2011 International Conference on Family Planning
29 November–2 December 2011
"Peer mentoring methodology for capacity-building integrated HIV and FP/PNC services: An experience of first-line health workers"
Charity Ndwiga, Charlotte Warren, and Timothy Abuya
Evidence suggests that integrated HIV and Sexual and Reproductive Health (SRH) services can improve access and quality of both HIV care prevention care and treatment among clients and SRH services. However this process requires additional knowledge and skills to maximise service provision. Although a number of approaches such as offsite training workshops have been used to improve knowledge and skills of health workers in Kenya, this still remains a challenge. The cost of offsite training is often prohibitive and the scarce human resource makes it difficult for health workers to leave facilities interrupting service delivery. To overcome this, Population Council and partners tested the feasibility and acceptability of using an onsite peer mentorship program to improve the knowledge and skills of health workers to provide quality integrated HIV and family planning (FP) services and quality integrated HIV and postnatal/FP services, as part of a larger research project which is measuring the costs and benefits of integrated HIV and SRH services. Two models of integration were introduced: HIV/FP and HIV/PNC.
Mentoring is a strategy that prompts sharing of information and skills among health workers to improve quality of care and/or introduce change in service delivery without removing staff from their workplace. It is based on a mutually beneficial learning relationship between two or more individuals who share responsibility and accountability that aims to support a mentee (learner) to work to achieve clear and defined learning goals. Using the national training materials on FP and HIV integration, postpartum FP and the Balanced Counseling Strategy Plus (BCS+) toolkit, mentoring tools were develop and pretested. This was followed by consensus building on the knowledge and skills requirements to be achieved for competence and the selection criteria for the mentors and the mentees. Sensitization meetings to introduce mentoring as a methodology of training were conducted for district and facility managers to enlist their support for the intervention. Health facilities were equipped with the minimum equipment and supplies for the provision of the integrated HIV and FP/PNC services.
Fourteen health facilities drawn from two districts in Kenya were included in the program. Purposeful sampling procedures were used to select 21 mentors into the program across all the study facilities for initiation into mentorship. The mentor then selected a mentee from the facility working in maternal and child health and FP units. Specific skills included training in insertion of long term family planning methods (ICD and implants) and HIV counseling and testing and use of the BCS+ which assists providers in assessing clients HIV/STI risks and enabling clients to make an informed choice for contraceptive method selection. The mentoring tools were designed with clear and concise instructions for competencies to be achieved. The mentoring process was expected to take place between the mentor and the mentee during quiet periods in the facility and on average took 100 hours over four to six months. A standard checklist was used to assess the mentee level of knowledge and skills before and after training. The end assessment was carried out by a mentor from a different facility and each mentee had to score at least 85 percent to pass and receive joint certification from the Nursing Council of Kenya and Division of Reproductive Health at National Level.
Seventy-four out of 85 mentees (87 percent) achieved the required level of competence in knowledge and skills for integrated services over one year. During this period of time, an increase in use of long term FP methods from 3.1% to 7.4% was noted. In the intervention sites (6) offering HIV/FP, the full range of the integrated package: FP provision, HTC, STI screening and management, dual protection and screening for cancer of the cervix were offered compared to only one site at baseline. Supportive facility management coupled with consistent supply of FP and HIV commodities were critical factors for successful mentoring.
Mentoring can bring change in health services delivery in term of quality improvement and staff motivation. It was demonstrated that learning from peers is acceptable and feasible among first level health workers even with poor staffing and limited infrastructure. Excellent for confidence building and staff motivation "I never thought I could train anyone, bring so much in our facility, let alone become popular for my good work" a satisfied mentor on her experience as mentor. Mentoring has been very well accepted by the policy makers. At national level the Reproductive and HIV programs are working together to adapt the mentoring process for national use in preparation for scale up.
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