Author: Peter Kaimenyi, MANI Maternal and Newborn Health Advisor
The United Nations (UN) Commission on Health Employment and Economic Growth projects a shortage of over 18 million health care workers by 2030, who are mainly needed in low and lower middle income countries. Human resources for health (HRH) are central to health system strengthening and are the backbone to achieving Universal Health Coverage (UHC). Shortages in staff availability could have disastrous implications not only to better health outcomes (Sustainable Development Goal 3) but also to decent work and economic growth (SDG 8). The situation is worsened by a lack of practical skills and unequal distribution of health providers, which often doesn’t match the populations’ health needs.
An innovative approach
Bungoma County, Kenya is using an innovative approach to address HCW shortages. The MANI project in collaboration with the County Government, developed an innovative Emergency Obstetric and Newborn Care (EmONC) HRH mentorship programme to address these challenges.
Maternal and Perinatal Death Surveillance and Response (MPDSR) is a system supported by MANI to improve quality of care based on learnings from maternal and perinatal death reviews. Thanks to these reviews, it was discovered that the four main tertiary hospitals (Bungoma Referral, Webuye, St. Damiano and Lugulu) faced the highest burden of caseloads and deaths. It was discovered that the four facilities received 62% of all maternal emergency referrals and conducted 26% of the total deliveries in Bungoma County.¹
But considering the HRH problem, 90% of the Bungoma County annual health budget goes to salaries, leaving less the remaining 10% to cover all the other recurrent costs. This makes it very challenging for the county to hire new staff.²
Working together to mentor health professionals
In mid-March 2017, the County and MANI initiated the EmONC mentorship programme to address the twin challenges of staff shortages in two maternity tertiary hospitals and inadequate skills of staff in lower level facilities. Health care workers at lower level facilities were invited to work in busy tertiary hospitals covering around the clock duties. This innovative approach gave staff at lower level facilities the opportunity to improve their skills, while at the same time reduce the work load of staff working in high volume hospitals. To take part in the training, health care workers had to have attended an EmONC training. They had to be willing to volunteer, eager to gain skills and experience, and be on leave from their home facility.
What the participants say about the programme
Over 200 HCW’s have taken part to the mentorship programme conducting 3395 deliveries in only 8 months, from March to October 2017. We have asked some of the staff members how the programme has impacted on their workloads. Since the programme started, this has reduced workload pressure in the hospitals, improving the quality of care at the same time. Esther Ahono, mentor from Webuye Hospital said:
…it has really assisted facility completeness of care for clients, they are able to have someone monitoring them from when they’re admitted until when they are discharged…
Staff from lower level facilities reported that the programme has helped “sharpen their skills” and that they “can now handle mothers with confidence”.
I would not have felt comfortable to do a vacuum delivery after EmONC training. Because of the mentorship, I felt confident enough...
The hospitals are seeing improvements in in how referrals are managed between facilities, when mentees return to their facility. It has also reduced the negative impact of the recent public sector nurse’s strike. Faith-based organisations were not part of the strike and therefore had increased workloads during the strike period. The programme proved to be an adaptable intervention, and helped to limit the negative impact of the strikes.
The programme has improved relationships between facilities in the county, where "There used to be a barrier between government and FBO facilities. That barrier has now been broken by the mentorship programme…” - Margaret Kuloba, Maternity in charge. And where the incidences of disrespect and abuse between mothers and facility’s staff have also been reduced.
The interaction between nurses and mothers has really improved, as mothers are leaving they are really appreciating being treated well.
The mentorship programme wins a Kenya’s First lady award
In June 2017, the Bungoma Health Department received a Beyond Zero Award from the First Lady, Margaret Kenyatta, in recognition of the achievements of the EmONC Mentorship Programme as being an innovative approach to tackling the human resource challenges faced in the county. The EmONC mentorship programme is an innovative cost-effective solution that can help countries to be responsive to Human Resource for Health (HRH) challenges and can be scaled up more widely. We call on policy makers to see HRH as an investment towards better quality of care for their populations and to ensure that HCW training goes beyond the classroom.
¹ Bungoma County DHIS2 (2016)
² Public Expenditure Report Bungoma County (2017)