Sierra Leone has had poor maternal and newborn health indicators for a long time and the recent Ebola Virus Disease (EVD) outbreak in the country has exacerbated this further. WHO global Maternal Mortality Ratio (MMR) estimates show Sierra Leone topping the list with a MMR of 1360/100,000 live births and the highest lifetime risk of maternal death (1 in 17).
Since 2013 CMNH, with funding from DFID through UNICEF, has been working closely with the Ministry of Health and Sanitation (MOHS) to help improve the situation by building the capacity of frontline healthcare workers in remote areas through On-the-Job (OJT) training. CMNH has trained 386 master trainers to deliver the programme to 2000 health care workers across 200 sites.
The OJT programme is led for CMNH by obstetrician and gynaecologist Dr Mselenge Mdegela and implemented with Technical Officers Betty Sam and Florence Bull based in Freetown, supported by volunteers from the UK.
In partnership with MoHS CMNH has developed a training package based on the country’s Basic Package for Essential Health Services (BPEHS) which aims to meet the training needs of Maternal and Child Health Aids (MCHA) who provide the majority of maternal and newborn care in Sierra Leone. The MCHAs undertake seven 2 day modules in, antenatal care, labour and delivery, emergency obstetric care, postnatal care, adolescent health, family planning and nutrition. To embed what they have learnt into practice participants are mentored and receive supportive supervision after each training.
The OJT is delivered country wide and on the most recent supervision visits in July 2016 it was clear that the programme was having an impact. When the team visited a community health centre in the Western Area of the country they were able to support a midwife to safely deliver a baby girl at the facility using vacuum extraction rather than referring the mother to another facility. Providing healthcare workers with skills to safely deliver babies within their facility is one of the key elements of the OJT; the midwife told the team that the support she is receiving during the OJT programme is giving her the confidence to safely carry out new procedures.
In Bonthe, one of the most remote districts in Sierra Leone, the OJT team were able to support the Community Health Officer (CHO) to provide refresher training for health care workers in new born resuscitation using training mannequins supplied as part of the programme. This short OJT training is the key element of the programme and prevents having to take staff away from their facilities for training. The OJT team helped the CHO who is a master trainer to plan for further short trainings that his team needed.
Shortly after visiting a community health centre in Jong Chiefdom the OJT team were called by the CHO to say that they had safely managed a woman within the facility using skills they had learnt through OJT. This meant that the woman did not have to be transferred to another facility 2 hours away for care. Supervision and mentorship is another key component of the OJT training, helping health care workers to develop their confidence in using new skills and understanding when and how to use them.
The OJT programme is an example of how partnership between NGOs, MoHS and health care workers can deliver training that actually has an impact on patient care without taking health care workers way from their patients. Combining short on-the-job training with provision of clinical equipment and, most importantly, following this up with supervision and support for health care workers is having a sustainable impact on health care workers and their patients.
Mselenge Mdegela is a Clinical Research Associate at the Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine. He is involved in designing, implementing and evaluating sexual and reproductive health teaching programs at LSTM and overseas. He is part of the EMOC team which provide technical assistance for implementing EMOC programs in low resource settings and a PhD student in the area of Human Resource for Health.