Growing Confidence & Quality in Cervical Cancer Services: EGPAF-Lesotho Technical Assistance Support to Mothers2mothers
Mothers2mothers (m2m) has been serving Lesotho’s communities since 2007. This implementing partner employs innovative, scalable solutions to help end pediatric AIDS and preventable maternal and child death. In m2m’s ‘mentor mothers’ model, local mothers champion services in the community, provide referral mechanisms, and promote linkage to care for the prevention of mother to child transmission (PMTCT) of HIV and other integrated services, such as cervical cancer screening.
Technical Capacity Assessment
The Technical Capacity Assessment revealed that knowledge and skill levels varied between m2m nurses. Gaps in these areas produced low confidence, which ultimately hindered program implementation. Nurses were not sufficiently offering routine cervical cancer screening to eligible clients.
Training of Trainers
EGPAF organized theoretical and practical cervical cancer screening and treatment training that reflected the national landscape. The separation between the theoretical and practical modules gave nurses enough time to internalize the material before applying it to their practice.
EGPAF fostered a comfortable and engaging learning environment, in which trainers took on a hands-on approach during practical sessions on areas including cervical exam & screening methods (VIA, VILI), pap smear; treatment of precancers using thermo-coagulation and LLETZ.
Participants felt comfortable practicing their skills repeatedly. A subsequent step-down training ensured that all providers of all experience levels recognized the importance of high-quality screening services and proper documentation.
Mentor mothers gained a greater understanding of the importance of cervical cancer screening, which helped them mobilize women at the community level and generate demand. Consequently, the m2m facility managed to screen 32 women in one day.
TA Activities: Mentorship Meets Monitoring and Evaluation
To foster a sustainable knowledge ecosystem, EGPAF mentored m2m’s district level staff in the areas of digital health information systems and monitoring and evaluation (M&E). Mentorship was also provided to Ministry of Health and the Christian Health Association of Lesotho (CHAL) nurses at each facility.
To improve documentation practices, mothers, nurses, and managers received a customized CommCare app that allowed for standardized collection and real-time reporting of cervical cancer data. EGPAF also provided technical support for the use of District Health Information Software 2, the design and Analysis Toolkit for Inventory and Monitoring, and Tableau. This allowed m2m to integrate its cervical cancer data into its existing systems and enabled the informatics team to develop user-friendly visualizations to inform decision-making.
Networking and Advocacy: Creating a Network of Sustainable Support Structures
Empowered by training and the ongoing mentorship of its district-level managers, m2m was better placed to foresee and react to issues that threatened the achievement of programmatic goals. Staff correctly predicted that the second wave of COVID-19 would compromise service provider availability and pandemic-related travel restrictions would limit health facility access.
These hindrances were expected to produce a negative trend in screening rates from Q3/Q4 FY2020 to Q1 FY21. To ensure it met its targets anyway, m2m launched a cervical screening campaign.
As a result of EGPAF mentorship and TA:
The partner worked to ensure that clients could be met in the field by leveraging the integrated network of advocacy, referral, and clinical services.
A second campaign was held in the Mafeteng district, in partnership with Lesotho’s District Health Management Team (DHMT).
Using their enhanced advocacy capabilities, mentor mothers mobilized women at the community level to generate demand for the event.
As a result of these collective efforts, m2m was able to screen 32 women in a single day.
