81308819-Strengthen individual and institutional capacities of health sector service providers relating to EmONC in Sierra Leone

The GIZ project "Health System Strengthening and Epidemic Prevention in Sierra Leone" has four outputs. The contract will comprise Output 2 which aims to strengthen capacities in emergency obstetric and neonatal care in selected health facilities in Kailahun, Kambia and Pujehun. This will be achieved by a need-based mix of human capacity development measures (in-service trainings, mentoring and internship programme) and several institutional capacity development measures concerning the availability of basic medical equipment as well as standard operating procedures, quality assurance processes and the referral system. A needs assessment for health facilities concerned will be conducted by GIZ before beginning of this contract. The contractor is to build on findings and ensure smooth continuation of activities under Output 2. The EmONC trainings will be conducted by trained trainers of the MoH, which will additionally be supported in the institutionalization of trainings as well as on improving the focus on competencies and women-centeredness of trainings. The mentoring approach will build on previous mentoring programs supported in the previous project phase and will be further developed utilizing the already build up expertise in the districts. Additionally, selected staff of BEmONC centres will be able to intern at district hospitals, and the establishment and use of an additional skills lab per district increases the safety of staff in the delivery of services and thus their quality. Institutional capacities will be improved by the limited provision of priority basic medical equipment, and trainings on preventive maintenance to ensure long-term functionality of the equipment procured will be given. To ensure compliance with standards, quality management including the availability of work aides and standard operating procedures will be supported. As inappropriate referrals from basic health services and inadequate preparedness at secondary health services contribute significantly to the overall maternal and newborn mortality, the project supports the improvement of the referral system in each district. As far as possible, other challenges in delivering adequate EmONC services, such as electricity and clean water supply or the availability of essential drugs, will be addressed by advising partners on possible solutions. The contractor is responsible to strengthening the individual capacities of health care workers relating to EmONC in Kailahun, Kambia and Pujehun. More specifically, this refers to the implementation of EmONC-related trainings according to the EmONC trainings plan that is developed by the Ministry of health with support of the project under Output 1; 325 health care workers from 64 health facilities are to be trained. As part of the project, the trainers of the MoH are to be advised on competency-based and women-centered training implementation. The implemented EmONC in-service trainings are to be sustainably institutionalized in the 3 partner districts in close collaboration with MoH/Directorate for Human Resources and Directorate of Reproductive and Child Health and the DHMTs of Kambia, Pujehun and Kailahun. Trainings need to be documented in a gender-disaggregated manner and the contractor needs to report progress to GIZ regularly.

The contractor is also responsible for implementing a mentoring program on EmONC with 340 health care workers according to a mentoring system concept, and to support the institutionalization of the approach. For this, it is important to liaise with other development partners active in mentoring approaches. To implement the mentoring program, refresher trainings for existing mentors need to be conducted, or additional mentors need to be trained in the mentoring approach. Biannual mentoring visits need to be implemented from the district hospital to the BEmONC facilities, and from the BEmONC facilities to peripheral health facilities in the respective catchment area. Additionally, off-site follow-ups must be ensured. The contractor needs to conduct a baseline assessment with a documentation tool for the mentoring approach that will be used for progress assessment on a yearly basis. Midwives from the supported health facilities will also be supported with an internship programme where they spend time in the district hospital to improve their capacities in obstetric and neonatal care. 3 BEmONC skills labs will be established by the contractor and their regular use must be ensured. In addition, the health facilities will be supported with medical and non-medical equipment based on a previously conducted needs-assessment. The contractor will ensure the procurement and distribution of the equipment as well as proper training, and will make the managing, using, and adequate handling of the equipment a regular component of the mentoring sessions.

During the first mentoring visit information on the existing quality assurance approaches, such as e.g. availability of standard operating procedures (SOP), regular quality circles, feedback mechanisms etc. will be collected, and based on findings, an action plan to improve quality management for EmONC services in each district will be developed jointly with relevant national and district partners. The implementation of this plan will be supported as well as the uptake of feedback by the quality management of the health facility. In addition, information on existing referral practices will be collected during the first mentoring visit in order to develop a plan for improvement of the referral system; developed material will also be part of the mentoring programme. Beyond that, district and national partners relevant for the functionality of the referral system and provision of required resources will be advised on improving the referral system planning and management to ensure safe and timely transportation of mothers and newborns.