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Thematic Fact Sheet - Health Worker Dialogues - RMNHP HealthyDev

Dr. Haseeb Ahsan
Dr. Haseeb Ahsan

The Reproductive, Maternal and Newborn Health Project aims to improve cooperation between primary health care workers in Nowshera and Haripur districts of Khyber Pakhtunkhwa, Pakistan by initiating a series of facilitated dialogues. Maternal and newborn mortality rates in the districts remain high due to a lack of coordination between community midwives, lady health workers, lady health visitors, and lady health supervisors. The dialogues seek to build understanding of roles and responsibilities between cadres and encourage referrals through respectful exchange. Initial feedback on the first dialogues in April 2016 was positive, with health workers gaining greater appreciation for their colleagues' work.

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Published by: Health Worker Dialogues Enhancing cooperation between different health worker cadres Photos: 息 GIZ/Haseeb Ahsan Commissioned by Project name Project region Duration Lead executing agency Maternal and newborn care is limited by a lack of cooperation between health workers Improving health care for mothers and newborn babies is key to reducing Khyber Pakhtunkhwas (KP) high maternal and neonatal mortality rates. Recent Population Council research estimates district-level maternal mortality ratios of 271 per 100,000 live births in Haripur and 279 in Nowshera. Within districts, trained primary-level health care is provided by community-based Community Midwives, Lady Health Workers, Lady Health Supervisors and facility-based Lady Health Visitors. However, despite the presence of these primary-level health care workers, the 2012-13 Demographic and Health Survey found that 38% of all mothers in KP received no antenatal check-ups and 61% missed out on postnatal care. Around 59% of births occurred at home, with 24% of all deliveries assisted by a traditional birth attendant and just 17% attended by a midwife, nurse or lady health visitor. The existing services for mothers and newborns are hampered by frictions between the different health worker cadres. Over足 lapping responsibilities and inter-professional rivalries limit communication about specific cases and create bottlenecks in the referral system. One of the main reasons for these tensions is systemic: Community Midwives are managed by a different programme from the Lady Health Supervisors and Lady Health Workers. Unfortunately, these two programmes are both ver足 tically administered and the different health professionals receive little encouragement to work together. Reproductive, Maternal and Newborn Health Project Pakistan, Khyber Pakhtunkhwa Province, Haripur and Nowshera Districts Khyber Pakhtunkhwa Department of Health January 2015 to December 2016 German Federal Ministry for Economic Cooperation and Development (BMZ) Improving communication between health workers and encouraging greater mutual respect The Reproductive, Maternal and Newborn Health Project (RMNHP) seeks to improve cooperation between primary health care workers in Nowshera and Haripur by initiating a series of fa- cilitated dialogues involving members from each of the different health worker cadres. In particular, the dialogues aim to: Raise health workers awareness about the roles and respon- sibilities of the different types of primary health care workers (via the Professional Profiles exercise) and encourage greater mutual respect Improve cooperation and referrals between primary health care workers Left: LHVs and CMWs of district Haripur having a discussion on areas of good collaboration and how to tackle existing barriers. Right: District Coordinator DHIS and Coordina- tor DHO office Nowshera explaining importance of good collaboration, timely referrals and keeping records.
Photos: 息 GIZ/Haseeb Ahsan Published by Deutsche Gesellschaft f端r Internationale Zusammenarbeit (GIZ) GmbH Registered offices Bonn and Eschborn, Germany GIZ Office Pakistan 23, Street #55, Sector F-7/4 Islamabad, Pakistan T +92 51 111 489 725 F +49 228 995 35-3500 RMNHP@giz.de www.giz.de Writer Susan Ramsay Authors of the approach Anna von Roenne in consultation with Jasmin Dirinpur and Haseeb Ahsan Layout Karsten van der Oord Printed by Crystal Printers As at June, 2016 GIZ is responsible for the content of this publication. In cooperation with Department of Health Khyber Pakhtunkhwa, MNCH Pro- gramme, National Programme for Family Planning and Primary Health Care, People卒s Primary Healthcare Initiative (PPHI) On behalf of Federal Ministry for Economic Cooperation and Development (BMZ) Division 222 Afghanistan, Pakistan Addresses of the BMZ Bonn BMZ Berlin BMZ offices Dahlmannstrae 4 Stresemannstrae 94 53113 Bonn, Germany 10963 Berlin, Germany T +49 228 995 35-0 T +493018535-0 F +49 228 995 35-3500 F +493018535-2501 poststelle@bmz.bund.de www.bmz.de Using facilitated dialogues to build better professional relationships The Generation Dialogue Approach was first developed in Guinea (West Africa) to reduce the widespread practice of female genital cutting. By creating the conditions for a respectful exchange of ideas, the approach has proven effective at promoting inter- generational understanding and positive social change in a number of countries in Africa. The Health Worker Dialogues are inspired by this method but instead use dialogue to improve cooperation between different cadres of health workers and promote greater mutual respect. To begin with, members of the four different health worker groups are brought together to get to know one another and each others' roles and responsibilities; and to jointly explore the barriers that prevent them from working more effectively together. Trained dialogue facilitators encourage participants to practise listening to one another and pose generative questions to help them to identify some of the key factors that limit colla足boration and to consider how these might be overcome. The facilitators are an interdisciplinary team, with members taken from each of the different health worker groups and they act as role-models, showing how well interdisciplinary collaboration can work. Following the initial dialogues, the groups are then opened up to district and provincial programme managers and health officers. As part of this process, the health workers present the results of their discussions and explain what they would like to do in order to collaborate better. They are also encouraged to identify any systemic barriers and to request that the programme managers and health officers take concrete steps to address these issues. A three- month follow-up meeting is used to monitor progress towards realising the planned changes and to assess whether there has been any increase in the number of referrals between health workers. Some positive first steps towards a more collaborative working relationship Four teams of facilitators took part in a three-day training in Islamabad in February 2016. It is planned that the teams will conduct one Health Worker Dialogue per month in each district. The dialogue workshops last 2.5 days and bring together representatives of the four different health worker groups who are working in the same area (i.e. Community Midwives, Lady Health Workers, Lady Health Visitors and Lady Health Supervisors). Provincial and district-level programme managers and health officers also attend the workshops to understand the barriers to better cooperation and to support the solutions proposed by the participating health workers. The first dialogue sessions were held on 4-6th April 2016 in Nowshera and 25-27th April 2016 in Haripur. So far, the feedback has been positive. The sessions are often the first opportunity for health workers to meet and get to know other colleagues working on maternal and newborn health in their community. Overall, participants have praised the dialogues for giving them a better understanding of their colleagues work and for highlighting the areas where their roles and responsibilities are complementary. Some workers have also reported an increased motivation to refer cases to one another and the RMNHP plans to assess whether there is a subsequent improvement in referrals in the coming months. Left: Lady Health Supervisor presenting professional profiles to HWD participants in Nowshera. Right: LHWs developing professional profiles during a group work session at the HWD workshop in Haripur.

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Thematic Fact Sheet - Health Worker Dialogues - RMNHP HealthyDev

  • 1. Published by: Health Worker Dialogues Enhancing cooperation between different health worker cadres Photos: 息 GIZ/Haseeb Ahsan Commissioned by Project name Project region Duration Lead executing agency Maternal and newborn care is limited by a lack of cooperation between health workers Improving health care for mothers and newborn babies is key to reducing Khyber Pakhtunkhwas (KP) high maternal and neonatal mortality rates. Recent Population Council research estimates district-level maternal mortality ratios of 271 per 100,000 live births in Haripur and 279 in Nowshera. Within districts, trained primary-level health care is provided by community-based Community Midwives, Lady Health Workers, Lady Health Supervisors and facility-based Lady Health Visitors. However, despite the presence of these primary-level health care workers, the 2012-13 Demographic and Health Survey found that 38% of all mothers in KP received no antenatal check-ups and 61% missed out on postnatal care. Around 59% of births occurred at home, with 24% of all deliveries assisted by a traditional birth attendant and just 17% attended by a midwife, nurse or lady health visitor. The existing services for mothers and newborns are hampered by frictions between the different health worker cadres. Over足 lapping responsibilities and inter-professional rivalries limit communication about specific cases and create bottlenecks in the referral system. One of the main reasons for these tensions is systemic: Community Midwives are managed by a different programme from the Lady Health Supervisors and Lady Health Workers. Unfortunately, these two programmes are both ver足 tically administered and the different health professionals receive little encouragement to work together. Reproductive, Maternal and Newborn Health Project Pakistan, Khyber Pakhtunkhwa Province, Haripur and Nowshera Districts Khyber Pakhtunkhwa Department of Health January 2015 to December 2016 German Federal Ministry for Economic Cooperation and Development (BMZ) Improving communication between health workers and encouraging greater mutual respect The Reproductive, Maternal and Newborn Health Project (RMNHP) seeks to improve cooperation between primary health care workers in Nowshera and Haripur by initiating a series of fa- cilitated dialogues involving members from each of the different health worker cadres. In particular, the dialogues aim to: Raise health workers awareness about the roles and respon- sibilities of the different types of primary health care workers (via the Professional Profiles exercise) and encourage greater mutual respect Improve cooperation and referrals between primary health care workers Left: LHVs and CMWs of district Haripur having a discussion on areas of good collaboration and how to tackle existing barriers. Right: District Coordinator DHIS and Coordina- tor DHO office Nowshera explaining importance of good collaboration, timely referrals and keeping records.
  • 2. Photos: 息 GIZ/Haseeb Ahsan Published by Deutsche Gesellschaft f端r Internationale Zusammenarbeit (GIZ) GmbH Registered offices Bonn and Eschborn, Germany GIZ Office Pakistan 23, Street #55, Sector F-7/4 Islamabad, Pakistan T +92 51 111 489 725 F +49 228 995 35-3500 RMNHP@giz.de www.giz.de Writer Susan Ramsay Authors of the approach Anna von Roenne in consultation with Jasmin Dirinpur and Haseeb Ahsan Layout Karsten van der Oord Printed by Crystal Printers As at June, 2016 GIZ is responsible for the content of this publication. In cooperation with Department of Health Khyber Pakhtunkhwa, MNCH Pro- gramme, National Programme for Family Planning and Primary Health Care, People卒s Primary Healthcare Initiative (PPHI) On behalf of Federal Ministry for Economic Cooperation and Development (BMZ) Division 222 Afghanistan, Pakistan Addresses of the BMZ Bonn BMZ Berlin BMZ offices Dahlmannstrae 4 Stresemannstrae 94 53113 Bonn, Germany 10963 Berlin, Germany T +49 228 995 35-0 T +493018535-0 F +49 228 995 35-3500 F +493018535-2501 poststelle@bmz.bund.de www.bmz.de Using facilitated dialogues to build better professional relationships The Generation Dialogue Approach was first developed in Guinea (West Africa) to reduce the widespread practice of female genital cutting. By creating the conditions for a respectful exchange of ideas, the approach has proven effective at promoting inter- generational understanding and positive social change in a number of countries in Africa. The Health Worker Dialogues are inspired by this method but instead use dialogue to improve cooperation between different cadres of health workers and promote greater mutual respect. To begin with, members of the four different health worker groups are brought together to get to know one another and each others' roles and responsibilities; and to jointly explore the barriers that prevent them from working more effectively together. Trained dialogue facilitators encourage participants to practise listening to one another and pose generative questions to help them to identify some of the key factors that limit colla足boration and to consider how these might be overcome. The facilitators are an interdisciplinary team, with members taken from each of the different health worker groups and they act as role-models, showing how well interdisciplinary collaboration can work. Following the initial dialogues, the groups are then opened up to district and provincial programme managers and health officers. As part of this process, the health workers present the results of their discussions and explain what they would like to do in order to collaborate better. They are also encouraged to identify any systemic barriers and to request that the programme managers and health officers take concrete steps to address these issues. A three- month follow-up meeting is used to monitor progress towards realising the planned changes and to assess whether there has been any increase in the number of referrals between health workers. Some positive first steps towards a more collaborative working relationship Four teams of facilitators took part in a three-day training in Islamabad in February 2016. It is planned that the teams will conduct one Health Worker Dialogue per month in each district. The dialogue workshops last 2.5 days and bring together representatives of the four different health worker groups who are working in the same area (i.e. Community Midwives, Lady Health Workers, Lady Health Visitors and Lady Health Supervisors). Provincial and district-level programme managers and health officers also attend the workshops to understand the barriers to better cooperation and to support the solutions proposed by the participating health workers. The first dialogue sessions were held on 4-6th April 2016 in Nowshera and 25-27th April 2016 in Haripur. So far, the feedback has been positive. The sessions are often the first opportunity for health workers to meet and get to know other colleagues working on maternal and newborn health in their community. Overall, participants have praised the dialogues for giving them a better understanding of their colleagues work and for highlighting the areas where their roles and responsibilities are complementary. Some workers have also reported an increased motivation to refer cases to one another and the RMNHP plans to assess whether there is a subsequent improvement in referrals in the coming months. Left: Lady Health Supervisor presenting professional profiles to HWD participants in Nowshera. Right: LHWs developing professional profiles during a group work session at the HWD workshop in Haripur.