Page 100 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 4 of 6 Original Research

‘[The mentor] gives technical support whenever I have a problem, ‘With complicated cases I like to know that [I] can phone [the
I call or they visit and whatever challenges I face they come.’ implementing agency].’(Facility manager 1, Johannesburg)
(Data capturer 2, Limpopo)
‘I’m being mentored at the moment, and it really helps to know
the doctor is there.’ (Nurse 3, Johannesburg)
In this reactive role, mentors were able to facilitate skill
building and knowledge transfer by ensuring that they were Participants’ willingness to contact their mentors when they
available to assist the DoH staff when the need arose; and experienced problems was also a result of trust and support
participants noted that mentors used the opportunities that mentors built up when interacting with the DoH staff
provided by the DoH staff contacting them to build on the when they were asked for help:
knowledge they gained through training:
‘And when my mentors come and evaluate me they don’t
‘Last week there was a patient here and we called [Name] and she complain, they just guide.’ (Nurse 2, Limpopo)
consulted with another doctor and came back to me to do in-
service training and teach us about the HIV virus and how deal ‘They give us a listening ear … they do not come to find mistakes
with the patients.’ (Facility manager 1, Limpopo) but to give us support and information to have team work spirit.’
(Deputy facility manager 2, Limpopo)
‘[Name] is my mentor and she regularly comes to check my
defaulter list – every problem I come across she is there to help These quotes also point to the importance of developing
… there was a duplication of patients and she helped.’ (Data
capturer 3, Gauteng) personal relationships between mentors and mentees which
in turn meant that participants felt comfortable enough to
While the DoH staff clearly valued the role of the contact their mentors when they needed help.
implementing agency’s mentors, the implementation of
reactive mentoring required careful attention to the level and A second important way in which the mentoring programme
type of assistance requested by healthcare workers to ensure provided psychosocial support to the DoH staff was by
that mentees continued to develop their own skills and did facilitating an improvement in health workers’ self-efficacy
not become overly dependent on their mentors, for example: for implementing their training and managing the initiation
of ART without having doctors present:
‘They help me with a lot of things I cannot work without them.’
(Nurse 4, Johannesburg) ‘I am like a doctor in the clinic as I can initiate.’ (Nurse 5, Limpopo)
‘I feel it empowered me through what I learnt and learn every
A second challenge in terms of reactive mentoring was that day.’ (Nurse 7, Limpopo)
because they were each responsible for several health
facilities, mentors were sometimes unavailable when their Finally, several nurses discussed how their mentors provided
help was needed. This had the potential to become an emotional outlet, which allowed them to deal with the
problematic as it could result in a breakdown in trust between stress of taking on the responsibility of initiating and
mentors and mentees: managing patients on ART:
‘They used to come but now that they have to service other ‘And the mentors come and encourage us as sometimes we get
clinics it is minimal.’ (Nurse 7, Limpopo) depressed when patients stop taking drugs.’ (Nurse 2, Limpopo)
‘Their support is helpful, and if we are feeling stressed we
Both proactive and reactive mentoring contributed to the offload.’ (Nurse 1, Limpopo)
ability of the DoH staff to implement the knowledge and
skills gained through attending training courses and Discussion
workshops. However, in addition to this, our interpretation
of participant interviews suggested that the mentorship The use of mentoring as an integral part of the implementing
programme also played an important empowering role for agency’s technical assistance programme appears to be
staff by providing a source of psychosocial support as they successful in facilitating healthcare workers’ implementation
took on new responsibilities. of knowledge and skills gained through training. Based on
our interpretation of evaluation interviews conducted with
healthcare workers, we suggest several attributes of the
Mentoring and psychosocial support programme contributed to this success.
The role of mentors in providing psychosocial support was
most important among nurses who were beginning to initiate Firstly, the mentoring programme used a multifaceted
ART. There were several ways in which the mentorship approach to supporting the health system. The implementing
programme provided psychosocial support to these staff. agency’s prior service delivery in the three provinces led them
Firstly, simply knowing that mentors were available to assist to identify key bottlenecks to ART implementation, and the
in problem-solving was important in enabling participants to mentoring programme was therefore designed to support
implement their training. The idea that their mentors were the clinical, administrative and pharmacy facets of the health
‘just a phone call away’ allowed them to take on this role system simultaneously. Chien et al. studied a similar approach
without undue fear that they would cause harm to their to mentoring in Malawi and found that supplementing
patients: clinical mentoring with support for facility and district-level

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