Knowledge Brief Health, Nutrition and Population Global Practice Healthcare staff training, a key pillar in improving quality of care in Nicaragua Amparo Gordillo Tobar, Silvia Morales, Emilce Herrera, Evelyn Rodríguez January 2019 KEY MESSAGES: • Quality of care is one of the pillars that underpin the Family and Community Health Model (MOSAFC) implementation. One of the critical elements to deliver quality of care lies in the problem-solving capability of health professionals across all levels of care. • Key training, e.g. Diploma in Hospital Administration, mirrors the commitment undertaken by the Nicaragua Ministry of Health towards institutional capacity building. This diploma course has helped hospitals complete their health diagnoses and develop strategic plans including four-year multi-year goals and results-based budgeting proposals. • The Ministry of Health has in place a Health Continuing Education Strategy across all levels of care for 2017-2021. Introduction Since the early implementation of the Family and Community Health Model (MOSAFC) in 2008, the Ministry of Health has envisioned the continuing education and capacity building of regional health education units as the process that plays a significant role in training and refreshing health professionals. In this context, it upgrades their technical capabilities, thus ensuring quality of care. The National Continuing Education Plan for Health Professionals proposes to train domestic primary and secondary providers linked with direct patient care with the aim of helping improve the quality of care delivered by healthcare units, while health trainees promote the active participation of citizens through the MOSAFC approach implemented by the Ministry of Health as a new participatory healthcare model. The Ministry of Health through the Health Education Continuing education in health is an innovative educational Directorate implements the guideline 8 of the National Health modality that features flexible contents and methods, Policy, which states the “development of Human Talent, as an constantly being improved to meet the needs of different essential axis for transforming the National Health System, health professionals. It is an option for the Health Education because human resources are the most decisive factor for Directorate (DGD) to advance the qualifications of MoH bringing about changes towards an effective, efficient and professionals, either professionally accredited or not, so they humanized approach to care” can gain new knowledge according to their profiles and technological innovation processes for enhanced healthcare During the MOSAFC implementation, between 2011 and performance. 2014, the Ministry of Health, supported by the International Development Association (IDA) via the Improving Community Page 1 HNPGP Knowledge Brief and Family Health Care Services World Bank Project Segovia, Carazo, Jinotega, León, Masaya, Chontales, Madriz, (P106870), upgraded general training activities to deliver Rivas, Boaco, Río San Juan, Matagalpa, Zelaya Central, specialized capacity-building activities, as follows: Chinandega, Estelí and Managua. (i) Diploma in Hospital Administration; (ii) Diploma in Design, To complete satisfactorily the Diploma course, trainees were Preparation, Implementation, Monitoring and Evaluation of required as diploma thesis to design a project, putting new Health-oriented Social Projects; (iii) Specialized International knowledge into action. Internship for Cervical Cancer Prevention; (iv) Sharing Specialized Knowledge in Medical Equipment Technology The Lenin Fonseca Hospital developed a detailed and Management, as well as other training processes. situational analysis, including a SWOT Analysis (Strengths, These trainings opened the discussion for a broader and more Weaknesses, Opportunities, and Threats). This allowed inclusive medium-term plan that will enrich knowledge in each the hospital managers attending the Diploma, who also in field of work in health, including clinical or administrative parallel took office, to make cost-effective decisions. The support training. team successfully introduced straightaway significant changes to optimize the performance of both strategic Training hospital managers in hospital health units and the hospital, including cost cutbacks (e.g. performance management four million cordobas in drugs and medicines). The representative of the hospital union believes it helped pull The Diploma in Hospital Management for 150 hospital and the hospital out of a major crisis that had threatened its very health unit managers nationwide helped develop professional existence. hospital managerial skills and introduce the development of strategic hospital plans, with emphasis on results-based budgeting. Advancing and Implementing the Cervical Cancer Prevention Strategy: Internship in Argentina As part of the Cervical Cancer Prevention Program, the MoH has allocated and is allocating resources for the prevention and treatment of cervical cancer in the country. Furthermore, its strategy includes developing skills among colposcopy screening staff in different SILAIS nationwide. The OB & GYN Specialists carrying out colposcopy screening procedures in public health units have been trained in These plans are drawn upon the context of each health unit, diagnosis and treatment of premalignant lesions, however and the specialty or specific responsibility held by the refreshment training in diagnostic tools and equipment or institutions. Therefore, they become feasible, all-inclusive as therapeutic techniques is required. much as possible tools pursuant to the guidelines provided by diploma trainers. Some groups made significant progress in In 2015, the Nicaragua MoH jointly with the World Bank implementing processes, e.g. Lenin Fonseca Hospital. requested the Government of Argentina international internships to train seven medicine doctors in advanced Besides contributing to increase efficiency, effectiveness and colposcopy and development of skills in associated treatment quality of health services, the Diploma outcomes have been and management, displaying Argentina’s medical advances in the basis to develop case studies for a potential postgraduate terms of uterine cancer prevention and treatment. course in hospital service administration in Nicaragua The German Nicaraguan Hospital went through the scope Diploma in Design, Preparation, of their services, including an exhaustive portfolio review, Implementation, Monitoring and Evaluation of service delivery strategies in the area of influence, population’s healthcare needs and actual demand for Health-oriented Social Project healthcare services. Thirty-three health professionals from different SILAIS The international internship program pursued the following (acronym that stands in Spanish for Local Comprehensive objectives: Health Care Systems) and seven health professionals from 1. Develop knowledge and skills in colposcopy the Central MoH directorates attended the Diploma Course, to diagnosis pursuant to the IFCPC classification in build institutional capacity through health staff education and force. training, focused particularly on project management. 2. Develop skills and abilities in therapeutic procedures (screening and treatment techniques of precancerous Diploma attendees came from the departments of Nueva lesions) Page 2 HNPGP Knowledge Brief 3. Become familiar with Argentina’s experiences for than 1,773 participants have been trained through replicating, implementing and assessing a cervical different courses and diploma courses (figure 1), while cancer-screening program. 220 staff members (males and females) from different branches of medicine have been introduced to the basic What did internship students think about the experience? natural medicine course (figure 1).  They identified the need for implementing a patient Figura 1. Health staff trained in Traditional Medicine information and monitoring system for Lower Genital Tract (LGT) pathology. Basic Course Diploma in Phytotherapy 2%  They updated successfully LGT pathology diagnostic 12% management knowledge.  They learned about how provincial health services Induction courses operate (health center in Huacalera Tilcara JUJUY), 86% whose actual conditions are similar to Nicaragua and management may be replicated in Nicaraguan hospitals.  They attended the Forum on Pathologies of the LGT. Total: 1,773 participants Journal articles and case studies around the world were presented, whose results may influence Source: Institute for Natural Medicine and Complementary Therapy effective and effective prevention, diagnosis and management of cervical cancer, leading eventually Training in Medical Equipment Maintenance to decreasing CC mortality indicators. and Optimal Use  They observed how municipalities organize The Government of National reconstruction launched in 2007 themselves to pinpoint and solve key inter-sectorial health issues. an enthusiastic medical equipment procurement process to ensure delivery of free, high quality healthcare services. They expressed the need for replicating the internship among MDs from other SILAIS, and downsizing its length The Ministry of Health currently has in place a health network from three to two weeks, considering quality and turnover covering approximately 7,501 Health Units nationwide, in provinces. classified in different levels of care: 11 Departmental Hospitals, 7 Regional Hospitals, 11 National Reference Hospitals, 2 Tertiary Specialized Centers, 33 Primary Training in Medical Waste Management– Hospitals, 137 Health Centers, 1,016 Health Posts, as well as Environmental Safeguards maternity waiting homes, primary health centers (casas Until 2016, in total 4050 workers have been trained in 10 bases) and social security clinics. hospitals, developing capacities concerning sorting, In 2010, the need for keeping the Ministry of Health equity collection, storage, treatment and management of investments and preserving and extending equipment service biohazardous and medical waste. lifetime to deliver better quality services became clearly a priority. In this scenario, the country intends to strengthen the As a consequence of these trainings, the SILAIS Medical Equipment Maintenance Division as the entity Environmental Management Units strengthened the medical responsible - within the Ministry of Health - for servicing, waste management M&E and implemented the Environmental augmenting effectiveness and extending the service lifetime Management Framework including, development of of medical and non-medical equipment in health units Environmental Management Plans for nine hospitals. nationwide. In line with this mandate, the government, with the support of the Improving Community and Family Health Care Training in Natural and Alternative Medicine Services Project, prepares a south-south skill development and Comprehensive Healthcare for and knowledge exchange plan to train key health workers for Multiethnic Populations ensuring medical equipment preventive and corrective maintenance. • Opened in December 2014, the Institute for Natural In the week of September 22-26, 2014, two staff members of Medicine and Complementary Therapy is the means the Medical Equipment Maintenance Center (CEMED) whereby the public health system promotes holistic attended a training program hosted by University of Campiñas healthcare services, harmonizing natural medicine with (UNICAMP) in Brazil, jointly with colleagues from other Western medicine. In these facilities, all health personnel develop techniques and knowledge in phytotherapy, countries. herbalism and complementary therapy. To date, more Page 3 HNPGP Knowledge Brief In the first two days, the work agenda focused on presenting Challenges ahead (2018-2023) the experience and development of the maintenance Based on Guideline 8 of the National Health Policy: strive management system developed by UNICAMP in Brazil. It integral human resource development by implementing the reviewed equipment maintenance in terms of management, National Continuing Education Plan, including training health efficiency and timeliness, including a field visit to the Medical professionals across all levels of care and different degrees of Equipment Maintenance Unit facilities, to showcase on site the complexity, the Plan considered different online and in-class maintenance operational model, thematic divisions, facility training modalities with national and international universities layout, maintenance tools and other support resources to to upgrade skill development at both central and local strengthen related activities. healthcare levels. Short and medium term milestones include: • Support the Continuing Education Program to keep The Brazil trip pinpointed weaknesses and strengths in the doctors, nurses, other health staff and trainees updated, CEMED equipment maintenance program, thus bringing into as to strengthen competencies. Nicaragua concrete ideas for establishing an equipment • Continue developing managerial skills among maintenance plan that ranks life support equipment down to management staff, through diplomas and courses earning those of lesser relative importance. This plan should clearly master's degree credits. identify key activities, resources and maintenance modalities. • Develop management and support skills in substantive support areas. Furthermore, it identified the different specific technical • Refurbish the Technological Health Institute. training courses on sophisticated medical equipment such as • Strengthen SILAIS teaching areas as cross-training defibrillators, cardiovectors and electrosurgery equipment that spaces. might be given in Nicaragua. • Promote international knowledge exchange (KE) with institutions or universities that may have greater expertise in specialized topics and relevant to Nicaragua public Other trainings health. • To bridge the gap in this type of resources in Health Units, • Develop university training processes to earn master and the National Autonomous University of Nicaragua trained specialty degree credits. and certified 42 cyto-technicians. • Strengthen research processes on medical practices • Scientific research fostered among all health workers, as presented in healthcare worker congresses. seen in the National Health Workers’ Day. The Health, Nutrition and Population Knowledge Briefs of the World Bank are a quick reference on the essentials of specific HNP- related topics summarizing new findings and information. These may highlight an issue and key interventions proven to be effective in improving health or disseminate new findings and lessons learned from the Regions. For more information on this topic, go to: www.worldbank.org/health. Page 4