This piece was originally featured on the PMI Impact Malaria blog.
By Anne Bulchis, PMI Impact Malaria Communications Manager, and Kate Wolf, PMI Impact Malaria Technical Advisor
As part of advancing global malaria service delivery, PMI Impact Malaria (IM) supports countries in their efforts to strengthen the quality of malaria services in health facilities and at the community level. IM’s quality assurance approach encourages continuous improvement of the competencies of health providers through a systematic and standardized series of country-driven interventions, including mentorship to improve workplace performance and provide ongoing professional development.
IM was supporting in-person mentoring in Cameroon and Côte d’Ivoire when the COVID-19 pandemic hit in March. Both countries promptly entered lockdown, endangering access to health services for the population and making it impossible for mentorship to continue in-person. In April, with the World Health Organization (WHO) projecting that malaria deaths could double as a result of COVID-19, mentorship went fully remote in both countries.
Moving from in-person to remote mentoring involved rapid deployment of a four-part process:
- Design: Developed a remote mentorship prototype package that included technical guidance for both malaria and COVID-19, along with a phone call guide focused on maintaining malaria service delivery and applying malaria and COVID-19 guidance from WHO and the U.S. President’s Malaria Initiative (PMI) on triaging of patients and implementing infection control measures.
- Test: Carried out preliminary mentorship calls to test the feasibility and suitability of the mentorship package.
- Adapt: Refined and translated the package for multi-country use in English and French.
- Implement: Conducted remote mentorship with previously mentored facilities, consisting of monthly calls in Côte d’Ivoire and one call per facility in Cameroon.
From April to June, the two countries made 172 calls to reach 220 health providers at 149 facilities. According to Landry Tchoutang, a mentor in Cameroon, “Remote mentorship helped us maintain a climate of trust and support between the health providers and us who are there to improve the quality of services.”
Through this open line of supportive communication, mentors were able to help facilities that were struggling to organize care in response to new guidelines. Facilities adopted solutions such as screening patients at the gate, setting up a separate entrance for those with fever, prioritizing malaria testing for all fevers, and providing antenatal care to women in a separate area.
A midwife in Côte d’Ivoire explained how much this guidance meant to her. “The remote mentoring during the critical phase of COVID-19 reassured us that the staff of PMI Impact Malaria did not abandon us.”
A substantial challenge early in the pandemic was supply chain disruptions that led to stockouts of commodities, particularly malaria rapid diagnostic tests (mRDTs) and sulfadoxine-pyrimethamine for malaria preventive therapy among pregnant women (IPTp). Mentors worked with district and national stakeholders to alert them to stockouts and locate or redeploy stocks, where possible. Mentors also helped rally resources for transportation of commodities and worked with providers to improve stock management techniques.
“Remote mentorship during the pandemic has strengthened our links with health providers,” said Dr. Jean Bosco Gbamélé, the mentorship team lead in Côte d’Ivoire.
Even in a post pandemic world, many of the benefits of this remote approach will remain relevant. Remote mentorship can help to reach more facilities at a lower cost, provide a bridge between in-person mentor visits, minimize transportation logistics and funds, and connect mentors with health facilities that are unreachable due to political instability, natural disasters, and other barriers.
The two biggest drawbacks with remote mentorship are that it does not allow for direct observation of the provider delivering services and not all facilities have cell phone coverage, so in-person mentorship will continue to play an important role.
Now that current pandemic-related restrictions are more relaxed in Cameroon and Cote d’Ivoire, the countries have resumed in-person mentorship. Cameroon is exploring remote mentorship for facilities affected by political insecurity where in-person support may not always be possible.
Stay tuned for more information in the coming months about ways that PMI Impact Malaria is supporting quality improvement of malaria services in the current COVID-19 context.
Header Photo Caption: A nurse performs a malaria rapid diagnostic test (mRDT) on a patient with fever in Niger. Photo Credit: PMI Impact Malaria
PMI Impact Malaria is funded and technically assisted by the U.S. President’s Malaria Initiative (PMI), and led by Population Services International (PSI) in partnership with Jhpiego, Medical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.
