Project News

Background

In line with Ghana's move towards strengthening Continuum of Care, the Ghana Health Service with support from JICA has developed a combined Maternal and Child Health Record Book (MCH RB) and the User Guide. The new combined MCH RB has been designed to link the health records of the mother to her child from pregnancy until the child attains the age of five.

Following the training of national and regional level trainers, a series of training of district-level trainers (ToT) was organized in all 10 regions of Ghana as the next step towards rolling out the use of the book nationwide. The training sought to build a core team of resource persons with a deep understanding of content and use of the book to support roll-out in all regions.

The objective of the ToT

The broad objective of the training was to strengthen capacity at district level for the roll-out of the MCH RB. The specific objectives of the training are listed below:

• To introduce participants to the concept of new combined Maternal and Child Health Record Book (MCH RB)
• To train participants on the effective use of the MCH RB
• To identify the roles of district-level facilitators in the roll-out of the books and build their capacity to conduct identified roles and tasks.
• To train the participants on how to monitor the progress of the implementation of the MCH RB at regional and district level

Training participants and facilitators

A total of eight hundred and sixty-nine (869) participants were trained as district facilitators or in some cases, regional facilitators from all ten regions between February and September 2018. Participants were Nutrition Officers, Midwives, Public Health Nurses, Community Health Nurses, Health Promotion Officers, Health Information Officers, Representatives from some Partner Organizations (USAID Spring Project, WFP and JICA CHPS for Life Project), and Tutors at some basic training institutions for health workers. The workshop was led by the regional level facilitators with the support from the national level facilitators and a team of JICA experts.

Design of the training program

The training ran through three and half days with classroom and field practice sessions. The program consists of classroom sessions on what is MCH RB, how to introduce MCH RB (Dear Mother messages), how to use MCH RB, anthropometric measurements and plotting on growth chart, health/nutrition needs and recommendations for mother and child, counseling skills, early childhood development and monitoring and supervision, as well as two field practices. The training was conducted utilizing the MCH RB and the User guide. In addition to these, the training employed video sessions, as well as Power-Point Presentations for the delivery of the training content. A variety of methods of instruction, including reading, recording exercises, discussions, role-plays, demonstrations, and field practice in selected health facilities were used during the training period.

Participants practicing plotting during a workshop in Volta region

Field practices were conducted in selected health facilities conducting Child Welfare Clinic and Antenatal Care. Participants practiced key skills such as introduction of the MCH RB to mothers and other caregivers, anthropometric measurements specifically measuring height and weight, recording and counselling of pregnant women, mothers and other caregivers. The use of the various monitoring tools and checklists were also introduced during the sessions.

A participant introducing MCH RB to a mother during field practice in Upper West region

A facilitators' meeting was conducted at the end of each day during the entire training period with support from national level facilitators and JICA experts. The meeting was to review the day's activities including the classroom and field practice sessions as well as logistics for the training. During the sessions, facilitators reported the performance of participants in their group, challenges faced during the day's session and outstanding questions or clarifications on the course content. The facilitator meeting session was also used to consolidate feedback on the contents of the MCH RB and User guide. Facilitators highlighted areas of the training contents that needed further clarifications or changes.

At the end of each training workshop, the regional level facilitators in consultation with the district teams developed and shared the regional roll-out plan.

Sensitization of Regional Managers and Key Stakeholders

A sensitization meeting was conducted for all Regional Managers and Key Stakeholders in all 10 Regions. The meeting aimed to create awareness on the MCH RB, orient key managers on the content of the book and the newly introduced services such as length measurement and nutrition counseling, inform and discuss the roll-out plan of the MCH RB with key decision-makers, discuss issues on sustainability and guidelines on the procurement of the book. Participants for the Regional Sensitization included Traditional and Religious Leaders, Representatives of the Regional Coordinating Council, Health Training Institutions, Teaching and Regional Hospitals, National Health Insurance Authority, Births and Deaths Registry, the Media and District Directors.

Regional Sensitization conducted in Greater Accra Region, July 2018

Achievements and future prospective

According to the results of evaluation questionnaire, most of the 867 participants indicated that they gained knowledge and skills on content and use of the MCH RB, conducting downstream training for health workers, providing supportive supervision and monitoring the implementation and roll-out of MCH RB. Also, the pre and post-test results indicate significant improvement of participants' knowledge. The trained district facilitators are expected to train health workers in their districts on utilization of MCH RB and conduct monitoring and supervision visits according to the regional roll-out plan. National and regional facilitators and JICA experts will guide efforts of district facilitators by conducting periodical coaching and monitoring visits.

Group photo of participants, facilitators and JICA experts during training in Brong Ahafo Region