Qi Role Play

“If you have capacity built to support quality close-to-community service provision you will encourage the community to maximally access service care and ensure healthy outcomes” Allone Ganizani, Ministry of Health Malawi.

Capacity strengthening is a critical strand throughout REACHOUT and one third of our budget is dedicated to taking forward capacity from a holistic perspective: strengthening the capacity of researchers, institutions, policy makers and practitioners. At the midway point of our REACHOUT journey and at our fifth consortium meeting in beautiful mountainous Cianjur (Indonesia), we thought it was an opportune moment to reflect and share experiences about some of our capacity strengthening strategies.

Building a legacy for close-to-community research: Strengthening researchers’ skill sets

REACHOUT has a ‘young researchers’ group. The group meets regularly to share experiences, resources and networks and came to Cianjur a week earlier than the rest of the consortium for research skills training led by Vicki Doyle, Malabika Sarker and Miriam Taegtmeyer. The sessions focused on qualitative and quantitative analysis and the ‘how to’ of integrating mixed data sets. Sozinho Ndima, from University Eduardo Mondlane in Mozambique explained:  “I enjoyed the focus on mixed methods and how to integrate different qualitative and quantitative data sets.”

Vicki explained: ‘there’s no point being a great researcher unless you can share your findings – this needs both verbal and written skills’. Sessions also included personal development plans (PDP); sharing your passions through a soap box delivery and elevator pitches (what do you say about your research when you only have two minutes with a key and powerful person in a lift).  Elias Bunte from REACH Ethiopia said: “it was very nice, we talked without power points, it gave us confidence about how to speak in public” and Sadia Chowdhury from the Bangladeshi James P Grant School of Public Health shared how she “enjoyed the quantitative analysis, as I’m a qualitative researcher I fully understood the motivational questionnaire which was great, I also liked discussing the pitfalls of mixed methods and the PDP was wonderful.”

Young researchers were challenged to practice their elevator pitches on policy makers and key stakeholders the following week.

A learning agenda, experience sharing and south-south exchange

Enabling joint learning and south-south exchange is a key component of our capacity strengthening strategy. The REACHOUT partnership includes countries taking forward innovative and respected Community Health Worker/close-to-community provider approaches and this provides an excellent opportunity to share experiences across contexts about practices and innovations that could be adapted. James P Grant School of Public Health leads the REACHOUT capacity strengthening strategy and are evaluating south-south learning and exchange. Many examples of south-south learning in the experiences on our first round of quality improvement cycles were shared during our consortium meeting in Cianjur, for example:

  • The district health officers from Cianjur district were interested to learn more about the process and impact of establishing the pregnant women’s forum in Ethiopia. Nega Teyikie from REACH Ethiopia explained how this meets regularly supported by female Health Extension Workers and has been one of the strategies in Ethiopia that has led to impressive increases throughout the first quality improvement cycle in uptake of both antenatal care and facility deliveries.
  • Robinson Karuga shared the LVCT Kenyan processes of undertaking community score cards with Dr Gita Maya, Director of Maternal Health in the Indonesian Ministry of Health and also learnt about tailored Indonesian approaches to community engagement, feedback and partnership. In the score card process, communities visit health facilities, and then through a community dialogue process, discuss and score five key priorities areas for action to improve quality. Health providers go through a similar process followed by a joint interface (community and health worker) and joint planning meeting.
  • Ershad Sumon from Marie Stopes in Bangladesh discussed with the REACHOUT team the importance of maintaining quality in the provision of menstrual regulation services in Bangladesh. Here to assess quality as seen through the eyes of clients, they have a “mood metre box” where clients can insert a token – in confidence- to rate the service they have received. The box is opened every day to get immediate feedback.  
  • We also had a very informative exposure trip to visit Poysandus and Kaders in Indonesia to learn about how this works in practice and share experiences across different contexts

Being a “NICE guy”: embedding quality improvement approaches to strengthen close to community services

The legacy of REACHOUT is sustained as improved close-to-community services, during the second Quality Improvement (QI) cycle, will move from a mainly researcher led process to one that is more embedded and owned by district practitioners and policy players. And each country partner was joined by at least one key policy maker in the Cianjur meeting to jointly go through a Training of Trainers approach for embedded QI cycles. This included training sessions in the morning and ‘teach back’ sessions in the afternoon, where participants were challenged to conduct 20 minute training sessions on the morning’s content (e.g. why quality is important, indicators and methods for quality) to colleagues who pretended to be participants from the various countries e.g. District officials and supervisors from Mozambique. The sessions were interactive and trainers used a lot of engaging adult learning approaches, such as role plays and group exercises. QI processes use a systematic approach and are simple, robust and regularly applied through a cyclical action learning approach. Vicki explained there is little research on the processes of embedding QI cycles in community health services and we will be both pioneers and “NICE guys” who Nurture, Inspire, (provide) Continuity and Embed. In a nutshell we need to inspire others and be creative facilitators and advocates for QI within our countries and programmes.

Charity Tatua, Lilian Otiso and Nelly Muturi role play quality in community health service provision in the teach back session. 

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