Posts or Comments 13 April 2021

Archive for "Training"

Case Management &Quality of Services &Training Bill Brieger | 27 Nov 2019

Improving the Quality of Malaria Case Management and Malaria Prevention During Pregnancy in Public Health Facilities in Burkina Faso

Thierry D. A. Ouedraogo, Ousmane Badolo, Mathurin Dodo, Bonkoungou Moumouni, Youssouf Sawadogo, Dao Blami, and Stanislas Nébié presented a poster entitled “Improving the Quality of Malaria Case Management and Malaria Prevention During Pregnancy in Public Health Facilities in Burkina Faso” at the 68th Annual Meeting of the American Society of Tropical Medicine and Hygiene. Their findings are shared below.

Background: In 2017, malaria was the leading cause of medical consultation (43.34%), of hospitalization (44.05%) and of death (16.13%) in Burkina Faso. The disease mostly kills children under five years and pregnant women. One objective of the National Malaria Control Program (NMCP) is to contribute to improving the health of the population by reducing malaria mortality rate by at least 40% compared to 2015 in Burkina Faso by the end of 2020.

In order to achieve that, the NMCP revised the malaria treatment guidelines in 2014 to take into account WHO guidelines on malaria case management and conducted training in primary health care facilities. NMCP implemented a one-day orientation training in district and regional hospitals since 2015, with the support of the PMI Improving Malaria Care Project.

Health Care Providers Training: The training of health care providers was carried out in several 5-days sessions at health districts level. It was aimed at strengthening their skills in the prevention and management of malaria cases in Primary health centers (CSPSs) according to the revised guidelines. 1,819 providers (633 females, 1,186 males) have been trained on the updated malaria prevention and control guidelines in 53 districts during this period.

The training covered the definition and epidemiology of malaria, malaria drug prevention, biological diagnosis of malaria, of uncomplicated malaria cases management, severe malaria case management, healing assessment and health education, monitoring and evaluation. Clinical learning sessions on uncomplicated and severe malaria case management have allowed providers to practice treatment themselves.

The goal of the project was To assess the diagnosis and case management of uncomplicated and severe malaria according malaria guideline in the various health facilities in Burkina Faso in 2017. A cross-sectional study was conducted in 2017 to assess the quality of malaria treatment and prevention during pregnancy in public health facilities.

Submission of protocol Ethics Committee included Information of the surveyed structures and Information to respondents & verbal agreement. The team also worked to provide Quality assurance, Investigator training, Supervision of data collection and Development of guidelines for data collection.

Data processing began with Data review. Data entry used Epi Info input The Data collection period ran from 17-30 September 2018. The assessment focused on the malaria diagnosis and treatment. A comparative analysis of 2015 and 2017 data was done to understand trends.

Challenges included The lack of regional and district regular supervision and
The treatment of presumptive cases without confirmation. The non-application of the treatment protocol for severe malaria occurred in some case and as were variations in doses and duration of treatment. There was some stock-out of drugs for the treatment of uncomplicated and severe malaria.

Overall there was an increase in correct procedures, and IMC project has strongly contributed to this success by training health care providers since 2015, by regularly monitoring the implementation of malaria control guidelines during supervision, and by ensuring the availability of supplies at all levels

Recommendations include Ensuring the effective implementation of national guidelines for malaria management according to levels of care and the availability of supplies for the diagnosis, treatment and prevention of malaria during pregnancy at all levels.

In Conclusion, The results of the evaluation show that all health centres surveyed (50/50) have the capacity to diagnose (confirm cases) and treat malaria cases. At the end of the study, the results indicate that progress has been made in the diagnosis and treatment of malaria from 2015 to 2017.

*Affiliation: PMI Improving Malaria Care Project; Jhpiego Burkina Faso. This poster was made possible by the generous support of the American people through the United States Agency for International Development (USAID) under Cooperative Agreement No. AID-624-A-13-00010 and the President’s Malaria Initiative (PMI). The contents are the responsibility of the authors and do not necessarily reflect the views of USAID, PMI or the United States Government.

Training Bill Brieger | 26 Nov 2019

Retention of malaria technical and training knowledge and skills by master mentors and general trainers in Myanmar

Ni Ni Aye,* San Kyawt Khine, May Aung Lin, Saw Lwin, Khin Than Win, Khin Lin, May Sandi Htin Aung, and Wyut Yi Shoon Lai Wai presented a poster on “Retention of technical and training knowledge and skills by master mentors and general trainers in three States/ Regions in Myanmar” at the 68 Annual Meeting of the American Society of Tropical Medicine and Hygiene. Their findings are shared below.

The National Malaria Control Program  of Myanmar aims to achieve malaria elimination through equitable and universal access to effective preventive and curative services to all at-risk populations in coordination with communities, national and international non-governmental organizations and other stakeholders.

The PMI-funded Defeat Malaria project supports the National Strategic Plan’s objective to reduce the malaria burden and contribute to malaria elimination in part through capacity development of integrated community malaria volunteers (ICMVs), a new type of cadre introduced in 2017.

Specifically, Defeat Malaria aims to improve this new cadre’s knowledge and skills in malaria epidemiology, prevention, and case management through a community-based intervention approach. 16 State/Regional (S/R) level master trainers (MTs) were trained from Kayin and Rakhine States and Tanintharyi Region, 13 of whom then trained 55 general trainers (GTs) in the same S/R to build the capacity of ICMVs.

Goals of the PMI Defeat Malaria Project (15 August 2016 – 14 August 2021) are to Reduce malaria burden, and to Control artemisinin-resistant malaria in target area Eliminate malaria in Myanmar. The Objectives of Defeat Malaria are to Ahieve universal coverage of at-risk populations, Strengthen malaria surveillance system, Enhance provider technical capacity and Promote community and public- and private-sector involvement in malaria control and elimination.

The specific Objectives of this study were To develop a cadre of core trainers with updated knowledge and skills in community based interventions to carry out cascade training of ICMVs in 3 S/R. It also aimed To evaluate the retention of knowledge and skills in malaria interventions and training techniques pre-training, immediately post-training, and at 9 months post-training, and in the process To improve training skills (facilitation, demonstration and coaching) during subsequent trainings.

Methodology For Master Mentors (MM) was a 5-day technical update session on malaria epidemiology, prevention and case management through a community-based intervention approach was conducted, followed by 5-day training skills course. For the general trainers (GT) a 5-day technical update and training skills course was provided.

Pre-training, immediate post-training and 9-month post-training malaria knowledge assessment was conducted using multiple choice questions. At the 9-month point a post-training assessment of training skills (facilitation, demonstration and coaching) using standardized checklists was undertaken.

In Conclusion, Master mentors who have basic knowledge of malaria technical and training skills became knowledgeable and competent on both skills (i.e. those from State/Regional level). Training modules on coaching skills need to be practiced more in TOT so that General Trainers can improve their skills. Project staff should emphasize why use of checklists to improve training skills is important, as this is a new element for local staff.

MM need continuous coaching to retain updated knowledge on malaria technical skills and their facilitation and coaching skills during the TOT and subsequent trainings. MM who are selected from district level and all General Trainers from Township level need even more practice and support. Project staff need to work with local NMCP staff as they learn coaching and mentoring in technical and training skills of GTs during their supervision visits to ICMVs at village level.

Actions taken in Project Year 3 (2018-2019) were based on assessment findings. MM and GT need more coaching after training to maintain knowledge and training skills. Selection of Master Mentors from State/Regional levels with knowledge of malaria and training skills improves retention of knowledge and skills post-training.

Township level NMCP staff had more time to conduct trainings than the Township Medical Officer so they will be prioritized for further trainings. Translations of knowledge tests for training skills were improved and were more understandable to participants. Project staff increased their support to local NMCP staff during supportive supervision visits to improve their coaching and mentoring skills, which are new skills for most.

Next Steps include Further assessments of knowledge and skills retention will be done for MM and GT 6 – 9 months post training. The project will continue support of NMCP staff as they support GT in subsequent trainings and supportive supervision for ICMV. Translation revisions of the training manuals, particularly knowledge assessments, will continue to ensure that language barriers are addressed.

*Affiliation: Jhpiego/Myanmar, PMI Defeat Malaria Project; University Research Co., Myanmar, PMI Defeat Malaria Project; Myanmar National Malaria Control Program

This poster is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of its Cooperative Agreement No. AID-482-A-16-00003 and the USAID Defeat Malaria Project. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID, PMI or the United States Government.

Mentoring &mHealth &Training &Uncategorized Bill Brieger | 25 Nov 2019

mMentoring, a New Approach to Improve Malaria Care in Burkina Faso

Moumouni Bonkoungou,* Ousmane Badolo, Youssouf Sawadogo, Stanislas Nebie, Thierry Ouedraogo, Yacouba Sawadogo, William Brieger, Gladys Tetteh, and Blami Dao presented their work on “mMentoring, a New Approach to Improve Malaria Care in Burkina Faso” at the 68th Annual Meeting of the American Society of Tropical Medicine and Hygiene as seen below.

Malaria is the leading cause of consultation (43.3%), hospitalization (44.1%) and death (16.1 %) in Burkina Faso. In the Sahel Region, the case fatality proportion due to malaria is 2% compared to 0.8% for the national average. This region is most affected by malaria than others. Also, the Sahel Region is currently experiencing high levels of insecurity making movement of health teams difficult and unsafe.

mMentoring is the use of mobile technology to ensure capacity building and continuing education among health staff. The process started by a workshop to develop messages, and briefing of the main actors.

Each week, messages and quizzes (An automatic answer is sent to each quiz) are sent to 753 providers (nurses, midwives, medical doctors) of the 115 health centers in the Sahel Region. Each month, messages are revised by a team at national level before being sent.

The messages sent were related to several key malaria prevention and control interventions, such as case definition, parasitological diagnosis, clinical case management of simple and severe cases, intermittent preventive treatment in pregnancy (IPTp), pre-referral treatment with rectal artesunate in children under 5 years, insecticide-treated bed nets.

After 10 months of implementation, 64 reinforcement messages on case management and prevention guideline and 63 quizzes were sent. Proportion of correct responses to the quizzes ranged from 43% and 96%. The lowest scores related to topics on management of severe cases while the highest were related to diagnosis of malaria.

The participation rate (number of respondents of the 753 targeted health workers) is on average 22% with 71% of participants from primary health facilities. Also, we notice IPT3 increased from 14.8% in the quarter 3 of 2017 to 45.6% in the same quarter of 2018 (with mMentoring).

The rate of performance of rapid diagnostic tests (RDTs) rose from 67.5% to 77.8%. The case fatality rate during this quarter of 2017 was 3.3% and 1.8% in 2018. As a real platform for continuing training, it would be wise to extend this approach to other regions of the country and also to other health actors like community health workers.






*Affiliations: PMI Improving Malaria Care Project, Ouagadougou, Burkina Faso, Ministry of Health, National Malaria Control Program, Ouagadougou, Burkina Faso, Johns Hopkins University, Baltimore, MD, United States, Jhpiego Baltimore, Baltimore, MD, United States

Case Management &Training Bill Brieger | 22 Nov 2019

Retention of malaria knowledge and skills and adherence to National Malaria Treatment Guidelines by integrated community malaria volunteers

Retention of malaria knowledge and skills and adherence to National Malaria Treatment Guidelines by integrated community malaria volunteers in three States/Regions in Myanmar is the focus of a poster presentation by Ni Ni Aye, Aung Thi, Kyawt Mon Win, Thiha Myint Soe, May Oo Khin, Khant Maung Maung, and Saw Naung Naung at the 68th Annual Meeting of the American Society of Tropical Medicine and Hygiene. They are affiliated with Jhpiego Myanmar PMI Defeat Malaria Project, University Research Co. Myanmar PMI Defeat Malaria Project, and Myanmar National Malaria Control Program.

The PMI-supported Defeat Malaria Project aims to enhance technical and operational capacity of the National Malaria Control Program and providers at all levels of the health system in 3 States/Regions (S/R). In 2017, Myanmar introduced a new type of cadre, Integrated Community Malaria Volunteers (ICMV), as a foundation for integrated malaria control activities at village level.

Defeat Malaria is developing their capacity to ensure malaria case management according to National Treatment Guidelines (NTG). To date, Defeat Malaria has prepared 71 national and S/R level trainers to train and supervise 776 ICMVs caring for a population of nearly 600,000 people.

The study would like to explore the knowledge and technical skills retention of ICMVs working in these three States/Regions and how exactly they follow the national treatment guidelines.  NMCP’s Policy on ICMV notes that Malaria volunteers have been renamed as Integrated Community Malaria Volunteers (ICMV). Their Primary roles are malaria diagnosis, treatment, referral and IEC/BCC activities. They Refer and follow up when other diseases are suspected, including TB, HIV, leprosy, dengue and filariasis.

The Objective of the study was to explore the retention of malaria knowledge and skills of Integrated Community Malaria Volunteers after the training in Kayin and Rakhine States and Taninthary Region.  Also the study explored adherence to National Treatment Guidelines by the Integrated Community Malaria Volunteers in Kayin and Rakhine States and Taninthary Region.

This will be the secondary data analysis of “malaria knowledge and skills retention” using post training follow up tools and checklist during the supported supervision of NMCP conducted jointly with Defeat Malaria team in 2018 -2019 in three state and Region. The study population included 92 ICMVs.

Initial and refresher ICMV trainings included a 5-day modular course for initial ICMV training as well as a 3 days focusing on malaria epidemiology, malaria diagnosis, treatment and referral. There was an IEC/ BCC component focusing on community-based prevention. Another component was a 2-day update on other diseases: TB, HIV, leprosy, dengue and filariasis including referral and follow up of suspected cases.

Another 3-day course for refresher ICMV training one year after initial training was provided. A 2-day session focusing on malaria diagnosis, treatment and referral, case studies and filling register was given. Finally, there was a 1-day update on other diseases.
Improved malaria knowledge among trained ICMVs in two regions (Gwa and Hlaningbwe) was demonstrated. There was reduced gap between pre- and post-test scores at initial vs. refresher training.

Initial training of ICMV and post training assessments of retention of malaria knowledge resulted in 892 ICMV from 14 townships being trained. 54% of ICMV had a passing score (?80%) in pre test for knowledge of malaria. More than 90% of ICMV had a passing score in post test for knowledge of malaria.

Additionally 92 ICMV were followed up after training to assess knowledge of malaria. 42 ICMV were assessed within 6 months after training, and 50 ICMV were assessed after 6 months of training.

Post training assessment of retention of malaria case management skills for ICMV 6 month after training found that 100% of ICMV achieved a passing score using a standardized skills check list during a simulation. Performance improved over the previous year’s 6-month post training assessment in RDT testing. 92% of ICMV told patients about blood testing and provided emotional support, and 100% of ICMV conducted RDT testing according to standardized checklist.

All ICMV disposed of used lancets immediately into safety box after use, and 95% of ICMV gave health education. 90% of ICMV recorded the test result in the main register. 100% of ICMV provide correct treatment according to NTG by using Job Aids. Only 30% of ICMV referred suspected other diseases (TB, leprosy, dengue) with negative RDT to the health centre.

Case management and adherence to NTG by ICMV during supervision period (Oct 2018 – September 2019) also reached 100%.

In conclusion, Supportive supervision, mentoring, and attention to language barriers lead to improved post-training retention of knowledge and skills. 1-6 months after ICMV training, retention of knowledge, skills, and decision making related to malaria case management are high in all 3 States/Regions. >6 months after completing training, knowledge retention and skills on malaria case management of ICMV are less in Rakhine and Tanintharyi Regions. Retention of knowledge and skills of ICMV who received lower scores due to language barriers were improved by mentoring during supervision in Kayin State.

After 6 months, a decline was noted in ICMVs’ communication skills for health education during RDT testing. Since most RDT tests are negative, they must use job aids to recall correct treatment for positive case but are still confused about use of primaquine even with job-aids. All ICMV adhered to NTG for positive cases and negative cases. They referred negative cases suspected of having other disease (TB, leprosy and dengue) to the health center.

Moving forward, tablets will be used to gather data during ICMV mentoring visits to facilitate data accuracy and sharing. Data will be uploaded to NMCP through Google. Project staff will continue to accompany NMCP on supportive supervision visits to ICMVs 1 – 6 months post training to model best practices and lend to sustainability of the approach.

This poster is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of its Cooperative Agreement No. AID-482-A-16-00003 and the USAID Defeat Malaria Project. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID, PMI or the United States Government.

Case Management &Health Workers &Planning &Severe Malaria &Training Bill Brieger | 01 Nov 2018

Malaria Response Plan in Times of High Transmission: An Approach to Improving the Quality of Hospital Malaria Management

Ousmane Badolo, Stanislas Nebie, Youssouf Sawadogo, Thierry Ouedraogo, Moumouni Bonkoungou, Mathurin Dodo, Danielle Burke, William Brieger, and Gladys Tetteh of Jhpiego and the Improving Malaria Care Project (USAID) in Burkina Faso presented a poster on helping hospitals develop a malaria response plan. Their findings are shared below.

In Burkina Faso Malaria cases peak from June-September (rainy season), exceeding hospital capacity and causing high number of deaths, especially in children under 5 years of age. The Improving Malaria Care Project, funded by USAID/President’s Malaria Initiative, provided support to National Malaria Control Program to develop and implement malaria preparedness and response plans in all 11 regional hospitals

The Objectives of this effort aimed to describe development and implementation of malaria preparedness and response plan. From this the project planned to share lessons learned and challenges Malaria Preparedness and Response Plan Development and Implementation Process is seen in the attached chart.

In preparation of hospital staff for planning, the training reached Nurses and midwives were largest groups of trained providers at 52% and 30%, respectively. Providers were selected by hospital management team from pediatric maternity and emergency units.

Severe Malaria Cases Trend Regional Hospital in Burkina Faso is seen in the attached graph. In a second graph, Malaria Case Fatality Rate Trend at Regional Hospitals in Burkina Faso is shown. Even though there were more cases of severe malaria in 2017, Malaria case fatality rate decreased after implementing malaria response plan.

Challenges faced by the hospitals included Lack of funding for response plan activities, which were not included in the routine hospital work plan. Also there was a Lack of beds in some hospital rooms, especially in pediatric unit. Timing of clients coming to hospital posed a challenge as many do not come early and sometimes come when only complications start.

Lessons learned from the intervention include the fact that On-the-job training is opportunity to improve providers’ skills. Response plans must consider that providers’ refreshment, and securing blood and other commodities may improve severe malaria case management. Monthly data collection and analysis may highlight progress in malaria planning through case management and orient decision-making. Follow-up visits strengthened provider engagement on severe malaria case Management

In Conclusion, Response plans may provide a way to reduce malaria mortality. Each hospital should consider incorporating response plan into its annual work plan

This poster was made possible by the generous support of the American people through the United States Agency for International Development (USAID) under Cooperative Agreement No. AID-624-A-13-00010 and the President’s Malaria Initiative (PMI). The contents are the responsibility of the authors and do not necessarily reflect the views of USAID, PMI or the United States Government.

Case Management &CHW &Training Bill Brieger | 31 Oct 2018

Improving Adherence to National Malaria Treatment Guidelines through a Low-Dose, High-Frequency Approach Targeting Village Malaria Workers in Selected Townships in Myanmar

Ni Ni Aye, May Aung Lin, Saw Lwin, Khin Than Win, Kyan Khaing, Nu Nu Khin, Kyaw Myint Tun who are colleagues from Jhpiego, PMI Defeat Malaria Project, University Research Co.,  Myanmar Nurses and Midwives Association; and the USAID/US President’s Malaria Initiative, Myanmar presented their experiences training village malaria workers on national malaria treatment guidelines at the 2018 Annual Meeting of the American Society of Tropical Medicine an Hygiene. Below are their findings.

The Trend of Malaria Cases and Deaths in Myanmar has been steadily decreasing. PMI Defeat Malaria Project (October 2016–September 2021) wants to ensure that this trend continues.

Project goals include reduce malaria burden, control artemisinin-resistant malaria in target area, and eliminate malaria in Myanmar. Specific Objectives are:

  • Achieve universal coverage of at-risk populations
  • Strengthen malaria surveillance system
  • Enhance provider technical capacity
  • Promote community and public and private-sector involvement in malaria control and elimination

Capacity Development Strategy for Village Malaria Workers (VMWs) focused on Two townships with low adherence to National Malaria Treatment Guidelines (NTGs): Palaw Township with 38 Village Malaria Workers (VMWs) and Gwa Township with 39 VMWs. The project used a Competency-based low-dose, high-frequency (LDHF) training approach. There were Three sessions, one day/month during June, July, and August 2017.

Post-training follow-up used a Clinical audit result review during supportive supervision and monitoring visits. Data quality assessment and verification was performed by field teams and monthly reports examined.

The project also Conducted refresher training using LDHF approach for at least two doses followed by on-the-job training and regular supervision and monitoring. They Formulated culturally appropriate materials for areas like Palaw Township where different languages are spoken. A Job Aid on Benefits of Adherence to Antimalarial Drug was developed.

VMW Rapid Diagnostic Testing was observed by Month. There was an Improvement in VMW Knowledge Assessment Scores with a positive Post-training Assessment Knowledge of Malaria.

Post-training Assessment for RDT Competency also took place. 85-90% of VMWs Told clients about blood testing and provided emotional support. 70-80% of VMWs Conducted RDT testing according to standards. 95-98% of VMWs Performed hand hygiene before and after rapid diagnostic test. 80-90% of VMWs Disposed used lancet immediately into safety box after use. 85-90% of VMWs Gave health education. Finally 80-90% Disposed of contaminated items appropriately and recorded test in malaria register, and 80% Used job aids/manual and provided correct treatment according to National Training Guidelines (NTGs).

In Conclusion, Improvement was seen in adherence to NTGs assessed as percent of uncomplicated malaria cases that received correct antimalarial treatment. VMWs Adhered to NTGs. In Gwa thus Increased from 72% to 100% and remained high. In Palaw this Stayed at 91% – 92% after training period. Therefore, the LDHF approach was appropriate for VMW capacity-building on protocol adherence in Gwa Township where there was no language barrier.

Next Steps include Conducting refresher training using LDHF approach for at least two doses followed by on-the-job training and regular supervision and monitoring. The project will Formulate culturally appropriate materials for areas like Palaw Township where different languages are spoken.

Education &Health Systems &Primary Health Care &Social/Cultural &Training Bill Brieger | 15 Mar 2018

New Fully Online Global Health Learning Programs at JHU

Continuing professional development has often been a challenge for people in the field. They may not be able to get study leave, but they do need advanced training in order to progress. The Johns Hopkins Bloomberg School of Public Health as started a new Online Programs for Applied Learning (OPAL) that offers completely online Masters and Certificate degrees.

The Department of International Health is Offering three Master of Applied Learning (MAS) and one Certificate covering global health. The Certificate can be completed in one year minimum and the MAS in two years minimum. More information on these programs can be obtained at the links below.

Case Management &Community &ITNs &Training Bill Brieger | 15 Nov 2017

Community Based Intervention in Malaria Training in Myanmar

Nu Nu Khin of Jhpiego who is working on the US PMI “Defeat Malaria Project” led by URC shares observations on the workshop being held in Yangon with national and regional/state malaria program staff to plan how to strengthen malaria interventions at the community level. The workshop has adapted Jhpiego’s Community Directed Intervention training package to the local setting.

Yesterday’s opening speech was being hailed as a significant milestone to give Community-Based Intervention (CBI) training teams the knowledge, skills, and attitudes they need to effectively provide quality malaria services and quality malaria information.

This core team is going to train the critical groups of community-level implementers including CBI focal persons and malaria volunteers at the community level.

We embarked this important step yesterday with the collaboration of Johns Hopkins University, Myanmar Ministry of Health and Sports, and World Health Organization Myanmar.

Participants will be developing action plans to apply the community approach to malaria efforts in townships and villages in three high transmission Rakhine State, Kayin State and Tanintharyi Region.

Case Management &Health Workers &Training Bill Brieger | 08 Nov 2017

Health provider orientation to national malaria case management guidelines in regional hospitals in Burkina Faso

Good clinical practice in managing malaria requires awareness and understanding of national case management guidelines. Moumouni Bonkoungou, Ousmane Badolo, and Thierry Ouedraogo of Jhpiego in Collaboration with the National Malaria Control Program and sponsorship from the “Improving Malaria Care” project of USAID/PMI explain how health workers in Burkina Faso were oriented to the national guidelines at the 66th Annual Meeting of the American Society of Tropical Medicine and Hygiene. They have found that short orientations are less expensive and reach more health workers that traditional training sessions.

Malaria remains the leading cause of consultations, hospitalization and death in health facilities in Burkina Faso. In 2015, 23,634 cases of severe malaria were recorded in hospitals with 1,634 deaths, a mortality rate of 7% at this level compared to 1% nationally. Since April 2014, 1,819 providers from 49 districts have been trained in malaria case management, specifically at the first level (health center – CSPS). Conversely, at referral centers – medical centers with surgical units (CMA), regional hospitals (CHR) and university hospitals (CHU) – providers are not well educated on the new WHO guidelines for malaria prevention and case management.

Health worker orientation session

This situation led the United States Agency for International Development-supported Improving Malaria Care (IMC) project and the National Malaria Control Program (NMCP) to organize orientation sessions for providers in 8 CHR in September 2016. The sessions were conducted by trainers at the national level, supported by clinicians from hospitals including pediatricians and gynecologists.

A total of 298 health workers were oriented, including 24 physicians, 157 nurses, 56 midwives, as well as pharmacists and laboratory technicians. 39% of participants were female and 43% have less than 5 years of service in these hospitals. The sessions have provided participants with an opportunity to familiarize themselves with the new guidelines for malaria prevention and case management.

The orientations have also made it possible to identify the difficulties encountered by referral structures in malaria case management, which include: insufficient staff, inadequate capacity building, no blood bank in some hospitals, reagent stock-outs, inadequacies in the referral system, and insufficient equipment.

To address these difficulties, staff redeployment, internal supervision, development of tools to monitor reagents stocks have been proposed. To move forward, response plans for the period of high malaria transmission is expected to be developed for these referral facilities.

Health Workers &Human Resources &IPTp &Training &Treatment Bill Brieger | 07 Nov 2017

Using rapid task analysis to strengthen Pre-Service Education (PSE) learning and performance of critical malaria interventions in Liberia

Understanding the tasks that health workers perform in real life can improve their basic Training. Marion Subah of MCSP and Jhpiego shares experiences in using Task Analysis to improve pre-service training of midwives and lab technicians in Liberia. Her findings summarized below, are presented at the American Society of Tropical Medicine’s 66th Annual Meeting.

Health worker task analysis helps human resource planners and managers update pre-service education (PSE) curricula and plan needed in-service training. In Liberia, a task analysis was conducted focusing on Liberia’s midwives’ and Medical Laboratory Technicians’ (MLT) work practices.

Task lists were developed using curricula, job descriptions and professional scope of practice, and validated by key stakeholders for each cadre. Responses from 25 MLTs and 26 midwives were examined that addressed the following questions:

  1. How often do you do the task (frequency)?
  2. Where did you learn to do the task (location)?
  3. How well do you think you are able to perform the task (performance)?
  4. How critical is the task in terms of patient and/or public health outcomes (criticality).

Eligibility criteria included those currently practicing between 6 months and 5.5 years following graduation. Midwives were assessed for five tasks relating to malaria service provision, including provision of preventive treatment for malaria in pregnancy, management of vector borne diseases, diagnosis and management uncomplicated malaria in adults and children (respectively), and provision of malaria preventive services.

Lab technicians were assessed for one malaria task, performance of parasitological tests. On average 61% of midwives learned these malaria tasks in PSE, 74% said they performed these tasks daily, 80% felt proficient in performing the tasks, and 82% rated the tasks moderate to high in criticality. For MLTs, 88% learned malaria testing in pre-service education, 100 % performed this task daily, 77% felt they were proficient and 93% said the task was of moderate to high criticality.

Task Analysis Flow Chart

The results from this rapid task analysis are being applied to the current curricula review. Courses that could be updated or strengthened have been identified. Malaria Case Management Technical Update and Effective Teaching Skills Training are being organized for tutors at the training schools. Finally, integrated supportive supervision tools are being strengthened to improve performance of these malaria tasks by midwives and lab technicians.

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