Mutually Reinforcing Strategies

Health partnerships often find that multiple, mutually reinforcing strategies are more effective than any single approach to changing health worker behaviour.

The HPS-funded Global Links Volunteer Programme sends UK paediatricians on 6–12 month placements in East and West Africa, and facilitates African doctors to undertake placements in the UK. The programme aims to improve paediatric care in hospitals and communities, improve paediatricians’ leadership skills and strengthen institutional links.

Volunteer UK paediatricians work on priorities agreed with their host institutions. One reports from Karatina General Hospital in Kenya on ways to encourage consistent neonatal blood sugar monitoring:

It can be difficult to change behaviours sometimes.

In our neonatal nursery in Kenya, blood sugar monitoring was poor.

By attacking this from several angles we were able to improve this. This consisted of:

1. Teaching sessions with the nursing staff and the medical officers on the importance of blood sugar monitoring in neonates.
2. Positive reinforcement when it was done appropriately.
3. Use of a white board to facilitate the nursing staff to remember to check blood sugars.
4. Asking about blood sugars for every baby on the ward round.
5. Reviewing blood sugar monitoring at mortality meetings attended by neonatal nurses and medical officers.

Global Links is run by the Royal College of Paediatrics and Child Health, the Kenyan Paediatric Association (KPA), the Ugandan Paediatric Association (UPA) and the West African College of Physicians (WACP), Faculty of Paediatrics.