It would be fair to assume that a government mandate to increase health services for pregnant women, breastfeeding mothers, and children under five, would only bring about positive, lifesaving changes. But in 2010, when Sierra Leone implemented the Free Health Care Initiative, a major uptick in patients was not matched by an increase in health workers — placing enormous stress on existing staff. Indeed, seven years later, the health worker shortage remains a significant challenge. At last count, Sierra Leone averaged just two health workers per 10,000 people.
Overcrowding, a lack of basic resources, and limited upward mobility were just a few factors that made it tremendously difficult to retain trained and motivated staff.
To help meet this challenge, Concern’s Innovations for Maternal, Newborn & Child Health initiative — in partnership with local organization Community Association for Psycho-social Services (CAPS) — sought to close the gap among maternal, newborn, and child health (MNCH) workers in the country’s remote Kono District by delivering psychosocial counseling and training.
Sometimes the most innovative concepts stem from the most basic principles
In the developed world, innovation is often characterized by shiny technology and modern medical breakthroughs. But in a country like Sierra Leone — with an estimated 1 in 17 mothers at risk of death during childbirth — the most innovative concepts stem from the most basic principles. In this case, improving the emotional health and coping strategies of frontline health workers had potential to improve MNCH outcomes.
Helping health workers cope
Thanks to funding from the Bill & Melinda Gates Foundation, Concern Worldwide and CAPS launched the Helping Health Workers Cope (HHWC) pilot project in 2012. Programming offered to health workers included counseling services and training sessions on stress management, self-care, and client care.
At the heart of the problem in Kono was the fact that exhausted and overwhelmed health workers struggle to cope with stresses — leading patients to resent them for delivering what they perceived as poor support. So, Concern’s Innovations initiative set out to promote less stressed and more resilient frontline health workers by:
- Sharing coping strategies, such as asking patients in the waiting area to speak quietly so health workers don’t have to yell
- Addressing workplace stressors, like interventions that helped health workers consider the viewpoint of patients and empathize with their situation
- Improving personal relationships between health workers, such as fostering solidarity among colleagues and helping them learn from each other’s mistakes
“I don’t think I will go out of my temper because I now know that maybe the woman has a stress or a problem that is bothering her from her home.”
Poor quality of care, true or perceived, leads to dissatisfaction with the health system and can negatively impact a woman’s healthcare-seeking patterns. On the flip side, resilient health workers are better able to handle stress, behave well in social situations, empathize with others, and appreciate their own self-worth and purpose — which is extremely important in countries like Sierra Leone where basic health resources, including staff, are lacking, and job satisfaction is low.
By arming health workers with effective coping mechanisms, the HHWC project found that health workers who utilized their new coping strategies were less stressed and formed positive relationships with both their patients and co-workers. This led many to feel more motivated and capable of doing their jobs well because they were caring for themselves both physically and emotionally.
“I don’t think I will go out of my temper because I now know that maybe the woman has a stress or a problem that is bothering her from her home,” said one of 300 health workers who participated in HHWC. “I will talk to her nicely and try to know her problem and see how best I can help her.”
A more resilient health workforce will be able to better handle the immense stresses that come with working in a developing country, such as the devastating 2014 Ebola outbreak
In terms of solidarity among colleagues, another health worker explained: “Before that program came, my co-workers [and I] were not in good terms, but now I can see reasons. If you have done a bad job… I will show you where you do not understand.’’
These seeming simple strategies of empathizing with clients and remembering to also care for one’s own self observed in the HHWC program show that psychosocial education can have major impacts on quality of health care delivery. A more resilient health workforce will be able to better handle the immense stresses that come with working in a developing country, such as the devastating 2014 Ebola outbreak, while also offering hope for a slow-but-steady improvement in MNCH outcomes over time.
A new era of innovation
Building on past successes including connecting mothers with health workers via mobile phones in Malawi, inviting engineers and nurses in Kenya to team up to design lifesaving medical equipment, and developing a software tool to enable health planners to use big data to increase access to emergency care with a Silicon Valley-based nonprofit, our Innovations initiative has expanded into the Centre for Innovation and Health. Today, the Centre aims to develop new solutions to the toughest challenges in MNCH and nutrition alongside those we hope to serve. We are continuing to embrace and integrate human centered design while collaborating with a wide range of partners from government, for profit companies, universities and other NGOs.
Learn more about Concern’s Centre for Innovation and Health: