Mentoring Health Staff in Mozambique
By Jacinta de Fatima
Maputo Province, Mozambique
May 15, 2008

As a care & treatment officer for EGPAF in Mozambique, I support various health centers in Maputo province through supervision visits and mentoring health staff.

When I first joined EGPAF and started to visit the health centers, I noticed that some health staff weren’t following all the necessary procedures in treating people living with HIV. To solve this problem, the first step was to identify the common issues I observed that hampered the quality of care provided to HIV patients. Such issues included incomplete clinical histories of patients, inadequate clinical exams, vital data missing from files, poor follow-up of treatment history and CD4 cell count (the test that measures how far a person’s HIV infection has progressed), and low patient attendance at follow-up visits.

Next, I analyzed the potential factors that contributed to poor compliance with established procedures: low levels of motivation on the part of the health staff, lack of skills and knowledge, inadequate monitoring of the program, negligence, insufficient training, and workload. It was not easy to deal with this situation. Many nights I dreamt of strategies to solve the problems I witnessed on the job at the health centers.

In the midst of this dilemma, I received an invitation from a partner NGO, I-TECH, to participate in a performance evaluation of tecnicos de medicina (the equivalent of physician assistants in the American health system) who are providing antiretroviral treatment (ART) and other services to people living with HIV throughout the country. I accepted the invitation and arrived in Inhambane province for the evaluation. We discovered that the health staff in Inhambane — a six-hour drive from Maputo — faced similar challenges to the tecnicos de medicina I worked with in Maputo. Based on the results of the evaluation, the Ministry of Health temporarily suspended the ART training program for tecnicos de medicina and nurses until these groups could receive further orientation.

Prior to the evaluation, I thought the barriers we faced were only experienced by the health centers supported by EGPAF. To my relief (but also to my dismay), these challenges were confronted by various health centers all over the country. Having a broader perspective enabled me to formulate strategies to address these issues without the stress I felt before. I now have several ideas for various types of training we can do to help the tecnicos de medicina provide more effective care.

I also have a renewed commitment to mentoring health staff, knowing that I must be patient because the results of my efforts will not been seen immediately. Sharing experiences with colleagues from other parts of the country reassured me that I am not alone and motivated me to brainstorm simple, but effective, ways to support my counterparts in the health centers.

Jacinta de Fatima joined EGPAF in May 2007 as a care and treatment officer. She is a tecnica de medicina and has extensive experience working for the Provincial Directorates of Health in Sofala and Maputo. Prior to joining EGPAF, she worked for Medicins sans Frontieres (MSF) treating patients with HIV. Jacinta is 45 years old and a proud mother of three daughters.