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