quarterly report (project year 1, quarter 4, april 1, 2017...

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MATERNAL AND CHILD SURVIVAL PROGRAM

Photo: Teah Doegmah/MCSP/HRH

HUMAN RESOURCES FOR HEALTH IN LIBERIA

Quarterly Report (Project Year 1, Quarter 4, April 1, 2017-June 30, 2017, PY1 Q4)

PY1, Q4 Report - Human Resources for Health in Liberia

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TABLE OF CONTENTS

TABLE OF CONTENTS 2

ACRONYMS AND ABBREVIATIONS 4

PROGRAM SUMMARY TABLE 6

INTRODUCTION 7

Project Objectives 7

Technical Approach 8

ACHIEVEMENTS IN THE OBJECTIVES AND INTERMEDIATE RESULTS 9

Key Achievements 9

Achievements by Objective 11

COORDINATION & COLLABORATION WITH PARTNERS 18

CROSS CUTTING 19

Monitoring, Evaluation, Research and Learning (MERL) 19

Communications 20

Establish mechanism to support coordination to facilitate communication and sharing 20

Gender 21

Quality Improvement 21

As a result of the LDHF Learning sessions conducted, clinical sites are improving in the following areas:

the safe and proper administration of MgSo4 by midwives and an increase in proper usage/plotting of

Partograph. 21

LESSONS LEARNED 22

CHALLENGES and OPPORTUNITIES 22

PLANNED ACTIVITIES FOR NEXT QUARTER 22

Annex 1: MCSP Performance Indicator Table Progress 24

Annex 2: MCSP HRH Trainings and Number of Participants 26

Annex 4: Knowledge & OCSE Results from Perinatal Training (LDHF – Phase II) 27

Annex 5: EmONC/Perinatal Low Dose High Frequency Practice 28

Annex 6: Number of Practice sessions for the EmONC/Perinatal/Low Dose High Frequency held per

topic across the five facilities for the months of April and May, 2017 28

Annex 7: Quarterly Performance of PSE Schools against the Pre-service Education Standards 29


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Annex 8: Tabular presentation of quarterly results for PSE Standards Achieved and Observed during

Supportive Supervision 30

Annex 10: MCSP HRH Short-Term Technical Assistance Visits during the Reporting Period 32

Annex 11: MCSP HRH Work plan Matrix Progress Update 33

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ACRONYMS AND ABBREVIATIONS

Acronym

AMTSL Active Management Third Stage of Labor

CDC Centers for Disease Control

CHAI Clinton Health Access Initiative

CHT County Health Team

CSH USAID Collaborative Support for Health Program

DKISM Deanna Kay Isaacson School of Midwifery

EBSNM Esther Bacon School of Nursing and Midwifery

EPCMD Ending Preventative Child and Maternal Deaths

ETS Effective Teaching Skills

EVD Ebola Virus Disease

GHET Global Health Ebola Team

HRH Human Resources for Health

HWF Health Workforce

HWP Health Workforce Program (Strategy)

IPC Infection Prevention and Control

LBNM Liberia Board of Nursing and Midwifery

LAMLT Liberia Association of Medical Laboratory Technologists

LDHF Low Dose High Frequency

LMDC Liberia Medical and Dental Council

LMA Liberian Midwifery Association

M&E Monitoring and Evaluation

MCHIP Maternal and Child Health Integrated Program

MNCH Maternal Newborn and Child Health

MCSP Maternal and Child Survival Program

MER Monitoring, Evaluation and Research

MLT Medical Laboratory Technicians

MOH Ministry of Health

MPCHS Mother Pattern College of Health Sciences

MSH Management Sciences for Health

MTPSER Midwifery Training Program South Eastern Region

NDU National Diagnostic Unit

OSCE Observed Structure Clinical Examination

PC Peace Corps

PIH Partners in Health

PPC Peer Practice Coordinator

PPH Postpartum Hemorrhage

PSE Pre-service education

PTP Phebe Paramedical Training Programs

RBHS Rebuilding Basic Health Services


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Acronym

RHS Restoration of Health Services

SMEs Subject Matter Experts

SPA Students Performance Assessment

SQS Safe and Quality Healthcare Services

STTA Short-term technical assistance

TNIMA Tubman National Institute of Medical Arts

UM University of Michigan

UMU United Methodist University

USAID United States Agency for International Development

WHO World Health Organization


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PROGRAM SUMMARY TABLE

Program Name: Maternal and Child Survival Program (MCSP): Human Resources for Health

in Liberia

Start Date and End

Date: April 1, 2016 – June 30, 2018

Name of Prime

Implementing Partner: Jhpiego Corporation

Agreement Number: AID-OAA-A-14-00028

Partner Organizations:

Jhpiego: Lead partner

John Snow Inc. (JSI): technical support in Child Health, Immunization

Save the Children: technical support in Newborn Health and Adolescent

Sexual and Reproductive Health

Key Partners: Ministry of Health (MOH), USAID CSH Program (MSH), World Bank, CHAI,

GFTAM, Peace Corps/SEED, LMDC, LBNM, NDU, WHO, CDC, LMA, and

LAMLT

Geographic Coverage: Grand Gedeh, Lofa, Bong, Montserrado

Reporting Period: April 1, 2017 through June 30, 2017 (Quarter 4, FY 2017)


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INTRODUCTION

The Maternal and Child Survival Program (MCSP) is a global U.S. Agency for International Development (USAID) cooperative agreement to introduce and support high-impact health interventions in 26 priority countries with the ultimate goal of ending preventable child and maternal deaths (EPCMD) within a generation. MCSP engages governments, policymakers, private sector leaders, health care providers, civil society, faith-based organizations and communities in adopting and accelerating proven approaches to address the major causes of maternal, newborn and child mortality, such as postpartum hemorrhage, birth asphyxia, essential newborn care, complications of the newborn, diarrhea, respectively, and improve the quality of health services from household to hospital. The Program will tackle these issues through approaches that also focus on health systems strengthening, household and community mobilization, gender integration and eHealth, among others. MCSP carries forward the momentum and lessons learned from the USAID funded Maternal and Child Health Integrated Program (MCHIP), which made significant progress in improving the health of women and children in over 50 developing countries throughout Africa, Asia, Latin America and the Caribbean. In light of the second order impacts of the 2014 Ebola Virus Disease (EVD) Outbreak, USAID/Liberia requested MCSP to support its commitment to strengthening Liberia’s frontline health workforce through the MCSP Liberia Human Resources for Health (HRH) project. This project, funded with Ebola Emergency Funding, is focused on strengthening registered midwifery and medical laboratory technician (MLT) pre-service education in targeted institutions throughout the country. MCSP/HRH is uniquely positioned to contribute to USAID/Liberia’s strategy toward strengthening and expanding Liberia’s skilled health workforce and ending preventable child and maternal deaths. Previous work implementing successful maternal, newborn and child health (MNCH) programs under MCHIP, the current MCSP Restoration of Health Services (RHS) project, and the pre-service education strengthening initiative under Rebuilding Basic Health Services (RBHS), have set the stage for efficient implementation of a technical approach designed to ensure clinical competence and a strengthened, more resilient health system. MCSP/HRH builds on previous work focused on Pre-service education (PSE) strengthening in Liberia, continuing to contribute to the strengthening of the health workforce (HWF), particularly focusing on strengthening capacity of midwives and lab technicians. This technical approach was designed with significant stakeholder input, leverages work completed under RBHS, and synergizes current Collaborative Support for Health (CSH) efforts in health professional regulation strengthening for midwifery and lab cadres. MCSP/HRH envisions that at the end of the program, Liberia will have stronger midwifery and laboratory educators, a larger and better prepared matriculating class of senior students equipped with practical skills, better-equipped and managed pre-service training institutions, and ultimately a more resilient health and laboratory workforce that will be well positioned to address Liberia’s maternal and child health needs and prevent future outbreaks of Ebola and other infectious disease. Goal: MCSP/HRH’s overarching goal is to rapidly mitigate the second order impacts of Ebola through a targeted technical approach focused on clinical competency of frontline midwives and lab technicians, and an expedited implementation strategy designed for rapid improvements and results.

Project Objectives

1. Objective One: Increase the quality of instruction at targeted pre-service training institutions by upgrading the technical competencies and teaching skills of faculty, including clinical preceptors, and strengthening curricula, course materials and delivery of both didactic and clinical training.

2. Objective Two: Strengthen the learning environment at targeted pre-service training institutions and clinical teaching sites in a comprehensive way through improved access to high-quality instructional resources, equipment and technology.


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Technical Approach

The technical approach of the project emphasizes the below pre-service model and highlights several influencing factors necessary in a pre-service education program to achieve quality outcomes in performance, community health and health systems. The influencing factors are students, faculty and preceptors, infrastructure and management, curriculum and clinical/practicum sites.

This report presents MCSP/HRH results and activities, organized by the project’s objective, from April 1, 2017 to June 30, 2017. The report has six sections:

1. Achievements in the objectives and intermediate results (IRs): This is a narrative section that complements the progress reported against the work plan matrix. It provides a detailed description of accomplishments and identifies any additional activities completed that were not part of the original work plan. Any additional activities completed were in response to the MOH, USAID or GHET requests.

2. Coordination and collaboration with partners: This section highlights specific coordination and collaboration activities during the reporting period.

3. Cross-cutting areas: This section describes some overarching, cross-cutting updates. It also outlines the project’s monitoring, evaluation and research (MER) activities, in addition to what is described in the above sections.

4. Opportunities, Challenges and Lessons Learned: This section highlights any major challenges and opportunities encountered, as well as lessons learned.

5. Key planned activities for the next quarter: This section highlights the key planned activities in the next quarter.

6. Annexes: The annexes provide progress against the performance monitoring plan, graphical representation of training results, trainings conducted, technical assistance provided, a success story, progress against the MCSP HRH work plan matrix and Rapid Assessment results.


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ACHIEVEMENTS IN THE OBJECTIVES AND INTERMEDIATE

RESULTS

The below table outlines MCSP/HRH key project interventions. All MCSP/HRH work plan activities are in support of these key interventions. The sections that follow highlight the MCSP/HRH key activities and achievements in support of these interventions and specifically, the MCSP/HRH objectives.

Key Achievements

MCSP/HRH’s technical approach is based on the pre-service education conceptual model that promotes competency and positive health outcomes by prioritizing activities centered on students, clinical practice, faculty and preceptor development, curriculum, infrastructure and management and is in alignment with the Government of Liberia’s Health Workforce Program.

Key MCSP/HRH Liberia Interventions

Rapid Assessment

OBJECTIVE 1: Increased quality of instruction at targeted pre-service training institutions achieved by upgrading the

technical competencies and teaching skills of faculty, including clinical preceptors, and strengthening curricula, course

materials and delivery of both didactic and clinical training.

Task 1.1: Support hiring of additional faculty in midwifery and lab schools

Task 1.2: Provide faculty with up-to-date teaching skills and faculty development opportunities

Task 1.3: Strengthen the preparation of clinical preceptors

Task 1.4: Upgrade the technical competencies of faculty, preceptors and matriculating class of midwifery and

lab graduates

Task 1.5: Strengthen clinical instruction

Task 1.6: Upgrade teaching and learning curricula

OBJECTIVE 2: Strengthened learning environment at targeted pre-service training institutions and teaching sites through

a comprehensive approach to improving access to high-quality instructional resources equipment and technology

Task 2.1: Improved skills labs at midwifery schools, improved and sufficient equipment for laboratory schools

Task 2.2: Provide equipment, supplies and light infrastructure improvements to strengthen clinical sites.

Task 2.3: Establish improved clinical practice management processes

Task 2.4: Support schools to strengthen management and administrative systems, leveraging structured

twinning partnerships

Task 2.5: Coordinate the upgrade of existing computer labs, or establishment of new ones


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During the reporting period, the MCSP/HRH Program recorded solid progress in the implementation of activities as outlined in the HRH Program work plan. Below is a summary of key achievements:

The PSE Gender Analysis Report was completed and submitted to USAID Liberia Mission for review.

MCSP/HRH conducted a Staff and PSE Orientation Workshop. The eight mentors that participated in the workshop confirmed that they have become an integral part of their assigned schools. They are assisting the staff in ensuring adherence to the steps of Effective Teaching Skills (ETS) and Student Performance Assessment (SPA) including: ensuring that tests are reliable and valid, that the student practice in the Skills Lab, and Observed Structure Clinical/Practical Exams (OSC/PE) are administered for skills assessment.

On May 1 and 5, 2017, MCSP facilitated Medical Laboratory Career Day activities in Bong and Montserrado respectively with support of the three MLT programs. The events brought together 130 seniors from 9 high schools across the two counties. Both Mother Pattern College of Health Sciences (MPCHS) and Phebe Paramedical Training Programs (PTP) recorded record numbers of over 400 applicants taking the entrance exams as a result of the facilitated Career Day.

MCSP completed the second low-dose-high-frequency (LDHF) training of 124 staff at the five hospital serving as clinical sites for the five midwifery schools. This training built participants knowledge and skills in managing obstetric complications, including conducting breech, shoulder dystocia and vacuum assisted deliveries with practice on the newly released Mama Birthie Model along with managing Post-Partum Hemorrhage, the number one cause of Maternal Mortality in Liberia.

MCSP completed the first facility specific Learning Session, led by hospital based Master Mentors for addressing specific challenges at each hospital in providing quality Perinatal Care, as well as building the capacity of the hospital Master Mentors to plan, organize and conduct in-service training/learning sessions at their facility for increased sustainability. Master Mentors are now working with the Peer Practice Providers to ensure that staff trained are practicing the weekly skills and are documenting the experience as well as supervising staff in the provision of quality care, mentoring and coaching staff in using the partograph, managing complications, i.e. patient with postpartum hemorrhage or preeclampsia/ eclampsia.

A three day interactive Leadership and Management training was held with MCSP staff and leaders/managers of the midwifery and lab PSE Institutions to initiate the process of strengthening leadership skills. The Leadership and Governance Advisor from the Collaborative Support for Health (CSH) program facilitated the workshop that was attended by 26 participants from the six PSE institutions. The goal of the workshop was to empower participants to apply integrated leadership and management skills to resolve key management challenges at their institutions and to allow them meet the LBNM standards for management of training institutions. This training will support the development of progress with PSE Institutions draft plans to meet the standards in the management section of the LBNM Quarterly Monitoring Tool.

MCSP and PSE Institution staff participated in a one week twinning visit to the University of Michigan in Ann Arbor, MI as part of the twinning process in strengthening management and leadership at Midwifery and Lab Schools. Many lessons were learned, especially that it is important to strengthen leadership and management for clinical practice as much as classroom management. The major recommendation is to apply all ETS processes and tools to clinical practice management.

MCSP/HRH conducted a four-day Quality Management System (QMS) Training Workshop for 12 Laboratory Preceptors and Faculty from the three supported Pre-Service Training Institutions in order to improve the management and quality in Laboratories and Skill Labs as well ensure continuous improvement of management and quality systems in the Laboratories nationally.

National MLT PSE Technical Working Group, the first of its kind, has been established with three subcommittees. The sub-committee for drafting the MLT Preservice Education Standards and Licensure process has completed the first draft that has been sent for review to the Regulatory Bodies.

MCSP/HRH continues to participate in the weekly National Laboratory and Health Workforce Program Meetings, Nursing and Midwifery Committee, and the monthly Reproductive Health Technical Working Group Meeting. At these meetings information is shared among partners engaged in strengthening Medical Laboratory and Nursing and Midwifery Pre Service Training Institutions.


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MCSP/HRH participated in the International Day of the Midwives celebrations held on May 5, 2017 in Buchanan, Grand Bassa County. Over 120 Professional and 200 Traditional Midwives from the 15 Counties participated in the celebrations. This day highlights the need for midwives who reportedly are making a difference to quality care and significantly contributing to raising the profile of the important contribution that Midwives make to the Health System in Liberia.

On May 20, 2017, MCSP/HRH delegation participated in the Graduation Ceremony of 43 Midwifery Students from the Deanna Kay Isaacson School of Midwifery (DKISM), formerly Midwifery Training Program Southeastern Region, in Zwedru, Grand Gedeh County. All Midwifery graduates will be employed as Registered Midwives in the region.

HRH Program Midwifery Team worked along with Observed Structure Clinical Examination (OSCE) Team to prepare and administer the OSCE Exam administered June 1-2, 2017 at the DKISM for graduating seniors in the midwifery program. Skills covered by students during the OSCE were: Manual removal of placenta; Abdominal Aorta Compression; and External and Internal Bi-manual compression. Instructors at DKISM are now using an Examination Blueprint before tests which are instrumental in compiling Question Item Banks.

During the reporting period MCSP/HRH conducted Supportive Supervision, Monitoring and Mentoring visits at all six PSE Training Institutions and their principal clinical/practical training sites using the MCSP/HRH Supervision and Monitoring Tool and the Liberia Board for Nursing and Midwifery approved Quarterly Monitoring Tool. The team utilized these visits to follow up on Action Plans developed during Effective Teaching Skills, Students Performance Assessment Workshops and the Coordination Meeting held between the schools and their primary Clinical Sites.

Achievements by Objective

OBJECTIVE 1: Increased quality of instruction at targeted pre-service training institutions

achieved by upgrading the technical competencies and teaching skills of faculty, including clinical

preceptors, and strengthening curricula, course materials and delivery of both didactic and

clinical training.

Task 1.1. I: Targeted marketing campaign to increase student intake for counties not yet at capacity,

Bong and Montserrado

MCSP/HRH supported two Medical Laboratory Technicians Career Days in Montserrado and Bong Counties on May 1 and 5, 2017 respectively. The events brought together 150 participants, a majority of whom were senior high school students (120) from nine of the top schools in Montserrado and Bong Counties (See Table 1 for more details). Focus of the Career Day was on demand generation and awareness for more Laboratory Technicians, especially females, to enter into Liberia’s health sector. Significantly, gender awareness was blended into the program at both sites where the messaging was used to encourage female students to take the laboratory profession as their future career. During the events, the female students were provided one on one counseling to highlight the need for female Laboratory Technicians in the public health workforce.

The three MCSP supported Pre-service education training institutions (MPCHS, TNIMA, and PTP), made presentations highlighting activities at their schools, specifically regarding admission requirements, selection criteria, as well as employment and career opportunities for a medical laboratory technician upon graduation. Multiple channels and materials were deployed during the activities including: radio talk shows, brochures, banners and poster sheets designed with motivational messages on the benefits of becoming a laboratory technician.

Initial impressions from the career day program showed that it was successful as evidence by written comments from the high school students who expressed their gratitude to MCSP and partners for the program. Students suggested that the career day should be a program that will reach out to the various schools in the country. As a result, many students applied to take the school entrance exams as the first steps in gaining admission to study to become a


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Medical Laboratory Technician for all three schools. The two institutions (MPCHS and PTP) who had planned entrance exam, reported record numbers of 400 students as the highest number of students who took the entrance exams at the end of May 2017.

Table 1: Details of students attended the program from the two Counties

Task 1.1.1.2: Coordinate with CSH to leverage scholarships for those counties where student intake

can be increased MCSP attended the MOH Scholarship Secretariat working session on May 4, 2017 with representatives from CSH, MOH and CHAI to incorporate final comments from stakeholders into the validated MOH scholarship guidelines. All inputs were organized and incorporated into the draft copy and shared.

Task 1.1.9 Hire Jhpiego education mentors to be embedded in each school to provide support of

implementation action plans, primary focus being to strengthen clinical practice and expand clinical

practice sites

The mentors working at the schools continued to build capacity, by introducing appropriate interventions and following up, ensuring that new lessons learned and action plans are implemented as evidenced in following activities:

Participated in the general staff meeting at the institutions, during which they received and provided updates and discussed relevant academic issues.

Assisted in setting up the lab practice site at the schools in preparation to receive supplies for MCSP HRH starting with the setting up of two microscopes that has been in storage.

Participated in activities of three major international health days including: World Malaria Day, World Blood Donor Day, and International Day of the Midwife. The Malaria Day events were sponsored by MOH/WHO while the Blood Donor Day events were organized by ACCEL Regional Blood Bank and Donation Center II located at the Phebe Hospital Compound. At both occasions, the MCSP mentors assisted the faculty in organizing students and accompanied them in performance dramas: “Importance of sleeping under mosquito net” for Malaria Day and “Importance of blood donation” on Blood Donor Day.

County No. of Students Sex

Montserrado 70 39 Females 31 Males

Bong 50 22 Females 28 Males

Total Students Att. 120 61 Females 59 Males

Photo: Senior schools students at the Bong Medical Laboratory Career Day


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Participated and co-facilitated with MCSP technical staff at the scientific session In-Service Education Day as part of the Liberian Midwifery Association celebration of International Midwifery Day activities. Topics presented during the session included:

o Respectful Maternity Care o Correct use of Partograph during labor o Use of Antenatal Corticosteroid o Management of Pre-eclampsia and Eclampsia, Breech Delivery, and Shoulder Dystocia

Worked along with the laboratory departments to do a presentation on Quality Management System (QMS) and the newly updated Acid Fast Baccilli (AFB) procedure with semester four Laboratory students.

Supported the Laboratory Clinical Supervisor to prepare materials and stations for OSCE and assisted in the administration of the OSCE, evaluation of the midwifery students during OSCE Exam and grading of the OSCE. Skills covered by students during the OSCE, included: Manual Removal of Placenta; Abdominal Aorta Compression; and External and Internal Bi-manual Compression

Presented on supervision and monitoring skills and stressed the importance of these activities implemented with the schools including the following:

o Using a tool for monitoring of classes o Drafting clinical schedules for the instructors with staff o Working with the school administration to draft monthly meeting schedules o Verification and analysis of past test papers.

Assisted the staff in developing Action Plans to address gaps identified during the monitoring and supervision in the following PSE standards areas: Infrastructure and Management, Clinical Sites, Faculty, Students, and Classroom Instructors. At the end of this exercise, the Action Plans were printed and distributed to the School Director and Midwifery Mentor and are now being implemented.

Participated in meetings with the Schools’ Directors, Clinical Instructors, and Preceptors from the primary health facilities serving as principal clinical sites. The meetings focused on the following:

o Schedule of conducting final semester OSCE, which is embedded into the curriculum and important in validating skills competency of students before progressing to the next level;

o Sharing of clinical expectations for students and agreement on which procedure to ensure students learn each semester; and

o Meeting will be held monthly between instructional staff, clinical staff and the preceptors in order to promote and maintain better coordination and interaction among Assisted Laboratory instructors to set up time for student practicals in the Skills Labs

Participated in an Effective Teaching Skills training and other in-service trainings at the schools.

Assisted the faculty in the preparation of course schedule and lesson planning for the upcoming semester. Some courses worked on were Emergency Preparedness, Teaching in Midwifery, and Pediatrics.

Assisted in the planning and preparing clinical rotational schedule for senior midwifery students and drafting of the students’ clinical schedule for the upcoming 2017

Participate in visits along with Peer Practice Coordinators (PPCs) at the principal clinical sites as part of the LDHF activities. This is done weekly to ensure that they are practicing at their assigned clinical sites, that participants are using the checklist and are signing the ledger to document practice with the PPC and to record practice on newborn resuscitation, active management of third stage labor, and normal delivery

Assisted in the administration of the entrance examinations

Worked with instructors to ensure they are now using an outline/blueprint to design tests, which have also helped with item banking.

Supported the clinical team during the regular meeting with students. Points discussed included the following: o Filling of log book by students and preceptors o Students notes during clinical o Students logging in daily attendance book

Reviewed the global gender standards that have been adopted by the MOH. The MOH is integrating gender into its health system strengthening approach comprising twenty standards that address gender issues in the provision of health care services including; right to services, availability of IEC/BCC materials on gender, using


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data for decision-making and availability of qualified providers. The session on gender involved presentation and practice on using the standards to conduct gender assessment.

Task 1.4.1: Provide simulation center or workplace based update in priority skills (high-criticality, low-

frequency) first for faculty and preceptors: IPC, normal labor and birth, newborn resuscitation,

managing shock, managing postpartum hemorrhage and pre-eclampsia/eclampsia, essential newborn

care, immunization

a. Perinatal Care quality improvement strengthening- Part II

During this quarter, MCSP/HRH reassembled the Midwifery Faculty, Preceptors, Master Mentors, Midwifery PSE Advisors, Staff Midwives, Nurses, and administrative staff of the five primary clinical sites (Liberia Japanese Friendship Maternity Hospital (LJFMH), Redemption, Phebe, Curran Lutheran and Martha Tubman Hospitals) at their respective facilities to participate in part two of the EmONC/Perinatal LDHF training. The goal of the workshop was to enable midwifery and nursing staff and preceptors to increase the knowledge, competencies and performance of key skills in order to appropriately manage obstetrical complications like postpartum hemorrhage, preeclampsia/eclampsia, breech delivery, etc to enable improved maternal and newborn health outcomes and to effectively teach and mentor midwifery students during clinical site practice. o The training focused on complications of mothers and babies and topics covered during the sessions

included:

o Pre/eclampsia/eclampsia, bleeding in pregnancy and Postpartum hemorrhage, maternal Sepsis, Preterm labor, and newborn problems-sepsis, prematurity, and asphyxia, as well as,

o Complicated deliveries of breech, shoulder dystocia and vacuum deliveries using the new Laerdal Mama Birthie model, which was developed primarily to be used for teaching the skills of complicated deliveries.

o There were 124 participants (6 males and 118 females) in this training from the following cadres: ward supervisors, staff development managers, nursing service directors, midwifery faculty, staff midwives, nurses and preceptors.

o The methods of assessment included knowledge assessment, pre and post-test and pre and post skill assessment/OSCE using models and checklists. See Annexes 3 and 4 for details of the assessment outcomes. Participants will continue to practice each required skill 20 minutes per week.

b. Perinatal Care quality improvement strengthening; Low Dose High Frequency first learning session Hospital-based Master Mentors planned, organized and conducted the first specific hospital-based perinatal learning session as part of the LDHF approach in Montserrado, Bong, Lofa and Grand Gedeh Counties, which included 104 participants. These sessions were participatory and interactive and master mentors were supported by staff to conduct the sessions at MTMH, Phebe Hospital, Redemption Hospital, JFK Maternity hospital, and EBSNM during June. The goals of this learning session were:

To share specific best practices, and lesson learned, as well as, actions to meet challenges that have impacted the quality of maternal and newborn health as the result of the LDHF Trainings at the specific facility and build technical skills on specific topics; and

To build the capacity of the Master Mentors at the hospital to plan, organize and conduct these sessions as a means of sustainability.

At each session, the participants reviewed best practices, discuss challenges experience and agreed on next

steps in addressing challenges at the facility/hospital. Topics for these sessions were Maternal Sepsis & Pre-

Term Labor; partograph; Newborn with Problems; Postpartum Hemorrhage & Pre-Eclampsia / Eclampsia.


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Task 1.4.2 Provide technical updates for Lab preceptors and faculty based on three existing courses

(combined into one)

MCSP/HRH conducted a four-day Quality Management System (QMS) Training Workshop for Laboratory Preceptors and faculties from the three supported PSE Institutions from May 30 to June 2, 2017. The workshop brought together 12 participants including: laboratory instructors and technicians from TNIMA, MPCHS, and PTP. Also in attendance were preceptors from JFK and Catholic Hospitals. The QMS training started with an online pre-test and ended with an online post-test hosted by Africabio Enterprises Inc. and certification of all participants (all participants received certifications). Africabio provided the team of primary facilitators. The objective of the workshop was to update lab preceptors and faculty to improve management practices and quality of standards and operating procedures in laboratories and skills labs, as well as ensure continuous improvement of management and the quality system in the laboratory. Topics covered during the QMS focused on the twelve essential elements of QMS:

o Organization o Personnel o Equipment o Purchasing and Inventory o Process Control o Information management o Documents and record o Occurrence management o Assessment o Process improvement o Customer service o Facilities and safety

During this workshop, all participants were registered by Africabio to retake the test if required as well as take other laboratory courses on this website providing an online option for staff development.

Task 1.6.1: Midwifery and Medical Laboratory Technicians (MLT) Curricula Update based on task

analysis findings for Registered Midwives, facilitate applied instructional design activity to update

curricula to match core competencies. Ensure that gender-sensitive pedagogy, new GOL quality

assurance approaches, IPC and respectful care are adequately addressed. MCSP/HRH conducted a three-day curriculum finalization workshop to confirm the adequacy of the updated curricula for meeting pre-service education training needs. Fifty (50) participants attended the workshop and represented the six MCSP/HRH supported PSE Institutions for Midwives and MLT (Phebe Paramedical Training Program, Esther Bacon School of Nursing and Midwifery, Midwifery Training Program Southeastern Region, Tubman National Institute of

Photo: Participants performing Breech Delivery at the Low Dose High Frequency Workshop


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Medical Arts, Mother Patern College of Health Sciences and United Methodist University). Those in attendance included: Deans, Directors, and Instructors, WHO, representatives from the two regulatory bodies, and national subject matter experts (SMEs). The Laboratory courses reviewed included: Chemistry, Microbiology, Parasitology, Blood Banking, Hematology, and Urinalysis. While for Midwifery, the participants reviewed and added inputs specifically to the five major Midwifery courses. Other courses reviewed in the midwifery curriculum included: Pediatrics, Psychiatric, Tropical and Communicable Disease, Medical Surgical and Midwifery (one, two, three, and four). Others were Fundamental of Midwifery One, Anatomy and Physiology, Research, Simplified Diagnosis, and Ethics.

There were eight smaller working groups that reviewed the Midwifery Curriculum while three groups were tasked to review the MLT Curriculum. Local and international SMEs will continue to review the curriculums during the next quarter and then the regulatory bodies will have final approval, followed by editing, formatting, printing and distribution.

Task 1.6.4: Provide HINARI orientation and training at each school

MCSP/HRH Communications Team is working with SMEs here in country (WHO, CDC, Global Fund) to ensure that the subscription process started for HINARI is finalized. Schools have now completed the required forms and are waiting for review and response from WHO.

OBJECTIVE 2: Strengthened learning environment at targeted pre-service training institutions

and teaching sites through a comprehensive approach to improving access to high-quality

instructional resources equipment and technology.

Task 2.1: Improved skills labs at midwifery schools, improved and sufficient equipment for laboratory

schools

Procurement of equipment and supplies for the PSE Institutions’ Skills Laboratories continues to progress. About 60 percent of the skills lab equipment is already procured and awaiting formal turnover to the MOH and distribution to the six PSE Institutions.

Task 2.2: Provide equipment, supplies and light infrastructure improvements to strengthen clinical sites

The equipment and supplies procured are awaiting distribution based on the Distribution Plan that MCSP developed. MOUs with the PSE’s are in process of being finalized. The handover ceremony between the MCSP, the MOH and the USAID Liberia Mission will occur on July 28th to formally handover the first equipment consignment.

Task 2.3: Establish improved clinical practice management processes

Photo: Laboratory staff reviewing their Curriculum


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MCSP reviewed the MOH’s Gender Based Violence and Family Planning Standards and aligned to the Jhpiego Global Gender Standards in order to provide facility based orientation and tools to ensure clinical practice sites provide an ethical and safe environment for students and address gender issues and sexual harassment. The process was to identify Core Gender Standards to improve quality services provided at PSE sites. Eight staff from MCSP and the MOH Family Health Division participated in the validation process. Following feedback from the pilot of the standards, MCSP HRH will integrate into program activities as appropriate.

Task 2.4: Support schools to strengthen management and administrative systems, leveraging structured

twinning partnerships

MCSP is working with USAID’s Collaborative Support Health (CSH) Project to adapt the Leadership Development Program (LDP) as part of the Twining approach in strengthening management at the schools as the initial step of the LDP. A three day interactive Leadership and Management training was held with faculty and staff of the Midwifery and MLT PSE institutions to train them in basic leadership and management skills that are relevant to the daily running of the institutions as part of the initial process. The CSH Project facilitated the workshop and there were 26 participants from the six PSE institutions. The goal of the Leadership and Management workshop was to empower participants to apply integrated leadership and management skills to resolve key management challenges at their institutions and to allow them to meet the LBNM standards for management of training institutions. At the end of the workshop, participants developed a plan of action of how to work towards meeting the management standards in the quarterly monitoring tool. They will finalize the plan for implementation during the next Quarter. As this was the initial workshop for strengthening leadership, MCSP will work with stakeholders, especially the twinning partners, to develop the Leadership Development course.

A team of four from MCSP and the Midwifery PSE institutions participated in a one-week study visit to the University of Michigan in Ann Arbor, MI to strengthen management and leadership at midwifery. The University of Michigan Midwifery Program is a twinning partner of the Phebe Training Program, Midwifery Training Program/Southeastern Region, Phebe Paramedical Training Program, and the Tubman National Institute of Medical Arts in Liberia. This visit allowed the HRH Program to work with the University of Michigan on the schools action plans for meeting PSE management standards, get a clear picture of how clinical practice is managed at UM, and review ideas of other best practices in PSE that can be applied to Liberia. The visit enabled the MCSP HRH Program to review strategies of the UM Midwifery program, the processes used for managing clinical practice, and the opportunities to evaluate them and adapt processes and tools applicable to Liberia. o The activities during the visit included: participation in meetings with senior midwifery management

team and faculty, attending clinical teaching skills workshop, touring the simulation lab and clinical sites, interaction with preceptors and students, observed skill teaching in the simulation lab and participating in a final meeting to develop next steps and action plans.

o Many lessons were learnt. One that is of particular importance is that strengthening of leadership and management for clinical practice is just as important if not more important then classroom management. The major recommendation is to apply all effective teaching skills processes and tools to Clinical Practice Management, including standardizing skills lab to align to hospital wards in promoting skills competency of students for a real life clinical/hospital setting, train clinical instructors and preceptors how to use standardized patients as this approach will not only strengthen knowledge and skills, but will also promote effective communication skills and a caring compassionate attitude that health care workers so much need in Liberia.

MCSP initiated the review and development of the School Information System (SIS). The SIS is the electronic data base that is being develop to be used at the schools so that information and dashboards are easily available and the data can be used for effective management at the PSE Institutions.

The first meeting was held with CHAI during this quarter to discuss the current status of iHRIS and existing plans for SIS development as part of MOH/HWP activities. iHRIS is the Integrated Human Resources Information System. MOH is using this system to track in-service Health Worker Training Courses; the pre-service modules have not yet been introduced in Liberia. MCSP and CHAI have agreed to collaborate on the


18

implementation of the SIS. CHAI has begun developing in MCSP-supported PSE institutions. In an effort to include the United Methodist University (UMU) on the list of schools supported by the Health Workforce Program (HWP), MCSP held meetings with the Associate Dean of UMU and the Secretary of the Medical College to discuss their information system needs. Following this meeting, MCSP was able to further understand the main functions and processes the school required related to data collections and period reporting.

MCSP is working on development of a database for the PSE Institutions that manages student records from the initial point of examination for admission to the last day of graduation. Due to the poor computer skills at the school and the complexity of managing a relational database, MCSP is developing a user-friendly application that is accessible through a web browser. This application requires a user to login with the username and password in order to operate the system. An authenticated user of this database can perform the following:

o Create an examination for a program, o Register students for an examination, o Record examination results, o Admit a student to a program, o Administer student courses, enroll student, etc.

Further refinement and development of the database will take place in the next Quarter. MCSP will continue to work with CHAI to support implementation of the HWP database in MCSP-supported schools. We anticipate this database to take place at MTPSER within the next quarter, with subsequent roll out to the other schools based on the findings from the initial introductions.

COORDINATION & COLLABORATION WITH PARTNERS

MCSP/HRH recognizes that coordination with the major stakeholders, especially MOH, LBNM, LAMLT, CHTs, CHAI, USAID, Peace Corps, WHO and other implementing partners is key for successful implementation and sustainability. The following are highlights of ways in which MCSP collaborated in PY1 Q4.

The MLT Pre-service Education Technical Working Group (TWG) has been established to assist in strengthening Lab Pre-service Education’s three subcommittees.

o The group has been working to finalize the accreditation process, adapting the PSE quality improvement standards and formalizing the licensure exams, using skills on best practice in assessment to review and strengthen exam questions and develop Question Item Banks.

o They have the first draft of the MLT PSE Standards that will be sent to Jhpiego Global Engagement and Communications Office (GECO) for editing, formatting and formal publication.

o The other two groups are completing the accreditation process for strengthening the Liberia Association of Medical Laboratory Technologists (LAMLT) as a regulatory body.

Collaborated with CSH and MOH to review TOR for HRH Technical/thematic working group for all HRH functions including PSE and IST

MCSP/HRH staff participated in the MOH’s Human Resources for Health consultant recruitment process with the interview on May 4, 2017 to recruit an international consultant for the development of the MOH Integrated In-service Training Policy. The panelist included representatives from HRH, CSH, MOH, CSA and Global Fund. Interview questions with scoring template was developed and used with panelists providing an average score for each applicant. The applicant with the highest score was selected

MCSP HRH participated in the vetting process for MOH In-service Training Consultant as one of the seven panelists. The process included shortlisting of qualified candidates, development of questionnaires, conducting of interviews, selection of the best candidate and submitting results and recommendations for hiring. Two candidates (females) were shortlisted for interview

MCSP/HRH Staff participated in the MOH TWG meeting on April 10, 2017. The purpose of the meeting was to

o Validate the National Human Resources for Health Policy and Plan 2011-20121 Mid-term Review/Situation Analysis report


19

o Present and discuss the MOH Employee Handbook that will guide the MOH in Policy and processes for human resources

o Met with CHAI to discuss MOH HWP plans for improving data collection systems at the PSE institutions supported jointly by HWP and MCSP. This includes all institutions except UMU. Plans developed to collaborate on implementation of improved information systems in the 5 overlapping institutions.

At the invitation of the National Health Promotion Division (NHPD), MOH, MCSP/HRH participated in a materials and messages revision and development workshop on maternal and newborn death surveillance review (MNDSR) facilitated at the Women Center in Gbarnga, Bong County. The five-day working sessions (June 5-9, 2017) was coordinated by NHPD in collaboration with the Family Health Division (FHD) and sponsored by the United Nations Population Funds (UNFPA). Some of the highlights of the message development exercise were:

o Participants reviewed the situation analysis and identified gaps including:

Community members unable to detect early and report promptly danger signs during pregnancy

Danger signs after delivery

Post- partum care for mother and newborn after delivery

Delays reaching health facility on time and

Delay in receiving care from health workers, with emphasis on the three major delays namely

o Messages and materials developed at the 5-day gathering included:

Community delay in receiving care from health workers

Developed four creative briefs (identifying targets and desired behaviors)

Danger signs in big belly or newborn

Danger signs after delivery

Postpartum care for mother and newborn after delivery

Male involvement

A total of three zero draft posters along with four draft for audio initiated

o The materials developed focused on the three delays (at the community, transport to the facility and receiving care at the facility). The materials and messages highlighted danger signs during pregnancy, labor, delivery and in the postpartum phase.

o MCSP was commended for responding to the MOH’s request and participating in the materials and messages revision and development workshop on MNDSR.

o MCSP participants recommend that the program adapt materials and messages applicable to our program interventions.

The Medical Laboratory Technical Working Group on PSE Standards conducted their regular bi-weekly meetings during the reporting period. Some of the outcomes these meetings included:

o Finalized the accreditation process for the MLT PSE institutions o Licensure process for the Medical Laboratory Technicians o Drafted the Governance and By laws for the Medical Laboratory Association

CROSS CUTTING

Monitoring, Evaluation, Research and Learning (MERL) During the reporting period MCSP/HRH conducted supportive supervision, monitoring and mentoring at all six PSE training institutions and their principal clinical/practical training sites using the MCSP/HRH supervision and monitoring tool and the Liberia Board for Nursing and Midwifery approved Quarterly Monitoring Tool. The goal of the visits was to enable MCSP/HRH team review on site things that are working well, according to standards, identify gaps and work with the school administration to address those gaps.


20

The team utilized these visits to follow up on action plans developed during the activities including; Effective Teaching Skills, Students Performance Assessment workshops and the coordination meeting held between the schools and their primary clinical sites.

During the visit interestingly, it was realized that some participants from these trainings have not been able to carry out all the planned activities or achieve some of the objectives of their action plans. This is due mainly to competing priorities or lack of resources including time and attention being provided by management. The team worked along with the school management and faculty to develop a new timeline for the implementation of the action plan. Copies were given to mentor to work with the school while the team will follow up during the next visit.

It was noted that the MTPSER, PTP and TNIMA Teams had conducted in-service training for other faculty members in ETS & SPA. The MCSP/HRH Team highlighted all pending action plans for prioritized development and completion. Staff were encouraged to use the action plans as part of their working tools and consider the document as work in progress. All action plans will be closely monitored to ensure use and implementation.

During the quarter under review, the MCSP monitoring, Evaluation, Research and Learning (MERL) unit completed the following activities which contributed to the appropriate use of data to guide the MCSP management team on decision making:

Drafted the HRH documentation and dissemination plan

Submitted the updated version of the M&E Plan to USAID for review

Uploaded EmONC/Perinatal/Low Dose High Frequency Phase II, Laboratory Quality Management System, Leadership and Management Development into TrainSMART and Midwifery Program Clinical Site data into project database

Collaborated with Technical Team to develop HRH Causal Pathways and measurement plans to articulate logical progression of results for specific interventions and expected evidence of change. Pathways were developed for: Skills Labs, Faculty Development, and School Governance and Management.

Data entry for HRH indicators into Performance Indicator Database System (PIDS)

Submitted abstract on Gender Analysis to AFREHealth Symposium (Accra, Ghana) and the 4th Global Forum on Human Resources for Health (Dublin, Ireland). Abstract was accepted to AFREHealth Symposium for oral presentation. We await a decision on the abstract submitted to the HRH Forum in Ireland.

Lolade Oseni (Sr. Technical Advisor, M&E; Washington, DC) provided program support to MCSP for the development of documentation and dissemination plan, Causal Pathway measurement plans, and the M&E Plan.

Communications

Establish mechanism to support coordination to facilitate communication and sharing

The MCSP/HRH In-country communications team worked closely with Liz Eddy, Communication Associate, and (MCSP STTA) to finalize the draft Communications Strategy and Plan. Liz’s STTA from April 7-23, 2017 and reviewed the following communications related area’s :

o Orientation to MCSP communications department and resources for the recently hired Communications Officer.

o Review MCSP style guide and working with templates. o Communications training sessions on correct branding. o Trainings to Improve Communications on Writing for Success and Improving Document Format

Training o Value of good written communications; improving sentences and paragraphs; organizing and

presenting materials o Trainings on improving Writing for Success and Improving Document Format


21

Gender

Gender Analysis Report has been submitted to USAID Mission for review. Based on the findings recommendations have been made in four areas:

o Increasing Family planning and RH services. o Build capacity of students to promote gender awareness o Addressing sexual harassment o Promote gender sensitivity in schools.

Quality Improvement

As a result of the LDHF Learning sessions conducted, clinical sites are improving in the following areas: the safe and proper administration of MgSo4 by midwives and an increase in proper usage/plotting of Partograph.

Photo: Participants plotting a Partograph

Figure 1: MCSP HRH LDHF Quality Improvement Model


22

LESSONS LEARNED

Students currently working with updated clinical schedules have enabled students to practice to full competency

all required skills

Promoting and publicizing our activities through mass multi media have had a positive impact on the implementation and uptake of program activities. Career Days that were facilitated for MLT and promoted using Multi and Social Media attracted over 400 applicants who participated in taking the MLT entrance exams, which is a significant increase from previous years.

When MCSP HRH conducted the monitoring visit, participation of the school management and faculty staff on the assessment team served as a motivation to the school staff in working with the MCSP HRH team in planning and taking action on addressing gaps identified

Monitoring and supervision must be facilitated regularly with feedback on data provided to the schools to be effective and used at all levels

SQS Training for graduating students is key to strengthening graduates capacity to use data for decision making at their respective facilities

Due to the LDHF perinatal training midwives are accurately documenting patient’s findings and health outcomes.

Monitoring and supervision visits should be conducted during active school sessions to enable the assessors to complete a monitoring process that assesses what is actually happening at the school.

SQS Training for graduating seniors should be scheduled before graduation; either prior to affiliation or following affiliation. Alternatively, SQS skills should be integrated into final, summative knowledge and skill assessments for matriculating students.

CHALLENGES and OPPORTUNITIES

There is a need for intensive MCSP HRH support at clinical sites to prepare preceptors and mentors to be able to perform their role competently when working with the students. To address this identified need, the HRH program initiated the LDHF intervention and facilitated LDHF Teaching Methodology Training at PSE affiliated clinical sites in February. MCSP will facilitate a Preceptor Orientation training for PSE affiliated clinical sites in September.

Need to obtain post-partum family planning commodities, as clients at the health facilities/clinical sites are requesting both implants and intrauterine devices. The staff at the clinical training sites are now working with the Family Planning Unit of the hospitals to ensure that the necessary commodities are available in the wards.

Poor internet connections create delays in report submissions and limits the ability to send updates from the PSE Training Institutions located in the rural parts of the country. MCSP has been using other communication methods (verbal reports over the phone) to receive reports in a timely manner when the internet service is poor.

The sheer variety and size of the procurements for the project are a challenge, however, major equipment and supplies have been order. The Procurement team is now utilizing a new tracking system and are able to provide updated information in a timely manner which is assisting to resolve remaining challenges efficiently.

The unmet need for Simulation Supervisors is making it difficult to ensure reliable open hours for school skills labs. To fill this gap, MCSP will train staff to be Simulation Supervisors at the Management of the Skills Labs Workshop planned for September.

PLANNED ACTIVITIES FOR NEXT QUARTER

Below are some of the key activities planned for July to September 2017: Activities for the next Quarter

Disseminate the validated Midwifery and Medical Lab Technician curricula for use in the schools


23

Conduct monthly and quarterly supportive supervision and mentoring visits to midwifery and medical laboratory pre-service education training institutions

Conduct training for preceptor orientation, management of skills lab and initiate the Faculty Development Program

Conduct Technical update workshop including IMNCI, EPI and Malaria and HIV diagnostic as well as OSCE workshops

Expand number of rural clinical practices sites for Midwives and Laboratory Technicians.

Continue to work through our faculty-based mentors and Twinning partners to mentor and coach academic institution faculty leadership and administration in best practice teaching and clinical site management.

Complete procurement and provision of equipment and supplies and development of teaching and learning materials.

Delivery and handover of vehicles and available skills lab equipment to PSE institutions.

Integrate findings/recommendations from the Gender Analysis

Implement measurement of the Casual Pathway and document project impact

Conduct quarterly joint coordination meeting with key implementing partners

Participate in Pre-service Education Implementing Partner Meetings

Facilitate coordination meetings between the Pre-service education institutions and the Health Facilities

Participate in Ministry of Health Scholarship meetings

Participate in National Health Promotion Division Technical Working Group meetings and the Material and Message Design working sessions.

Organize and conduct the MCSP/HRH Quarterly Review Meeting

Facilitate Midwifery and Laboratory Technicians Demand Generation activities

Conduct and roll out preceptor teaching skills to lab and midwifery preceptor.

Validate and finalize Preceptor Orientation and Clinical Practice Guidance Materials and Tools

Provide simulation center or workplace-based updates (skills)

Continue to review and download relevant instructional videos for maternal health, newborn health, and laboratory

Provide HINARI orientation and training at each school

Work with each Midwifery and Laboratory School to prepare and implement their simulation lab management plan and processes

Establish Laboratory Twinning relationships and agree on focus

Finalize the Gender Assessment Report and conduct the Gender Dissemination Workshop

Identify and offer academic program management course for administrators

Identify and support the use of an academic management database for PSEs

Pending USAID approval, implement strategies to collect data and monitor new indicators in M&E Plan and Causal Pathway

Continue monitoring of LDHF training approach, including interim clinical standards assessment to assess quality of care

Further develop dashboards to monitor program performance and progress

Update, produce and disseminate MCSP/HRH promotional materials for identified target audiences and key stakeholder groups.

Annex 1: MCSP Performance Indicator Table Progress

Indicator

# Indicator Frequency

Baseline

Value

PY1

Q1

(Jul-

Sept,

2016)

PY1

Q2

(Oct-

Dec,

2016)

PY1

Q3

(Jan-

Mar,

2017)

PY1

Q4

(Apr-

Jun,

2017)

FY17

Target

Life of

Project

Target

(FY18

Target)

Comments

GOAL: To strengthen the capability and resilience of Liberia’s frontline health workforce to address second order impacts from the

Ebola crisis while strengthening the resilience of the workforce to provide quality, safe and respectful services.

0.1

Number of new

healthcare

workers who

graduated from a

pre-service

training

institution

supported by

MCSP during the

reporting period

Annually

N/A

N/A

N/A

N/A

43

117

165

0.2

Percent of

graduating

students in

MCSP-supported

schools who pass

state board

exams

Annually

81%

MW

95%

MLT

N/A N/A N/A

N/A

81% MW; 95% MLT

90%

MW

95%

MLT

0.3

Number (MLT)

or Percent

(Midwifery) of

first year spaces

filled

Annually

58%

MW

28 MLT

N/A

N/A

N/A

N/A

N/A

N/A

Objective 1: Increased quality of instruction at targeted pre-service training institutions achieved by upgrading the technical

competencies and teaching skills of faculty, including clinical preceptors, and strengthening curricula, course materials, and delivery of

both didactic and clinical training.

1.1

Number of

persons trained

in priority

technical areas

with MCSP

support

Quarterly N/A 72 54 186 155 230 250

1.2

Percent of

persons trained

and proficient in

key technical

areas

Quarterly N/A 63% N/A 68%

80%

80% 80%

1.3

Number of

clinical

practice/lab

practicum sites

established or

strengthened

Quarterly N/A 0 0 0 5 19 27

1.4

Number of

clinical/lab

preceptors that

complete the

preceptor

orientation

package



25

1.5

Proportion of

prospective

graduates

achieving 80% or

greater on

objective

structured

clinical exam

(OSCE)

Annually 85% N/A N/A N/A N/A 88% 90%

1.6

Number of

curricula updated

with MCSP

support

Annually N/A N/A N/A N/A N/A 2 2

Objective 2: Strengthened learning environment at targeted pre-service training institutions and teaching sites through a

comprehensive approach to improving access to high quality instructional resources, equipment and technology.

2.1

Percent of

MCSP-supported

pre-service

institutions with

skills labs that

are equipped and

staffed full time

with at least one

clinical instructor

trained in skills

lab management

Quarterly

0%

0%

0%

0%

0%

63%

100%

Procurement

of

equipment in

progress, at

least 10 staff

trained in

QMS, LDHF

2.2

Number of pre-

service

institutions and

clinical practice

sites that

received

equipment

procured by

MCSP


Procurement

of

equipment in

progress

2.3

Number of

twinning

partnerships

established

Quarterly N/A 0 3 0 0 3

3

(Midline

target)

2.4

Proportion of

twinning

partnerships that

met action plan

deliverables for

the quarter

Quarterly

N/A

N/A

100%

N/A

N/A

N/A

100%

(midline

target)


26

Annex 2: MCSP HRH Trainings and Number of Participants

Annex 3: Number of new health care workers who graduated

from a pre-service training institution supported by MCSP HRH

during the Quarter (April-June 2017)

S/N

Training

# of

participants 1. EmONC/Perinatal/Low Dose High Frequency (CM/RM –

86, RN – 24, NM – 14) Male - 6, Female – 118

124

2. Laboratory Quality Management System (Lab Technician – 5; Lab Technologist – 5) Male - 8 Female – 2

10

3. Leadership Management and Development Training (Administrative Asst. 1, Midwife 1, Lab Tech 2, Lab Technologist 4, Medical Director 1, Nurse Midwife 6, Registered Nurse 6) Male- 9 Female- 12

21

Total: 155

S/N Graduated Students # Disaggregation

1 Midwifery Training Program Southeastern

Region

43

Male 16,

Female 27


27

Annex 4: Knowledge & OCSE Results from Perinatal Training (LDHF –

Phase II)

0%

20%

40%

60%

80%

100%

120%

Kn

ow

led

ge

OSC

E-M

RP

OSC

E-C

AA

OSC

E-A

BB

Kn

ow

led

ge

OSC

E-M

RP

OSC

E-C

AA

OSC

E-A

BB

Kn

ow

led

ge

OSC

E-M

RP

OSC

E-C

AA

OSC

E-A

BB

Kn

ow

led

ge

OSC

E-M

RP

OSC

E-C

AA

OSC

E-A

BB

Kn

ow

led

ge

OSC

E-M

RP

OSC

E-C

AA

OSC

E-A

BB

Curran Hospital Japanese Friendship Martha Tubman Phebe Hospital Redemption

Institutions Performance across Test Categories

Pre Post

PY1, Q4 Report - Human Resources for Health in Liberia 28

Annex 5: EmONC/Perinatal Low Dose High Frequency Practice

Annex 6: Number of Practice sessions for the EmONC/Perinatal/Low

Dose High Frequency held per topic across the five facilities for the

months of April and May, 2017

054

1

44

0

28

78

6285

51

249

258

32

256721

41 024

0

0

100

200

300

400

500

600

700

1-Apr-17 1-May-17

Nu

mb

er

of

Sess

ion

Total LDHF practice sessions per technical areas

PPFP

Immediate Care of New Born

Vacuum

IPC

Partograph

PPIUCD

KMC

Labour and delivery

Active management of third stage labour

Newborn Resuscitation

Assisting a Breech Birth

Compression of Abdominal Aorta

This graph shows the number of Practice sessions for the EmONC/Perinatal/Low Dose High

Frequency held per topic across the five facilities for the months of April and May, 2017.

-

4

1

6

16

-

2

4

6

8

10

12

14

16

18

Curran Lutheran LJFMH Martha Tubman Phebe Redemption

Average LDHF Practice Hours per Person (Apr-May 2017)


Annex 7: Quarterly Performance of PSE Schools against the Pre-service

Education Standards

55%

48%55%

47%

89%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

EBSNM MTPSER PTP UMU TNIMA

PSE Standard Performance Per Facility

This graph shows the PSE Schools quarterly performance against the PSE Performance Standards as assessed during the Technical Team supportive supervision visit within the quarter.


Annex 8: Tabular presentation of quarterly results for PSE Standards

Achieved and Observed during Supportive Supervision

S/N

School (s)

Clinical Site

Curriculum

Faculty

School Infrastructure & Management

Students

Classroom Observation

1. PTP 2 10 5 9 4 0

2. TNIMA 5 10 6 11 6 12

3. UMU 2 - 2 8 4 0

4. EBSNM 2 10 3 9 4 4

5. MTPSER 2 10 2 8 4 1

Achieved 13 40 18 45 22 17

Observed 25 50 35 90 30 41


Annex 9: Quarterly performance of PSE Schools on thematic areas of the PSE Standards from the

supportive supervision

Sum of Standards Achieved Sum of Standards Observed

4 4 4 4

66 6 6 6 6

0

1

2

3

4

5

6

7


Nu

mb

er

PSE Schools

PSE Standards-Student

98

98

11

18 18 18 18 18

0

5

10

15

20


Nu

mb

er

PSE Schools

PSE Standards-School Infrastruture and Management

3

2

5

2

6

7 7 7 7 7

0

1

2

3

4

5

6

7

8


Nu

mb

er

PSE Schools

PSE Standards-Faculty

10 10 10 10 1010 10 10 10 10

0

2

4

6

8

10

12


Nu

mb

er

PSE Schools

PSE Standards-Curriculum

2 2 2 2

55 5 5 5 5

0

1

2

3

4

5

6


Nu

mb

er

PSE Schools

PSE Standards-Clinical Site

4

1

1213

14 14

0

2

4

6

8

10

12

14

16


Nu

mb

er

PSE Schools

PSE Standards-Classroom Observation

NB: Quarterly performance of PSE Schools on thematic areas of the PSE

Standards from the supportive supervision held


Annex 10: MCSP HRH Short-Term Technical Assistance Visits during

the Reporting Period

Who What When Duration of Trip

Liz Eddy To finalize draft Communications strategy and plan, and facilitate other communications related issues including; correct branding, trainings on improving communications on Writing for Success and Improving Document Format.

April 7-23, 2017 2 weeks

Rosemary Kamunya, Senior Technical - Training

To facilitate the EmONC Master Mentor Training

April 24 – 29, 2017 1 week

Erica L. Chin, MA Instructional Technologist, Medical Illustrator

To provide program support to MCSP/HRH for video capture and production

May 23, - June 2, 2017

2 weeks

Lolade Oseni, MBBS, MPH, CPH, Senior Technical Advisor, M&E, Washington, DC

To provide program support to MCSP for the development of documentation and dissemination plan and Causal Pathway for HRH and as well as work on the M&E Plan

June 1 – 16, 2017 2 weeks (1 week MCSP HRH, 1 week MCSP RHS)

Nathan Rehr, Senior

Program Coordinator

To provide procurement support and work with MCSP staff to develop distribution plans and tools for PSE institutions to track and manage their inventory.

June 25-July 5, 2017 2 weeks (split with MCSP RHS)


Annex 11: MCSP HRH Work plan Matrix Progress Update

To supplement the narrative progress updates in this report, below is an update on MCSP’s progress against each activity in the work plan matrix that has been planned for this reporting period.

Activities Numbers

Activities for April – June 2017

Status update (Pending, Ongoing, and Completed)

UPDATES

Mgt 3 Mgt 6 Mgt. 7.4 RA 1

Project staff hired and oriented to MCSP HRH Establish coordination mechanisms and joint planning with in country partners Conduct quarterly monitoring, mentoring and supervision visits to each school Conduct PSE Gender Analysis to identify any gender related barriers to enrollment and retention of students and understand Gender disparities in performance of students

Ongoing Ongoing On-going Ongoing

Medical Laboratory Staff Laboratory Officer has been finalized and staff is expected to start early July, 2017. Joint Coordination meetings were held with TWG meetings with MOH and implementing partner (List few achievements; review policy etc) The first Monitoring and Supervision visit was conducted at MTPSER, Phebe and Esther Bacon with the Midwifery and Laboratory schools in Zwedru, Bong and Lofa Counties. The purpose of the visits was to follow up with the level of achievement with action plans developed from previous trainings. The country program has obtained ownership of the Gender Analysis Report, consolidated all of the comments and submitted to USAID Liberia Mission for review.

Objectives: 1.1

Support hiring of 18 Liberian nationals as additional permanent faculty (per HWP definition). Per HWP, ideally are master's level technicians with 3 years of experience. Otherwise, will hire Bachelors (targeting UMU graduates and adding the ETS)

Ongoing

The two PSE institutions (PTP and MPCHS) are still in the process of identifying suitable candidates who will be hired and will receive salary support from MCSP/HRH. However, the 16 staff initially hired will continue receiving salary support until January 31st, 2018.


Activities Numbers



UPDATES

1.2 1.3.5 1.4

Provide faculty with up-to- date teaching skills and faculty development opportunities Engage with the LBNM and the Medical Laboratory Board and the school’s staff to validate and finalize the preceptor orientation and clinical practice guidance materials and tools Upgrade the technical competencies of faculty, preceptors and matriculating class of Midwifery and Laboratory graduates

On-going Ongoing Ongoing

The Faculty technical updates have commenced with the development of the Faculty training materials in progress. Training is planned from May 2017 to June, 2017 Preceptor Orientation Materials for Midwifery Preceptor and Lab Supervisors are under development and will be reviewed, validated and approved by the LBNM and the MLT Board. During the supervisory and monitoring visit to Esther Bacon during the quarter, it was established that recent Midwifery graduates and Faculties have not been trained in Safe and Quality Services (SQS). Esther Bacon has placed in a request to MCSP/HRH for the training of its recent graduates and faculties. The SQS training is scheduled for the next quarter.

2.1 2.2 2.4

Improved skills laboratory at Midwifery schools, improved and sufficient equipment for laboratory schools Provide equipment, supplies and light infrastructure improvements to strengthen clinical sites Support schools to strengthen management and administrative systems, leveraging structured twinning partnership

Ongoing Ongoing Ongoing

Items are being procured internationally for the Pre-service education training institutions Skills Laboratories and the first consignment has arrived in country. Work is progressing on securing storage and preparing distribution plans. List for equipment specifications was developed and approved, Vendors identified and the list of equipment submitted for progressing to procurement. PSE Institutions participated in the CSH Leadership and Management Workshop in May 2017 with the University of Michigan to follow up on the development of Management Action Plans with the PSE remotely. Plans for the University of Michigan to


Activities Numbers



UPDATES

facilitate their second in country visit in September 2017.Emphasis during this visit will be to focus on strengthening governance and management at the PSE Institutions. For the Laboratory Program, MCSP/HRH is working out contractual processes with Kenyatta University and / or, Addis Ababa University and/or Kwame Nkrumah University of Science and Technology for Twinning. PSE Information System is being developed to help manage details of students from the point of admission to graduation. This information systems will be used by the school administration to oversee student activities in various auto-generated reports at UMU.


Newly Graduated, Second Generation

Midwife Reflects on Education and What

Inspires Her to “Love the Career”

SUCCESS STORY LIBERIA – HUMAN RESOURCES FOR HEALTH

NAME Patience Dahn

ROLES

SUMMARY

Patience Dahn is a recent graduate from the

Tubman National Institute of Medical Arts’ School

of Midwifery. She is a passionate second-

generation midwife, recently recognized at

graduation for her academic success record.

MCSP/HRH partners with TNIMA to help fill

critical teaching gaps by financially supporting

faculty salaries. This support helps ensure TNIMA

is able to attract and maintain quality faculty

members that instruct the next generation of

midwives. Degree in hand, Patience is ready to

start the lifesaving career path she has admired

since childhood.

In mid-April 11 midwives graduated from the Tubman National

Institute of Medical Arts’ (TNIMA) School of Midwifery program.

It was TNIMA’s 61st commencement ceremony. The new

midwives will help women across the country deliver safely – a

key outcome needed to lower Liberia’s high maternal mortality

rate of 1,072 per 100,000 women.

Patience Dahn is one the recent graduates. A high-performing,

deeply motivated TNIMA student, Patience was given the “Best

Midwife Award” from the local office of the World Health

Organization (WHO) for her outstanding academic performance.

According to Patience, she made her decision to become a

registered midwife after observing her mother’s work as a

traditional midwife. Patience said, “I used to like the way she took

care of women. That’s when I started to begin to love the

career.” Patience added that as a child she would hear her

mother help women through labor. She would go to sleep and

then in “the twinkle of an eye” would hear a newborn baby

crying. She remembers the sound of new life fondly, saying “I used

to love that.”

Becoming a highly-trained, registered midwife through TNIMA

was important to Patience. Working as a traditional midwife, her

mother helped women out of her home, not in a hospital or

clinic. While greatly admiring her mother’s work,

LOCATION

J. F. K. Medical Center Compound

Monrovia, Liberia

Patience Dahn in a happy mood while chatting at JFK. Photo: Liz Eddy/MCSP

“Because my mother is a traditional midwife, I used to like the way

she took care of women, that’s when I started to begin to love the

career.”

Patience Dahn, Registered Midwife and

Recent Graduate, Tubman National

Institute of Medical Arts

ROLES

Registered Midwife, Recent Graduate

Tubman National Institute of Medical Arts


Since February 2017 USAID’s Maternal and Child Survival Program (MCSP) has supported the TNIMA School of

Midwifery through its MCSP/Human Resources for Health (HRH) project

Patience advocates for women to deliver in facilities where

they can receive care for complications and have access to

trained medical staff like registered midwives and doctors.

HRH helps fill critical teaching gaps by financially supporting salaries of some TNIMA faculty members.

Consistent, supported faculty members are better able to foster a quality learning environment for Patience

and many other students.

Now, with her degree in hand, Patience is ready to start a career as an official registered midwife. She hopes

“to see more women to attend to, and I hope to serve humanity and serve my country.” In the future she

hopes to move up in her career by becoming an officer-in-charge in a facility.

Patience added that her mother is very proud of her. Her mother was able to attend her graduation and see

the second generation midwife in the Dahn family become a reality.

“I hope to serve humanity and serve my country.”

Patience Dahn, Registered Midwife

and Recent Graduate, Tubman National

Institute of Medical Arts