IntraHealth International, Washington, DC, USA.
University of Zambia, Lusaka, Zambia.
Glob Health Sci Pract. 2018 Dec 27;6(4):736-746. doi: 10.9745/GHSP-D-18-00067.
In Zambia, nurses and nurse-midwives lead more than half of rural facilities and guide primary health care delivery. Based on a formative assessment, the Ministry of Health (MOH) determined that improved leadership capacity and management skills of facility heads would help maximize the potential of Zambia's community-level investments. In support of these efforts, the Primary Health Care to Communities (PHC2C) initiative designed and tested a 12-month blended learning program for a certificate in leadership and management practice (CLMP) to build leadership and management competencies of rural facility heads, including increasing their ability to lead frontline teams and strengthening their skills and confidence in technology use. The CLMP was created with leadership from the MOH, technical guidance from the University of Zambia, and expertise from PHC2C partners IntraHealth International, Johnson & Johnson, and mPowering Frontline Health Workers. In total, 20 nurse facility heads and 5 district nurse supervisors in 20 rural facilities across 5 districts were selected to test the course content and delivery approach. A mixed-methods approach, including evaluation of facility heads' presentations on community health improvement projects, focus group discussions with community members, and key informant interviews with nurses, clinical officers, and other stakeholders, was used to assess the results. Findings suggested that the facility heads had successfully strengthened their leadership and management competencies, increased their ability to lead frontline teams, and strengthened their skills and confidence in use of technology, including using a WhatsApp community of practice for support and consultation with other colleagues, with demonstrated improvements in the quality and accessibility of services. Based on assessment results and lessons from the test intervention, the Zambian government has committed to institutionalize CLMP as a national continuing professional development program, required for nurses posted to lead rural facilities. The planning, design, and implementation of this program offer an example to other countries and global actors of how nurses empowered with competence and confidence can play a significant role in coordinating the maze of community actors and navigating the complexities of community health systems to advance primary health care and universal health coverage.
在赞比亚，护士和助产学专业人员领导着超过一半的农村医疗机构，并指导初级卫生保健服务的提供。根据一项形成性评估，赞比亚卫生部（MOH）确定，提高机构负责人的领导能力和管理技能将有助于最大限度地发挥赞比亚社区一级投资的潜力。为了支持这些努力，初级卫生保健社区（PHC2C）倡议设计并测试了为期 12 个月的领导力和管理实践证书（CLMP）混合学习计划，以培养农村医疗机构负责人的领导能力和管理能力，包括提高他们领导一线团队的能力，并加强他们在技术使用方面的技能和信心。CLMP 的创建得到了 MOH 的领导、赞比亚大学的技术指导以及 PHC2C 合作伙伴 IntraHealth International、强生公司和 mPowering Frontline Health Workers 的专业知识的支持。共有 20 名护士机构负责人和 5 名地区护士监督员在 5 个地区的 20 个农村机构中被选中来测试课程内容和交付方法。采用混合方法，包括评估机构负责人关于社区卫生改善项目的介绍、与社区成员的焦点小组讨论以及与护士、临床医生和其他利益相关者的关键人物访谈，以评估结果。调查结果表明，机构负责人成功地加强了他们的领导和管理能力，提高了领导一线团队的能力，并加强了他们在技术使用方面的技能和信心，包括使用 WhatsApp 实践社区进行支持和与其他同事协商，服务的质量和可及性都得到了提高。根据评估结果和测试干预措施的经验教训，赞比亚政府承诺将 CLMP 作为一项国家持续专业发展计划制度化，要求在农村领导机构工作的护士必须参加。该计划的规划、设计和实施为其他国家和全球行为者提供了一个范例，说明了经过培训、充满信心的护士如何在协调社区行动者的复杂网络和应对社区卫生系统的复杂性方面发挥重要作用，从而推进初级卫生保健和全民健康覆盖。
