Abstract
BackgroundHealth worker performance has been the focus of numerous interventions and evaluation studies in low- and middle-income countries. Few have examined changes in individual provider performance with an intervention encompassing post-training support contacts to improve their clinical practice and resolve programmatic problems. This paper reports the results of an intervention with 3471 abortion providers in India, Nepal and Nigeria.MethodsFollowing abortion care training, providers received in-person visits and virtual contacts by a clinical and programmatic support team for a 12-month period, designed to address their individual practice issues. The intervention also included technical assistance to and upgrades in facilities where the providers worked. Quantitative measures to assess provider performance were established, including: 1) Increase in service provision; 2) Consistent service provision; 3) Provision of high quality of care through use of World Health Organization-recommended uterine evacuation technologies, management of pain and provision of post-abortion contraception; and 4) Post-abortion contraception method mix. Descriptive univariate analysis was conducted, followed by examination of the bivariate relationships between all independent variables and the four dependent performance outcome variables by calculating unadjusted odds ratios, by country and overall. Finally, multivariate logistic regression was performed for each outcome.ResultsProviders received an average of 5.7 contacts. Sixty-two percent and 46% of providers met measures for consistent service provision and quality of care, respectively. Fewer providers achieved an increased number of services (24%). Forty-six percent provided an appropriate postabortion contraceptive mix to clients. Most providers met the quality components for use of WHO-recommended abortion methods and provision of pain management. Factors significantly associated with achievement of all measures were providers working in sites offering community outreach and those trained in intervention year two. The number of in-person contacts was significantly associated with achievement of three of four measures.ConclusionPost-training support holds promise for strengthening health worker performance. Further research is needed to compare this intervention with other approaches and assess how post-training contacts could be incorporated into current health system supervision.
Highlights
Health worker performance has been the focus of numerous interventions and evaluation studies in low- and middle-income countries
Ensuring high-quality health worker performance is an ongoing challenge in low- and middle-income countries (LMICs) [1,2,3]
Almost three-quarters of providers worked in primary level health facilities, less than onehalf of Nigerian providers did so
Summary
Health worker performance has been the focus of numerous interventions and evaluation studies in low- and middle-income countries. Assessments of maternal-child health and family planning interventions are common, especially in primary health care (PHC) settings [5,6,7,8,9,10,11] These include various approaches to health worker supervision [6, 8,9,10,11]; mentoring, task-sharing and community outreach [12]; audit and feedback [2]; standards-based management and recognition of achievements [9]; provider training/refresher updates and follow-up outreach visits [13, 14]; and improvement collaboratives [15]. A few interventions demonstrated large effects in achieving desired outcomes, many had small to moderate effects, and others were inconclusive or had little or none
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