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

2. 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

3. 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

4. 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

5. 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

6. Thank you