Funded by the African Grants Programme supported by THET and Johnson & Johnson
This was a 12-month project designed in response to the lack of assessment and regular refresher training available for MCHAs in Kambia. The project aimed to devise a simple but effective evaluation tool to assess the knowledge and clinical practice of MCHAs working at the 69 community health centres across the district, and to deliver individualised refresher training in response.
Find out more about this project by watching our latest short film (8 mins):
Justification for the MCHA Supervision project
- Kambia has an unacceptably high number of maternal deaths each year (11 have been recorded between January -April 2017 so far)
- MCHAs deliver frontline services to pregnant women, newborns and children, so improving the quality of the care they provide should have a positive impact on the health outcomes of women and children accessing the health system
- MCHAs have very limited initial training (a 2 year course to become qualified)
- MCHAs received centralised training en-mass a number of times each year, but this training is not one-to-one and there is no individualised assessment or follow-up which often makes it ineffective. This is also an expensive model of delivering MCHA training.
- MCHAs often receive little or no on-going, systematic supervision from senior district health managers due to the limited resources of the DHMT.
- The DHMT identified an urgent need to devise a cost-effective model for evaluating the quality of MCHA practice across the district and for delivering supportive, one-to-one supervision at rural health centres.
- 2 long-term volunteers were deployed in Kambia (one for 6 months, one for 9 months) to work with the DHMT to devise and implement the project.
- It was agreed that an MCHA mentoring system would be the most cost-effective model for delivering supervision of the MCHA work force.
- An new MCHA Supervision Tool was created and piloted at 22 rural health centres in Kambia (The MCHA Supervision Tool is available for download here). The tool was based on the Sierra Leone Ministry of Health’s MCHA Curriculum.
- 30 Kambia health staff were then trained to become new MCHA Mentors by our 2 long-term volunteers and by 2 short-term volunteers from GHNHSFT during a one-week workshop
- Following the training, 27 new MCHA Mentors were appointed to deliver supportive supervisions to 2-3 MCHAs each at nearby health centres
- Over a 2.5 month period 104 MCHAs were assessed once by MCHA Mentors at their health centres using the new MCHA Supervision Tool and given individualised refresher training in response to their assessment. Each supervision session lasted one hour and included an assessment of MCHA knowledge of 2 medical scenarios (such as managing antenatal care, resuscitating a newborn, how to deal with a breech delivery)
- This cycle of supportive supervision provided baseline data to give an indication of the current level of MCHA knowledge and practice based on 2 medical scenarios which we could then match against the most common causes of maternal death.
Initial Project Findings
- Of the 104 MCHAs who participated in the first cycle of supervision, 75 attained a combined pass mark of 65% or higher on completion of 2 scenarios of the MCHA Supervision Tool
- However, only 51 out of the 104 MCHAs attained a pass mark for both of the scenarios
- MCHAs demonstrated good knowledge and skills for dealing with medical scenarios that they manage regularly during their daily work at health centres, but perform poorly in less common emergency scenarios. For instance, MCHAs scored highly in antenatal care but poorly in dealing with cord prolapse and post-partum haemorrhage.
- There is a strong correlation between those topics that MCHAs scored poorly and the most common causes of maternal death in Kambia, which indicates that more training is needed in dealing with obstetric emergencies.
- It was also found that MCHAs who receive regular supervision from more senior colleagues on a daily basis at their place of work scored more highly than those MCHAs who receive little or no regular supervision.
We are extremely grateful to our two volunteers, Dr Alice Fulton (photographed above) and midwife Ridwana Pandor, for their major contributions to this project.
“Medicine is dynamic. The training of staff must therefore be dynamic and must meet the changes faced in delivering effective healthcare to the community. This project has identified the training needs of MCHAs for the first time in Kambia. It gives clear indications of what our MCHAs need, what the gaps in knowledge and skills are, and how we need to fill those gaps. We need to continue this process so that the impact is seen and experienced by the patients coming to MCHAs at the PHUs. If we can continue this process healthcare will improve.” MCHA Mentor
“I have enjoyed being involved in this project as a mentor because it makes me learn more and keep up my own reading. I then share this learning with my MCHAs to make them stronger in the field. I have enjoyed the process of providing this supervision and visiting MCHAs at other PHUs. I have gained a better sense of how well MCHAs are coping with medical cases in the district.” MCHA Mentor
“It is good to have a colleague looking after you and to remind you of things you learned but have forgotten. I did not feel that she was policing me but helping me. I would like to see my Mentor every month at least. But sometimes even when you know what to do we don’t have the drugs or equipment to do are job properly.” MCHA
“This is the first time I have had supervision in this way at my PHU. The mentor asked me questions about how to manage some emergencies at the PHU. If I did not know the answer or if I got it wrong, she told be what to do, so that I could learn from her. It was good to do this where I work. She was very friendly and I learned a lot because she helped me and took her time.” MCHA
Our project funding from the African Grants Programme has now ended, but we would like to continue to provide further cycles of supportive supervision to the MCHAs in Kambia so that we can track the impact of ongoing assessment and refresher training on the quality of healthcare that they provide to women and children in the district.Continuation of the MCHA Project
We are therefore actively seeking donations to fund a the continuation of the project for a further 12 months. It costs around £3,500 for each supervision cycle for 150 MCHAs and we would like to provide a minimum of 6 cycles over the next 6-12 months.
If you would like to support this project, please make a regular or on-off donation using the secure online link here