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Kikaya V, Katembwe F, Yabili J, Mbwanya M, Dhuse E, Gomez P, Waxman R, Mohan D, Tappis H. Effectiveness of Capacity-Building and Quality Improvement Interventions to Improve Day-of-Birth Care in Kinshasa, Democratic Republic of the Congo. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:GHSP-D-23-00236. [PMID: 38365280 PMCID: PMC10906559 DOI: 10.9745/ghsp-d-23-00236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/23/2024] [Indexed: 02/18/2024]
Abstract
In sub-Saharan African settings like the Democratic Republic of the Congo, high-quality care during childbirth and the immediate postpartum period is lacking in public facilities, necessitating multipronged interventions to improve care. We used a pre-post design to examine the effectiveness of a low-dose, high-frequency capacity-building and quality improvement (QI) intervention to improve care for women and newborns around the day of birth in 16 health facilities in Kinshasa, Democratic Republic of the Congo. Effectiveness was assessed based on changes in provider skills, key health indicators, and beneficiary satisfaction. To assess changes in the competency of the 188 providers participating in the intervention, we conducted objective structured clinical examinations on care for mothers and newborns on the day of birth, immediate postpartum family planning (PPFP) counseling and method provision, and postabortion care before and after implementation of training and at 6 and 12 months after training. Interrupted time series (ITS) analysis techniques were used to analyze routine health service data for changes in select maternal, newborn, and postpartum outcomes before and after the intervention. To assess changes in clients' perceptions of care, 2 rounds of telephone surveys were administered. Before the intervention, less than 2% of participating providers demonstrated competency in skills. Immediately after training, more than 80% demonstrated competency, and 70% retained competency after 12 months. ITS analyses show the risk of early neonatal death declined significantly by 9% (95% confidence interval [CI]=4%, 13%, P<.001), and likelihood of immediate PPFP uptake increased significantly by 72% (95% CI=53%, 92%, P<.001). Client satisfaction improved by 58% over the life of the project. These findings build on previous studies documenting the effectiveness of clinical capacity-building and QI approaches. If implemented at scale, this approach has the potential to substantively contribute to improving maternal and perinatal health in similar settings.
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Affiliation(s)
| | | | - Jacky Yabili
- Jhpiego, Kinshasa, Democratic Republic of the Congo
| | | | | | | | | | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hannah Tappis
- Jhpiego, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Osoro CB, Dellicour S, Ochodo E, Young T, Ter Kuile F, Gutman JR, Hill J. Healthcare provider and drug dispenser knowledge and adherence to guidelines for the case management of malaria in pregnancy in the context of multiple first-line artemisinin-based combination therapy in western Kenya. Malar J 2023; 22:262. [PMID: 37679753 PMCID: PMC10486056 DOI: 10.1186/s12936-023-04692-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Concerns about emerging resistance to artemether-lumefantrine (AL) in Africa prompted the pilot introduction of multiple first-line therapies (MFT) in Western Kenya, potentially exposing women-of-childbearing-age (WOCBA) to anti-malarials with unknown safety profiles in the first trimester. The study assessed healthcare provider knowledge and adherence to national guidelines for managing malaria in pregnancy in the context of the MFT pilot. METHODS From March to April 2022, a cross-sectional study was conducted in 50 health facilities (HF) and 40 drug outlets (DO) using structured questionnaires to assess pregnancy detection, malaria diagnosis, and treatment choices by trimester. Differences between HF and DO providers and between MFT and non-MFT HFs were assessed using Chi-square tests. RESULTS Of 174 providers (77% HF, 23% DO), 56% were from MFT pilot facilities. Most providers had tertiary education; 5% HF and 20% DO had only primary or secondary education. More HF than DO providers had knowledge of malaria treatment guidelines (62% vs. 40%, p = 0.023), received training in malaria in pregnancy (49% vs. 20%, p = 0.002), and reported assessing for pregnancy in WOCBA (98% vs. 78%, p < 0.001). Most providers insisted on parasitological diagnosis, with 59% HF using microscopy and 85% DO using rapid diagnostic tests. More HF than DO providers could correctly name the drugs for treating uncomplicated malaria in the first trimester (oral quinine, or AL if quinine is unavailable) (90% vs. 58%, p < 0.001), second and third trimesters (artemisinin-based combination therapy) (84% vs. 70%, p = 0.07), and for severe malaria (parenteral artesunate/artemether) (94% vs. 60%, p < 0.001). Among HF providers, those in the MFT pilot had more knowledge of malaria treatment guidelines (67% vs. 49%, p = 0.08) and had received training on treatment of malaria in pregnancy (56% vs. 32%, p = 0.03). Few providers (10% HF and 12% DO) had adequate knowledge of malaria treatment in pregnancy, defined as the correct drug and dose for uncomplicated and severe malaria in all trimesters. CONCLUSIONS Knowledge of national malaria in pregnancy treatment guidelines among providers in Western Kenya is suboptimal. Robust training on appropriate anti-malarial and dosage is needed, particularly given the recent change in recommendation for artemether-lumefantrine use in the first trimester. Supervision of DO and HF practices is essential for correct treatment of malaria in pregnancy in the context of MFT programmes.
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Affiliation(s)
- Caroline B Osoro
- Centre for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578, Kisumu, 40100, Kenya.
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.
| | - Stephanie Dellicour
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool Pembroke Place, Liverpool, L3 5QA, UK
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578, Kisumu, 40100, Kenya
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa
| | - Taryn Young
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa
| | - Feiko Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool Pembroke Place, Liverpool, L3 5QA, UK
| | - Julie R Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA
| | - Jenny Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool Pembroke Place, Liverpool, L3 5QA, UK
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Hicks S, Abuna F, Odhiambo B, Dettinger JC, Sila J, Oketch G, Sifuna E, Ngumbau N, Gómez L, John-Stewart GC, Kinuthia J, Wagner AD. Integrating PrEP in maternal and child health clinics in Kenya: analysis of a service availability and readiness assessment (SARA) survey. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1206150. [PMID: 37484872 PMCID: PMC10359145 DOI: 10.3389/frph.2023.1206150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/12/2023] [Indexed: 07/25/2023] Open
Abstract
Background Risk of HIV acquisition is high during pregnancy and postpartum, and pre-exposure prophylaxis (PrEP) is recommended for peripartum populations. Integrating PrEP into maternal and child health (MCH) clinics is feasible and acceptable. Understanding clinics' service availability and readiness is essential for effective scale up. Methods The PrEP in Pregnancy, Accelerating Reach and Efficiency study (PrEPARE; NCT04712994) engaged PrEP-experienced facilities previously linked to a programmatic or research study in Western Kenya to document available services and commodities via a modified service availability and readiness assessment (SARA) survey with 20 PrEP tracer items covering: staffing/guidelines, services/equipment, and medicines/commodities. Facilities' prior study engagement occurred between 2017 and 2019; SARA survey data was collected between April 2020 and June 2021. Descriptive statistics were stratified by prior study engagement. ANOVA tests assessed associations between facility characteristics and gaps. Fisher's tests assessed differences in commodity availability and stockouts. Results Of the 55 facilities surveyed, 60% had received PrEP training in the last two years, 95% offered PrEP integrated into MCH, and 64% and 78% had both auditory and visual privacy in PrEP and HIV testing service (HTS) delivery spaces, respectively. Supervision frequency was heterogeneous, but 82% had received a supervision visit within 3 months. Availability of commodities was variable and the most commonly unavailable commodities were PrEP in MCH (71% available) and risk assessment screening tool (RAST) and PrEP cards (60% and 75% available, respectively). The number of service and commodity gaps per facility ranged from zero to eight (median: 3; IQR: 2, 5). The most frequent gaps were: PrEP training and risk assessment cards (40% each), lack of privacy in PrEP (36%) and HIV testing services (31%) spaces, PrEP pills in MCH (29%), and PrEP cards (25%). There were no differences in mean number of gaps by county, previous study engagement, or public vs. private status. Level 4 facilities had fewer gaps (mean 2.2) than level 2, 3, and 5 facilities (mean 5.7, 4.5, and 5.3 respectively; p < 0.001). Conclusions PrEP service availability and readiness was generally high across MCH facilities. However, there is a need for increased frequency of provider training and supportive supervision focused on fidelity. To address key commodity stockouts such as PrEP pills, implementation of electronic logistics management information systems may be needed. Targeting these gaps is essential to effectively scale up integrated PrEP delivery, especially among facilities with limited infrastructure.
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Affiliation(s)
- Sarah Hicks
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Felix Abuna
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Ben Odhiambo
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Julia C. Dettinger
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Joseph Sila
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - George Oketch
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Enock Sifuna
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Nancy Ngumbau
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Laurén Gómez
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Grace C. John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Departments of Medicine, University of Washington, Seattle, WA, United States
- Departments of Pediatrics, University of Washington, Seattle WA, United States
| | - John Kinuthia
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, WA, United States
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Using process-oriented groups reflections with health care providers to improve childbirth care in the Democratic Republic of Congo - An implementation study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100804. [PMID: 36476783 DOI: 10.1016/j.srhc.2022.100804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/11/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE The ability to systematically reflect on care during labour and birth needs to be developed among health care providers. This study investigates the experiences of health care providers who have participated in process-oriented group reflections. The activity of group reflections was one of the three pillars of a training intervention seeking to implement evidence-based care routines during labour and birth that could contribute to reduced mortality and improved maternal and newborn health in the Democratic Republic of Congo (DRC). METHODS Using a qualitative approach, we interviewed 131 health care providers, in focus groups (n = 19) and individually (n = 2). Analysis of transcribed interviews was conducted using qualitative content analysis according to Elo and Kyngäs. RESULTS Group reflections added essential knowledge to the other components of the three-pillar training intervention. Through sharing and analysing care situations health care providers got increased self-awareness, tools to achieve structured and safe care routines, and to practice teamworking. CONCLUSION Using a structured model of process-oriented group reflection for health care providers on care during labour and birth proved to be a vital aspect of the training intervention, as it added knowledge to the skills gained through theoretical and simulation-based education. The three-pillar training intervention improved care routines that supported healthy births and management of complications. We recommend that structured and secure group reflections be included in similar training activities in the DRC and elsewhere, and assessed in further studies.
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Graham HR, Bakare AA, Ayede AI, Eleyinmi J, Olatunde O, Bakare OR, Edunwale B, Neal EFG, Qazi S, McPake B, Peel D, Gray AZ, Duke T, Falade AG. Cost-effectiveness and sustainability of improved hospital oxygen systems in Nigeria. BMJ Glob Health 2022; 7:bmjgh-2022-009278. [PMID: 35948344 PMCID: PMC9379491 DOI: 10.1136/bmjgh-2022-009278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/19/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Improving hospital oxygen systems can improve quality of care and reduce mortality for children, but we lack data on cost-effectiveness or sustainability. This study evaluated medium-term sustainability and cost-effectiveness of the Nigeria Oxygen Implementation programme. Methods Prospective follow-up of a stepped-wedge trial involving 12 secondary-level hospitals. Cross-sectional facility assessment, clinical audit (January–March 2021), summary admission data (January 2018–December 2020), programme cost data. Intervention: pulse oximetry introduction followed by solar-powered oxygen system installation with clinical and technical training and support. Primary outcomes: (i) proportion of children screened with pulse oximetry; (ii) proportion of hypoxaemic (SpO2 <90%) children who received oxygen. Comparison across three time periods: preintervention (2014–2015), intervention (2016–2017) and follow-up (2018–2020) using mixed-effects logistic regression. Calculated cost-effectiveness of the intervention on child pneumonia mortality using programme costs, recorded deaths and estimated counterfactual deaths using effectiveness estimates from our effectiveness study. Reported cost-effectiveness over the original 2-year intervention period (2016–2017) and extrapolated over 5 years (2016–2020). Results Pulse oximetry coverage for neonates and children remained high during follow-up (83% and 81%) compared with full oxygen system period (94% and 92%) and preintervention (3.9% and 2.9%). Oxygen coverage for hypoxaemic neonates/children was similarly high (94%/88%) compared with full oxygen system period (90%/82%). Functional oxygen sources were present in 11/12 (92%) paediatric areas and all (8/8) neonatal areas; three-quarters (15/20) of wards had a functional oximeter. Of 32 concentrators deployed, 23/32 (72%) passed technical testing and usage was high (median 10 797 hours). Estimated 5-year cost-effectiveness US$86 per patient treated, $2694–4382 per life saved and $82–125 per disability-adjusted life year-averted. We identified practical issues for hospitals and Ministries of Health wishing to adapt and scale up pulse oximetry and oxygen. Conclusion Hospital-level improvements to oxygen and pulse oximetry systems in Nigerian hospitals have been sustained over the medium-term and are a highly cost-effective child pneumonia intervention.
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Affiliation(s)
- Hamish R Graham
- Centre for International Child Health, University of Melbourne, MCRI, The Royal Children's Hospital, Parkville, Victoria, Australia .,Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
| | - Ayobami A Bakare
- Department of Community Medicine, University College Hospital Ibadan, Ibadan, Nigeria.,Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Adejumoke Idowu Ayede
- Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria.,Department of Paediatrics, School of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joseph Eleyinmi
- Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
| | - Oyaniyi Olatunde
- Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
| | - Oluwabunmi R Bakare
- Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
| | - Blessing Edunwale
- Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
| | - Eleanor F G Neal
- Infection and Immunity, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Shamim Qazi
- Independent Consultant Paediatrician, Geneva, Switzerland
| | - Barbara McPake
- Nossal Institute for Global Health, Melbourne, Victoria, Australia
| | | | - Amy Z Gray
- Centre for International Child Health, University of Melbourne, MCRI, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, MCRI, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Adegoke G Falade
- Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria.,Department of Paediatrics, School of Medicine, University of Ibadan, Ibadan, Nigeria
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Rowe SY, Ross-Degnan D, Peters DH, Holloway KA, Rowe AK. The effectiveness of supervision strategies to improve health care provider practices in low- and middle-income countries: secondary analysis of a systematic review. HUMAN RESOURCES FOR HEALTH 2022; 20:1. [PMID: 34991608 PMCID: PMC8734232 DOI: 10.1186/s12960-021-00683-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/31/2021] [Indexed: 06/03/2023]
Abstract
BACKGROUND Although supervision is a ubiquitous approach to support health programs and improve health care provider (HCP) performance in low- and middle-income countries (LMICs), quantitative evidence of its effects is unclear. The objectives of this study are to describe the effect of supervision strategies on HCP practices in LMICs and to identify attributes associated with greater effectiveness of routine supervision. METHODS We performed a secondary analysis of data on HCP practice outcomes (e.g., percentage of patients correctly treated) from a systematic review on improving HCP performance. The review included controlled trials and interrupted time series studies. We described distributions of effect sizes (defined as percentage-point [%-point] changes) for each supervision strategy. To identify attributes associated with supervision effectiveness, we performed random-effects linear regression modeling and examined studies that directly compared different approaches of routine supervision. RESULTS We analyzed data from 81 studies from 36 countries. For professional HCPs, such as nurses and physicians, primarily working at health facilities, routine supervision (median improvement when compared to controls: 10.7%-points; IQR: 9.9, 27.9) had similar effects on HCP practices as audit with feedback (median improvement: 10.1%-points; IQR: 6.2, 23.7). Two attributes were associated with greater mean effectiveness of routine supervision (p < 0.10): supervisors received supervision (by 8.8-11.5%-points), and supervisors participated in problem-solving with HCPs (by 14.2-20.8%-points). Training for supervisors and use of a checklist during supervision visits were not associated with effectiveness. The effects of supervision frequency (i.e., number of visits per year) and dose (i.e., the number of supervision visits during a study) were unclear. For lay HCPs, the effect of routine supervision was difficult to characterize because few studies existed, and effectiveness in those studies varied considerably. Evidence quality for all findings was low primarily because many studies had a high risk of bias. CONCLUSIONS Although evidence is limited, to promote more effective supervision, our study supports supervising supervisors and having supervisors engage in problem-solving with HCPs. Supervision's integral role in health systems in LMICs justifies a more deliberate research agenda to identify how to deliver supervision to optimize its effect on HCP practices.
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Affiliation(s)
| | - Dennis Ross-Degnan
- Harvard Medical School, Boston, USA
- Harvard Pilgrim Health Care Institute, Boston, USA
| | - David H. Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Kathleen A. Holloway
- World Health Organization, Southeast Asia Regional Office, Delhi, India
- International Institute of Health Management Research, Jaipur, India
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - Alexander K. Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
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Alidina S, Tibyehabwa L, Alreja SS, Barash D, Bien-Aime D, Cainer M, Charles K, Ernest E, Eyembe J, Fitzgerald L, Giiti GC, Hellar A, Hussein Y, Kahindo F, Kenemo B, Kihunrwa A, Kisakye S, Kissima I, Meara JG, Reynolds C, Staffa SJ, Sydlowski M, Varallo J, Zanial N, Kapologwe NA, Mayengo CD. A multimodal mentorship intervention to improve surgical quality in Tanzania's Lake Zone: a convergent, mixed methods assessment. HUMAN RESOURCES FOR HEALTH 2021; 19:115. [PMID: 34551758 PMCID: PMC8458007 DOI: 10.1186/s12960-021-00652-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/01/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND Safe, high-quality surgical care in many African countries is a critical need. Challenges include availability of surgical providers, improving quality of care, and building workforce capacity. Despite growing evidence that mentoring is effective in African healthcare settings, less is known about its role in surgery. We examined a multimodal approach to mentorship as part of a safe surgery intervention (Safe Surgery 2020) to improve surgical quality. Our goal was to distill lessons for policy makers, intervention designers, and practitioners on key elements of a successful surgical mentorship program. METHODS We used a convergent, mixed-methods design to examine the experiences of mentees, mentors, and facility leaders with mentorship at 10 health facilities in Tanzania's Lake Zone. A multidisciplinary team of mentors worked with surgical providers over 17 months using in-person mentorship, telementoring, and WhatsApp. We conducted surveys, in-depth interviews, and focus groups to capture data in four categories: (1) satisfaction with mentorship; (2) perceived impact; (3) elements of a successful mentoring program; and (4) challenges to implementing mentorship. We analyzed quantitative data using frequency analysis and qualitative data using the constant comparison method. Recurrent and unifying concepts were identified through merging the qualitative and quantitative data. RESULTS Overall, 96% of mentees experienced the intervention as positive, 88% were satisfied, and 100% supported continuing the intervention in the future. Mentees, mentors, and facility leaders perceived improvements in surgical practice, the surgical ecosystem, and in reducing postsurgical infections. Several themes related to the intervention's success emerged: (1) the intervention's design, including its multimodality, side-by-side mentorship, and standardization of practices; (2) the mentee-mentor relationship, including a friendly, safe, non-hierarchical, team relationship, as well as mentors' understanding of the local context; and (3) mentorship characteristics, including non-judgmental feedback, experience, and accessibility. Challenges included resistance to change, shortage of providers, mentorship dose, and logistics. CONCLUSIONS Our study suggests a multimodal mentorship approach is promising in building the capacity of surgical providers. By distilling the experiences of the mentees, mentors, and facility leaders, our lessons provide a foundation for future efforts to establish effective surgical mentorship programs that build provider capacity and ultimately improve surgical quality.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Leopold Tibyehabwa
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Sakshie Sanjay Alreja
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | | | - Danta Bien-Aime
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Monica Cainer
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Kevin Charles
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Edwin Ernest
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | | | - Laura Fitzgerald
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Geofrey C. Giiti
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Augustino Hellar
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Yahaya Hussein
- Department of Health, Social Welfare, and Nutrition Service, President’s Office – Regional Administration and Local Government, Dodoma, Tanzania
| | | | - Benard Kenemo
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Albert Kihunrwa
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Steve Kisakye
- D-Implement, Dalberg Advisors, Dar es Salaam, Tanzania
| | | | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA USA
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Cheri Reynolds
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Steven J. Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA USA
| | - Meaghan Sydlowski
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - John Varallo
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Noor Zanial
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Ntuli A. Kapologwe
- Department of Health, Social Welfare, and Nutrition Service, President’s Office – Regional Administration and Local Government, Dodoma, Tanzania
| | - Caroline Damian Mayengo
- Department of Curative Services, Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
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