Page 98 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 6 Original Research

Mentoring programmes supporting the scale-up of HIV Structured interviews to explore health workers’ perceptions
treatment in sub-Saharan Africa (SSA) have frequently of the implementing agency’s mentoring programme were
focussed either on mentoring clinical staff or on supporting conducted by independent consultants with 74 participants
administrative and logistical processes. 1,4,5,6 While these (both male and female) from government health facilities
programmes have shown impressive results, their focus on in Limpopo Province, Gauteng and the Western Cape.
either clinical or administrative processes may lead to Interviews were conducted in person, in private rooms at
constraints in their effectiveness. Therefore, we explore the individual facilities, between October 2014 and July 2015.
role of targeted mentoring using a needs-based approach to Refusal rates were very low, with only five participants
support both clinical and some administrative processes as refusing to participate in interviews as a result of repeatedly
part of a technical assistance package targeting HIV and being unavailable or having to attend to urgent medical
tuberculosis (TB) services at public healthcare facilities in problems in their facilities. Participants were purposively
three provinces of South Africa. selected based on their involvement in the technical
assistance programme. Interviews were conducted with
Methods facility managers and their deputies, nurses, pharmacists

Study setting and data staff. While the evaluation included questions
relating to the entire technical assistance package, this article
The study was conducted at selected health facilities in focusses on understanding healthcare workers’ perceptions
Limpopo, Gauteng and the Western Cape. Facilities in of the mentoring component of the package.
Limpopo and the Western Cape were situated in rural
districts, while the Gauteng facilities were located in peri- Signed informed consent was obtained from all participants
urban townships. All facilities had been receiving technical prior to their participation. To maintain anonymity of
assistance from Anova Health Institute (hereafter referred to respondents, no identifying information was collected.
as ‘the implementing agency’) since 2010, and most had The study protocol and materials were approved by the
previously been sites where the agency had directly provided University of the Witwatersrand’s Human Research Ethics
HIV-related services. Committee (M120625).

The implementing agency’s HIV and TB-related health systems Data analysis
strengthening (HSS) support activities were primarily funded
by USAID/PEPFAR. In 2009, PEPFAR’s focus shifted away Interviews were audio-recorded and transcribed verbatim.
12
from direct service provision towards technical assistance Data were managed using NVIVO 11 and were analysed
13
and HSS. Hence, the focus of the implementing agency’s using a thematic analysis approach. Firstly, interview
7
work between 2009 and 2014 was on HSS and the provision transcripts were read carefully while paying particular
of technical support to the South African Government’s HIV attention to discussion related to the mentoring programme.
response, with staff mentoring forming a central aspect of Once the two authors responsible for data analysis were
this support. Mentoring was provided to nurses to assist with familiar with the data set, initial coding was conducted
the implementation of nurse initiated and managed ART independently by each author to identify units of text with
(NIMART); to data capturers and administrators to assist relevance to the research topic. Text units dealing with the
with managing the ART (antiretroviral therapy) programmes same issue were grouped together in an initial set of themes
reporting requirements; and to pharmacy staff to support and 48 basic themes were interpreted from the data in this
efficient stock control and pharmacy management. stage. The same unit of text could be included in more than
one theme.
Theoretical framework
These themes were then discussed and refined in relation to
This study was informed by literature focussing on mentoring both the coded content of the basic themes, and the data set
as a broad approach to individual and organisational as a whole, in order to create a coherent set of organising
8,9
development in various contexts, as well as research themes. Five organising themes were produced in this
focussing more specifically on mentoring in the context stage of analysis. Finally, these organising themes were
of technical assistance programmes in LMICs. 2,5,10 This analysed to develop two main themes related to the role
literature was reviewed in reference to the World Health of the implementing agency’s mentoring programme in
11
Organization’s 2006 recommendations on the use of clinical implementing HIV-related services. These were: (1) targeted
mentoring to support HIV programme implementation in mentoring as knowledge and skills transfer and (2) mentoring
resource-limited settings. as psychosocial support.

Study design Ethical consideration
This study is a qualitative evaluation of the role of mentoring Signed informed consent was obtained from all participants.
as part of a technical assistance package targeting HIV and The study protocol was approved by the University of
TB services as provided by the implementing agency at public the Witwatersrand’s Human Research Ethics Committee
healthcare facilities in three South African health districts. (reference number: M120625).

http://www.sajhivmed.org.za 91 Open Access