IPHE

Innovative Participatory Health Education ‘IPHE’ ™ An approach for QUALITY and RELEVANCE of health professional education Dr. Khalifa Elmusharaf, PhD Researcher in health system & Policy Head of Reproductive & Child Health Research Unit 'RCRU’ University of Medical Sciences & Technology

Any health professional education system should aim to: Meet the needs of individuals and populations in an equitable and efficient manner. Ensure that health professionals are accountable to the communities they are mandated to serve.

Challenges faced by Health Professional Graduates (1) Even well-educated health professionals may find themselves ill-prepared to meet the challenges they face when they take up posts within a country health system.

Challenges (2) The mix of skills they have acquired during their professional education is often not well oriented to their eventual workplace.

Challenges (3) The scientific content of their education may be poorly matched to the epidemiology of the communities in which they work.

Transformative scale-up “ It is a process of education system and health systems reform that addresses the Quantity , quality and relevance of health care providers in order to increase access to health service and to improve population health outcomes”

Transformative scale up of health professional education

The challenge facing many countries is how to educate and train their health workforce to address the prioritized needs of the health system within limited budgets

Connecting health Research in Africa and Ireland Consortium (ChRAIC) www.ChRAIC.org Lesotho Mozambique Sierra Leone Sudan Uganda Malawi

Qualitative Training Consultant Our training consultant is "Options - UK“; a British Organization which has unique expertise in: Strengthening services Increasing access improving the quality of health and social care at levels of the health system Pioneer in Participatory Ethnographic Evaluation and Research. Donor: Irish Aid

Nvivo Training, Consultancy and Support Qualitative Data Training: is an Irish independent training organisation for qualitative researchers using computer aided data analysis systems Nvivo . We enjoy telephone, email, and remote log in support for the life of our project Donor: NUI Galway

A Case from South Sudan Martha is 26 years old. She lives in Malout, a small rural town in Upper Nile State in South Sudan that just emerged from 50 years of civil war conflict. She did not receive formal education. Her husband has a relatively good job with a Chinese oil company in a nearby village

Case study from South Sudan During her current pregnancy she didn’t get any antenatal care because she didn’t get ill. There is one trained midwife in the town, but since this is her fifth pregnancy, she feels that there is no need to visit the midwife, particularly, she charges much more than the Daia (TBAs).

It was September; a heavy rainy season, the woman started having pain around 9 o’clock in the evening (0hr). The Daia was called to examine her. The Daia said that she doesn’t have a problem. The woman didn’t deliver till the 3 o’clock afternoon of the next day (18 hrs).

Her mother decided to go to the market to get a tractor to take her to the Hospital in Renk City (Distance: 5 hours) since the small cars can’t go through the bad and muddy road. So she went and brought a tractor and put the woman on the back in mattress. The tractor was rented with a cost of $100 USD.

In the midway between Malout and Renk they stopped the tractor and got down under a tree and the woman gave birth about 6 o’clock (21hrs). The Daia went to a nearby village and brought water and cleaned the baby and the mother. The Daia couldn’t deliver the placenta and the woman started to bleed.

They moved to the hospital and arrived there at night around 10 o’clock and the doctor was not around (25hrs) . Someone went to call the doctor, who came quickly to examine her. The doctor decided to operate immediately. The woman didn’t cope with the bleeding and died before the operation.

The women in South Sudan face alarmingly low maternal health status to the extent that UNICEF survey found that: Girls in southern Sudan are more likely to die in pregnancy and childbirth than to finish primary school (UNFPA 2006).

However, very low utilization of accessible maternal health care facilities in post conflict states is one of the major obstacles to improve maternal survival, ....which is much influence by DEMAND side barriers. Most of the efforts of Health System including International and National NGOs have been done to reduce supply side barriers

How could we contribute to re/building the Reproductive and Child Health System?

(1) Health system Health System: Let us build more hospitals, Let us train more doctors; people are dying over there. Health systems ( Policy makers, senior officers, health professionals ) do not understand the context, and if they do, this understanding was not useful in the planning for accessible maternal health care services that can reduce the maternal mortality

(2) Health education Many health education approaches have been used to promote women health in post conflict settings. Yet, most of these approaches had limited understanding of complexity of social institutions and cultures in which behavior is contextualized.

(3) Health education Ready made health education materials that: Handed down from OUTSIDE Are not rooted in the CULTURE Are lacking OWNERSHIP Have repeatedly failed And in some cases, have done more harm than good (Lush et al., 2003, Ogden et al., 2003)

(4) Students’ education Students are not well prepared to work in our health system. Students are not oriented to their population needs. Disadvantages of Classroom traditional way of teaching

What we need On job training for decision makers and program designers (training & advocacy) To effectively engage students to gain in-depth understanding of needs and social behaviour Community involvement & Social mobilization

We designed and conducted an Innovative Participatory Health Education Project ‘IPHE’.

Participatory Ethnographic Evaluation & Research (PEER) PEER is an innovative, rapid, participatory and qualitative research method involving ordinary members of the community to generate in-depth and contextual data (Price and Hawkins 2002).

PEER in brief Ordinary women from 16 villages attended a training on Participatory Ethnographic Evaluation & Research, designed research instruments, conducted interviews and analysed data on maternal health

Participatory training workshop Non literate women were trained on: Concept of peer research Discussed important issues of maternal health in their community Identified key themes and questions for the qualitative research Developed images to remind them with the questions

Final themes and sub themes Family & Determinants of Family Size, Experiences of Pregnancy, Experiences of Birth, (20 sub themes and Images)

The 4 th day of the training workshop Ready for the fieldwork

They returned to their villages to carry out in-depth interviews in the third person format with three of their friends three times over three weeks

De-briefing with PEER researchers Researchers visit them to collect their findings in a series of debriefing sessions

Researcher visited the women in their villages, ‘ They Visited hard-to-reach communities ’

Researcher is making detailed notes of the narrative data that women had collected.

Key themes were identified and data were analyzed thematically according to the analytical framework. Emerging themes and insights were incorporated into this framework

Final Analysis Workshop PEER researchers provided their own analysis of the data in forms of: Top-line findings. Drama Generating stories Which assisted greatly in contextualising and interpreting the data

They became experts in important issues in their community, and form a pool of expertise who can be involved in future programmes. The women were very proud of themselves being able to conduct this qualitative research.

Reproductive Health Project Management ‘RHPM’ A parallel 4 days training workshop was conducted on Reproductive Health Project Management. This training workshop targeted 10 senior officers in MOH in the Renk County

RHPM Goals The primary goal To advocate for maternal health. The secondary goals To increase their knowledge, awareness and skills to help them developing, implementing, assessing, monitoring and evaluating health projects in the field of reproductive health in this post conflict setting.

They depended on the list of maternal health issues generated by the IPHE’s participants to develop two reproductive health project proposals. Mama Marina: Director of reproductive health & Midwifery schools

In the last day of the workshop, we brought them all together; the local people and senior officers; to discuss maternal health issues in their area.

The senior officers presented their assignments (2 reproductive health project proposals) in front of the IPHE’s participants who gave them feedback and comments.

At the end of this project the senior officers, students and IPHE’s participants’ understanding of maternal health issues in Renk County was enhanced

The learning and behavioral change for students happened during the process of developing and delivering of the educational materials.

The local community understood, appreciated and enjoyed the delivered materials since they were tailored and conveyed by their local people.

The senior officers said that this approach helped them to identify the maternal health issues through the lenses of their local people which will influence their decision making.

IPHE Approach engaged senior officers with community members and promoted their knowledge about maternal health issues.

Involving local theatrical band members and employees from local women organization will help ensure the sustainability of this project

Enjoy watching 6 min IPHE documentary film @ www.youtube.com/rcruTV

Thank You www.rcru.org Facebook.com/rcru.org [email_address] South Sudan capital Juba, Sign warning of the dangers of war http://www.militaryimages.net/photopost/data/743/WAR_South_Sudan_.jpg

IPHE

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