The Ghana mentoring program: a network of support and excellence
Wednesday, February 16, 2011
Ipas Ghana's Mentor Provider Network ensures new abortion providers are equipped to provide the best care possible.Skilled and motivated clinical providers are the backbone of a successful comprehensive abortion care program. However, providing abortion care can be difficult because of logistical, operational and cultural barriers. In settings where abortion is heavily stigmatized, providers may feel alone and unsupported. Providers who have recently received abortion care training often need additional support to feel confident providing a new service. Mentoring, a reciprocal and collaborative learning relationship between an experienced provider and a new provider, can ensure abortion care clinicians feel empowered to perform their work and do not become overwhelmed by technical and cultural barriers to care provision. Ipas Ghana has implemented the Mentor Provider Network, a successful mentoring model that identifies, supports and builds a network of highly skilled abortion providers and mentors to ensure Ghanaian women are receiving the best care possible.
Dr. Joseph Mills, Ipas Ghana senior training and services advisor, explains the cultural barriers facing abortion providers: “In Ghana, comprehensive abortion care services are still stigmatized and as a result, some providers are treated negatively by colleagues or community members because they are abortion providers and easily drop out after their training. The mentoring relationship has reduced this occurrence.”
Ghana’s mentoring model is based on the premise that high-level investment in fewer carefully screened individual clinicians leads to sustainable, high-quality abortion care. “In our stigmatized and religious environment, added to our long-held traditional beliefs, the introduction of mentoring as an integral part of preparing a would-be provider has contributed a great deal in maintaining service provision in most facilities. Our program is very careful in selecting a mentor for a mentee. The mentor continually provides guidance. The corollary is a self-motivated provider who is ready to work against all odds to save a woman in need,” explains Dr. Koma S. Jehu-Appiah, Ipas Ghana country director.
Ipas Ghana training and service delivery improvement (TSDI) staff select mentors among highly skilled Ipas-trained providers who are proficient in comprehensive abortion care delivery, who have demonstrated leadership and a commitment to excellence, and have participated in a values clarification and attitude transformation (VCAT) workshop, among other selection criteria.
Mentors are assigned to offer individualized support to providers immediately after training. Mentoring includes overseeing the providers’ clinical practicum, providing clinical and emotional support, and ensuring that the necessary competencies – including confidence – to provide comprehensive abortion care services are met.
During clinical mentoring visits, mentors are able to:
• Demonstrate correct techniques
• Supervise the mentee performing a procedure and provide feedback
• Review logbooks and service data
• Facilitate professional networking and peer support
• Help resolve equipment shortages and other problems
The mentoring model has really contributed to Ipas Ghana’s overall success, says Dr. Mills. “The mentoring relationship has become an important component of our training. It has also provided needed morale and emotional support for the mentees once they start providing services,” he adds.
Juliet Amewu, a mentee in the Ghana program, says the presence of mentors “makes you feel you're not alone and in times of difficulty they are there to support you.”
Mentors supervise an important component of abortion care capacity building in Ghana: swap visits. Approximately three to six months after receiving training, three new providers from one facility visit another facility and observe the new providers there as they demonstrate how they deliver abortion care from start (intake) to finish (when the patient leaves with a contraceptive method, if desired) under the supervision of a mentor. Following a checklist, the visiting providers review the facility, including the reception area, client flow and privacy, availability of informational materials, infection prevention and contraceptive services and the detailed steps for a successful procedure. They all then meet in private to discuss their observations, ask and respond to questions and make suggestions for improvements. The providers then reverse roles and repeat the visit at the other facility. Swap visits enable providers to reinforce what they learned during training, hone their skills by helping to improve uterine evacuation services in an unfamiliar environment, and further develop their self-confidence.
Providers who have benefited from the Mentor Provider Network have described their mentoring relationship as very useful and report high levels of satisfaction with network activities. Dr. Mills adds, “The message we get from providers is that the individual recognition, encouragement and support creates an increased self-esteem and confidence in providing comprehensive abortion care services. The mentors, on the other-hand, say that the satisfaction of helping mentees acquire the skills to provide these services and in so doing helping to reduce maternal morbidity and mortality is fulfilling.”
Jacqueline Victoria Ackah is a mentor in the Ghana program; her connection to abortion is a personal one: “A very good friend of mine died 30 years ago from an unsafe abortion. She took herbal concoctions and had an enema. By the time she was rushed to the hospital, she was gone.” She takes her job as mentor to other abortion providers very seriously, “I make sure those I'm mentoring provide comprehensive abortion care services as required by the set standards and protocols. I always offer help and direction in times of trouble. Because of the mentoring program, she says, “Women will have good access to safe abortion as well as postabortion care and the mortality rate will be lowered.”
She adds, “I'm proud to be part of those who are helping to reduce the rate at which women die from unsafe abortions through the provision of comprehensive abortion and postabortion care services.”
Philomina Mireku, a practicing midwife and a mentor in Ghana’s Mentor Provider Network, says she is most proud when “the mentees call to inform me how well women are being saved from abortion complications, even death.” She adds, “I am a midwife saving lives – and not just lives, the lives of women: our mothers, sisters, daughters, who all have potential to offer.”