Africa has the world’s worst health record. It carries one-quarter of the global disease burden, yet it spends only 1 per cent of the worldwide health expenditure and has only 3 per cent of the world’s health workers. According to the WHO, regions where there is more than one physician for less than 1,000 patients, are rare. The region lacks the infrastructure to provide basic health care to many of its people. There are hardly sufficient skilled healthcare workers, only a handful of standard hospitals and there is a lack of medical devices. As a result, investors from across the world have spent millions trying to improve the healthcare situation in Africa.
This has given way to innovation and digital health technology e.g. mobile phones, apps, tablets, telemedicine, 3D printing and medical drones. Solutions which mostly by-pass traditional infrastructures or national regulations and cost less than the usual healthcare equipment and supplies.
Despite the success of digital health interventions to date, adequately trained healthcare personnel are needed in order to effectively leverage technology in the sector. Addressing the shortage of skilled healthcare professionals in most countries in Africa, as well as their training, mentorship and access to education, is a vital aspect to meeting healthcare challenges across the continent. This has led to a lot of interest and investment in training and mentorship of healthcare staff in the resource-restricted settings in Africa to upskill the healthcare workforce as a prerequisite to maximising the benefits from the innovations made possible with the spread of digital health technologies.
Most of the healthcare improvement work currently going on in Africa is focused on training, mentoring and coaching to address the skills gap that continues to impact patient care poorly. As you may know, mentorship and coaching traditionally occur in the facility where the staff are, and training is done away from the facility. All these activities translate to the biggest percentage of money spent on any project with similar activities. The costs typically include transportation, remuneration, accommodation, venue for training rentals and per diem costs for the staff who regularly travel to the field to conduct the activities. Due to a lack of skilled workers, the lead mentors and coaches typically are more qualified and, therefore, more likely to be from other countries which drive the costs even higher.
Fast forward to the year 2020 and the COVID-19 pandemic brings the healthcare systems and the world at large to a standstill. Suddenly countries and counties are locked down, lead mentors and coaches are evacuated, large crowd gatherings are prohibited and the healthcare staff in the facilities find themselves isolated from the world and the only mode of communication becomes the internet and the phone. All these new rules posed a great challenge to how training, mentorship and coaching have traditionally worked and for a time most activities come to a standstill as organisations tried to figure out how best to mitigate the challenges.
Working remotely has become the new normal and organisations focused on training, mentorship and coaching in healthcare are learning how best to adapt to it. The COVID-19 pandemic has pushed teams to think of ways to still deliver the most needed mentorship and coaching remotely to staff in resource-restricted areas, to sustain the gains that have been achieved so far as well as keep up with project goals and timelines.
Nurses In Africa has learnt a lot of lessons over the past six months while adjusting to conducting training, mentorship and coaching remotely in Africa. They include:
Internet is key otherwise the process can't survive
Contrary to most people’s perception about African countries, most of the facilities in the areas with poor accessibility now have access to the internet and as a result, most healthcare professionals have smartphones that we can leverage on. Of course, as part of the review of the project work plan, factor in the cost of airtime for the staff involved. Some facilities may still be in areas that have no internet, and this is an opportunity to engage stakeholders outside of healthcare to invest in the development of such infrastructure for multiple gains in the community. Either way, remote mentorship in areas with the internet still reduces the number of facilities overall receiving regular physical sessions of mentorship.
Social Media is here to stay
It is important to find different innovative ways to engage the staff remotely otherwise motivation becomes an uphill task. It is at this point that the healthcare world needs to acknowledge and take advantage of the social media platform where most of our target audience spends their time. WhatsApp groups, Twitter, Instagram and Facebook communities for daily updates and easy follow up, telegram for notes on a cloud saving on phone space and TikTok for innovations and team challenges can lighten things up and zoom for group meetings and webinars. Documentation of project activities and success stories doesn’t have to be limited to word documents moving forward. Having interacted with staff from different countries during mentorship, it is safe to say that the age group of our health professionals’ leans towards millennials and as such we have to identify the most effective ways to engage them to ensure learning takes place. Continuous virtual collaborative learning is definitely possible at a minimal cost.
Web-based scenarios and simulations are possible
The mentors need to provide web-based scenarios and simulations that the mentee can use to practice the said skill for assessment and feedback. An added benefit is that the mentee is able to revisit the session virtually as many times as possible and practice unlike when it's physical and they can only learn when the mentor is present. The opportunity to showcase the “real thing” for the mentee to see virtually provides an avenue for benchmarking and development of a mental picture which makes it easier for them to meet their goal. Here is to killing three birds with one stone!
Virtual mentorship and coaching are strategies for cost reduction and sustainability
At the end of the day, organisations spend a lot of money to enable mentors, coaches, trainers work with healthcare staff in their facilities to upskill them and improve patient outcomes within a time limit and resources. The race against time and resources most of the time leads to projects that end successfully but prematurely and with very little impact on the ground due to poor uptake and sustainability. Virtual training, mentorship and coaching are one of the ways we can markedly reduce costs for project implementation as well as pave way for skills uptake and sustainability as project timelines and activities would be prolonged. The most common reason why the ministries of health rarely follow up on projects handed over to them especially with a focus on training, mentorship and coaching, is the lack of resources to conduct the activities as they were being done. A virtual programme provides an avenue for the continued support from any corner of the world at a minimal cost as well as time for learning to take place and become a standard of operation.
Just like the rest of the world, the healthcare sector has to identify ways to adapt to the new environment and beyond it. Technology and innovation have enabled the world to keep moving despite the ’standstill’. The lessons learnt over the past six months has enabled our mentors to virtually interact with mentees all over Africa with very little downtime, leading to the development of a virtual one-stop mentorship and coaching platform specifically for nurses. The COVID-19 pandemic in the ‘Year of the Nurse’ has not only provided room for innovation due to necessity but also an opportunity for significant history with a focus on nursing to be documented.
Ogongo will be part of the ‘Quality and safety lessons learned from COVID in the African context’ panel discussion on Monday, October 12 at Omnia Health Live Africa.