Introducing capacity building and mentorship program for routine immunization by local medical colleges
Creators: name: Ashenafi Amare
name: Alemayehu Teklu Toni
name: Biniyam Tilahun
name: Zeleke Abebaw Mekonen
Publisher: name: Gates Open Research
Year: 2019

description: In this project, we have developed a program to supplement the government led supervision through a capacity building and mentorship approach by medical college staffs with better knowledge, skills, and preparation to give supportive supervision and onsite training on specific immunization programs.<br>The primary implementation hypothesis is that Introducing Capacity building and Mentorship Program (CBMP)by medical and health science colleges is feasible, acceptable and effective. We plan to develop an appropriate implementation strategy that results in infidelity, adoption, and penetration of the health workers' in-service training program and increases the reach of routine immunization services to every household.<br>The primary effectiveness hypothesis is that supplementing the existing supportive supervision program with Capacity building and Mentorship Program (CBMP) by the local medical colleges is superior to the already existing supervision system in the programmatic outcomes and front line health worker capacity building. The secondary effectiveness hypothesis is Introducing Capacity building and Mentorship Program (CBMP) by medical colleges would increase the service delivery outcomes (quality and safety of immunization practices), engagement of community members and increase the immunization uptake by the community<br><br>The package of interventions was developed was implemented in the intervention areas including the development of supportive supervision and mentorship guidelines, training in continuous supportive supervision and mentoring, monitoring and evaluation of performance.<br><br>To evaluate the effectiveness we have used a quasi-experimental pre-post randomized design. We have also used the Reach, Effectiveness, Adoption, Implementation, and Mainatainace (RE-AIM) framework was used to evaluate the implementation process. Data was generated from baseline and follow-up surveys of health care providers and supervisors in intervention and control health facilities by structured interviews, document reviews, and observations during the vaccination sessions. In addition, a self-administered questionnaire was used for district health office workers. The intervention packages include the development of supportive supervision and mentorship guidelines and tools that supplement the existing approach, training in continuous supportive supervision and mentoring, and on-site capacity building and mentorship. The mentorship was done by trained college staff (nurses, medical doctors, and public health professionals) with the district health office workers who were expected to learn by shadowing.<br>The study included 30 health facilities (15 intervention and 15 control). During the intervention period we were able to train 25 supervisors from the medical college and the district health office who conducted 65 mentorship activities (86.7% completion) for 15 health facilities in a six month period reaching to 40 health workers in both health centers and health posts with a high rate of content fidelity measured monthly. It was found that the CBMPI intervention package has a statistically significant effect (P=0.0001) in the overall implementation of Reaching Every District (RED) outcomes and mainly in the planning, outreach and data use components. The difference in difference estimator is positive for Penta III coverage and complete vaccination coverage with the health facilities in the intervention district having a statistically significant higher coverage of 17.4% and 16.6% than health facilities in the control group over time respectively. On the other hand, the Penta out rate has reduced significantly on average by 2.6% in the intervention group than the control group over time. Knowledge and skills of the health workers were found to be improved significantly (P&lt;0.05) after the intervention in most of the performance measures. Health workers also assessed the program and capacity of the mentors and it’s was found that the number of supervisory activities, checklist availability, rate of written feedback and process of correction was greatly improved after the intervention (p&lt;0.05). The attitude of the supervisor, communication, knowledge, and problem-solving skills of the supervisors was found to be significantly improved when compared with the pre-intervention period (P&lt;0.05). The cost for the total cost spent on training and supervision during the study is US $73,600 which makes it US $4,907 for each health facility and the incremental costs per additional percent increase in average health facilities RED score and per additional percent increase in average service delivery outcomes over the evaluation period were estimated to be US$ 1,208 and US$ 4,329 respectively. During the qualitative evaluation, all the key informants mentioned that the CBMPI program was effective and the new approach is acceptable by health workers for integration in the routine EPI program and they would love it to be continued.