teamed up to train health workers from around the world to share their accounts of providing health services to underserved communities, those health workers began gaining influence at the highest levels of policymaking. With coaching and support, health workers who’ve never traveled beyond their communities can persuade policymakers worldwide to strengthen their health systems and expand access to the services they provide.

2. Rethink how our activities are designed.

As leaders of NGOs, it’s easy to stay in the mindset of the funding organizations with whom we work, most of which have traditionally dictated what, where, and how development work is to be done. It’s a top-down approach that creates systemic power imbalance right off the bat.

But consider how the power would shift if countries conceptualized their own activities, based on their own data and their own understanding of their populations’ needs.

USAID has taken the lead on localization.

Fortunately USAID has taken the lead on localization, come up with a strategy, and begun moving this agenda forward using everything the agency has learned from PEPFAR and other initiatives. One major focus of USAID’s strategy is building the capacity of local NGOs to manage available resources, such as through USAID’s Accelerating Support to Advanced Local Partners project.

This is an essential part of solving the power imbalance—but it’s not enough.

International NGOs must embrace a new mindset. We must be willing to commit to deliberately, effectively transitioning responsibilities to local entities. And we must invest more in the design phase of activities, supporting countries to analyze the available data and use those data to inform how they approach funders.

3. Become a broker to help both donors and partner countries get results.

To make locally led development a reality, international and regional NGOs have a critical role to play. We’re well positioned to advise, provide technical services, and serve as brokers between donors, governments, and their local partners to help get the best out of their investments to generate global public goods.

But to do so, we must:

Agree on a new agenda—one that accelerates countries’ progress, rather than merely continuing it.
Develop a new set of principles driven by inclusion, equity, and host countries’ goals to eradicate poverty rapidly and grow their economies.
Engage a new brand of development actors, such as social entrepreneurs, that are ready and eager to be a part of development in their countries.

A 5-year agenda for transformation

As we lead our organizations into the future, we must stay focused on the so-what of localization and why we are transforming our business models.

Localization is not about countries working in isolation, but about being part of a global community that has made significant progress in reducing extreme poverty. About building together toward a future of inclusive, locally led development.

A commitment to transforming the current top-down approach is a prerequisite for that future.

It’s not going to happen overnight. But if we dedicate the next 5-10 years to taking these steps, we can all save lives faster—together.

Pape Gaye, founder & CEO of the Baobab Institute, served as president and CEO of IntraHealth during 2004–2020. He is a lifelong champion of local capacity development. Maqsoda Maqsodi is currently president & CEO (interim) of IntraHealth and is leading its transformation agenda while upholding its 43-year legacy of inclusive, effective local partnerships for greater global health.

By Maqsoda Maqsodi

President and chief executive officer

By Pape Amadou Gaye

Founder & President, Baobab Institute

Family Planning & Reproductive Health Education & Performance

Is In The Media

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Integrated Performance and Quality Management: Combining the Optimizing Performance and Quality and Collaborative Quality Improvement Approaches to Improve HIV Service Delivery in the Democratic Republic of the Congo

ihadmin2 — Wed, 11 Jan 2023 16:39:27 +0000

Integrated Performance and Quality Management: Combining the Optimizing Performance and Quality and Collaborative Quality Improvement Approaches to Improve HIV Service Delivery in the Democratic Republic of the Congo 2022 ihadmin2 January 11, 2023

The main objective of the IHAP-HK project is to build local capacity to ensure the continuum of quality HIV care and services at multiple levels of the health system (health zone, health facilities, community sites). To achieve this, beginning in September 2017, IHAP-HK combined IntraHealth’s Optimizing Performance and Quality (OPQ) methodology with a collaborative quality improvement approach to create the Integrated Quality and Performance Management (IQPM) approach. OPQ is a stakeholder-driven, cyclical process for analyzing human and organizational performance and setting up interventions to improve performance and quality and build on strengths and successes. IQPM is an innovative approach that allows health stakeholders to solve performance and quality problems at health facilities and generate best practices to achieve desired performance levels.

Download

Countries Democratic Republic of the Congo

Projects Integrated HIV/AIDS Project in Haut Katanga

Topics HIV & AIDS Education & Performance

By Cecile Edambolo Yema, Cyprien Tendo, Jean-Claude Kiluba, Melanie Joiner, Osée Lieke, Pascal Milenge, Sujata Bijou

Inaugural Cohort Graduates from South Sudan’s Public Health Institute

kseaton — Fri, 29 Jul 2022 15:12:32 +0000

Inaugural Cohort Graduates from South Sudan’s Public Health Institute kseaton July 29, 2022 August 01, 2022 Juba, South Sudan

The first class of the South Sudan Public Health Institute (SSPHI) fellowship program graduated on June 3, 2022. Through support from IntraHealth International, these 42 health workers are now entering the country’s health system with new expertise in data management, leadership management, and governance.

Due to decades of conflict in South Sudan, the country’s higher education infrastructure is underdeveloped and there is no institution of higher learning that provides on-the-job learning for the current health workforce. So, the Ministry of Health worked with government, health, academic, and funding partners to help build consensus on training needs and prioritized training courses on data management, leadership management, and governance.

“Having public health leaders who make informed decisions using evidence from high-quality data is essential to the development of any country,” says Dr. Angok Gordon Kuol, director of the South Sudan Public Health Institute. “So we’re thrilled to help increase these health workers’ skills to improve health services in South Sudan.”

Through financial support from the US Centers for Disease Control and Prevention and programmatic support from IntraHealth, the South Sudan Public Health Institute launched the three-month fellowship for health leaders on March 18, 2022. IntraHealth helped the South Sudan Ministry of Health establish the institute and the fellowship program, including recruiting a technical team, conducting a training needs assessment, and developing course materials, validating them, and rolling them out.

Members of the inaugural fellowship program include leaders from the Ministry of Health, such as directors general, commission directors, program managers, and department heads at the national, state, and country level. Graduating fellows are urged to apply everything they learned upon returning to South Sudan’s health sector.

This is a big step in the right direction for the health systems strengthening in South Sudan.

Over 145 people attended the graduation in June, including representatives from the Ministry of Health, US Centers for Disease Control and Prevention, United Nations Development Programme, World Health Organization, and IntraHealth.

“This graduation of the first cohort is a remarkable and historic milestone for the South Sudan Public Health Institute,” says Alfred Okiria, IntraHealth’s South Sudan project director. “The fellowship program is an excellent tool for capacity building for the Ministry of Health and a great development to address some of the current skills and competency challenges in South Sudan’s public health workforce. This is a big step in the right direction for the health systems strengthening interventions for the country.”

SSPHI hopes to continue to build health worker skills and competencies and close the existing skills gap in the country. They have honed their curriculum based on lessons learned with the first cohort and built much-need training capacity for the next round of fellows.

Oniba Opio contributed reporting for this article.

South Sudan Education & Performance Leadership and Governance Health Workforce & Systems Management and Performance

IntraHealth Reached 317,443 Health Workers in 2021, Extending Health Care to Millions

kseaton — Wed, 29 Jun 2022 15:11:35 +0000

IntraHealth Reached 317,443 Health Workers in 2021, Extending Health Care to Millions kseaton June 29, 2022 June 29, 2022 Chapel Hill, NC

During 2021, the second year of the COVID-19 pandemic, IntraHealth International reached 317,443 health workers in 42 countries, helping to make high-quality health care available to more people around the world. Our programs led to:

$33,399,555 in financial aid provided for student health workers through IntraHealth programs
2,524,424 COVID-19 vaccines distributed through IntraHealth programs
223,677 men provided with voluntary medical male circumcision to prevent HIV infection
2,264,216 messages sent to and from health workers via mHero, WhatsApp, or other digital health tools
898,190 individuals tested for HIV and received results
8,231,279 family planning users through IntraHealth programs
1,389,009 new users of contraception
504,185 children under 5 treated for malaria

Even before the pandemic, the World Health Organization estimated a shortfall of 18 million health workers by 2030. Now, 15 million more health workers are needed in low and lower-middle income countries alone to respond to the needs of the health system and achieve universal health coverage.

IntraHealth International reached 317,443 health workers in 42 countries.

“The difficulties many countries have faced in responding to COVID-19 and rapidly delivering vaccines, tests, treatment, and supportive care have shone a spotlight on vulnerabilities in health systems and workforces around the world,” says Polly Dunford, IntraHealth’s president and CEO. “But we know that by investing in and supporting health workers—including and especially community health workers, nurses, and midwives—we can make great strides in COVID-19 response and in achieving universal health coverage.”

In 2021, IntraHealth focused on expanding digital health tools, responding to global health security threats, and training and supporting local health organizations. We expanded our iHRIS software to 25 countries, who now use it to manage their health worker personnel records, trained 9,000+ health workers on COVID-19 response, and worked with 74 local organizations to help them prepare to receive funding from USAID and PEPFAR.

See more 2021 results in our full annual report.

IntraHealth believes everyone everywhere should have the health care they need to thrive. Our mission is to improve the performance of health workers and strengthen the systems in which they work.

Banner photo: Jeanne Uwimana is a gender-based violence officer at the Isange One Stop Center at the Nyanza District Hospital. Photo by Innocent Ishimwe for IntraHealth International.

Health Areas Family Planning & Reproductive Health HIV & AIDS Infectious Diseases Maternal, Newborn, & Child Health Mental Health Noncommunicable Diseases Nutrition Community Health Digital Health Education & Performance Health workforce development Gender Equality Global health security Health Workforce & Systems Health WorkersNamuwaya Nsabu weighs her 9 month old baby before receiving immunization services at Nakaloke Health Center III in Mbale, Uganda. Photo by Esther Ruth Mbabazi for IntraHealth International.

Project to Improve Health and Nutrition in West Africa Expands to Guinea

kseaton — Fri, 01 Apr 2022 15:01:40 +0000

Project to Improve Health and Nutrition in West Africa Expands to Guinea kseaton April 01, 2022 April 01, 2022

More women and babies in francophone West Africa will have access to integrated services as IntraHealth’s INSPiRE project expands into Guinea. In Guinea, as well as in eight other Ouagadougou Partnership countries in the region, INSPiRE works to integrate family planning, nutrition, and maternal, newborn, and child care. This means providing clients with a comprehensive package of essential health services during each visit—such as family planning and nutrition services and maternal care and infant care—to eliminate missed opportunities for care and make services more accessible for women and babies.

Countries in West Africa have some of the highest maternal and infant mortality rates in the world. Women in Guinea face a 1-in-29 lifetime risk of maternal death and 25 of every 1,000 newborns do not survive their first 28 days. An estimated 23% of women have an unmet need for family planning and 6.1% of children under 5 are affected by acute malnutrition.

So the Ministry of Health and national technical working group for integration developed an action plan and chose the Coyah Health District in Guinea as the pilot site.

IntraHealth’s INSPiRE project will help implement the program’s service integration approach in 28 health facilities, which will help them provide more efficient services and help families who have to travel great distances to health facilities get access to all the care they need.

"We have the implementation resources already available and adaptable for Guinea."

INSPiRE began in 2017 in three francophone West African countries: Burkina Faso, Côte d’Ivoire, and Niger. “Implementation in these three countries has made it possible for us to draw lessons learned that will be very useful in Guinea,” says Robert Bambara, INSPiRE’s monitoring, evaluation, and learning officer. “It’s also helpful because we have all of the implementation resources already available and easily adaptable for Guinea.”

Using these lessons learned, INSPiRE introduced the service integration approach at the national level to build political will and facilitate implementation. They started with government partnerships and commitments, and then established a national-level technical working group and developed an action plan. But a paradigm shift is still required and stakeholders at all levels, from government and health authorities to the health workers and clients themselves, will have to adapt to a new way of thinking about health services.

"Guinean’s will have better access to high-quality care when & where they need it."

“Evidence shows that this approach has a definite influence on services,” says Bambara.

“Through INSPiRE’s strategies, we’ll be able to improve training, build health worker skills, develop indicators and collection tools, and revise Guinea’s guidelines so that Guinean’s have better access to high-quality health care when and where they need it.”

INSPiRE is funded by the Bill and Melinda Gates Foundation in partnership with Helen Keller International, and Institut de Recherche en Sciences de la Santé.

Resources

INSPiRE Integration Model

Developing Composite Indicators for Integrated Family Planning; Maternal, Newborn, and Child Health; and Nutrition Services

Guinea Maternal, Newborn, & Child Health Education & Performance Health workforce development INSPiRE

To Improve Family Planning Services, Bangladesh Puts Health Workers at the Center of Training

kseaton — Mon, 28 Mar 2022 16:48:06 +0000

To Improve Family Planning Services, Bangladesh Puts Health Workers at the Center of Training kseaton March 28, 2022

March 30, 2022

How we’re changing approaches in health training centers to increase client satisfaction and service quality.

A little over three years ago, I began hearing about USAID’s Accelerating Universal Access to Family Planning Project in Bangladesh. The project—named Shukhi Jibon, which means “happy life” in Bengali—focuses on developing the family planning workforce and contributes to the health and well-being of Bangladeshis by increasing their use of family planning services.

Shukhi Jibon, I knew, could make a big difference in Bangladesh. For family planning providers, it could help improve health workers’ skills and confidence. For the government and training institutes, the project could improve the quality, efficiency, and performance of family planning services and increase client satisfaction.

Throughout my career, I had worked passionately to improve sexual and reproductive health, family planning, and maternal and child health. If Shukhi Jibon were successful, its benefits would filter beyond family planning to other areas of the health system. So, when the chance to join the project presented itself, I seized the opportunity.

A new approach to training

Family planning in Bangladesh has come a long way, but progress has plateaued in the last decade and regional disparities remain. In response, the government began focusing on universal health coverage, including reproductive health services, and made health workforce development a priority.

Putting health workers at the center of the solution was essential.

Putting health workers at the center of the solution was essential. Happy, satisfied clients are more likely to continue to communicate with their providers and encourage friends and family to seek care as well. But to achieve this kind of multiplier effect in family planning—essentially,

to ensure people who need it most receive the best services and solutions—every health worker must be highly skilled and confident in the services they provide.

Key findings from a training needs assessment we conducted at the beginning of Shukhi Jibon showed us that more than 90% of health facilities in Bangladesh provided family planning services, yet only 57% of clinics had staff who were trained in family planning. Even among those who had been trained, many lacked confidence in their skills. And despite health workers’ obvious skills and confidence gaps, survey respondents also repeatedly questioned the value of trainings. It was apparent that there was a sense of fatigue and perception that the trainings weren’t useful, partly because the trainings were mostly lecture-based and lacked interaction and practicum opportunities.

The Shukhi Jibon way

Shukhi Jibon is led by Pathfinder International, in partnership with lntraHealth International, and in collaboration with the Directorate General for Family Planning, Directorate General of Health Services, and the National Institute of Population Research and Training in the Bangladesh Ministry of Health and Family Welfare.

We knew we needed to change how trainings were conducted and managed.

As collaborators, we knew our solutions needed to address not just the skills and confidence gap, but fundamentally change how trainings were conducted and managed. So we introduced adult learning best practices into curriculum development, trainings, and delivery, and addressed system needs in an efficient, cost-effective way. Some of the approaches and systems we implemented included:

Competency-based training (CBT): a learning-by-doing approach that is interactive, participatory, supports learners, and ensures high-quality practicum training for everyone.
Training management information system (TMIS): a web-based data collection software that helps us administer, document, track, manage, and report on training programs and make data driven decisions.
Optimizing performance and quality (OPQ) approach: IntraHealth’s signature approach for problem solving and capacity building to improve job performance.
Improvement collaboratives (IC): a quality improvement approach that brings people together to improve the quality of training institutes by developing collaborative plans to address gaps in their performance.

And the combined impact of these approaches and tools is making a difference. Trainers who use CBT in their classes report enjoying their sessions more. Trainers and trainees alike are engaged, and trainees better understand training materials.

Managers and heads of training institutes, meanwhile, who previously made decisions ad hoc, are using data from TMIS along with the processes and information derived from OPQ and IC for data-driven decision-making.

We’ve trained trainers from the National Institute of Population Research and Training, Directorate General for Family Planning, Directorate General of Health Services, and other government agencies on CBT and they are now providing training themselves, which has the potential to benefit other types of health worker training.

Shukhi Jibon has also been collaborating closely with other nonprofit partners to ensure cohesion across projects. We supported CBT integration and adult learning into postpartum family planning and maternal and child health trainings led by other nonprofits.

Government officials from the Ministry of Health and Family Welfare, National Institute of Population Research and Training, and Directorate General of Family Planning at a training program. Photo Taken by Mahbubur Rashid for IntraHealth International.

A small group convenes with a trainer to review competency-based training. Photo Taken by Mahbubur Rashid for IntraHealth International.

A training of trainers session on the optimizing performance quality approach and improvement collaboratives. Photo Taken by Mahbubur Rashid for IntraHealth International.

Sessions conducted by a trained trainer on competency-based training. Photo taken by Mahbubur Rashid for IntraHealth International.

High level government officials and trained trainers with the trainers’ manual on competency-based training. Photo taken by Rayan Sharif for IntraHealth International.

Keys to success

In our early days, we really struggled to get people to see and understand the value of CBT and TMIS. Government officials were reluctant to change. To them, what Shukhi Jibon was offering had already been done.

Once we began our training of trainers and demonstrated the impact of CBT approaches, those same government officials started paying attention, some even asking why they didn’t get this kind of training earlier. That’s when we knew we were making progress. After that, in each district we’ve worked, we’ve called on some of these converted officials, and they’ve become our best advocates.

We have always put relationship-building first.

So what’s been central to our success thus far? We have always put relationship-building first. And we prioritize transparency. By our actions and interactions, we’ve slowly won people over.

The future of family planning training in Bangladesh

We’ve laid the groundwork and now it’s time to strive for sustainability and move toward strategy and policymaking. We would like to see our programs included in the next sector plan as well as in the National Institute of Population Research and Training and Directorate General for Family Planning operational plans. Then, the government will own the programs, and we can transfer Shukhi Jibon to the National Institute of Population Research and Training.

Once the Shukhi Jibon project is complete, we will see competency-based training integrated into Bangladesh’s health worker training system and training organizations can start to focus on building trainer techniques. Our dream is that health workers will be able to provide high-quality family planning services and follow standards that will keep their clients coming back.

Accelerating Universal Access to Family Planning is funded by the US Agency for International Development. IntraHealth International is a supporting partner for Pathfinder International.

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Resources

Bangladesh Family Planning Training Needs Assessment: Technical Brief

USAID AUAFP Training Needs Assessment: Final Report

By Mahbubur Rashid

Senior technical advisor

Accelerating Universal Access to Family Planning (AUAFP) Family Planning & Reproductive Health Education & Performance Health workforce development World Health Worker Week Health Workforce & Systems Management and Performance Health Workers Bangladesh

High level government officials and participants at a workshop for improving quality of training. Photo by Rayan Sharif for IntraHealth International.

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New Approach Helps Nursing and Midwifery Schools in Mali Improve Curricula and Achieve Accreditation

kseaton — Mon, 29 Nov 2021 15:33:54 +0000

New Approach Helps Nursing and Midwifery Schools in Mali Improve Curricula and Achieve Accreditation kseaton November 29, 2021 November 29, 2021

Eight nursing and midwifery schools in Mali—a country that has long experienced a shortage of qualified nurses and midwives—are now accredited and using a competency-based approach curriculum, compared to only three schools in 2017.

Thanks to a partnership between IntraHealth International and Mali’s Ministry of Health and Social Development, the number of accredited nursing and midwifery schools has more than doubled and 829 more nursing and midwifery students are benefitting from a high-quality education, improving the quality of the health workforce in Mali.

A new report—Accreditation of private midwifery and nursing schools in Mali: a local sustainable solution to increasing the supply of qualified health workers—outlines how the partnership has worked to improve the quality of education in Mali’s private universities, better manage the country’s available health workers, and initiate a decentralized strategy for health worker recruitment and motivation.

Mali has an average of 6 health workers per 10,000 people (the World Health Organization recommends 23 skilled health workers per 10,000 people). Northern regions such as Timbuktu, Gao, and Kidal have 4, 5, and 13 health workers per 10,000 people respectively, while the capital of Bamako has 23.

We need to focus on our shortage of health workers.

“We need to focus on our shortage of health workers,” says Cheick Touré, IntraHealth’s country director in Mali. “We know that the density of health workers is high in the cities but in the rural areas it’s very low. We need to recruit nurses and community health workers there to provide services for women in their communities.”

Since 2017, the USAID-funded Mali Human Resources for Health Strengthening Activity, led by IntraHealth, worked with the Ministry of Health and Social Development and Ministry of Higher Education and Scientific Research in six regions to train more health workers by improving the quality of education in private universities, better manage available health workers through the iHRIS health workforce information system, and address the low rate of retention of health workers in rural and hard-to-reach areas.

As part of this effort, IntraHealth collaborated with national and regional decision-makers using the West African Health Organization (WAHO) accreditation system to help 10 private nursing schools introduce WAHO’s regionally accepted, competency-based curriculum in reproductive, maternal, newborn, and child health (RMNCH).

Accreditation is an essential part of improving health training institutions—a key mechanism for assuring quality and protecting public health and safety. Additionally, having an accredited institution increases the number of student applications, thus expanding the pipeline of new health workers. As a result of this work:

90.5% of students at these schools demonstrated the required competencies to progress to the next year level.
203 students completed their clinical practice internships in rural and peri-urban areas within Mali’s northern regions.
89% of students at the Gao Nursing School in northern Mali passed their national exams compared to a national rate of less than 50%.
93% of the graduates recruited by South Sudan’s Ministry of Health and Social Development, communities, and nongovernmental organizations are still working the northern regions.

“Thanks to the competency-based approach implemented by the project to strengthen human resources for health, the student is now placed at the heart of their learning,” says Dr. Mamadou Maiga, a teacher at the Gao Nursing School.

Introducing a standardized regional curriculum in Mali has helped improved graduation rates and student enrollment as well as the quality of health worker training. IntraHealth’s support to the regulatory bodies that oversee accreditation has helped more schools sustainably complete the process in Mali. Now, other countries in the region who similarly rely on private sector institutions for health workers have a model to utilize to increase their own health workforce.

IntraHealth International is now partnering with Takeda Pharmaceutical Company Limited and 12 private schools in Mali, Senegal, and Niger to sustainably increase the number of qualified, well-trained nurses who can serve rural communities in these countries—all of which face a critical shortage of health workers. To learn more about the new Improving Maternal and Child Health Care in Rural West Africa Through High-Quality Education for Nurses and Midwives project, click here.

Mali Education & Performance Health workforce development Health Workers Midwives NursesHealth workers at their graduation ceremony in Gao, Mali in February 2020. Photo by Doucoure Sekou for IntraHealth International.Mali Human Resources for Health Strengthening Activity

Health Worker Training Helps More Sick Newborns Survive in Uganda

kseaton — Tue, 23 Nov 2021 16:59:48 +0000

Health Worker Training Helps More Sick Newborns Survive in Uganda kseaton November 23, 2021

November 23, 2021

This hospital is making changes to reduce preterm births—and they're paying off.

When 25-year-old Aida Adongo started bleeding during her seventh month of pregnancy, she knew she had to seek care quickly. By the time she reached the Lwala Hospital, the nearest health facility in her community, she had already delivered one twin. The other was born safely at the hospital, thanks to the swift response of the medical team when she arrived.

In Uganda, preterm births—babies born before 37 weeks—like Aida’s are likely to occur for women who do not attend antenatal visits. This often means women living in rural areas, far from health facilities, are at a higher risk of having their babies early. Approximately 226,000 babies are born too soon every year in Uganda and of these, 12,500 children under five die due to preterm complications.

The Ministry of Health in Uganda is committed to improving the survival and health of newborns through high-quality maternal and newborn care, especially for babies who have a low birth weight or are sick.

Lwala Hospital in the Kalaki District of eastern Uganda is one of the health facilities IntraHealth International’s USAID-funded Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-E) project supports.

Through essential newborn care mentorships, RHITES-E helps the Lwala Hospital and others like it maintain functional neonatal units and maternity wards staffed by skilled midwives.

“We struggled to deliver high-quality care for our babies born too soon and small,” says Clere Amunyo, the health worker in charge at the Maternity Lwala Hospital.

“However, with support from RHITES-E, we now have a fully functioning neonatal unit.”

RHITES-E supplies the maternity unit with basic obstetric equipment, including delivery kits, caesarean kits, penguin suckers (to clear a baby’s mouth and nose), and manual resuscitators. RHITES-E has also helped the Kalaki District review over 90% of the perinatal deaths (a dramatic increase from 5% in 2018), which helps health workers understand and tackle the root causes of perinatal deaths and implement collective actions to prevent them. Since the training, there have been no perinatal deaths.

My hope was restored when I received good care from the midwives here. My babies are strong and I am happy.

The midwives at the maternity ward have also been trained on kangaroo mother care, an effective method of holding a baby that involves skin-to-skin contact and reduces mortality for hospitalized infants with low birth weight by 40%.

This is how Aida’s preterm twins survived.

“I lost my first twins at six months,” Aida says. “I worried this would happen again. My hope was restored when I received good care from the midwives here. My babies are strong and I am happy.”

Health workers help Aida with kangaroo mother care at the health facility.

Aida with her newborn twins.

RHITES-E is training more midwives through onsite mentorship and coaching to implement kangaroo mother care and to make sure preterm babies aren’t separated from their mothers, which has proven to be effective in nurturing the newborn while providing care and treatment for the mother at the same time.

But the hospital’s leadership has changed more than just their approach to medical treatment. They are also tackling community-driven factors that lead to preterm babies by working with local leaders to address teenage pregnancies—the leading cause of preterm babies at hospitals—through health education and life skills workshops. The teenage pregnancy rate in Uganda is 25% and is highest in the Teso region, which is home to Kalaki District, at 31%. And school closures to due to COVID-19 have only increased early pregnancy rates for young women.

“We conduct intentional community engagement activities to create awareness around teen pregnancies,” says Ruth Enyimu, the senior hospital administrator. “We work collectively to empower the girls and their families on prevention measures.”

The hospital staff offer health education and counseling sessions to adolescents and young women based on the “Four Toos” (too early, too soon, too many, and too frequent) concept that addresses the dangers of early pregnancy and how it can be avoided.

Amid these successes, the hospital still struggles with an inadequate ambulance referral system; a dilapidated infrastructure for maternal, neonatal, and child health; and insufficient equipment for optimal service delivery. However, with the help from a government results-based financing grant (funding that is only released once a project has achieved specific results) for 51 districts to improve reproductive, maternal, and child health, hospitals are making progress. For example, now the hospital can transport emergency cases thanks to this type of government funding.

For now, the hospital is working to make sure every baby born prematurely receives high-quality care. And it’s working—more little beings are surviving.

By Irene Mirembe

Knowledge management manager, IntraHealth International

Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-East) Family Planning & Reproductive Health Maternal, Newborn, & Child Health Education & Performance Health workforce development Midwives Uganda

A baby is measured for size at the Busowobi Health Center in Iganga District, Uganda. Photo by Tommy Trenchard for IntraHealth International.

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More Mothers and Babies in Senegal Gain Access to High-Quality Health Services through Neema

kseaton — Mon, 22 Nov 2021 16:33:17 +0000

More Mothers and Babies in Senegal Gain Access to High-Quality Health Services through Neema kseaton November 22, 2021 November 22, 2021

Over the past five years, more than 1.7 million children under five in Senegal received nutrition services through IntraHealth International’s USAID-funded Integrated Service Delivery – Healthy Behaviors Project—called Neema. The program also helped over 80% of health facilities in seven regions build functional referral systems to connect community members to services at nearby health facilities; made family planning services available to more people, resulting in 675,000 years of protection from unwanted pregnancies for couples through contraceptives; and monitored the growth and promotion of 62,635 children under two.

Since 2016, the program has improved health for women and children in Senegal by strengthening health services and making them accessible to more people in seven regions of the country. Neema’s two ambitious goals were to:

Increase access to and use of high-quality health services and products in the public sector.
Help more community members adopt healthy behaviors in the regions of Diourbel, Kédougou, Kolda, Matam, Saint Louis, Sédhiou, and Tambacounda.

Despite the challenge of Senegal’s health worker shortage and the onset of the COVID-19 pandemic, Neema helped improve women’s and children’s health through the following results:

69.7% of women of reproductive age now say they use a family planning method for at least two years after childbirth, a 49.7% increase from 2017.
77% of women of reproductive age are practicing early breastfeeding, compared to 60% in 2017 (a 17% increase).
53.4% of mothers seek care for their children within 24 hours of the beginning of symptoms or the next day, a 57% increase from 2017.
80% of children with moderate acute malnutrition ended up cured thanks to the production and use of fortified flour.

To achieve these results and increase the number of women who receive high-quality, consistent health services, Neema used IntraHealth’s Tutorat approach, wherein experienced health workers coach and mentor other health workers from the same health districts. Tutorat focuses on the specific needs of health workers through a customized approach, which assesses performance gaps, improves individual performance, and addresses individual learning needs while also minimizing disruptions in health services.

Neema also worked with health workers to prevent malaria among pregnant women and provide HIV services for community members. Program staff trained health workers on intermittent preventive therapy and the importance of long-lasting insecticide-treated bed nets; helped health facilities develop a case-management system that fills data gaps and improves care at the post; and worked with the National Malaria Control Program to implement the Seasonal Malaria Chemoprevention campaign, which reached 836,975 children under ten.

In the seven Neema-supported regions, the number of people living with HIV who were tested increased from 71% in 2017 to 81% in 2019 and the number of people on antiretroviral treatment rose to 28,960, a 17% increase from 2017.

“I’m so proud of the work we’ve done to help mothers and babies, especially the progress we’ve made with the maternal mortality rate,” says Babacar Gueye, chief of party and IntraHealth’s country director in Senegal. “We’ve made more progress in the last five years than we did during the last two decades.”

Neema was funded by the US Agency for International Development in partnership with the National Alliance of Communities for Health (ANCS), ChildFund International, Helen Keller International, Ideas42, Johns Hopkins University Center for Communication Programs (JHU/CCP), and Réseau Siggil Jigéen (RSJ).

Senegal Family Planning & Reproductive Health Maternal, Newborn, & Child Health Noncommunicable Diseases Nutrition Community Health Education & Performance Leadership and Governance Community Health WorkersClients waiting at the Tanaff Health Center in Senegal in 2019. Photo by Clement Tardif for IntraHealth International.Neema