Millennium Development Goals Beyond 2015

Millennium Development Goals Beyond 2015: Improving Access to health for the mother and child.

      Although a lot has been done worldwide to reduce child mortality and improve maternal health, mothers and children in most parts of Africa still have a hard time accessing health care. I would therefore propose that in the millennium development goals (MDG) beyond 2015, we should include the goal of improving access to health care for the mother and child.

      The main reason for lack of accessibility to health care is due to lack of health facilities and the poor distribution of these facilities hence making it difficult to reach them. In most areas of Africa, especially the rural areas, people walk for over 5 km to access the nearest health facility. This becomes very difficult for a pregnant woman or for a child needing health care or basic immunization. Women in their last months of pregnancy opt to camp near a health facility just in case the labor commences. At the same time the facilities have no room to lodge the women who are not in labor yet. They are asked to go back home and come when in labor. This only leads to women walking back for the many kilometers and either deliver on the way or when labor commences, the family decides to take the nearer option which is the traditional birth attendant (TBAs).

      Apart from the long distances, most health facilities in rural areas lack essential medications, necessary equipment's and skilled attendants. A number of health facilities are manned by only one nurse and a support staff. In case of a referral or a need to accompany a client to the referred hospital, then the facility is closed for this period. In case the health care worker gets an off or a personal emergency, then there is no option, but for the health facility to remain closed. The clients would not risk relying on these facilities and walking for long distance just to meet it closed. Of course this has encouraged TBAs, home deliveries and also self prescription and buying of the over the counter antibiotics for those who are sick.

      Another contributing factor for the lack of access to health facilities is the poor referral system and poverty. Many people would prefer to be locally treated due to the fact that if a client gets some complications in the facility, it would be difficult to reach a main hospital in the urban areas because the health facilities have no ambulances or staffs to escort during the referral. In addition, clients are expected to pay out of pocket for the health care. This is very difficult especially because most of the time an illness or an emergency always strikes when people have no money at all. Due to this, many would prefer to get services from traditional healers and TBAs due to the believe that they are cheaper and families can pay for the services through giving goods or farm products available.

      Coupled with the above problems, there is no adequate data collected to identify, how many mothers deliver in homes, how many die and how many get complications. Monitoring and evaluation is poorly done and hence no evidence is presented on the need to enhance access of health care.

The Political Implication of the Proposed MDGs Beyond 2015:

·         This will can increase coverage and reduce barriers through coordinating actions and policies across the health system

·         With this goal in place the governments will place maternal and child health, in particular high on its political agenda of reform.

·         The governments will fast-track system wide reforms in maternal health

The sub goals that may need to be put into attention are:

·         Operationalizing the health facilities and Improve the referral system

·         Employment and retention of skilled health care workers

·         Strengthen monitoring and Evaluation and acting on the results

·         Free services for the mother and children under 5 years.

·         Health care financing

Coaching to Strengthen Health System Performance

The Power of Coaching and Follow up: Lessons in strengthening health system performance

 

   Following various training's in leadership, management and governance in the Eastern region of Kenya, It evidently showed that coaching is a unique approach to developing health care providers potential in a more effective and sustainable way. During the post training coaching, one could not help but notice the uniqueness of making the follow up coaching sessions to participants in their work place other than converging them to one venue.

      A number of organizations use a lot of resources for training and updating the health care providers, with the expectation that the outcome would be positive and sustainable. But in most cases, change does not happen and when it happens it does so very slowly and after consuming a lot of resources and time. Upon participating in various coaching session, the genuine value added by this activity is noticeable as described below.

           

Value: During the coaching session, many team members expressed that these strategy of coaching after training, made the teams feel valued. The Coaching focused on practically building the skills and resources of the team. While at the work place, the teams do not rely on a review schedule, but now support one another along the path to meeting their goals. It was easy to realize that the best learning moment for many teams and the majority of these people were not direct participants of the training. During coaching, the teams start getting the time and space to explore areas of their work that get pushed to the side and they start believing in higher values like courage and altruism to achieve results.

Team Work and Mutual Trust: During coaching the direct training participant are encouraged to involve and invite the larger team and colleagues at work. This strategy has made the whole team to understand better what is expected and they were all able to discuss the anticipate had results and brainstorm on alternative ways to achieve their results. It was realized that coaching language was adopted within the organization. In one of the health facility, one nursing officer in charge, once said that “We realized coaching after trainings was the best way to make follow up for our staffs after continuous medical educations (CMEs) or any updates. In this way the trained personel gets to practice what was taught and to demonstrate to others the skill gained” Isaac Ithiki, Nursing Officer in charge, Siakago Hospital. Most teams that were coached voiced out the realization of a positive change among all staffs because of continuously being acknowledged and involved during the coaching sessions and this was building a more workable workplace.

 Enhancing Governance: During the post training coaching, the teams understood the value and importance of giving continual performance feedback to their larger supporting teams, both positive and corrective. To strengthen performance and support all the teams consistently gave feedback and meeting held were well documented.   The teams focused on progression and this was a motivation to many. The coaching provided staffs with the opportunity to grow and achieve optimal performance through the consistent feedback.

      One mistake that a number of Organizations offering capacity building to health care providers commit is the overlooking or avoiding the performance issue and assuming the health worker understands the significance of the training. This is a typical mistake. To support the team in improving their performance, the trainers must be able to make follow ups to the institution and recognize the nature of issue, challenges and opportunities available for enhancing the changing behavior. This can best be done through a coaching session at the work environment.                                                                                                                        

Keep Growing and exploring alternatives:  The coaching sessions helped the health care workers choose sustainable alternatives ways of achieving results.  After discussions, a number of teams gave their verbal commitment regarding what action will be taken and when it will be taken. The teams explored ways that an issue can be improved or corrected by brainstorming alternative solutions and maximizing the number of choices to consider. One facility wanted to meet their measurable result of immunizing 1250 children with Vitamin A. They had a number of challenges and one of them was the lack of a community unit which could not be formed for that level of hospital.  During the coaching sessions with the larger team many of who were not the direct participants of the training, they found a way of linking a dispensary with a community unit, to the hospital. The team surpassed their target and by the end of 6 months they had immunized 1608 children with vitamin A and achieved a number of secondary results too. Dr Ann, the district Medical officer and the acting medical superintendent, was one of the training participants, and she pointed out that the coaching that was conducted to all the facility staffs made the difference and enhanced the team to reaching their potential as high performers. Dr Ann said “It seems people fear to ask enough from themselves.  When you stretch yourself, and set higher aspirations, then you know you have it in you. This achievement was a motivation and inspiration”.

Conclusion

Post training coaching develops the team capability and competencies allowing people to see new perspectives around their actions leading to greater performance. A number of capacity building organizations have expressed their admiration to using this strategy to strengthen the health workers performance. A Chinese philosopher, Wang Yang-Ming (1472-1529) believed that knowledge is incomplete until it becomes conduct, and conduct is not complete until it becomes knowledge at work. Coaching can be the key to achieve and replicate this success.