Against the backdrop of COVID-19 we are hearing more about the importance of strengthening health systems and the health workforce in combatting this pandemic, especially in resource-limited settings. The WHO’s Director General tells us that “we’re as strong as the weakest link.” In the blog below Dr Mawaheb Shelli in Libya shares her experience about a project that is aiming to do just that.
Primary Care International (PCI) and the International Rescue Committee (IRC) are working together with Premiere Urgence International (PUI) to support the Libyan Ministry of Health to develop a model for primary care across four pilot sites in the country. As part of this European Union funded project we are providing support to health system strengthening and development of care pathways and guidelines, and running a series of training workshops on improving the care of patients with non-communicable diseases (NCDs).
In doing so, we aim to empower health facility staff to become champions in their communities by cascading the training they received. This builds local capacity which is critical to the long-term delivery of care.
A key element of ensuring sustainability of this project is to support the development of ‘mentors’. As qualified practitioners (GPs and nurses) and healthcare advocates, mentors play a key role in quality assurance and monitoring adherence to care pathways and guides, helping resolve challenges arising as the pathways are implemented across the pilot sites.
Dr Mawaheb Shelli is one such mentor. She is based in Tripoli and is the Health Awareness National Manager for IRC. She shares her experience with us:
There are a lot of NCDs in Libya and the best place to manage these is usually at primary care level. However, there are a lot of challenges regarding primary care in my country: a lack of drugs and the equipment is not maintained. Healthcare workers are not trained well and, in general, primary care is seen as less important and skilled.
This project aims to change this. It engages health workers from small primary health facilities and invests in them to reach their full potential. This allows us to provide high quality care to our communities.
As a mentor I helped support the health workers from the Ministry of Health attending the five workshops run by PCI. I encouraged their interaction, ensured they provided feedback and provided ongoing communication in between and after the workshops. For example, to see if they have been able to use the new guidelines in their work. I work together with other ‘mentors’, who each have a very focused remit (for example health promotor, mental health, nurse or Health Management Information System – HMIS)
Since the workshops I have also supported these same health workers from the Ministry of Health in delivering ‘cascade training’ with their colleagues. This is a really key part of the project to ensure maximum impact. The cascade trainings organised to date have run smoothly and I observed a real increase in confidence levels of the trainees. We have already received feedback that there has been an improvement in quality of care for patients as clinicians are finding it easier to follow the new clinical guidelines and care pathways.
We have also supported the healthcare workers in staying in touch and providing each other with peer support. For example, we set up Viber and WhatsApp support groups and these have been very active, especially during the run up to the cascade training – with participants sharing photos and suggestions to improve training.
The security situation remains a huge challenge for us. We adapt our work where necessary and remain mindful of the burden that places on us all: patients, health workers and the project team.
As a mentor and in my Health Awareness role I was also involved in health promotion screening activities around World Diabetes Day: screening and also sharing knowledge about disease prevention and correct disease management using leaflets we had prepared to raise awareness. I was supporting staff at a small primary health care facility in the Soug Aljoomaa municipality of Tripoli: it was the first time something like this had been done. We had about 150 people come for screening and identified new patients, who were supported with counselling and registered for follow up visits in the facility.
Attending the PCI run mentor-workshop this February really helped bring all the pieces together. This included a focus on communication skills and the best part was learning from the role plays and dramas we participated in throughout.
Next steps for me are to continue to support the guidance and care pathways being implemented across the pilot sites – and really see how strengthened systems and health workforce can lead to an improved quality of care for the people in my country.”
 The main types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.