A Clinical Mentoring Approach To Safe Abortion Service in Nepal: Lessons Learned

A CLINICAL MENTORING
APPROACH TO SAFE ABORTION

SERVICE IN NEPAL:
LESSONS LEARNED
2017 Ipas Nepal.
Citation: Ipas Nepal. (2017). A Clinical Mentoring Approach to Abortion Service in Nepal: Lessons Learned. Kathmandu,
Nepal: Ipas Nepal.
Ipas works globally so that women and girls have improved sexual and reproductive health and rights through enhanced ac-
cess to and use of safe abortion and contraceptive care. We believe in a world where every woman and girl has the right and
ability to determine her own sexuality and reproductive health.
Cover photo: Ipas Nepal
The photographs used in this publication are for illustrative purposes only; they do not imply any particular attitudes,
behaviors, or actions on the part of the any person who appears in the photographs.
Ipas Nepal
P.O. Box no. 11621
Kathmandu, Nepal
+011-977-1-552-4459
ipasnepal@ipas.org
A CLINICAL MENTORING
APPROACH TO SAFE ABORTION
SERVICE IN NEPAL:
LESSONS LEARNED
A CLINICAL MENTORING APPROACH TO SAFE ABORTION SERVICE IN NEPAL
TABLE OF CONTENTS
1. BACKGROUND.................................................................................................................. 1
1.1 Concept of Provider Support Team.............................................................................. 1
1.2 Clinical Mentoring Overview......................................................................................... 2
1.2.1 Aims of clinical mentoring...................................................................................... 2
1.2.2 The clinical mentor................................................................................................. 3
1.3 Clinical Mentoring Process in Safe Abortion Services.................................................. 5
1.3.1 Identifying needs.................................................................................................... 5
1.3.2 Place of clinical mentoring..................................................................................... 6
1.3.3 Methods of clinical mentoring................................................................................ 6
1.3.4 Orientation for clinical mentors.............................................................................. 7
1.3.5 How are mentors assigned?................................................................................... 8
1.3.6 Timing of clinical mentoring support...................................................................... 8
1.3.7 Recording and reporting of clinical mentoring approach....................................... 8
2. RESULTS OF CLINICAL MENTORING APPROACH.......................................................... 9
2.1 Relationship between mentors and mentees................................................................ 9
2.2 Means of Communication.............................................................................................. 9
2.3 Supporting the Mentees............................................................................................. 10
2.4 Advantages of Clinical Mentoring............................................................................... 11
2.5 Ratings of the Mentoring Program............................................................................. 13
3. DISCUSSION.................................................................................................................... 14
4. CONCLUSION AND RECOMMENDATIONS.................................................................. 15
References............................................................................................................................ 16
Interview Guideline for Clinical Mentors .......................................................................... 17
Interview Guideline for Clinical Mentees.......................................................................... 20
ii
LIST OF TABLES
Table 1: Average score and level of agreement by clinical mentor (N=6).......................... 13
Table 2: Average score and level of agreement by mentees (N=13).................................. 14
LIST OF FIGURES
Figure 1: Provider support concept...................................................................................... 1
Figure 2: Continuum of education for health care providers................................................ 2
Figure 3: Clinical mentoring orientation................................................................................ 7
iii
List of Acronyms
ANMs Auxiliary Nurse Midwives
CAC Comprehensive Abortion Care
COPE Client Oriented Provider Efficient
FHD Family Health Division
QA Quality Assurance
QI Quality Improvement
MA Medical Abortion
MVA Manual Vacuum Aspiration
NHTC National Health Training Centre
PHCC Primary Health Care Centre
PST Provider Support Team
SAS Safe Abortion Service
iv
Government of Nepal Tel: 4261436

Ministry of Health 4261712
Department of Health Services Fax: 4262238
(Family Health Division)
Pachali, Teku
Kathmandu, Nepal
Foreword
The documentation on A Clinical Mentoring Approach to Safe Abortion Service in Nepal: Lessons Learned
was conducted under the aegis of Family Health Division (FHD), Department of Health Services (DoHS), and
Ipas Nepal provided technical and financial support. The primary objective of this study is to document the
details of the clinical mentoring process (needs assessment, method and types used) and monitoring quality
of clinical mentoring, assess whether clinical mentoring and coaching is provided as per the individual
provider need, and assess the effectiveness of clinical mentoring and its influence on providers
performance. Moreover, this study also aimed to assess the factors that facilitate effective mentoring,
including the characteristics of effective mentors, and identify barriers preventing the mentors to fulfil their
responsibilities, which is instrumental in order to strengthen service delivery and quality at point of care.
It is imminent that the FHD is giving more emphasis on strengthening service delivery and improving the
quality of care at all levels of health facilities. The FHD is also committed to ensure that its workforce consists
of highly qualified and experienced health care providers. Subsequently, National Health Training Center
provides competency-based training to safe abortion providers. It is highly important to ensure that
providers adhere to national guidelines and retain the knowledge and skills to deliver high quality services. In
order to achieve this, a group of clinicians are trained to provide individualized support to abortion care
providers to achieve and maintain clinical competency and provide high quality care.
This study assessed the experience of clinical mentors and mentees as well as documented the clinical
mentoring process. The study will serve as a resource for effective implementation of the clinical mentoring
approach in future. We anticipate it can be replicated in other health programs that build the skills of
providers.
I would like to thank all the internal and external stakeholders for their inputs and involvement to the
development of this report.
I would like to extend my appreciation to Ipas Nepal for providing technical and financial support for this
study.
Dr. Naresh Pratap K.C.

Director
v
vi
1. BACKGROUND
Increased utilization of health services may not necessarily improve health outcomes unless
the services are characterized by excellence in delivery along with other benchmarks for
good quality. But improved quality of care does result in greater use of health facilities and
better utilization of health services by individuals and communities, which in turn leads to
better health outcomes.
In Nepal, the importance of quality is discussed in several government health plans (1-3),
and a Quality Assurance (QA) system is described in the 2007 Policy on Quality Health
Services (4). In safe abortion service (SAS), fundamental aspects of high-quality care include
womens care with respect to her social circumstances and individual needs, and delivery
of accurate and appropriate information and counseling that supports women in making
informed choice on safe abortion technology and postabortion contraception (5). A
hallmark of high-quality services is that which ensures confidentiality, privacy, respect and
positive interactions between women and staff of the health facility (6).
To provide high-quality SAS, it is necessary to create an enabling environment and linkages

with technical expertise in the facility so that service providers can translate their skills into
practice and get support when needed, especially if there are complications. Safe abortion
programs conducted in various countries have demonstrated that training for service
providers is necessary but is not always sufficient to ensure that providers are competent,
confident and able to practice their acquired knowledge and skills. In addition to well-
managed competency based trainings, standards and guidelines, regular availability of
supplies and technologies, clinical and programmatic support and supervision, and attitudes
of providers and communities affect a providers ability to put skills into practice. (7).
Ipas in coordination and collaboration with Family Health Division (FHD) has been
implementing a clinical mentoring approach for several years with the objective of
providing need-based support to the provider in delivering high-quality services. Clinical
mentors are trained and experienced senior nurses or ob/gyns who can provide ongoing
individual support to health-care providers in enhancing their skills in abortion care and
related services. Clinical mentors provide appropriate clinical inputs as early as needed and
help the provider in achieving competency and confidence.
1.1 Concept of Provider Support Team

To support abortion care providers, Provider Support Teams (PSTs) have been formed in all
safe abortion intervention districts. PST members include clinical mentors, health system
personnel and Ipas staff members or consultants. They work to ensure that providers
receive clinical and programmatic support when needed to achieve and maintain high
performance and provide quality services. The PST nurtures a team approach culture
in the district so that team members will work together, support each other, respect each
others responsibilities and improve the overall quality of service.
Figure 1: Provider support concept
Clinical
Mentoring/Coaching + Program Support Provider Support
1
In addition to the above approaches, Ipas is also implementing competency-based

training, standard post-training follow up mechanisms, and periodic client exit interviews at
intervention sites.
Programmatic support: Support provided to an individual and or a site to address

logistics, management support needs and other inputs to overcome barriers to service
provision.
Clinical mentoring: A collaborative relationship in which an experienced health-care

provider guides improvement in the quality of care delivered by other providers to
achieve high levels of performance in their jobs.
To complement the PST approach, Ipas is implementing the Client Oriented Provider
Efficient (COPE) approach in all intervention health facilities. COPE is a process of
improving quality of care at a health facility by engaging providers and staff actively in
identifying gaps, developing solutions, generating local resources, carrying out activities
and monitoring overall quality of services.
1.2 Clinical mentoring overview

Clinical mentoring is a system of practical training and consultation that fosters ongoing
professional development to yield sustainable high-quality clinical care outcomes (6). There
is a sustained, collaborative relationship in which a highly-experienced health care provider
guides improvement in the quality of care delivered by less-experienced providers and the
health-care systems in which they work.
1.2.1 Aims of clinical mentoring

Ensure that newly-trained providers are clinically competent and confident and have
updated knowledge and skills to provide quality safe abortion care
Facilitate liaison and consultation with other PST members if programmatic support
is needed so that programmatic problems are resolved (e.g., supplies, commodities,
recording, reporting, equipment/instruments)
Mentoring is a part of the continuum of education required to create competent health-care

providers. It is integrated with and immediately follows initial training.
Figure 2: Continuum of education for health-care providers
Initial training Continuing education

Case-based classroom training
Clerkships and clinical rotations Clinical mentoring
Source: Adapted from WHO 2006 (8)
2
1.2.2 Clinical Mentor

A clinical mentor is an experienced clinician for specific subjects/domains who provides
clinical support to recently trained providers as frequently and often as needed. The clinical
mentor may or may not have conducted the clinical training; may be on or off-site, and
may be an independent consultant or health systems employee. Clinical mentors may be
physicians or midlevel providers. Ipas Nepal in coordination and collaboration with FHD
and National Health Training Centre (NHTC) has selected clinical mentors for first-trimester
abortion services from the government health system, and includes staff nurses, senior
ANMs and medical doctors who are experienced MA and MVA providers. For second-
trimester service, clinical mentors are selected from experienced senior obstetricians/
gynecologists working in government and nongovernment tertiary-level hospitals, medical
colleges and training centers (Adapted from Ipass Clinical Mentoring and Provider Support
for Abortion-Related Care).
Selection criteria for clinical mentors

Selection of appropriate clinical mentors is vital for success of this approach. There are
general and specific criteria of selection, which are as follows:
General criteria
Regularly providing safe abortion service as per the National Standard and protocol for
a minimum of one year
Strong clinical coaching, guiding and problem-solving skills
Available and willing to mentor and monitor trainees as often as needed
Skills to document all clinical mentoring and programmatic inputs and outcomes
appropriately in required format and submit relevant documents in a timely manner
Effective and respectful interpersonal and communication skills
Other characteristics to consider: age and geographical proximity to providers
Additional considerations include:
Cadre: Clinical mentors can be physicians or midlevel providers, depending on the

cadre of providers they mentor.
Seniority: There are advantages of recruiting senior clinician trainers as clinical

mentors. They have great experience, and their seniority is immediately recognized
and respected.
Public versus private sector: Clinical mentors can be public or private sector clinicians.
However, they must be available to fulfill their time-intensive mentoring responsibilities.
However, it is more useful to select clinical mentors from public sector for public sector
mentees. It is also important from the sustainability perspective.
Specific selection criteria

Clinical mentors for MA providers
Must be a trained comprehensive abortion care (CAC) provider who has been
providing quality service for a minimum of one year in a hospital or PHCC
3
Must have provided service to a minimum of 30 clients
Must be a listed service provider
Must have received orientation for clinical mentors
Clinical mentors for second-trimester providers

Must be a competent, listed second-trimester provider and providing service on a
regular basis
Must have participated in orientation on clinical mentoring
Must be willing to travel for clinical mentoring
Prospective clinical mentors should be screened for and possess as many of these
qualities as possible, with the understanding that these skills may be further developed
through training, practice and experience. Mentors should be prepared to take a positive,
supportive approach to mentoring so that providers see it as supportive rather than punitive
or an added burden.
Major roles and responsibilities of clinical mentors

Clinical mentors have the following roles and responsibilities:
Provide clinical support and encouragement to service providers after completion of

clinical training
Observe and assess the providers performance and results and develop plans
for needed improvements, discuss and resolve issues that affect performance and
document all inputs and performance in a timely manner
Respond to provider requests for support in a timely manner
Determine when the provider achieves clinical confidence and ensure competency is
maintained
Characteristics of effective mentors

Knowledgeable and respected in their field by service providers
Role model in providing services as per the national standard and protocol
Responsive and available to providers
Interested in the mentoring relationship
Believes in providers capabilities and potential
Good listening skills
Roles and responsibilities of mentees

The roles of mentees in the clinical mentoring approach are:
Provide services to the best of her/his abilities and qualifications
Agree to be followed up by the clinical mentor following clinical training and on an

ongoing basis and to receive guidance from any others on the Provider Support Team
who are providing clinical mentoring and programmatic support
4
Keep accurate records of all the services provided, report any adverse events, and share
those records with the clinical mentor, supervisor, health system personnel or others
providing programmatic support and Ipas staff when requested to do so
Contact with the mentor when clinical support is needed
Make improvements and achieve performance expectations
Inform the mentor and Ipas staff in case of any changes in contact information prior to
posting in another location
Benefits of mentoring
Improves skills and performance of mentees
Increases confidence and ensures competency of mentees to provide quality service
Increases job satisfaction
Reduces stress of mentees due to increased support
Promotes and enhances personal and professional development over time
Further development of leadership skills of mentors
Recognition of mentors skills, status and expertise
Increases personal and professional satisfaction
1.3 Clinical Mentoring Process in Safe Abortion Services
1.3.1 Identifying needs

The first step of the clinical mentoring approach is identification of needs to strengthen
clinical mentoring. Here are ways to identify mentee needs:
Identification of less-competent service providers in the training

If a service provider is not able to acquire adequate knowledge and skills during CAC
training, it is essential to do clinical mentoring within three weeks post-training. As per
the rules of National Health Training Center (NHTC), a trainee needs to obtain a minimum
score of 85 percent, in both knowledge and skill parameters, at the end of training to be
competent and certified. If a trainee receives less than 90 percent, it is mandatory to send
a clinical mentor to the trainees working facility within three weeks post-training to support
her to and make her confident in providing service. To provide clinical mentoring for such
trainees (if a trainee obtained less than 90 percent) the trainer has to inform her respective
clinical mentor about the needs. The main purpose of this visit is to ensure that the provider
is clinically competent and is providing service per the guidelines and protocol. Likewise,
for those trainees who received more than 90 percent, programmatic support is provided
within 3-4 weeks and need-based clinical support is provided.
Needs of service providers

For service providers who have scored more than 90 percent on their post-tests, an
immediate site visit is not needed. However, if a service provider feels any confusion and
5
needs any kind of support in clinical knowledge and skills, she informs her respective clinical
mentor either through telephone or other communication channels. Trainings cover the core
technical information and skills, but in actual practice there are many situations that deviate
from the expected. A strong clinical mentoring system helps to support new providers to
provide careinstead of declining services. Based on the types of needs, clinical mentors
provide support to mentees either by telephone or a visit to the providers work place.
However, if mentoring cannot take place in the providers work place, it could be done at
the mentors work place, too.
Routine visits
Ipas staff and D/PHO staff conduct regular visits to service facilities to assess progress
and challenges. In such visits, if the staff feel that service providers have confusion in any
technical part of service, the visitor informs the clinical mentor and asks her/him to support
the service providers in clinical matters.
Regular COPE meetings

To develop quality culture in the SAS intervention sites, COPE is implemented in all
intervention sites. It is encouraged that sites do a self-assessment and discuss the progress
and challenges of the program. Team meetings can be used to identify any additional
support needed by providers, and clinical mentors are contacted by the Public Health
Nurse (PHN) or District Public/Health Office (SP/HO) staffs or District Coordinators (DCs) for
necessary support.
Low performance
Low-performing providers (performing less than three cases in a quarter) are identified
during regular monitoring visits by PHN, D(P)HO staffs or Ipas staff or by observing logbook
data. If the low performance is due to providers not being able to apply their skills, clinical
mentoring is planned immediately by Ipas staff to address the issue.
1.3.2 Place of clinical mentoring

Clinical mentoring is preferably done at the providers work place, but in some situations,
service providers can visit the clinical mentors work place. However, it is essential for clinical
mentors to visit their mentees health facilities initially to assess their skills and working
environment. The location of clinical mentoring should be fixed in negotiation between
the mentor and mentee. If there are no clients at the mentees health facility and there is a
higher client flow at the mentors health facility, the mentee can be invited there to practice
with an adequate number of clients.
1.3.3 Methods of clinical mentoring

The means of providing clinical mentoring depends on the nature and type of the need of
mentees. We recommend several ways of providing clinical mentoring to service providers:
In-person contact and site visit

Whenever the purpose is clinical coaching, it is best to make a visit in person. On-site visits
help clinical mentors understand the working conditions and quality of services provided
by their mentees. If there is need for the hands-on practice, then clients need to be
available so that the provider can be observed, evaluated using the standard checklist, and
provided feedback and support on the gaps identified. If there are no abortion clients and
6
the provider needs support in provision of bimanual exams, then this can be achieved by
bimanual examination on ANC, gynecological or family planning clients in the facility.
Additionally, support can be provided using an anatomic model. When visiting the site, the
clinical mentor also needs to review the Health Management Information System(HMIS)
3.7, client personal profiles, and how infection prevention(IP) is maintained. The mentor can
also do role play for a counselling session and provide feedback (positive as well need to
improve) to the providers and the team.
Inviting service provider to clinical mentors work station

Sometimes the clinical mentor may have mentees with similar needs in clinical
improvement. In such situations, the clinical mentor can invite a group of two-three
providers who have common needs and organize a coaching session or provide a refresher
course in the health facility where the clinical mentor works. A benefit of inviting the
providers to the clinical mentors workplace is that, in addition to the opportunity to observe
the providers working with clients, other skills of providers can be monitored and improved
simultaneously.
Telephone contact
Clinical mentors can support service providers through regular telephone contact. Contact
can be initiated by either the clinical mentor or the provider. Telephone contact will help
the mentor to evaluate the providers individual needs and plan where and when to
meet. Telephone contact, if made within three weeks after the training, will be helpful in
indentifying the situation and any barriers to service provision.
Email
There is an increasing use of the internet system. If service is available, the clinical mentor
and mentee can communicate via internet. This might be particularly useful for second-
trimester providers, who are more likely to have regular access to internet services.
1.3.4 Orientation for clinical mentors

Ipas, in coordination with FHD and Figure 3: Clinical mentoring orientation
NHTC, conducts orientation for new
clinical mentors. MA clinical mentors
receive three days of orientation; second-
trimester clinical mentors receive a two-day
orientation. In this orientation, they learn
about the concept of provider support;
the role of clinical mentors; the process
of clinical mentoring; reporting and
recording; use of different tools; clinical
standardization on MA, MVA, IUCD and
implants and new updates on different
topics. In addition, they are updated on
topics such as balanced counseling and
use of misoprostol for incomplete abortion.
Each year, all clinical mentors are re-oriented on the above topics as per their need.
7
1.3.5 How are mentors assigned?

Once mentors have completed the orientation program, they are assigned to their
mentees. Each clinical mentor is assigned a maximum of four newly trained providers to
ensure high-quality support and coaching. Clinical mentors are assigned mentees who live
and work closely by, to facilitate frequent conversation, meetings and provision of technical
support.
With respect to second-trimester service provision, clinical mentors are are chosen from a
pool of trainers based on their willingness to travel and ability to meet the criteria.
Newly trained service providers should ideally be oriented to the role of clinical mentors
and provided with the name, address and contact address of their mentor during the last
day of clinical training. At present we are not able to provide the name of the CMs during
the training and this is being communicated by the PHN or Ipas staff as recommended
names are coming late. Sometimes the message is provided during clinical mentoring
orientation.
1.3.6 Timing of clinical mentoring support

First visit
The first contact should be made within three weeks post-training for all trained providers.
This visit is usually conducted by a programmatic person either onsite or by telephone.
However, as noted above, for providers who scored less than 90 percent on their post-
training test or who are having trouble applying their skills, the visit should be made by a
clinical mentor.
Follow up
After the initial visit, a follow-up visit should be scheduled per the providers need. We
have found that providers often do not proactively contact their clinical mentors but wait
to be contacted by the mentors via telephone or other means. This may be due to cultural
practices in Nepal where asking for support from a senior or supervisor or colleagues is
shameful and inappropriate. However, Ipas Nepal encourages service providers to ask for
support from Clinical Mentors in different forums.
1.3 7 Recording and reporting of Clinical Mentoring Approach

As per Ipas Nepals current practice, a Provider Progress Report (PPR) should be completed
every time a mentor contacts a provider. This applies for both in-person and telephone
contact. The form allows mentors to document the problem identified and the inputs
provided during the clinical mentoring. Additionally, a skill assessment checklist is used to
assess and document the clinical skill of the provider.
8
2. RESULTS OF CLINICAL MENTORING

APPROACH
This section presents the findings of a study carried out to assess the perspectives of clinical
mentors and service providers on the clinical mentoring approach in Morang, Parsa and
Rupendahi districts. The assessment was carried out in May 2016. Although the usefulness
of clinical mentoring was praised with respect to events like monitoring visits and training, a
formal evaluation has not been conducted to assess its effectiveness.
Nineteen service providers were interviewed: six mentors and thirteen mentees. Two of the
mentors selected for the study were obstetrician/gynecologists from Kathmandu; the other
four mentors were staff nurses - two from Rupandehi and one each from Parsa and Morang
district. The age of mentors was above 50 years, while mentees were between 21 and 30
years. Mentees were selected from different levels of health facilities: three were working at
hospitals, four at PHCC and six at health posts.
2.1 Relationship between mentors and mentees

There should be a good personal relationship between clinical mentors and mentees to
make the approach more effective. They must have good trust and understanding. The
assessment revealed that there was a strong relationship which included trust, respect,
belief and assurance between the mentors and their mentees. The relationship had
progressed from being a hierarchical teacher-student level to a more balanced level. They
were more like colleagues now.
Over the course of time, more than just a mentor, I have become friend with my mentees
and this has strengthened our relationship.
Second-trimester mentor
Besides advising on SAS, which was the main purpose of the mentor-mentee relationship,
they have also provided their guidance on other crucial issues like childbirth and
contraceptives. It was found that mentees required additional assistance in the areas of
contraception, particularly in regards to the removal of implants and insertion of intrauterine
devices. However, it should also be noted that for some mentor-mentees, the relationship
and guidance was exclusively limited to SAS only.
2.2 Means of communication

Telephone calls were the main medium of communication between mentors and mentees.
Mentees called the mentors in case any advice was needed, and they found it easy in
solving their queries. Mentors were found guiding their mentees even after office hours.
Mentors said that after-office-hour calls had not been an issue for them.
They call me at all times, especially in the day time and I do not find it bothersome to
receive their calls, as I know they need advice and help.
MA mentor
The study participants also expressed that telephone communication was a convenient
means for them because of its easy access and use. Most of the mentors said the mentees
contacted them to seek their advice to solve an issue, but they complained that mentees
9
did not report back to them on whether the problem was solved or whether their advice
effectively worked in that instance. They were quite worried with this, as it was not always
feasible for them to contact the mentees to get the updates. Further, some of the mentors
expressed that they have not had enough balance to call the mentees so they suggested
that some incentives might be arranged to motivate the mentors. This issue was raised by
all the MA mentors.
It definitely would be more reassuring if the mentees would call back to inform the progress
of the situation. However, in case of referral, we usually follow up about the arrival and
management of the client from our side.
MA mentor at the zonal hospital
Recently, a mentee called me regarding high fever in a client after intake of MA pills.
I advised her on how to manage that case over the phone. I would have felt more
reassured and comfortable had the mentee called me to report the progress following my
instructions.
MA mentor at a referral hospital
I always call from my cell phone, but sometimes there is no balance and sometimes I do not
have enough money to re-charge it. I feel some incentives should be arranged.
MA mentee at a health post
I usually call my mentor whenever I am confused, sometimes maybe too frequently. After
talking to her I realize my mistakes; but it has given me the opportunity to improve myself.
MA mentee
Whenever I have a problem or need advice, I call my mentor I try to do accordingly. If

I am unable to do so, I would talk to her and refer the client. Even when my mentor is in
Kathmandu or travelling elsewhere, she promptly takes my calls and advises me.
2.3 Supporting the mentees

Mentors expressed that usually the mentees need advice on minor problems related
to medical abortion, such as fever following use of MA pills, prolonged bleeding and
abdominal pain. Also, many times, they felt confusion in ruling out uterus size, ectopic
pregnancy, medical conditions pertaining to medical abortion, contraceptive issues and
problems related to child birth. Mentees followed the advice given by mentors and did
accordingly but in case of the need for referral services, they communicate with mentors
and provide details of clients for their management at the referral sites. This communication
mechanism was helpful for both the clients and the mentees for better referral services.
Once the mentees inform us that they are referring a case, stating the reasons, they also
give us their contact number and also give my number to the client to ensure the client
reaches the right place safely.
MA mentor
A woman, who had a previous ectopic pregnancy, had taken MA pills and did not have
bleeding or pain. The mentee called me asking for further advice. I suggested her for
referral for further examination. It is easy for them to make referrals after implementation of
the program.
10
Initially, I did not feel confident during the training for palpitation, ectopic pregnancy, etc.
However, with each new day managing the cases, I developed more confidence. Nobody
visited my site, as it is far from the district headquarter. Also, I did not contact any mentors.
In my work, I did not face any complications, so I did not feel necessary to call the mentor;
however, I worried sometimes on what to do in case of complications.
MA mentee
The mentoring program has helped me to refer clients to the appropriate referral site when
needed. I always call my mentor before referring and give the details of the clients so that
the client reaches the correct place and gets prompt treatment.
The best thing, I feel, is I can refer clients to the proper place in case of need and the
referral mechanism has been well coordinated.
Second-trimester mentors, however, said that their mentees rarely asked them for guidance;
rather, they just provided updates on what they had done. One of the reasons for mentees
not seeking guidance could be due to their several years of experience, through which they
already had developed adequate skills and confidence.
Clinical mentors were not able to assess the skills of all the MA providers, as the support
visits were need-based. However, the mentors could test the skills of some service providers
visiting their respective health facilities. In case of second-trimester mentees, the visit was
conducted as per the standard schedule and their skills were assessed.
The mentors mentioned that initially they were keeping a record of the calls attended;
however, more recently they have not been able to continue it due to time constraints
and because it was not possible to keep a note in their diaries either. Nevertheless, for
the second-trimester mentoring program, a check list has been provided and the skills
assessment is being continued.
2.4 Advantages of Clinical Mentoring

All the mentors, both MA and second-trimester, said that clinical mentoring was useful in
sharing their knowledge and helping their mentees. They said mentoring can be satisfying
and motivating, and that they wanted to continue mentoring in the future. However, some
said they felt exhausted due to the workload at their own workplaces. Overall, though,
they perceived mentoring positively as it helped them to update their skills and knowledge
and gain confidence. They had some doubts and worries regarding the sustainability of
the program and suggested that it would be better to align the referral system with the
mentoring program. It means the referrals should be preferably to the same facility where
the mentors work. It will help to have better case history of clients, prompt service due to
earlier communication and ensure the back referral.
I have multiple duties. In addition to managing the duty roster, I need to look after the
labor room and gynecological ward. So it is difficult at times.
MA mentor at a busy referral hospital
I feel privileged being a mentor; however, it is also important for me to upgrade my

knowledge to be able to guide my junior colleagues. So I think refresher courses are
important for us as well.
11
The relationship offers reciprocal benefits for mentors willing to invest their time in
developing another professional. In addition to personal satisfaction of sharing our
knowledge and experience, mentoring also helps for the professional growth of mentor
themselves.
Initially, I had not expected mentoring would be this fruitful for both the mentors and the
mentees.
Mentors were available whenever a mentee required support or advice. Their prompt
response assisted mentees to work even in difficult circumstances and boosted their
confidence.
Whenever I am in trouble or have any doubt, I can call my mentors for help. I then manage
the situation as per their advice.
The training alone was not sufficient to build my confidence. Having a mentor is like having
a guardian. Their support has helped me to perform better.
MA mentee
I think clinical mentoring is really required, mentors should support us to do things rightly.
We may need their support during complications. So they should provide suggestions in
such circumstances.
MA mentee
Despite these advantages, the participants said it would have been better to have clinical
mentoring on a regular basis rather than the current need-based practice. It would provide
an opportunity for onsite coaching and doubt clarification along with demonstrating their
skills. Some of the participants said that, though it was easy to contact the mentors and
follow their advice, there were not frequent supervision visits from the mentors, which
minimized the chances of their skill assessment and learning.
Although recording and reporting is covered in the training, I was not clear about it. My
mentor, during her visit, checked my recording and reporting sheets and supported me on
this. In addition, she asked about the side effects of miso and mife and the contraindications.
She suggested that I improve recording and reporting. I found clinical mentoring very
supportive and useful.
MA mentee
I would be happier if my mentor visits twice or at least once a year to oversee the work that
I am doing, including recording and reporting.
MA mentee
Likewise, mentors also mentioned that staff transfers create a challenge in smooth
operation of mentoring program. Staff members are demotivated particularly when they
are transferred to another section. Mentors stated they can contribute for a long time, if a
mechanism is built in to keep the trained staff in the maternal and child health department
for a certain period of time.
12
2.5 Ratings of the mentoring program

Both mentors and mentees were asked to rate the clinical mentoring program. It was
measured using the six-item Likert type scale, where respondents were asked to rate
their experience on a five-point scale. Scoring range was 1-5 (determined by the means
of scoring) with highest score 5 representing strongly agree/excellent and lowest score
1 representing very poor/strongly disagree. The level of agreement depicts the sum of
somewhat agree and strongly agree.
Overall, 33 percent of clinical mentors rated clinical mentoring as an excellent program,

while 67 percent rated it as a good program. Similarly, 17 percent rated their experience as
a participant in the program as excellent and 33 percent rated having excellent relationship
with their mentee. Furthermore, 17 percent of clinical mentors strongly agreed that mentors
role is clearly defined, 33 percent strongly agreed that mentors are benefitting personally
from relationship with mentees and the same number of clinical mentors strongly agreed
that mentor program coordinators (Ipas team) were accessible, easy to talk to and seek
advice from as noted in Table 1.
Table 1: Average score and level of agreement by clinical mentor (N=6)
Level of Somewhat Strongly

Items Avg
agreement agree agree
Mentor roles clearly defined 4.2 100 83.4 16.6
Mentor coordinators were
accessible, easy to talk to and 4.3 100 66.7 33.3
seek advice from
Benefitted personally from
4.3 100 66.7 33.3
relationship with mentee
Level of
Items Avg Good Excellent
agreement
Experience as a participant of
4.2 100 83.4 16.6
clinical mentoring program
Relationship with mentee 4.3 100 66.7 33.3
Rate overall mentor program 4.3 100 66.7 33.3
Note: the average score was constructed by giving scores: fully satisfied=5, satisfied=4,
neutral=3, dissatisfied=2, fully dissatisfied=1; and level of agreements was constructed by
adding up responses somewhat agree and strongly agree.
A majority (92 percent) of the mentees rated their experience as participant of clinical
mentoring program as good. Nearly eight in ten of the mentees rated their relationship with
the mentor as good and almost half (46 percent) rated the overall program as excellent.
Although 31 percent of the mentees strongly agreed that they enjoyed working with
their clinical mentor, only 15 percent strongly agreed that they learnt new things from the
clinical mentors. More than half of the mentees (54 percent) strongly agreed that they were
comfortable discussing clinical problems with the mentors and enjoyed being part of the
program, as presented in Table 2.
13
Table 2: Average score and level of agreement by mentees (N=13)
Level of Somewhat Strongly

Items Avg
agreement agree agree
Learned new things from clinical
4.2 100 84.7 15.3
mentor
Enjoyed working with clinical
4.3 100 69.3 30.7
mentor
Comfortable talking to mentor
4.5 100 46.1 53.9
about clinical problems
Benefitted personally from
4.4 100 61.6 38.4
relationship with mentor
Feels confident/competent in
4.4 100 61.6 38.4
providing abortion services
Enjoyed being part of clinical
4.5 100 46.1 53.9
mentoring program
Level of
Items Avg Good Excellent
agreement
Experience as participants of
4.0 100 92.3 7.7
clinical mentoring program
Rate relationship with mentor 4.1 100 84.7 15.3
Rate overall mentor program 4.5 100 53.9 46.1
Note: the average score was constructed by giving scores: fully satisfied=5, satisfied=4,
neutral=3, dissatisfied=2, fully dissatisfied=1; and level of agreements was constructed by
adding up responses somewhat agree and strongly agree.
3. DISCUSSION
Providers, mentors, service delivery facilities and ultimately clients all have benefited from
the clinical mentoring approach. Results of this assessment indicate that the mentorship
program was a beneficial process for both mentors and mentees.
Mentors benefitted by sharing their knowledge, skills and having increased motivation to
upgrade their knowledge. Additionally, they have established strong relationships with
their mentees. However, because of infrequent site visits from MA mentors, onsite skill
assessment of the mentees was not possible. Skill assessment is crucial to ensure that the
mentoring program has enhanced the skills of mentees and has benefited the mentees as
well as the clients. Training followed by clinical mentoring is one approach for fostering the
competency of clinical service providers to provide the quality service (9, 10, 11).
Currently, the mentors are maintaining communication and providing effective feedback,
which has resulted in mentees gaining confidence to provide quality services. A strong
referral linkage is also established between mentors and mentees, which allows the
mentees to refer clients if the need arises. This mechanism seemed to be a strong aspect
of the program as a strong referral mechanism has been developed. More importantly,
there were fewer referrals as the mentees were capable of tackling the problems at their
respective sites.
14
Although the guidelines clearly state that a personal visit is best, personal cell phone calls
were the preferred means of communication in the field, as mentors could contact the
mentees clients easily. However, communication cost was an issue, particularly when the
service providers had to make multiple calls to a single client.
Since the mentees were seeking advice regarding issues other than medical abortion
such as contraception, ectopic pregnancy and problems related to child birth - it seems
important to integrate clinical mentorship activities into other clinical training activities.
Minimum supervision should be done to ensure that mentees are translating their
knowledge and skills, developed through trainings, into practice. The senior staff were
also motivated on their professional development, and this has also given them more
opportunity to learn. At the same time, they have gained respect and trust from the
mentees, which, although intangible, has been a factor of motivation.
Clinical mentoring is itself taken as more sustainable way of learning within the job setting,
without disrupting service (12, 13, 14). Yet, to ensure the sustainability of clinical mentoring,
it should be well integrated within the government plan and structure (15). For instance,
Government of Nepal has allocated certain budget to districts for supporting clinical
mentoring in family planning and safe motherhood program. A single clinical mentor for the
reproductive health program might help to institutionalize the clinical mentoring approach
in the government delivery system.
With the ongoing mentoring program, the mentees have been able to manage or refer
even the most complicated cases, as they can contact their mentors when in doubt and
seek prompt advice. Regarding the frequency of mentoring visits, mentees preferred the
regular mentoring over the need-based mentoring, as they believe they can benefit more
from regular mentoring. They stated it would help to have routine assessment of their skills,
get the feedback and get updated regularly.
4. CONCLUSION AND RECOMMENDATIONS

Fostering the mentoring program has a benefit for both the mentors and mentees: Mentees
receive guidance and support from mentors, while mentors get the opportunity to reflect
on their own goals and professional development. It also develops a culture of learning
among the senior staff members.
This assessment makes following recommendations for enhanced quality and optimum
benefits from the clinical mentoring approach:
1. It is important for the mentors to be officially appointed by the government for

better ownership. Preferably, mentors should be from higher-level health facilities of
same district or the facilities where clients are likely to visit in case of referrals. This
will help to better integrate the mentoring approach within the system at local the
level, and will align referrals with mentoring approach.
2. Mentoring should be integrated into other reproductive health programs, such as

family planning and safe motherhood, for better sustainability, wherever feasible.
Involvement of same mentor in all activities helps for better mentoring.
3. More clinical mentors are needed for more frequent supervision and monitoring.
15
4. Provision of communication incentives for the mentees to encourage them to have

regular communication with the mentor.
5. Compulsory reporting back after receiving the advice from mentors should be
reinforced during the training of service providers. This will not only help mentors
confirm whether his/her advice worked or not, but will also strengthen the
relationship between mentors and mentees.
6. A regular refresher orientation program should be implemented to enhance mentors

knowledge and skills about the clinical mentoring approach and technical areas.
7. Further study is recommended to continue assessing the impact of the clinical

mentoring process.
References
1. Government of Nepal, Ministry of Health and Population. Health Sector Reform Unit. Second Long Term
Health Plan 1997-2017: Perspective Plan for Health Sector Development.2007.
2. Government of Nepal, Ministry of Health and Population. Nepal Health Sector Program Implementation
Plan (2004-2009).Kathmandu: Nepal; 2004.
3. Government of Nepal, Ministry of Health and Population. Nepal Health Sector Program Implementation
Plan II(NHSP-II) 2010 - 2015. Kathmandu: Nepal; 2010.
4. Government of Nepal, Ministry of Health and Population. Policy on Quality Health Services; 2007.5. Min-
istry of Health and Population, Department of Health Service, Family Health Division and National Health
Training Centre. Guidelines on Clinical Mentoring Approach to Service Providers (Nepali Version). Kath-
mandu: Nepal;2007
6. Buchan J, Dal Poz MR. Skill mix in the health care workforce: reviewing the evidence. Bulletin of the World
Health Organization.2002,80 (7).
7. Ipas.Global guidance and tools for improving provider and site performance,2011.
8. World Health Organization. WHO recommendation for clinical mentoring to support-up scale-up of HIC
acre, antiretroviral therapy and prevention in resource-constrained settings.In Genva. World Health Organi-
zation; 2005.
9. Manzi A, Magge H, Hedt-Gauthier B, Michaelis A, Cyamatare F, Nyirazinyoye L et al. Clinical mentorship to
improve pediatric quality of care at the health centers in rural Rwanda: a qualitative study of perceptions
and acceptability of health care workers. BMC Health Services Research. 2014;14(1).
10. Fischer E, Jayana K, Cunningham T, Washington M, Mony P, Bradley J et al. Nurse Mentors to Advance
Quality Improvement in Primary Health Centers: Lessons From a Pilot Program in Northern Karnataka,
India. Global Health: Science and Practice. 2015;3(4):660-675.
11. Rowe A, de Savigny D, Lanata C, Victora C. How can we achieve and maintain high-quality performance of
health workers in low-resource settings? The Lancet. 2005;366(9490):1026-1035.
12. Ndwiga C, Abuya T, Mutemwa R, Kimani J, Colombini M, Mayhew S et al. Exploring experiences in peer
mentoring as a strategy for capacity building in sexual reproductive health and HIV service integration in
Kenya. BMC Health Services Research. 2014;14(1).
13. Elizabeth A Fischera, Krishnamurthy Jayanab, Troy Cunningham, Maryann Washington, Prem Mony, Janet
Bradley, Stephen Moses. Nurse Mentors to Advance Quality Improvement in Primary Health Centers: Les-
sons From a Pilot Program in Northern Karnataka, India.
14. Yumkella F. Retention of Health Care workers in Low-Resource settings: Challenges and Responses. Intra-
Health International: Capacity Project Technical Brief No. 1 Chapel Hill, NC; 2006.
15. Okereke E, Tukur J, Aminu A, Butera J, Mohammed B, Tanko M et al. An innovation for improving ma-
ternal, newborn and child health (MNCH) service delivery in Jigawa State, northern Nigeria: a qualitative
study of stakeholders perceptions about clinical mentoring. BMC Health Services Research. 2015;15(1).
? Yumkella F. Retention of Health Care workers in Low-Resource settings: Challenges and Responses. Intra-
Health International: Capacity Project Technical Brief No. 1 Chapel Hill, NC; 2006.
16
Annex:
Interview Guideline for Clinical Mentors
Mentor ID: ____________________________________________________________________
Cadre of clinical mentor:
o ANM
o Staff Nurse
o Medical Officer
o Ob/gyn or MDGP
Age: ____________
Gender:
o Male
o Female
Are you trained in CAC?
o Yes
o No
If yes, when were you trained in CAC? (DD/MM/YY) _____/_____/_____
Are you a CAC Trainer?
o Yes
o No
Cadre of mentee:
o ANM
o Staff Nurse
o Medical Officer
o Ob/gyn or MDGP
Have you officially been assigned to your mentee?
o Yes
o No
o Dont know
17
Section A:
1. How long have you been involved in mentoring for safe abortion service? Did you receive a
formal training on mentoring?
2. What kind of relationship do you share with the mentee? (Probes: Is there trust/respect in the
feedback process? Do they feel respected?)
3. How do you learn about your mentees needs? Do you feel confident they will contact you when
they need clinical support? Do they directly contact you, or through other means? Do you feel
this process is working?
4. How often have you been providing clinical mentoring (frequency of clinical mentoring)? Are
you able to provide support to the mentees whenever they ask for it? If not, what is hampering
you from doing so?
5. When you go for onsite clinical mentoring, how do you assess mentees skills? After mentoring,
how do you ensure the issue has been resolved? Do you do any follow up?
6. Do you also provide inputs to the mentees through telephone conversations? How often does
this happen? Do you feel this is effective?
7. While mentoring, do you do any kind of performance assessment using data? Are you filling out
any kinds of forms after mentoring (for both onsite and telephone)?
8. How do you ensure a mentee is confident and competent?
9. What tools/job aids/technology are helpful to you as a mentor? Can you think of any other
tools/job aids/technology that would be helpful to you as a mentor?
10. What kinds of results do you see from the the clinical mentoring process?
11. Are you satisfied with the process? What was most satisfying about the mentor program? What
was least satisfying about the mentor program?
12. What motivates you to do this job?
18
13. What are the most effective approaches in your work? What do you think are the most important
characteristics of an effective mentor and effective mentoring relationship?
14. What would you suggest to improve the mentor program?
Section B:
We would like to have your opinion of the mentor program so that we may evaluate and strengthen
our program for the future. Please answer the questions below.
15. Would you serve as a mentor again next year or in the future?
Yes No Dont Know
16. Did the mentor training session help you prepare for your mentoring experience?
Yes No Dont Know
17. Would you have liked additional training for mentors?
Yes No Dont Know
18. Was the time you spent with your mentee sufficient, too much, or too little?
Sufficient time Too much time Too little time Dont know
For the following statements, please answer whether you Strongly Agree, Somewhat Agree, Feel
Neutral, Somewhat Disagree, Strongly Disagree.
19. Your mentor roles were clearly defined.
Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree
20. The mentor program coordinators were accessible and easy to talk to and to seek advice from
when necessary.
21. I benefited personally from the relationship with the mentee.
For the following questions, please rate your experience on the scale of Excellent, Good, Neutral,
Poor, Very Poor.
22. How would you rate the quality of your experience as a participant in the program?
Excellent Good Neutral Poor Very poor
23. How would you rate your relationship with your mentee?
24. Overall, how would you rate the mentor program?
19
Interview Guideline for Clinical Mentees

Provider ID:____________________________
Facility ID:_____________________________
MA Training Date: _____/_____/_____
Demographic of mentees
Age: ________________
Gender:
o Male
o Female
Cadre of Mentee:
o ANM
o Staff Nurse
o Medical Officer
o Ob/gyn or MDGP
How long have you been providing safe abortion service (MA/MVA/2nd tri)? ______yrs ______mnths
Cadre of Mentor:
o ANM
o Staff Nurse
o Medical Officer
o Ob/gyn or MDGP
Section A:
1. Number of cases done during training ______________________
2. At the end of training, did you feel confident and competent?
3. If not, did your clinical mentor help you to be more confident and competent?
4. Whom do you generally contact when you need clinical support in providing safe abortion
services? Do you feel comfortable in asking for support from your clinical mentor?
20
5. After your training, during the course of your service delivery, from whom and how many times
did you receive support?
Public Health Nurse(PHN)
Site In Charge(Site Supervisor)
Clinical Mentors
Ipas staff/Consultant
Health Facility Management Committee(HFMoC)
6. Do you know that you have a Clinical Mentor assigned to you to support you clinically? If yes,
how long have they supported you in the clinical mentoring role?
7. How do you generally contact your clinical mentors for support? (Example: direct phone call,
through District Coordinators.) Do you feel this is an effective mode or are there other modes of
contact you would prefer?
8. Are the clinical mentors available as per your need? Do you feel you get the support promptly?
Do you think clinical mentoring should happen more frequently at a scheduled time rather than
the current practice (need based)?
9. List some of the activities you have done with your mentor:
10. Give an example of something you learned from your mentor (if applicable):
11. What types of support do you receive from your clinical mentor?
12. Are you satisfied with the kind of support you received from the clinical mentors? If no, what
improvements need to be made?
13. What do you think about the communication with your mentor? (Probes: Do you receive clear
feedback? Do you feel respected? Are you able to speak openly/honestly about issues?)
14. Do you feel the clinical mentors assigned to you have all the characteristics that an effective
mentor should have? (Probes: Do they provide positive guidance and constructive feedback?
Do they take a personal interest in mentoring relationship? Do they demonstrate a positive
attitude and act as a role model?) If not, what could be improved?
15. Do you feel confident and competent in providing safe abortion service as a result of clinical
mentoring?
21
16. What was the most useful element of the mentor program?
17. What did you not like about the mentor program?
18. What do you think we should change or do differently next year?
Section B:
We would like to have your opinion of the mentor program so that we may assess and strengthen our
program for the future. Please answer the questions below.
19. Would you want a mentor next year or in the future?
Yes No Dont Know
20. Was the time you spent with your mentor sufficient, too much, or too little?
Sufficient time Too much time Too little time Dont know
For the following statements, please answer whether you Strongly Agree, Somewhat Agree, Feel
Neutral, Somewhat Disagree, Strongly Disagree
21. I learned new things from my clinical mentor.
22. I enjoyed working with my clinical mentor.
23. I felt comfortable talking to my mentor about clinical problems/needs for safe abortion services.
24. I benefited personally from the relationship with the mentor.
25. I feel confident/competent in providing safe abortion services as a result of the mentoring.
26. I enjoyed being part of the clinical mentoring program.
For the following questions, please rate your experience on the scale of Excellent, Good, Neutral,
Poor, Very Poor.
27. How would you rate the quality of your experience as a participant in the program?
22
28. How would you rate your relationship with your mentor?
29. Overall, how would you rate the mentor program?
23
24
NEPCM-E17

A Clinical Mentoring Approach To Safe Abortion Service in Nepal: Lessons Learned

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

A Clinical Mentoring Approach To Safe Abortion Service in Nepal: Lessons Learned

Uploaded by

Copyright:

Available Formats

A CLINICAL MENTORING

APPROACH TO SAFE ABORTION

Cover photo: Ipas Nepal

1.1 Concept of Provider Support Team.............................................................................. 1

1.2 Clinical Mentoring Overview......................................................................................... 2

1.2.1 Aims of clinical mentoring...................................................................................... 2

1.2.2 The clinical mentor................................................................................................. 3

1.3 Clinical Mentoring Process in Safe Abortion Services.................................................. 5

1.3.1 Identifying needs.................................................................................................... 5

1.3.2 Place of clinical mentoring..................................................................................... 6

1.3.3 Methods of clinical mentoring................................................................................ 6

1.3.4 Orientation for clinical mentors.............................................................................. 7

1.3.5 How are mentors assigned?................................................................................... 8

1.3.6 Timing of clinical mentoring support...................................................................... 8

1.3.7 Recording and reporting of clinical mentoring approach....................................... 8

2. RESULTS OF CLINICAL MENTORING APPROACH.......................................................... 9

2.1 Relationship between mentors and mentees................................................................ 9

2.2 Means of Communication.............................................................................................. 9

2.3 Supporting the Mentees............................................................................................. 10

2.4 Advantages of Clinical Mentoring............................................................................... 11

2.5 Ratings of the Mentoring Program............................................................................. 13

4. CONCLUSION AND RECOMMENDATIONS.................................................................. 15

Interview Guideline for Clinical Mentors .......................................................................... 17

Interview Guideline for Clinical Mentees.......................................................................... 20

Table 2: Average score and level of agreement by mentees (N=13).................................. 14

Figure 2: Continuum of education for health care providers................................................ 2

Figure 3: Clinical mentoring orientation................................................................................ 7

ANMs Auxiliary Nurse Midwives

CAC Comprehensive Abortion Care

COPE Client Oriented Provider Efficient

FHD Family Health Division

MVA Manual Vacuum Aspiration

NHTC National Health Training Centre

PHCC Primary Health Care Centre

PST Provider Support Team

SAS Safe Abortion Service

Government of Nepal Tel: 4261436

Dr. Naresh Pratap K.C.

To provide high-quality SAS, it is necessary to create an enabling environment and linkages

1.1 Concept of Provider Support Team

Figure 1: Provider support concept

In addition to the above approaches, Ipas is also implementing competency-based

Programmatic support: Support provided to an individual and or a site to address

Clinical mentoring: A collaborative relationship in which an experienced health-care

1.2 Clinical mentoring overview

1.2.1 Aims of clinical mentoring

Mentoring is a part of the continuum of education required to create competent health-care

Figure 2: Continuum of education for health-care providers

Initial training Continuing education

Source: Adapted from WHO 2006 (8)

1.2.2 Clinical Mentor

Selection criteria for clinical mentors

Strong clinical coaching, guiding and problem-solving skills

Available and willing to mentor and monitor trainees as often as needed

Effective and respectful interpersonal and communication skills

Other characteristics to consider: age and geographical proximity to providers

Additional considerations include:

Cadre: Clinical mentors can be physicians or midlevel providers, depending on the

Seniority: There are advantages of recruiting senior clinician trainers as clinical

Specific selection criteria

Must have provided service to a minimum of 30 clients

Must be a listed service provider

Must have received orientation for clinical mentors

If yes, when were you trained in CAC? (DD/MM/YY) ___/_/___