The Lancet’s series Midwifery has raised significant discussion among the global maternal health network on the role and importance of health workers—specifically midwives—in improving maternal, newborn and child health outcomes in low-resource settings. Unquestionably, the variety of interventions implemented to improve maternal and newborn outcomes require a skilled workforce to enact them. To have greater impact in the reduction of maternal mortality, we need to consider improved models for training, professional development, and positive incentives for health professionals and the development of quality health systems.
The 2014 State of the World’s Midwifery Report paints a bleak picture of the maternal health workforce in Kenya. Across the continuum of care—from pre-conception to postnatal and newborn care—the country meets only half of the approximate 40 million necessary clinical consultations annually. There remains a dearth of health professionals—midwives, nurses, or doctors—to meet the needs required to improve maternal and child health indicators in the country.
To meet the health needs of women and newborns, it is important not only to develop a well-trained maternal health workforce, but to develop maternal health leaders. Jacaranda Health provides affordable, quality maternal and newborn health services in peri-urban areas where the population density is high and access to safe maternity care is low. The organization is taking a systematic approach to professional development of its workforce to strengthen technical abilities and competencies in the provision of patient-centered care and provide a pathway for their growth and development as future leaders in the health landscape through:
- Structured orientation and mentorship: Clinical staff members undergo a 3-6 week on-boarding program comprised of education sessions (clinical and non-clinical topics) and practical skills and drills in their job setting. In addition, new staff members shadow an experienced preceptor-mentor for the duration of their orientation. The preceptor serves as a guide and support through the new staff’s first year.
- Performance management: Clinical staff members receive an annual performance evaluation; structured qualitative and quantitative feedback derived from ongoing evaluations throughout the year. These evaluations include audits of adherence to set standards, test scores from continuous training programs, and peer feedback. Staff members identify their areas of strength and weakness, in addition to opportunities for improvement of which they will be evaluated in the upcoming year.
- Task-shifting: Support team members—our patient care assistants (PCAs)—are trained-up to assist in delegated clinical tasks; such as, assessments and client education. For example, PCAs can obtain vital signs, perform point of care testing (hemoglobin and blood glucose), and provide patient education on topics including birth and obstetric emergency planning and postpartum family planning—skills normally under a nurse’s scope of practice. PCAs also participate in drills alongside nurses to actively assist in obstetric emergency management. The goals of task-shifting are to both motivate the PCAs to develop their professional skill sets and optimize our midwives’ time in the provision of comprehensive clinical care.
- Specialisation: Jacaranda has created processes to develop “champions” in the following areas: paediatric services, skills and emergency management, family planning, quality improvement, management, and customer care. Champions receive additional training and mentoring in their subspecialty areas and subsequently lead professional development of their colleagues and peers in these areas. They are at the forefront to address issues and improve services. This role is an additional tool to professional development.
- A professional development ladder: We are in the process of developing a formal career ladder that offers staff a pathway for professional advancement. Our champions and preceptor-mentors are the first step to this process. This will be followed by a training program for charge nurses to take on increasing management opportunities. A final step aims at specialized career tracks to elevate nurses to clinical specialists, researchers, educators, and administrators.
We believe our clinical workforce is a major contributor to our successful outcomes. Through the outlined initiatives, we aim to address health workforce related challenges by focusing on opportunities to improve performance and set a new standard for nursing care in Kenya. Through the testing and dissemination of practical facility-based human resource approaches, we aim to create a new generation of quality-oriented and patient-centered nurse leaders to spearhead the advancement of maternal health initiatives in East Africa.