MCHIP/ZIMBABWELDHF and Intensive Mentorship:

Improving Practice and Patient

Outcomes in Zambia

Presenter: Samantha Holcombe

March 2, 2015

Background

Commenced 1st October 2011

End date 30th June 2014

In-country partners:

Jhpiego – Maternal Health

Save the Children – Newborn Health

Context: Key clinical implementing partner of

USG-led Saving Mothers, Giving Life endeavor

(end date September 2017)

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Saving Mothers, Giving Life

Conceived as 1-year, USG-led endeavor to

reduce maternal mortality by 50% in 4 districts in

Zambia

→ Now, 5-years, 8+ districts

Interventions focus on labor/delivery and

immediate post partum period

Service delivery (EmONC)

Facility infrastructure (labor wards, MWHs)

Emergency transport

Demand creation (facility deliveries)

3

Target Districts

Luapula Province (MCHIP)

Mansa

Samfya

Eastern Province

Chipata

Lundazi

Nyimba

Southern Province

Choma

Kalomo

Central Province

Kabwe

Phase I

Pilot

Districts

1) Increase the quality of labor/delivery and

postpartum/postnatal care services in MOH

facilities in SMGL Districts

2) Build capacity of MOH facilities in Mansa District to

increase uterotonic coverage through use of

AMTSL in facilities and through distribution of

misoprostol for home birth

3) Expand the availability of quality post-partum family

planning services in MOH facilities in Mansa

District

5

MCHIP/Country Objectives

Key Interventions

Scale-up of EmONC services

Scale-up newborn resuscitation

w/HBB approach

Roll-out of misoprostol for

postpartum hemorrhage (PPH)

prevention

Strengthening of long-acting

reversible contraception (LARC)

and postpartum family planning

(PPFP) services

Development of district clinical

mentorship program

Purpose

To build the capacity of MOH and partner

staff in SMGL districts to conduct targeted,

clinical, on-site mentorship in EmONC,

reinforcing practical knowledge and skills, to

ensure that clients receive high-quality,

improved services which will help reduce

both maternal and child mortality

District Clinical Mentorship Program

Strategy:

Reinforce skills using “low

dose/high frequency”

approach

Build capacity of district

MCDMCH & partner staff

to provide quality

mentorship

Mentorship ApproachEstablishing Mentors

1 week clinical mentorship

training, including skills

update and on-site clinical

practicum

16–20 mentor trainees

recruited, including the DMO,

DNO, SMGL Coordinator,

staff from hospitals and large

UHCs, and MCHIP and other

maternal health implementing

partner staff

Facility Visits

Mentors divided into teams of 2-3 persons

with diverse clinical expertise

All facilities visited monthly by

mentorship team for at least one full day

Mentor teams arrive in morning and help

service clients, taking the opportunity for

mentorship with any maternity/newborn

clients and freeing health care providers’ time

for mentorship in the afternoon

Facility Visits

Review files and registers

Targeted technical assistance Identify any challenges encountered with EmONC

service delivery

Refer to previous month’s action plan

Mentor on focus EmONC function

Assess providers’ skill competency on anatomic

models or with clients using skills checklists

Mentors fill out report form for DCMO and

MCHIP, develop an action plan to be completed

before next month’s mentorship visit

Benefits of Mentorship

Low-cost intervention

Can maximize benefits of complementary,

higher-cost interventions

Opportunity for building more sustainable,

local capacity

Provides clinical support and long-term

morale

Addresses site-specific unique challenges

faced by health staff

Outcomes

Immediate and sustained application of skills

learned during EmONC training;

Improved provider confidence and morale;

Management of complications at rural health

center level that previously were referred to

other facilities

Reduced pressure on emergency transport

systems and referral facilities

Improved outcomes for pregnant women

Key Achievements

In Mansa Y6 Q2, 100%

of pre-eclampsia cases

and 95% of PPH cases

were treated according

to clinical guidelines

From baseline to Y6 Q2,

use of the partograph

increased from 6 to 45

percent

Care Meeting National Standards—

Pre-Eclampsia, Mansa District

0

2

4

6

8

10

12

14

16

18

Baseline MCHIP Y4 MCHIP Y5 MCHIP Y6

# o

f cases

Women with Pre-Eclampsia Women with Pre-Eclampsia Receiving Care According to National Standards

Care Meeting National Standards—

Eclampsia, Mansa District

0

2

4

6

8

10

12

14

16

18

Baseline MCHIP Y4 MCHIP Y5 MCHIP Y6

# o

f cases

Women with Eclampsia Women with Eclampsia Receiving Care According to National Standards

Keys to Success

Strong ownership by the local DCMO

Diverse partner involvement and

collaboration

Proper training in mentorship skills

Use of anatomic models for on-site clinical

simulations

Ongoing assessment of providers’ EmONC

skills even in the absence of live client cases

Lessons Learned

Mentors’ clinical skills should be routinely

assessed

Simple, user-friendly tools help to ensure

program success

Monthly targeting of specific EmONC skills with

anatomic models ensures skills remain sharp

Peer mentorship through facility exchange visits

is critical and can significantly improve service

delivery

Video

https://www.youtube.com/watch?v=5-

1qY8IzF1o&feature=youtu.be

Twatotela!

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