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Presentation during the session on LMG Training Successes at the First National Conference on Health Leadership, Management and Governance
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LMG and Community engagement
The 1st National Conference on Health Leadership, Management and Governance
Dr. Gondi J. , MOPHS, NyanzaAnd: CHS TAG and JICA SEMAH project
1. Background: CHS implementation 2. LMG activities, roles and gaps of
the various actors. 3. Results from Nyanza CHS LMG
study 4. Conclusion and Recommendations.
Contents
Households
CHWs
Supportive Supervision
CHEWs/CHCs
Supportive Supervision
District CHS focal person
HH visitation & Service provision
Data collection
Report submission
Report submission
BackgroundCHS structure
Nyanza has 6 counties; Total C.Us = 633; 2 counties (Siaya and Homabay) have 100% CU coverage.
LMG trainings are conducted to DHMTs and health workers in the health facility. In Nyanza 100% DHMTs trained on LMG through SEMAH project.
For the CHS; LMG is included in the CHC and CHEW trainings.
Background
LGM training components in standard CHEW training manual is inadequate in LMG
Standard Policy on performance enablers: Transport; Diverse professional background of CHEWs ?
Background: leadership issues on CHEW
CHCs
• Clear guideline on membership
• LGM training for CHC members exists.
• Overall Effective Participation in CHS challenged by: • Weak resource
mobilization.• Expectations versus
Voluntarism.• Complex and
technical training manual
Identified and Selected through a participatory community approach.
Trained through a basic and advanced package to improve quality and performance. LMG limited.
HH coverage target of 100 HH/month difficult to attain.
Enablers and motivation provided for effectiveness is diverse: CHW KIT, Transport Retention, Stipend?
Satisfaction Recognition etc.
CHWs
So, We introduced a pilot study on refresher training with LMG components conducted in 4 district, Nyanza province
Nyanza CHS LMG study
Households
CHWs
Supportive Supervision
CHEWs/CHCs
Supportive Supervision
District CHS focal person
HH visitation & Service provide
Data collection
Report submission
Report submission
Referral & Defaulter tracing
mechanism
Background- CHS structure with gaps-
Reporting monitoring
tool (checklist)
Reporting monitoring
tool
Training
Training
The results from baseline surveyEven though these knowledge are minimum requirement for CHEW and CHWs, They had limited knowledge
The cascade down from CHEW to CHWs and Household member is one of the issues. LGM skill and facilitation skill must be useful to solve.
Refresher CHEW & CHWs training components
Facilitation skill1. Leadership management & governance2. Coaching and Mentoring3. Overview of facilitation skill4. Time management/Effective meeting4. Communication skill5. Report/Proposal writing skill
Case management
1. High impact intervention
2. Risk factors in pregnancy
3. Danger signs in pregnancy
4. Danger signs in neonatal and childhood
5. Case management for neonatal health and nutrition
6. Case management for major diseases
Data management1. Data definition / collection2. Data cleaning\summarizing3. Data analysis / presentation4. Data interpretation
Participants: Community health extension workers (CHEWs) Community health workers (CHWs) Schedule:
This trainings were monthly based, one day intensive training. In total, 7 days trainings were conducted from Jan to July. The training consist of two phase.
Step one: Refresher CHEW training by DCHSFP
Step two: Cascade down training to CHWs by CHEWs
CHEW&CHWs refresher training with LMG components
Training situation
Comparison of the three groupsComparison of the three groups
CHEW & CHWs training
Defaulter Tracing activity
Group 3 : 24 CU
Group 2 20
Group 1 20
Target 64 CUs in 4 pilot district
1.Facilitation skill
2.Case Management
3.Data management
1.Referral and defaulter tracing card
2.Defaulter tracing model
KKWW
SYSY GeGemm
UgenyUgenyaa
Study designClustered Randomized Control Trial
(cRCT)
Base-line survey
End-line survey
Cluster random sampling
Compared with control group, the health knowledge on HII, Danger sings etc of CHEW, CHWs and household member (mother with children aged 1-2 years) was significantly improved (p< 0.001).
The Number of Household coverage by CHWs was also significantly increased, compared with control group (p< 0.001). (Increased by nearly 1.5 times)
Effectiveness of the community model
-Results from cluster randomized control trial-
P<0.001
P<0.001
Streamline the CHEW recruitment for effective performance. In addition, given the diverse backgrounds, the CHEW training, supervision and continuous support need to harmonized and strengthened.
It is important to conduct refresher training including LMG components to the existing CHEWs.
Integrate LMG components when a training on specific technical topics, so that the knowledge gap between CHEW, CHWs and HH member is reduced.
Conclusion and Recommendations
STANDARDISE CHW stipend issue; from the study here, CHW performance improved without stipend???
Review HH Coverage target? focusing on Priority HHs such as HH with MNCH etc.
Feedback on the CHC training manual from the implementers.
Recommendation cont..
MOPHS: PHMT Nyanza, DHMTs JICAH SEMAH project
Acknowledgments
Thanks