Improving health worker motivation and performance to deliver adolescent sexual and reproductive health services in the Democratic Republic of Congo: study design of implementation research to assess the feasibility, acceptability, and effectiveness of a package of interventions

ABSTRACT

During its last funding cycle from 2018–2020, the Global Fund in collaboration with the Ministry of Health, World Health Organization, and implementing partners Cordaid and Santé Rural (SANRU), implemented a multi-sectoral, contextualized approach to improve the sexual and reproductive health of adolescent girls and young women in two regions in the Democratic Republic of the Congo, which included community-based, school-based and health facility-based actions. This implementation research focuses on the health-facility component. The objective of this research is to evaluate the feasibility, acceptability, and effectiveness of a package of interventions to improve health workers’ knowledge, skills, and attitudes in providing sexual and reproductive health services to adolescents, whilst concomitantly creating an enabling work environment for building health workers’ motivation. The package includes a combination of job descriptions, training and refresher training, desk reference tools, and collaborative learning. The package did not focus on improving amenities, providing or repairing equipment, or providing medicines and supplies. The underlying theoretical framework informing the project and the implementation research draws from Social Network Theory, Diffusion of Innovations and Normalization Process Theory. Qualitative and quantitative process and outcome data from in-depth interviews and focus group discussions with health workers and health managers, field notes, monitoring reports, costing sheets, and health worker surveys, adolescent mystery client assessments, and exit interviews with adolescents will be collected as part of a time-series study. The findings from this implementation research will be utilized to inform future adaptations and/or scale-up of the package of interventions to improve health worker motivation and performance in the Democratic Republic of the Congo and elsewhere. The findings will also contribute to advancing the use of theoretical approaches within the field of implementation research.

KEYWORDS:

• Adolescent sexual and reproductive health
• health worker training
• collaborative learning
• implementation research
• heath worker motivation
• health worker performance

Responsible Editor

Stig Wall

Responsible Editor

Stig Wall

Acknowledgments

We would like to thank all local stakeholders including PNLS and PNSA the health workers and adolescent clients, Sylvie Olela Odimba, and the research team led by Eric Mafuta at the University of Kinshasa, School of Public Health. Sylvie Olela Odimba, and the research team at the University of Kinshasa, School of Public Health.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics and consent

Ethical approval has been obtained by the WHO-ERC (ERC.0003228) and the University of Kinshasa Ethics Review Board. No primary data are reported in this study design article.

Paper context

There is limited knowledge of how to deliver effective interventions at scale in resource constrained settings. This study describes the development, implementation, and evaluation plan to assess the feasibility, acceptability, and effectiveness of a package of interventions aimed at improving health worker motivation and performance in the Democratic Republic of the Congo. The findings will contribute to the evidence base of how interventions can move beyond piecemeal efforts and towards comprehensive approaches.

Additional information

Funding

This research has received funding from the Global Fund and the World Health Organization.

Notes on contributors

Sheri Bastien

VC (Venkatraman Chandra-Mouli) conceived the paper. VC and MP (Marina Plesons) engaged SB (Sheri Bastien) to lead the preparation of the paper. SB led the development of the paper. Erin Ferenchick (EF), and Symplice Mbola-Mbassi (SM) provided background information on the project, relevant documents, and inputs from the perspectives of those who designed the initiative, oversaw its execution, and supported it technically. VC, MP, and EF contributed to the development of the paper with detailed inputs on drafts. However, all authors contributed to the paper as it evolved, and approved the final version.