RESUMEN
BACKGROUND: Maternal and Child Health Aides are the largest nursing cadre in Sierra Leone providing maternal and child health care at primary level. Poor healthcare infrastructure and persistent shortage of suitably qualified health care workers have contributed to high maternal and newborn morbidity and mortality. In 2012, 50% of the MCHAides cohort failed their final examination and the Government of Sierra Leone expressed concerns about the quality of teaching within the programmes. Lack of teaching resources and poor standards of teaching led to high failure rates in final examinations reducing the number of newly qualified nurses available for deployment. METHODS: A mixed-methods approach using semi-structured observations of teaching sessions and completion of a questionnaire by students was used. Fourteen MCHAide Training Schools across all districts of Sierra Leone, 140 MCHAide tutors and 513 students were included in the study. In each school, teaching was observed by two researchers at baseline, 3 and 6 months after the tutor training programme. Students completed a questionnaire on the quality of teaching and learning in their school at the same time points. RESULTS: A total of 513 students completed the questionnaire, 120 tutors took part in the training and 66 lessons across all schools were observed. There was a statistically significant (p < 0.05) improvement in mean student evaluation of teaching and learning in 12/19 areas tested at follow-up compared to baseline. Observation of 66 teaching sessions demonstrated an increase in the number of student-focused, interactive teaching methods used. CONCLUSION: Prior to the teaching and learning workshops there was little student-focused learning within the schools. Teaching was conducted predominantly using lectures even for practical sessions. Training tutors to move away from didactic teaching towards a more student-focused approach leads to increased student satisfaction with teaching and learning within the schools.
RESUMEN
OBJECTIVE: Maternal and Child Health Aides (MCH Aide) in Sierra Leone provide the majority of maternity services at primary care level. To formulate recommendations for improving the quality and scale-up of MCH Aides training an evaluation of all schools across Sierra Leone was undertaken. DESIGN: Structured, direct observation of two randomly selected teaching sessions per school using pre-tested standardised review forms. Event sampling with random selection of timetabled sessions across all 14 MCH Aide Training Schools. SETTING: All MCH Aide training schools across Sierra Leone. PARTICIPANTS: Tutors across 14 MCH Aide training schools observed in August 2013. MEASUREMENTS: Assessment of four key elements of teaching and learning: (1) teaching style, (2) use of visual aids, (3) teaching environment and (4) student involvement. FINDINGS: In the majority of teaching schools there was over-crowding (11/14), lack of furniture and inconsistent electricity supply. Ten of 26 tutors used lesson plans and teaching was mostly tutor- rather than student-focused. Majority of tutors use a didactic approach rather than active learning methods. Teaching aides were rarely available (15% of lessons). Tutors were knowledgeable in their subject area and there was evidence of an excellent tutor-student relationship. KEY CONCLUSIONS: Training for Maternal and Child health Aides relies on teacher focused didactic methods, which may hinder student learning. Teaching and learning within the schools needs to be enhanced by a combination of tutor development and improvements in the learning environment. IMPLICATIONS FOR PRACTICE: Interventions to improve the quality of teaching are urgently needed and should include training on teaching techniques and student assessment for tutors, provision of audio visual equipment and teaching aides such as posters and mannequins. Monitoring and Evaluation of interventions is critical to be able to amend the programmes approach and address further challenges at an early stage.