How to support health worker capacity in fragile context: case of a coaching strategy in Burundi
(2017) European Congress on Tropical Medicine and International Health (ECTMIH) — Location: Antwerp, Belgium (16.October.2017)
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- How to support health worker capacity in fragile context: case of a coaching strategy in Burundi Anne Fromont1, Dr Marie-Claire Ryanguyenabi2, Dr Wolfhard Hammer 3, Dr Slim Haddad4 1- School of Public Health, Université Libre de Bruxelles, Bruxelles, Belgique 2- Deutsche Gesellschaft fur Internationale Zusammenarbeit (GIZ), Bujumbura, Burundi 3- External consultant, Usingen, Germany 4- Research Unit, UHC Quebec, Quebec, Canada Introduction The Burundi context negatively affects the capacity of health workers in several ways: poor quality of initial training, migration issue of educated people, supervision style based on control rather support… In order to improve the quality of care, an in situ coaching was provided by a GIZ team in 2014-15. This coaching encompassed the whole staff of 62 health centers. Aim Our study aimed to assess the impact of such a coaching on explicit types of knowledge depending on the social groups (gender, age, professional role, qualification...). Methodology We mixed quantitative data on socio-demographic parameters with qualitative and individual responses to 3 open questions about social representations of quality (SRQ). Qualitative data were analysed with Iramuteq©, a textual analysis software. These data were collected before, at mid-time and after the intervention. Results Of the whole population of health workers, those without any professional qualification represented 50%. The turn-over showed linear correlation with the level of training (chi²=90.2 ; p<0.000): marginal for workers without any professional qualification, it rose to 47% over 2 years for the higher educated. The response rate from individual questionnaires was quite stable (66%-69% - about 650 respondents for each collection). In addition to a common and normative level (e‧i. the quality of the patient reception), the SRQ were anchored to the level of qualification (but not directly to the positional role). The more the level of initial training was low, the more the SRQ changed during the intervention. For the workers without any professional qualification, we observed a clear increase of explicit knowledge pointing to a form of professionalization. Conclusion In this fragile context, conventional mechanisms for developing professional capacity, as the supportive supervision, are dysfunctional. By addressing the whole staff, an in-situ coaching involved low-skilled workers who are often excluded from continuous training despite technical and strategical roles (as hygiene, reception…). As they are a community-based group, they are also more stable than other staff. These kind of local support could be an opportunity to develop professional capacities and, in fine, to improve quality of care in a sustainable way despite highly unfavourable conditions.
- Affiliations
Ecole de Santé Publique ULB
Citations
Fromont, A., Ryanguyenabi, M.-C., Hammer, W., & Haddad, S. (2017). How to support health worker capacity in fragile context: case of a coaching strategy in Burundi. European Congress on Tropical Medicine and International Health (ECTMIH), Antwerp, Belgium. https://hdl.handle.net/2078.5/106073