At PCI we provide tailor-made support to build capacity in people and primary healthcare systems. However it can sometimes be hard to envisage what this actually means! This blog from Ms Miata Johnson, nurse and Public Health Officer with UNHCR in Tanzania, helps bring to life what we do. It provides some concrete examples of what our approach can help achieve for those working in more challenging primary healthcare settings.
“During humanitarian emergencies, the first priority is usually savings lives. Non-Communicable Diseases (NCDs) are most often forgotten and there is disruption in care for people living with NCDs. But these diseases do not go away and it is therefore essential that NCD management is integrated into primary health care as soon as possible in humanitarian crisis.
To ensure this happens, UNHCR partnered with PCI to roll out an integrated NCD programme in a number of different countries and refugee settings, including where I work in Tanzania. Existing healthcare staff in refugee camps there were trained on all aspects of NCD care with a specific focus on diabetes, hypertension, cardiovascular disease, asthma and COPD (lung diseases eg asthma). The support of PCI to our work in Tanzania was very helpful in identifying the needs and addressing the gaps in NCD programmes in the camps.
Some of the key components that PCI provided us with were:
NCD field guides and other training materials
These clinical guides[1] have been useful to clinicians in assessing, diagnosing and treating NCDs. With the help of the field guides, the clinicians in all camps were able to do a proper diagnosis of their patients and proper classification. For example after the training, the NCD clinicians reviewed files of some existing hypertension patients and realised that they had not been properly diagnosed. Learning from the field guides means these people are now receiving the necessary care. Initial diagnosis of hypertension previously had to be done at the Out-patient department but now it can be done at the NCD clinic.
The Training of Trainers/ cascade training model[2]
From this model, clinicians were able to cascade training to other staff during the morning clinical meetings. The training materials were also used to organise training for more than 10 newly recruited staff who are now stationed in the NCD clinic. This means we can reach many more healthcare staff and therefore more patients.
NCD training website
This PCI website is for people who have participated in the training to access materials and support after the face to face training is completed. It has been useful for our staff in getting updated information on NCDs. Additionally, clinicians are able to read about cases from other countries and contexts and share their own experiences.
Mentoring[3] calls/ follow-up support
The follow up support from the PCI teams was very helpful and contributed to our achievements (more on this below). The close follow-up resulted in implementation of actions points that were initially delayed or stalled.
Did we achieve what we set out to?
PCI encouraged us to focus on monitoring and evaluation (M&E) throughout the programme. This helped us in capturing gaps in the programme and in identifying issues on quality of care. For example it helped us review the availability of drugs and improve the stock level for proper management, which helped in addressing the issue of stock out. Through monitoring, we were able to enforce the use of the new registers, field guides, appointment book for follow up etc. Overall the scores from the monitoring encouraged the staff and partners to perform better and to put new systems in place.
It is recommended that this NCD M&E tool be incorporated in the UNHCR Balanced Scorecard assessments to monitor public health programs.
Since working together with PCI we have been able to achieve the following:
- Include NCDs in the overall Country Operation Plan operation (COP) for Tanzania.
- Establish regular (weekly or monthly) NCD specific clinics in the camps.
- Provide NCD Field guides to be used at NCD clinics which are used to better assess, diagnose and treat patients
- Put in place a good record system for NCDs instead having files at the OPD clinics.
- Help identify new NCD cases that couldn’t be identified through normal OPD clinics.
- Introduce registers at NCD clinics to capture new and existing cases for close follow up.
- Better forecasting the actual needs for medicine and medical supplies for NCDs.
- Quarterly monitoring of the NCD programme to ensure quality of care.
- Exchange visits between camps.
- NCD activities now clearly captured and reflected in partners workplan and linked to performance indicators.
[1] PCI’s highly-regarded ‘Clinical Guides’ offer adaptable, pragmatic guidance on clinical care of different NCDs in humanitarian, low- and middle-income settings. They are free from pharmaceutical industry influence, aligned to the WHO Essential Medicines List and available in English, French, Arabic and Portuguese.
[2] PCI has developed carefully structured cascade training programmes which enable our initial training to be cascaded and embedded much more widely. We train clinicians and managers to be Trainers/Champions: focusing on building confidence and motivation as much as skills and competence. With a package of training materials, clinical guides and toolkits from PCI (available in a variety of languages), they take responsibility for cascading training to other healthcare workers. Following our peer-to-peer learning model, Trainers then become a resource for workforce development into the future.
[3] PCI places as much emphasis on developing leaders as it does on clinical training. Local leaders are critical to the success – and sustainability – of any new initiative. Through tailored mentoring and distance support programmes, PCI acts as a critical friend to leaders seeking to manage change within their organisations. We focus on building confidence and motivation as much as we do skills and competence.