How to measure performance among community midwives in Sudan: An Implementation Research Study Dr. Ayat Abu-Agla MBBS, MPH, MD Community Medicine, MFPH abuaglaa@tcd.ie Dr Frédérique Vallieres, PhD

Background on Sudan Major HRH challenges Sudan Health Expenditure Numerical shortages Skill mix imbalances Inequitable geographic distribution Migration Issues of regulation, performance and productivity Sudan Health Expenditure 2011 Loss of 75% of its oil revenue creating a 30% gap in the national budget; inflation; 2012 Country’s health expenditure at 9.8%, Catastrophic out-of-pocket expenditure HRH Performance Inter/national/regional priority 2013 Primary Health Care Expansion Program Trained 14,000 Community Midwives

Objectives Overall Objective Specific Objectives Developing a practical measure of performance among community midwives in low- resource settings Specific Objectives Part One: To determine how to measure performance among community midwives in low resource settings Part Two: To develop a contextually-relevant tool to measure performance among community midwives in Sudan Part Three: To assess the factorial validity of a tool to measure performance among community midwives in Sudan

Implementation Research Methods Phase 1 Systematic review of performance measures for maternal health workers in low and middle-income countries Designed to determine the different tools used to measure performance Phase 2 13 key informant interviews; 4 focus group discussions with beneficiaries, and 8 IR workshops with CMWs and RMCH state coordinators 2 consultative rounds-Delphi and CMW expert group consultative meetings Co-define, characterise and co-develop a measure of performance for CMWs Phase 3 The tool was administered in a sample of 282 community midwives in 2 consecutive rounds in 3 different states Tests the construct validity of the newly developed contextually-relevant tool using confirmatory factor analysis techniques

Performance Tool The Performance Tool measured the following constructs: Knowledge Compliance Competency Job satisfaction Supportive Supervision Work Motivation   Implementation Research approach allowed for the development of a measure of performance that is: Evidence-based (i.e. through the systematic review) Contextually appropriate (through participation of key stakeholders) CMW Performance tool is nationally endorsed by Federal Ministry of Health-Sudan

Thank you