Facility-Facility Mentoring to Drive Sustainable Quality Improvements in Health Facilities

Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: In the past 20 years, Indonesia has conducted in-service training for many providers, but training has not translated into improved outcomes. The USAID-funded Expanding Maternal and Newborn Survival program (EMAS) has moved away from training. Instead higher-performing facilities conduct ongoing, systematic mentoring of lower-performing facilities to improve clinical services and governance.

Methodology: Mentoring is done by teams of proficient staff. A team of staff from the “mentee” facility visits the mentor facility to observe service delivery and clinical governance. The mentors spend 5-7 days at the mentee facility to work with the staff of the facility. Mentoring focuses on establishing good clinical governance systems (use of performance standards, dashboards, data use for decision-making, near-miss/death audits, emergency drills). Visits continue until the mentee facility achieves the desired level of performance, at which time it subsequently becomes a mentor for other facilities. Mentoring includes both public and private facilities.

Results: From one mentor hospital, 28 hospitals and over 100 health centers have been developed into mentors. Through mentoring, facilities establish clinical governance systems that improve quality. This innovative approach of facility-facility mentoring has been well received within mentor/mentee facilities, and the district/provincial government. Provincial Health Offices have rosters of mentors who are available to mentor other districts. Districts are now budgeting for mentoring visits instead of staff training, indicating acceptance and sustainability. Another important result is that facility staff becomes highly motivated to improve their own performance when they start mentoring other facilities.

Conclusion: Mentoring by Indonesian peers is an acceptable, feasible and effective in improving performance within health facilities. Mentoring has improved clinical governance and helped institutionalize new practices. District and Provincial governments have allocated resources to coordinate and pay for mentors to conduct mentoring throughout the district/province.