&lt;p&gt;How Effective are Mentoring Programs for Improving Health Worker Competence and Institutional Performance in Africa? A Systematic Review of Quantitative Evidence&lt;/p&gt;

Feyissa, Garumma Tolu

doi:10.2147/jmdh.s228951

Cited by 39 publications

(45 citation statements)

References 46 publications

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“…This evaluation in four regions of Ethiopia showed that optimizing the health extension program intervention was not associated with any positive change in the health extension workers’ ability to correctly classify common childhood illnesses within the integrated community case management program. The intervention included evidence-based components that potentially could influence the quality of care provided [ 9 , 10 ]. However, when combined in the upscaled intervention, there was no effect.…”

Section: Discussionmentioning

confidence: 99%

“…Community-based interventions have the potential to reduce morbidity and mortality in children under the age of five years [ 8 ]. Performance reviews and mentoring of primary health care workers has been effective in improving the clinical management of childhood illnesses [ 9 ]. Regular supportive supervision, in-service training, and community ownerships are also interventions that potentially could improve the performance of community health workers [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Association between a complex community intervention and quality of health extension workers’ performance to correctly classify common childhood illnesses in four regions of Ethiopia

et al. 2021

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Background Due to low care utilization, a complex intervention was done for two years to optimize the Ethiopian Health Extension Program. Improved quality of the integrated community case management services was an intermediate outcome of this intervention through community education and mobilization, capacity building of health workers, and strengthening of district ownership and accountability of sick child services. We evaluated the association between the intervention and the health extension workers’ ability to correctly classify common childhood illnesses in four regions of Ethiopia. Methods Baseline and endline assessments were done in 2016 and 2018 in intervention and comparison areas in four regions of Ethiopia. Ill children aged 2 to 59 months were mobilized to visit health posts for an assessment that was followed by re-examination. We analyzed sensitivity, specificity, and difference-in-difference of correct classification with multilevel mixed logistic regression in intervention and comparison areas at baseline and endline. Results Health extensions workers’ consultations with ill children were observed in intervention (n = 710) and comparison areas (n = 615). At baseline, re-examination of the children showed that in intervention areas, health extension workers’ sensitivity for fever or malaria was 54%, 68% for respiratory infections, 90% for diarrheal diseases, and 34% for malnutrition. At endline, it was 40% for fever or malaria, 49% for respiratory infections, 85% for diarrheal diseases, and 48% for malnutrition. Specificity was higher (89–100%) for all childhood illnesses. Difference-in-differences was 6% for correct classification of fever or malaria [aOR = 1.45 95% CI: 0.81–2.60], 4% for respiratory tract infection [aOR = 1.49 95% CI: 0.81–2.74], and 5% for diarrheal diseases [aOR = 1.74 95% CI: 0.77–3.92]. Conclusion This study revealed that the Optimization of Health Extension Program intervention, which included training, supportive supervision, and performance reviews of health extension workers, was not associated with an improved classification of childhood illnesses by these Ethiopian primary health care workers. Trial registration ISRCTN12040912, http://www.isrctn.com/ISRCTN12040912.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between a complex community intervention and quality of health extension workers’ performance to correctly classify common childhood illnesses in four regions of Ethiopia

et al. 2021

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“…Training in clinical management skills as well as the supply of equipment and pharmaceutical drugs are prerequisites for good quality services. Supportive supervision, performance reviews, and clinical mentorship may improve the quality of care provided [ 31 – 33 ]. In our study most health extension workers had been trained on the clinical management of sick children, but only a fifth had been trained in the past 12 months.…”

Section: Discussionmentioning

confidence: 99%

Quality of clinical assessment and management of sick children by Health Extension Workers in four regions of Ethiopia: A cross-sectional survey

et al. 2020

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Background Care-seeking for sick children at the Ethiopian primary health care level is low. This problem may partly be due to unfavorable community perceptions of the quality of care provided. There is, however, limited knowledge on the quality of the clinical assessment and management provided by the health extension workers at the health posts. This study aimed to examine the quality of clinical assessment, classification and management provided to sick under-five children by health extension workers in four regions of Ethiopia. Methods Clinical observations of 620 consultations of sick children by health extension workers were conducted from December 2016 to February 2017. A clinical pathway analysis was performed to analyze whether sick children were appropriately assessed, classified and managed according to the integrated Community Case Management guidelines. Results Most sick children presented with complaints of cough (58%), diarrhea (36%), and fever (26%).Three quarters of children with respiratory complaints had their respiratory rate counted (74%, 95% CI 69-78), while a third (33%, 95% CI 27-40) of children with diarrhea were assessed for dehydration. Half (53%, 95% CI 49-57) of the sick children were assessed for general danger signs, while a majority (89%, 95% CI 86-92) had their arm circumference measured for malnutrition. Half of the sick children received some treatment and less than one-fifth were referred according to the integrated Community Case management guidelines. Comprehensive counseling was provided to 38% (95% CI 35-42) of the caregivers.

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“…A few studies, however, have evaluated the use of audit and feedback for frontline workers. For example, a performance review and mentoring intervention in Ethiopia improved both work volume and the ability of extension workers to diagnose common illnesses [ 38 ]. In Mozambique and Uganda, an intervention that included the use of smart phones to provide direct voice connections to supervisors as well as decision support and performance feedback also improved the management of common childhood illnesses [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model

Juarez¹,

Dionicio²,

Sacuj³

et al. 2021

IJERPH

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Rural Guatemala has one of the highest rates of chronic child malnutrition (stunting) in the world, with little progress despite considerable efforts to scale up evidence-based nutrition interventions. Recent literature suggests that one factor limiting impact is inadequate supervisory support for frontline workers. Here we describe a community-based quality improvement intervention in a region with a high rate of stunting. The intervention provided audit and feedback support to frontline nutrition workers through electronic worklists, performance dashboards, and one-on-one feedback sessions. We visualized performance indicators and child nutrition outcomes during the improvement intervention using run charts and control charts. In this small community-based sample (125 households at program initiation), over the two-year improvement period, there were marked improvements in the delivery of program components, such as growth monitoring services and micronutrient supplements. The prevalence of child stunting fell from 42.4 to 30.6%, meeting criteria for special cause variation. The mean length/height-for-age Z-score rose from −1.77 to −1.47, also meeting criteria for special cause variation. In conclusion, the addition of structured performance visualization and audit and feedback components to an existing community-based nutrition program improved child health indicators significantly through improving the fidelity of an existing evidence-based nutrition package.

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<p>How Effective are Mentoring Programs for Improving Health Worker Competence and Institutional Performance in Africa? A Systematic Review of Quantitative Evidence</p>

Cited by 39 publications

References 46 publications

Association between a complex community intervention and quality of health extension workers’ performance to correctly classify common childhood illnesses in four regions of Ethiopia

Association between a complex community intervention and quality of health extension workers’ performance to correctly classify common childhood illnesses in four regions of Ethiopia

Quality of clinical assessment and management of sick children by Health Extension Workers in four regions of Ethiopia: A cross-sectional survey

Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model

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