Innovation for the improvement of reproductive, maternal, newborn, child and adolescent health services in Niger

Mr. Aboubacar CHAIBOU BEGOU is the Liaison Officer of the Global Financing Facility in Niger. He is a health economist with more than 15 years of experience in economic analysis and evaluation in the health sector. His expertise includes budget planning and programming, health financing, and health project and program management and monitoring

Innovation for the improvement of reproductive, maternal, newborn, child and adolescent health services in Niger

In Niger, the provision of quality health services is hampered by limited resources, including the scarcity and mobility of qualified human resources. To overcome these problems, the Ministry of Public Health, Population and Social Affairs, with the support of its Technical and Financial Partners (UNFPA, SWEDD, WAHO and INSPiRE), implemented a number of strategies, including an innovative coaching strategy known as «Tutorat». This strategy, also known as «Mentorat» (mentoring), involves the integration of a qualified health worker with significant professional experience into a given health team, to provide support, guidance and advice in a timely manner. The goal of this strategy is to support continuous learning, so as to improve the quality of maternal and child health services, including the management of obstetric complications.

Commonly referred to as a “mentor”, this newly integrated person generally has a midwife or gynecologist / obstetrician profile, with more than 10 years of professional experience. Their integration is voluntary and comes from a strong personal sense of motivation.

Selection and training of candidates

The selection of candidates is governed by a committee appointed by the Ministry of Public Health, Population and Social Affairs, which pre-selects candidates on the basis of applications; they are then subjected to a written examination and a practical test.

Once the mentors have been recruited, a workshop is organized at the central level (Niamey) by a technical committee for the actors in charge of supervision at the regional and central levels (heads of departments of the Regional Directorates of Public Health, gynecologists and obstetricians, as well as pediatricians, heads of the Directorate General of Reproductive Health and the Directorate of Mother and Child Health). This is done in order to promote a common understanding of the approach, as well as the roles and responsibilities of the different actors at all levels. In order to take into account the needs and specificities of each region, regional adaptation workshops are also organized before the mentors leave for the intervention sites.

Selection of intervention sites

Once these workshops have been conducted, the mentors are deployed to health facilities offering basic emergency obstetric and neonatal care. The program prioritizes health facilities with poor performance, particularly in terms of quality, and/or an insufficient number of trained health workers.

Mentor status

The mentors recruited are also trained and brought up to date through some very precise terms of reference. They work five days a week and their activities extend over six months, given that one mentor is assigned to four integrated health centers and conducts mobile outreach activities to reach populations in remote or hard-to-reach areas.

The mentors are salaried and also receive per diems to cover their travel expenses. These per diems are provided according to the current per diem rates established by the government and the United Nations system.

Pilot project and expansion

Initiated in 2017, this mentoring approach was initially tested in 106 Integrated Health Centers (IHCs) located in three regions. It was expanded six months ago to include a total of approximately 300 IHCs in six regions.

Monitoring and evaluation

The mentors’ terms of reference include quarterly reports to provide updates on service provider monitoring. The mentors also submit an annual report to the IHCs, the health districts and the Regional Public Health Department.

A WhatsApp group has also been created by the committees at the regional and national levels to guide the mentors and monitor their activities.

The mentoring approach is evaluated at three levels:

1. Programmatic (district) level, which involves an analysis of planned and completed activities, as well as the financial resources projected, mobilized, and used during a given period. This level is primarily concerned with supervisors and mentors.
2. Service Delivery Level (SDL), which focuses on the skill level of providers, the quality of services offered, and the performance indicators of SDLs. This level also involves a visualization of progress from baseline. This visualization exercise is done after a mentor has conducted three coaching and support visits to a SDL.
3. Beneficiary level, which measures the level of satisfaction of both clients and service providers.

Results to date

The mentoring strategy has achieved encouraging preliminary results, also contributing to the continuity of essential maternal and child health services in the context of the COVID-19 pandemic.  In particular, the mentors’ guidance has resulted in the:

• Training of 14,839 health workers in several priority areas,
• Recruitment of 29,776 new contraceptive users,
• Placement of over 2,000 contraceptive implants by service providers,
• Appropriate management of 3,053 obstetrical complications and, by extension, a reduction in medical evacuations.

Significant improvements in the preparation and management of files, registers, partograms, etc. have also been recorded.

It should be noted, however, that insecurity in some areas has hampered the ability of mentors, supervisors, and clients to travel, somewhat limiting the reach of the program.

Lessons Learned

The success and sustainability of this innovative strategy depends significantly on the:

• Motivation of mentors,
• Availability of inputs,
• Functionality of equipment purposed for emergency obstetrical and neonatal care,
• Involvement of health managers at the regional and district levels for supervision and monitoring purposes.

In addition, the integration of nutrition and immunization into the mentoring program could further contribute to the improvement of reproductive, maternal, newborn, child, and adolescent health and nutrition services in Niger.