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Jean Pierre Rakotovao, MCHIP Chief of PartyMarc Eric Razakariasy, MCHIP Training Advisor

Claudine Ramiandrazafy, MCHIP Training Advisor

Fanja Ralaiarifenina, MCHIP Monitoring Evaluation Responsible

ImprovementsinQualityofservicesthrough6melypost-trainingsupport

GMHC 2013, Arusha Tanzanie

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Introduction

To achieve the MillenniumDevelopment Goal # 4 and 5,

one of the strategies being

implemented is competency

building of service providers with

regard to maternal and neonatal

health issues.

However, these trainings havelittle impact without the

establishment of an effective

system of post-training follow-up

and supervision

Background Goals/objectives

Strategy Results Lessons learned

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Maternal and Reproductive

Health Population: 20 millions Total fertility rate: 4.8 (per DHS

IV 2008) Contraceptive prevalence: 40%

(modern methods: 29%)

Antenatal care: 86% for 1+ visit Home delivery is high: 64% (has

remained high)

Maternal Mortality

MMR: 498 per 100,000 live births(DHS)

Ranked 141 out of 181 countries(Hogan 2010 Lancet)

Major causes of maternal death(EmONC survey 2010):

Hemorrhage: 39% Prolonged labor: 22% Infection: 20% PE/E: 15%

We improve providers competency to take care of these maincauses of maternal and neonatal deaths

Introduction Background Goals/objectives

Strategy Results Lessons learned

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Our strategy is to improve thecompetencies of providers post-

training by supporting them to

maintain their level of acquired skillsand thus offer a better quality of

services.

The approach consists of performingat least 2 post-training follow-up

visits on a monthly basis after thetraining.

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Introduction Background Goals/objectives

Strategy Results Lessons learned

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Historically in Madagascar, trainings ofservice providers has had unsuccessful

results in building competency and

increasing the use of new essential skills.

Despite training evaluation results showingthe acquisition of new skills by providers, in

many cases these newly acquired skills

were not appropriately applied.

The MCHIP project explored the factorsleading to the training failures and found that

one reason has been the absence of

adequate follow-up by the trainer or the

coach in the workplace

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Introduction Background Goals/objectives

Strategy Results Lessons learned

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Established standard : conduct a follow-up or supervisory visit after 3 months of

training.

MCHIP found that this follow-up was notheld for various reasons such as the lackof resources (no budgeting) and

availability of coaches.

Even in cases where the follow-up tookplace, the newly trained provider was not

readily capable of applying the skills

because he could not convince his direct

supervisor to allow him to do so, or did

not yet feel safe to perform the skills by

himself.

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Introduction Background Goals/objectives

Strategy Results Lessons learned

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MCHIP's innovative approach was tointroduce two post-training follow up

visits on a monthly basis after the

training. These visits offer an

opportunity to reinforce skills and to

follow-up on the trainee's action plan

for mentoring.

This approach allows for a rapidappraisal of any challenges or

problems with the new skills as well as

the opportunity to remedy them andbuild confidence and maintain

competency in the provider

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Introduction Background Goals/objectives

Strategy Results Lessons learned

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The space of one month is respected and the result shows a loss of7.3 points on the first follow up and 1.25 points on the second.

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84

86

88

90

92

94

96

Training Followup1 Followup2

95.2

87.9

93.95

Miarinarivo

Training

Followup1

Followup2

Introduction Background Goals/objectives

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The space is two months : the result shows a loss of 1.33 points onthe first follow up and 5 points on the second

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87

88

89

90

91

92

93

94

95

Training Followup1 Followup2

95

93.7

90

Ambatondrazaka

Training

Followup1

Followup2

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The space is more than three months between thetraining and the first follow up and 1 month between first

and second follow up: the result show a loss of 34 points

on the first follow up and 9 points on the second follow

up.

10

0

20

40

60

80

100

Training Followup1 Followup2

92

58

83

Toamasina

Training

Followup1

Followup2

Introduction Background Goals/objectives

Strategy Results Lessons learned

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11

0

10

20

30

40

50

60

70

80

90

100

Training Followup1 Followup2

95.2

87.9

93.959593.7 9092

58

83

Meanofcompetencyscore

Miarinarivo Ambatondrazaka Toamasina

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Other organizations working inMadagascar have taken notice of

these results and have begun

budgeting and implementing timely

post-training follow-ups.

Providers who have benefitted fromthis new approach report high

numbers of skills application, and

report feeling more motivated andcompetent to apply effectively what

they have learned.

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Introduction Background Goals/objectives

Strategy Results Lessons learned

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To maintain the level of

competency

Provide site anatomical models Provide job aids

Always involve the directsupervisor in the training and

follow up

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Introduction Background Goals/objectives

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www.mchip.net

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Merci!

Misaotra !