“Delivering appropriate
education and training through
a Link”
Wales for Africa Health Links
Conference July 7th 2011
Dr Rachel Lindoewood, Paediatrician and
Powys Molo Health Link co-ordinator
Biography
• Paediatrician in Powys ,based in Brecon
Children’s Centre
• Powys Molo Health Link Co-ordinator
• 9 years working clinically and managerially in a
rural hospital in Eastern Kenya
• Married to Paul (DWA), two children born in
Kenya
• Just completed specialist top up training
• Interests in Childhood Disability&International
Child Health
Powys Molo (Kenya) Health Link
Part of Brecon Molo
Community Partnership
Background of the Link
 - Part of Brecon Molo Community Partnership, one of
six pilot partnerships under the Welsh Assembly Gold
Star scheme in October 2007
 - First team from Brecon visited Molo in October
2007 incl. physiotherapist who gathered health
information and made key contact with District
Physiotherapist
 -Molo badly affected by post election violence in
Kenya so Molo Health link co-ordinator Dr Magdaline
Itumbi not established until July 2008
Statistics
•
•
•
•
•
•
•
•
PopulationArea
Density
Health Facilities-
•
Health Care Workers-
•
Molo, Njoro
&Kuresoi
Powys
500,000
4032km2
124/km2
District&2Subdistrict
•
•
•
•
hospitals,6 Health
centres,29dispensaries,
Community Units
1 specialist,6Drs,15COs,
RGN,SEN,CHWs, AHPs
132,000
5196 km2
24/km2
10 Community
Hospitals, 30 GP
Practices, Public health
•
15 specialists,
GPs,specialist RGNs,
AHPs, PH staff
POWYS MOLO HEALTH GROUPAIMS AND OBJECTIVES
– To support Community Health Service development
and Staff Continued Professional development in
primary and secondary care settings within the 3
districts.
– Of benefit to Powys Teaching Health Board in
terms of building leadership skills, resourcefulness
and better understanding of global health and
development issues amongst its staff.
– By end of 2012 ,we aim to have contributed to a
reduction in Child and Maternal Mortality and
morbidity in Molo, Njoro and Kuresoi districts in the
Rift Valley Province of Kenya
Key Principles For
Training
P artner requested and Locally delivered
•
• A ppropriate presentation style
• R elevant, up to date content
• T raining provided by or in close collaboration with local
• N
and/or national colleagues
ational policies and programmes considered
• E nd point- improve healthcare in line with MDGs
and local service development.
• R eflection, evaluation, and follow up.
• S ustainable- training trainers, reasonable costs
Example 1 – Public Health
• Link started at same time as
National “community strategy”
reached Molo - help requested
from Link.
• Very similar to Ugandan
Programme
• Idea for South to South Link
with Mbale (PONT link)
• Exchange visits facilitated by
Link (grant application
completed in Molo 2009 visit)
• Complementary to locally
provided training -public health
team inspired rather
than daunted by
Mbale teams policy into
practice
Example 1- Public Health, cont
• More specific request for training in Monitoring and
evaluation made during PH doctor visit to Powys in 2009
• Developed proposal and training pack
• Co-trainer identified- Njoro District Public Health Officer
• Training delivered October 2010 to 45 HWs,with one
training day per district
• Rolled out to 450 CHWs April 2011
Example 2- Maternal Health
• Child Health Scoping visit Feb 2010 list of
topics requested by Medical Officer in Charge
included “Shoulder Dystocia”.
• Powys Midwife sent training needs
questionnaire-completed by staff ,used in
course development
• Local Co-trainer identified
• Kenyan Obstetric
Practice guidelines
obtained and
referred to
Example 2 – Maternal Health, cont
• Powys Midwife & Molo
District Public Health
Nurse
• 2 day update course
delivered October 2010,
30 frontline Health
Workers
• Request for further
training.
•
• Evaluation comments
demonstrated the thirst
for knowledge and
•
learning and
interest in practice
in
Wales
Concern from Powys
Midwife regarding overmedicalization of birth.
Plans for exchange visits
to address the previous 2
points
Example 3- Child Health
• Feb 2010 list of topics
requested included
“Club Foot” and
“neonatal resuscitation”
• Minimal impact on
reducing Child Mortality
in hospital & community
• Separate ministries of
health hampering
service improvement
– (
eg lack of supplies).
Example 3- Child Health, cont.
• Kenyan Paediatricians already developed evidence based
Emergency Triage and Treatment + (ETAT+) course for
District Hospitals –facility/district based
• 5 day Course for 25 front line staff who treat sick
children in the 3 districts -end 2011
• Lack of Child Health Champion to support ETAT+
implementation-VSO Paediatrician Sept 2011
•
•
Newborn Care training for CHWs 2012
Example 4-Cross
sector/Multiagency
• Scoping visit included visits to
Government and NGO partners outside
health-Schools, Children’s Home, Street
Children Project, Vulnerable child
community based support
• Need for interagency collaboration for
Child Protection identified
• Safeguarding training
– journey beginning
Education - Other Examples
• Broader than Training in scope / staff cadre
• Hope to link Public Health “Healthy Schools” with
“Child to Child” approach in collaboration with
education links
• TALC books/CDs in Health
Facilities
• Molo Link Co-ordinator committed to do
Masters in Public Health without leaving her
community- deferred 2 years but enrolling next
week, distance learning LSHTM, mainly
self funding - our role encouragement.
Powys Molo Health Link
Strengths
• Link co-ordinator worked in
another area of Kenya
• Initiator and now Chairman
of Community Link lived in
Molo
• Committed Molo based coordinator identified early on
• Support from Health Board
and Powys Public Health
• Wales for Africa Network
catalyst for south to south
link, ETAT+ , VSO
•
Key Similarities of
Weaknesses
• Small Organisation spread
over wide geographical area
• Wide skill mix, few reserves
• Powys staff current roles all
community based
• Risk of spreading ourselves
too thinly and doing nothing
well
• Communications with Molo
challenging-Technical
difficulties and staff
capacity
• Change in Personal in Hosp.
Any Questions?