The disruption of our day-to-day lives caused by the coronavirus provides an opportunity to reflect and to reconsider what we do, how we do it, and why we do it. Things we took for granted, like onsite coaching and mentoring at health facilities, became impossible. Furthermore, staff have had to work from home. This means that a lot of our routines were interrupted.
Our project in partnership with the Ministry of Health of Ethiopia supports the goal of a high-quality, equitable health system, in which providers want to work and people want to seek care. It uses a zonal scale-up approach mainly focused on improving maternal and newborn health. As part of this project, I support efforts to create a sustainable quality improvement (QI) cadre through the Ethiopian health system.
The challenges of the COVID-19 pandemic offered an opportunity to rethink our habits and routines and make systematic changes. In particular, the current crisis has forced us to rethink how we deal with coaching with multiple QI team members. We have worked with 137 woreda (provinces) and 669 health facilities in the last year, with 12 senior project officers located across the country — and we implemented virtual coaching for the first time to reach all trained QI coaches.
We deployed both individual and group virtual coaching through phone and video calls, text messages, and social media during the pandemic. Coaching aims to improve the skills of woreda and zonal QI coaches. It includes data review and project document review. The duration of each session depends upon the predefined coaching topics and any concerns that need to be addressed. Challenges included infrastructure for internet connectivity, discipline for time management, and attitudes towards accepting virtual coaching as real coaching.
The team tested this approach in nine zones and utilized it to provide continuous QI coaching by senior project officers and zonal and woreda improvement coaches. Using virtual coaching, the team reached almost all health facilities. From April 6 to September 30, 2020, they supported 12 zonal coaches and 142 woreda coaches. They conducted a total of 1,488 virtual coaching sessions, including 1,247 voice calls, 186 conference calls, and 55 text messages. The average call duration informs us about the depth of discussions happening in each call.
Figure 1: Number of virtual coaching sessions conducted and average call duration from April 6–September 30, 2020
In turn, onsite woreda and zonal QI coaches provided in-person coaching locally. After a state of emergency, both in-person and onsite coaching continued, implementing standard precautions for COVID-19.
Virtual coaching helps us to sustain the gains of improvement activities that began before the first COVID-19 case was identified in Ethiopia in March 2020. Based on data collected from health facilities, 18 indicators from both the antenatal care bundle and the health management information system showed signals of improvement in different health facilities, which led to significant improvement in some indicators at woreda, zonal, regional, and national level.
Figure 2: ANC bundle aggregated from nine zones in five regions, July 2019–October 2020
Through this work, we have found:
- Virtual coaching is effective and efficient to build the capacities of coaches and facility QI teams.
- Appropriate infrastructure availability — such as internet connectivity — should be assessed before starting virtual coaching.
- Measuring the duration of coaching sessions creates an opportunity to assess the depth of coaching and the strength of interactions of coaches and QI team members.
Dr. Biniam, a regional quality improvement coach, said, “I couldn’t imagine how the improvement activities [would] proceed and sustain the gains from QI in this COVID-19 pandemic era without virtual coaching. It is simple enough to reach woreda and zonal coaches at the tip of your finger, without [spending] resources and time for travel.”
Nebiyou Wendwessen Hailemariam, MPH, is a Monitoring & Evaluation Advisor at IHI.
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