AOGU in partnership with UHMG
From May 29, to June 3, 2017, the Association of Obstetricians and Gynecologists of Uganda (AOGU), together with the Uganda Pediatric Association (UPA) provided post-training facility-based mentorship for the health workers in facilities in Northern, South Western Central, and Eastern region which are supported by UHMG. This report is an activity report of the post-training mentorship.
The general objectives of the post-training follow-on mentorship was as follows: To assess knowledge and skills retention, assess if the health workers apply what they have learned in their routine clinic responsibilities, assess the challenges in the delivery of quality emergency obstetric and newborn care in the facilities, and assess and reinforce both knowledge and skills of these health workers, assess accomplishments of prior quality improvement action plans, and to develop new action plans and implementation actions for improved quality of newborn and obstetric care. In addition, to develop work plans for quality improvement. The specific objectives were to ensure that the persons mentored: apply
best practices in BEmONC at the workplace from the learning acquired during classroom-based training; Foster teamwork amongst MCH clinical teams; Facilitate individual continued learning at the workplace through day to day work experiences; Facilitate individual and facility quality improvement initiatives in the delivery of evidenced based emergency obstetric care and Essential New-born Care; and develop and implement quality improvement action plans. For the mentors, the specific objectives were to review progress made on the action plans drawn during the last mentorship and to organize/ re- arrange the maternity unit according to Uganda national standards.
The Mentorship was conducted by a group of Obstetricians and Pediatricians from the Association of Obstetrics and Gynecologists in Uganda (AOGU) and Uganda Pediatric Associations (UPA.
In general, the mentorship was based on specific gaps identified after a site inspection skills assessment of common key emergency situations health providers are likely to encounter in their practice, and involved one-on-one mentorship or group mentorship, with discussion of knowledge, and necessary skills and performance in relation to ALARM/HBB, demonstration by mentee and observation by mentor of key knowledge and skills aspects using either a case study or patient as well as feedback; guidance and demonstration by mentor on best practices related to ALARM/HBB.
The specific mentorship activity involved rapid assessment of the applied knowledge and skills in using a partogram, newborn care, and management postpartum hemorrhage; discussion with the mentees to augment the acquisition of skills and competencies in provision of emergency obstetric care and newborn care, identification of knowledge and skills gaps, and reinforcement of knowledge and skills of rapid assessment and triage, routine management of labor and newborn resuscitation and management of obstetric and newborn emergencies. New areas of quality improvement were discussed, as mentees developed action plans to address identified gaps.
From the mentorship activity, the following were key issues noted: The partogram from UHMG had a printing error lacking the back page this made the midwives not to do the right thing since they had been instructed to use only the UHMG partogram. Also, the voucher system was working in some facilities and had failed or was not accepted in others. For some facilities, there was irregular disbursement of funds. Regarding the facility visits, the dates communicated to the health faculties were not tallying with the hard copies given to the mentors; they had to go some facilities twice as they could not be received on the day given. This created wastage of time and fuel. In addition, some staff who had received training in EMNOC had left or transferred their services to other areas. Regarding skills acquisition and application by the mentored staff, many staff requires continuing training in EMNOC. Newborn resuscitation skills are generally poor even after training, and some staff had not had opportunity to learn from colleagues or practice what they had learnt. Also, many facilities lacked necessities such as critical equipment for newborn resuscitation, partograph books and management protocols. Proprietors in these facilities should be
tasked to procure these equipment or to support their staff to implement the necessary changes to ensure quality service. More emphasis should be placed on correct completion and interpretation of the partograph, as well as correct documentation in the appropriate data registers.
As recommendation for future action, protocols and management guidelines should be availed for hand washing, preparation of instruments, drug dosages, mixing of disinfectants, and waste disposal many health workers need further mentoring and provision of necessary supplies for infection prevention practices, particularly segregation of wastes, and storage of prepared instruments, sundries and equipment. Besides, healthcare providers require continuing support to master skills in newborn resuscitation. In addition, facility-based mentorship should be an on-going activity. Those who receive training should share the acquired knowledge and skills with their colleagues, through demonstration or continuing professional development seminars.