1. Empowering Health Workers
Through Psychosocial Support
Techniques in Sierra Leone
Ariel Higgins-Steele
Policy & Knowledge Management Specialist
Fall Meeting 2013
www.innovationsformnch.org

2. Innovations for Maternal, Newborn & Child Health, Concern Worldwide
About this Initiative
To identify and test innovative MNCH pilot
projects that achieve transformative
change, involve communities throughout
the process, and capture learning related
to outcomes as well as process
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3. The Context: Sierra Leone
Some of the world’s worst MNCH indicators
• Maternal mortality: 890 out of 100,000 births
• Neonatal mortality: 50 out of 1,000 live births
• Under-five mortality: 182 out of 1,000 live births
A weak and under-resourced health system
• Number of health workers per 10,000 population: 2
Continued barriers to accessing facility-based care
•
From Concern’s barrier research, women and caregivers
perceived health workers to have low motivation, poor attitudes,
and provide poor quality of care
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4. The Context: Health Worker Attitudes
In Kono District, government health workers were
assessed to understand their attitudes and perceptions
prior to implementation (n=271)
96% felt not at all or
rarely satisfied with their
job
75% responded that they
often felt stress on the job
65% responded that they
were coping poorly with
workplace stressors
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5. Theory of Change: Helping Health Workers Cope
HWs
unsatisfied
and
demotivated
at work
Improved
knowledge
and ability to
apply coping
skills
Intervention
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Improved
well-being,
job
satisfaction
and
motivation
Improved
provider-client
interaction
Improved
providerprovider
interaction
Greater
client
satisfaction
(perception
of quality of
care)
Improved
MNCH
outcomes

6. The Approach: Helping Health Workers Cope
Objectives:
•
Improve coping techniques among health workers by addressing
workplace stressors and introducing support services
•
Improve interpersonal relationships among health workers and
with patients
•
Increase patient satisfaction
•
Increase facility-based care seeking
Target population: 271 Health Care Workers in Kono District from 75 primary care
facilities (catchment population of over 388,000 people)
Timeframe: Aug. 2011 to May 2013
Implementing partner: Community Association for Psychosocial Services (CAPS)
Scale: District-wide, with 12/14 Chiefdoms covered
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7. Intervention & Monitoring
•
Intake
•
•
•
Counseling – 10 weeks
Training
•
•
Clinical intake to assess
group (263) or individual (8)
counseling
Client care, self-care,
stress management
Refresher
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8. Monitoring Data: Quantitative (1)
Health workers report improvements across all categories:
motivation, job satisfaction, relationships, etc.
100%
90%
80%
Chart 1. Health workers feel motivated (n=271)
2%
13%
28%
70%
59%
60%
50%
40%
30%
72%
70%
31%
20%
10%
12%
0%
Intake
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6%
First follow-up
Second Follow-up
No FU
Often
Sometimes
Rarely
Not at all

9. Monitoring Data: Quantitative (2)
100%
90%
80%
Chart 2. Health workers have positive relationships with
their clients
4%
4%
7%
12%
32%
70%
59%
60%
50%
66%
40%
30%
63%
20%
31%
10%
16%
0%
Intake
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First follow-up
Second Follow-up
No FU
Often
Sometimes
Rarely
Not at all

10. Monitoring Data: Qualitative
•
Counselors collected stories/scenarios from health
workers on how techniques were applied in real-life
scenarios ranging from relationships (professional and
personal) to informal support groups
•
Client interviews report improved health worker attitude
and quality of care received at the health facilities.
“There has been a dramatic change in her [health worker] attitude.
Very few women used to come here [health center] but her new
attitude to the community has encouraged us greatly.”
- Theresa D., Client, Koakor Clinic, Kono District
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11. Evaluation Design
Key questions:
• What are the factors influencing active participation of HW?
• What changes do HW perceive in themselves with regard to
their knowledge levels and ability to apply/practice their
skills, as well as the scope to do so?
• How has participation in the project affected relationships at
the workplace (provider-provider, as well as provider-client)?
Mixed method evaluation comprised of
• Health worker survey (against comparison group)
•
•
•
•
Scale of job satisfaction and motivation (retrospective pre-tests)
Anchoring vignettes
FGDs for women of MNCH services
Key informants
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12. Questions?
Fall Meeting 2013
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