Presentation during the session on LMG Training Successes at the First National Conference on Health Leadership, Management and Governance

1. LMG and Community engagement
The 1st National Conference on Health Leadership,
Management and Governance
Dr. Gondi J. , MOPHS, Nyanza
And: CHS TAG and JICA SEMAH project

2. Contents
1. Background: CHS implementation
2. LMG activities, roles and gaps of the
various actors.
3. Results from Nyanza CHS LMG study
4. Conclusion and Recommendations.

3. Background
CHS structure
District CHS focal person
Report submission Supportive Supervision
CHEWs/CHCs
Report submission Supportive Supervision
CHWs
HH visitation &
Data collection Service provision
Households

4. Background
∗ Nyanza has 6 counties; Total C.Us = 633; 2 counties
(Siaya and Homabay) have 100% CU coverage.
∗ LMG trainings are conducted to DHMTs and health
workers in the health facility. In Nyanza 100% DHMTs
trained on LMG through SEMAH project.
∗ For the CHS; LMG is included in the CHC and CHEW
trainings.

5. Background:
leadership issues on CHEW
∗ LGM training components in standard CHEW training
manual is inadequate in LMG
∗ Standard Policy on performance enablers: Transport;
∗ Diverse professional background of CHEWs ?

6. CHCs
• Clear guideline on membership
• LGM training for CHC members
exists.
• Overall Effective Participation in
CHS challenged by:
• Weak resource
mobilization.
• Expectations versus
Voluntarism.
• Complex and technical
training manual

7. CHWs
∗ Identified and Selected through a
participatory community approach.
∗ Trained through a basic and
advanced package to improve quality
and performance. LMG limited.
∗ HH coverage target of 100 HH/month
difficult to attain.
∗ Enablers and motivation provided for
effectiveness is diverse:
∗ CHW KIT,
∗ Transport Retention,
∗ Stipend? Satisfaction
∗ Recognition etc.

8. Nyanza CHS LMG study
∗ So, We introduced a pilot study on
refresher training with LMG
components conducted in 4 district,
Nyanza province
∗

9. Background
Reporting
- CHS structure with gaps-
monitoring tool District CHS focal person
(checklist)
Report submission Supportive Supervision
Reporting CHEWs/CHCs Training
monitoring tool
Report submission Supportive Supervision
CHWs Training
HH visitation &
Data collection Referral & Defaulter
Service provide
tracing mechanism
Households

10. The results from baseline survey
Even though these knowledge are
minimum requirement for CHEW and
CHWs, They had limited knowledge
The cascade down from CHEW to CHWs
and Household member is one of the
issues. LGM skill and facilitation skill
must be useful to solve.

11. Refresher CHEW & CHWs training components
Case management
1. High impact intervention
Facilitation skill 2. Risk factors in pregnancy
1. Leadership management & Data management
3. Danger signs in pregnancy
governance 1. Data definition / collection
4. Danger signs in neonatal
2. Coaching and Mentoring 2. Data cleaningsummarizing
and childhood
3. Overview of facilitation skill 3. Data analysis /
5. Case management for
4. Time management/Effective presentation
neonatal health and
meeting 4. Data interpretation
nutrition
4. Communication skill 6. Case management for
5. Report/Proposal writing skill major diseases

12. CHEW&CHWs refresher training with
LMG components
∗ Participants:
Community health extension workers (CHEWs)
Community health workers (CHWs)
∗ Schedule:
This trainings were monthly based, one day intensive
training. In total, 7 days trainings were conducted from Jan
to July. The training consist of two phase.
Step one: Refresher CHEW training by DCHSFP
Step two: Cascade down training to CHWs by CHEWs

13. Training situation

14. Study design
Clustered Randomized Control Trial (cRCT)
SY KW Gem Ugenya
Target 64 CUs in 4 pilot district
Base-line survey
Cluster random sampling
Group 3 : 24 CU Group 2 20 Group 1 20
1.Facilitation skill
CHEW & CHWs training 2.Case Management
3.Data management
1.Referral and defaulter
Defaulter Tracing activity tracing card
2.Defaulter tracing
model
End-line survey
Comparison of the three groups

15. Effectiveness of the community model
-Results from cluster randomized control trial-
P<0.001
∗ Compared with control group, the health knowledge
P<0.001
on HII, Danger sings etc of CHEW, CHWs and
household member (mother with children aged 1-2
years) was significantly improved (p< 0.001).
∗ The Number of Household coverage by CHWs was
also significantly increased, compared with control
group (p< 0.001). (Increased by nearly 1.5 times)

16. Conclusion and Recommendations
∗ Streamline the CHEW recruitment for effective
performance. In addition, given the diverse
backgrounds, the CHEW training, supervision and
continuous support need to harmonized and
strengthened.
∗ It is important to conduct refresher training
including LMG components to the existing CHEWs.
∗ Integrate LMG components when a training on
specific technical topics, so that the knowledge gap
between CHEW, CHWs and HH member is reduced.

17. Recommendation cont..
∗ STANDARDISE CHW stipend issue; from the study
here, CHW performance improved without stipend???
∗ Review HH Coverage target? focusing on Priority HHs
such as HH with MNCH etc.
∗ Feedback on the CHC training manual from the
implementers.

18. Acknowledgments
∗ MOPHS: PHMT Nyanza, DHMTs
∗ JICAH SEMAH project

19. Thanks