Title

A multimodal mentorship intervention to improve surgical quality in Tanzania’s Lake Zone: a convergent, mixed methods assessment

Authors

Shehnaz Alidina, Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
Leopold Tibyehabwa, Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD, USA
Sakshie Sanjay Alreja, Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
David Barash, GE Foundation, Boston, MA, USA
Danta Bien-Aime, Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
Monica Cainer, Assist International, Dar es Salaam, Tanzania and Ripon, CA, USA
Kevin Charles, Assist International, Dar es Salaam, Tanzania and Ripon, CA, USA
Edwin Ernest, Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD, USA
Joachim Eyembe, Musoma Regional Hospital, Musoma, Tanzania
Laura Fitzgerald, Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD, USA
Geofrey C. Giiti, Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
Augustino Hellar, Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD, USA
Yahay Hussein, Department of Health, Social Welfare, and Nutrition Service, President’s Office – Regional Administration and Local Government, Dodoma, Tanzania
Furaha Kahindo, Nyakahanga Hospital, Karagwe, Tanzania
Benard Kenemo, Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
Albert Kihunrwa, Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
Steve Kisakye, D‑Implement, Dalberg Advisors, Dar es Salaam, Tanzania
Innocent Kissima, Assist International, Dar es Salaam, Tanzania and Ripon, CA, USA
John G. Meara, Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA, Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA, USA, Department of Paediatrics, University of Melbourne, Melbourne, Australia
Cheri Reynolds, Assist International, Dar es Salaam, Tanzania and Ripon, CA, USA
Steven J. Staffa, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
Meaghan Sydlowski, Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
John Varallo, Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD, USA
Noor Zanial, Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
Ntuli A. Kapologwe, Department of Health, Social Welfare, and Nutrition Service, President’s Office – Regional Administration and Local Government, Dodoma, Tanzania
Caroline Damian Mayengo, Department of Curative Services, Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania

Document Type

Article

Publication Date

2021

Abstract

Background: Safe, high‑quality surgical care in many African countries is a critical need. Challenges include availability of surgical providers, improving quality of care, and building workforce capacity. Despite growing evidence that mentoring is effective in African healthcare settings, less is known about its role in surgery. We examined a multimodal approach to mentorship as part of a safe surgery intervention (Safe Surgery 2020) to improve surgical quality. Our goal was to distill lessons for policy makers, intervention designers, and practitioners on key elements of a successful surgical mentorship program.

Methods: We used a convergent, mixed‑methods design to examine the experiences of mentees, mentors, and facility leaders with mentorship at 10 health facilities in Tanzania’s Lake Zone. A multidisciplinary team of mentors worked with surgical providers over 17 months using in‑person mentorship, telementoring, and WhatsApp. We conducted surveys, in‑depth interviews, and focus groups to capture data in four categories: (1) satisfaction with mentorship; (2) perceived impact; (3) elements of a successful mentoring program; and (4) challenges to implementing mentorship. We analyzed quantitative data using frequency analysis and qualitative data using the constant comparison method. Recurrent and unifying concepts were identified through merging the qualitative and quantitative data.

Results: Overall, 96% of mentees experienced the intervention as positive, 88% were satisfied, and 100% supported continuing the intervention in the future. Mentees, mentors, and facility leaders perceived improvements in surgical practice, the surgical ecosystem, and in reducing postsurgical infections. Several themes related to the intervention’s success emerged: (1) the intervention’s design, including its multimodality, side‑by‑side mentorship, and standardization of practices; (2) the mentee–mentor relationship, including a friendly, safe, non‑hierarchical, team relationship, as well as mentors’ understanding of the local context; and (3) mentorship characteristics, including non‑judgmental feedback, experience, and accessibility. Challenges included resistance to change, shortage of providers, mentorship dose, and logistics.

Conclusions: Our study suggests a multimodal mentorship approach is promising in building the capacity of surgical providers. By distilling the experiences of the mentees, mentors, and facility leaders, our lessons provide a foundation for future efforts to establish effective surgical mentorship programs that build provider capacity and ultimately improve surgical quality.

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