MCSP Laos Quarterly Report Quarter 3–April 1 to June 31, 2016

Despite achieving dramatic targets for the number of skilled birth attendants, the quality of these attendants is inadequate due to rapid production and lack of standard pre-service education. The MOH has launched the National Reproductive, Maternal, Newborn and Child Health Strategy and Action Plan 2016-2020, and the Midwifery Improvement Plan 2016-2020, which recognize the need to develop capacity among midwives and maternal and newborn healthcare providers in Laos. The MCSP Laos program has worked with government and other partners to evaluate and expand the mentorship for quality of care activities for MNH service providers in select districts of Luang Prabang and Sayaboury provinces. The goal is to share the learning gained from the mentorship approach at the central level to inform the development of supportive supervision in Laos and to integrate the support/coaching elements of mentoring that are vital to improve quality and capacity into the existing, routine MOH quality assurance system. The program has made significant progress in improving the quality of maternal and newborn care in Luang Prabang and Sayaboury provinces. Two rounds of mentoring visits were conducted in Luang Prabang and Sayaboury provinces, with the objective of building the skills of MNH providers in ten districts to provide quality care at the time of birth for normal delivery as well as when the baby is not breathing. The mentoring practices were well received in the districts, and lessons learned from the visits included the importance of including all staff who are involved in MCH, not exclusively midwives, and the need to consider ways to ensure the skills developed during practice with MamaNatalies are transferred to real delivery situations. The program has also established selection criteria for the selection of the next cadre of district mentors and drafted the PY3 workplan along with plans for the second STTA scheduled for August. Additionally, 11 out of 15 Master Mentors have completed the training of trainers (ToT) workshop for Early Essential Newborn care (EENC). The program has also observed that a common set of basic skills and activities were not being performed up to standard, including newborn resuscitation, skin to skin, and EENC, and has identified the need to consider ways to ensure the skills developed during practice with MamaNatalies are transferred to real delivery situations. The program has also introduced a new mentee name list to capture the variety of roles and levels of experience among mentees and has incorporated a designated session on the partograph into the two-day site visit schedule during the second round of mentoring visits. The session included a practice review of a partograph case study with feedback for coaching about the correct use and documentation. In addition, at least twenty charts from the facilities were checked for errors and feedback was provided to the facilities. A Mentor Progress Form was also piloted to record the progress of mentor development. The program has also observed that some mentors lacked initiative, and there were varying degrees of support in the facilities, with some working atmospheres being collaborative and supportive, while others were less so. The program has recommended providing support to mentees and facility managers to address these challenges. The program has also observed that visiting teams, where possible, combined two district visits together and remained in the field for five to six days at a time, and has recommended a balance of conducting two visits during one week followed by only one visit the following week, allowing time for the holistic debrief discussion among MCSP team members as the approach is refined and further developed.