Republic of Kenya

MINISTRY OF HEALTH

STRENGTHENING RH/HIV
INTEGRATION SERVICES
NATIONAL
MENTORSHIP
GUIDELINES FIRST EDITION
FEBRUARY 2013
 TABLE OF CONTENTS

Foreword.................................................................................................................................................. iv

Introduction............................................................................................................................................. 1

Overview of Mentoring..................................................................................................................... 1

National Mentorship Guidelines............................................................................................................. 1

Programme Objectives ................................................................................................................... 1

Mentorship Guidelines and Programme Organization .................................................................. 1

National Documents and Guidelines to Be Used in Mentorship Programme .............................. 2

Mentorship Programme Course Organization................................................................................ 3

Requirements for Successful Implementation....................................................................................... 4

Annex 1: Additional Resources............................................................................................................... 5

Annex 2: Abbreviations and Acronyms.................................................................................................... 6

Annex 3: Definitions and Glossary.......................................................................................................... 6

Annex 4: List of contributors................................................................................................................... 7

 FOREWORD

Operational research and scientific evidence demon- Evidence through operational research has dem-
strate that integration of HIV and Sexual and Reproduc- onstrated that mentoring is one feasible strategy for
tive Health (SRH) services improves access to and quality provider training and is acceptable among health service
of the two individual services. However, this process providers and managers at different levels of health
requires additional knowledge and skills to maximise care. The National Mentorship Guidelines respond to
service provision. Although a number of approaches, the objectives of the National Reproductive Health and
such as off-site training workshops, have been applied to HIV Integration Strategy and aims to strengthen the
improve knowledge and skills of health workers in Kenya, human resources capacity for providing integrated RH
capacity-building remains a challenge within our larger and HIV services at all levels and increasing demand for
Reproductive Health Plan. The cost of off-site training is high-quality RH and HIV services. In order to apply the
often prohibitive and scarce human resources also make objectives of the Guidelines, providers and managers
it difficult for health workers to leave their facilities to at- utilize the Mentor’s Guide and Mentee’s Guide to employ
tend training workshops. a mentoring training approach and equip healthcare
workers with the necessary skills critical for successful
RH/HIV integration.

Dr. S.K Sharif Dr. F. Kimani

Director, Public Health and Sanitation Director, Medical Service
Ministry of Public Health & Sanitation Ministry of Medical Services

iv
 INTRODUCTION

Integration of healthcare services provides an unpar- Mentoring has a particular place in Kenya’s health
alleled opportunity to expand access to a wide range services as the National Reproductive Health Training Plan
of care for women and their families, including family 2007–2012 emphasized the use of participatory train-
planning, HIV testing and counselling, and other health ing processes and solidifying the link between theory and
services including cervical cancer screening and physical practice, in order to improve the use and performance of
exams. This effort is driven by the fact that many clients its health personnel.1 After development and pilot trials,
have the need for several services simultaneously and of- Kenya’s Division of Reproductive Health (DRH) and National
fering them all in the same venue and through the same AIDS & STI Control Programme (NASCOP) worked closely
provider reduces the number of missed opportunities. with a technical working group of experts to compile the
Capacity-building for integrated RH/HIV services is a key Mentorship Guidelines. These Guidelines and accompany-
strategy in improving the uptake of these integrated ser- ing tools orient mentors and mentees through a structured
vices among women in Kenya. In this process, healthcare Mentorship Programme focusing on strengthening capacity
workers must become familiar with a broader range of and increasing demand for integrated RH/HIV services.
skills and gain competencies in clinical application of all
types of services. Overview of Mentoring
The mentorship approach is one methodology of train- The goal of mentoring is to advance professional devel-
ing that allows providers to enhance their knowledge and opment and establish productive, independent service
skills in broad areas of content without providers in RH /HIV integration. Mentoring is a one-on-
moving outside of the work station for theoretical and one knowledge and skills transfer relationship between
practical instruction. With mentorship, their place of a more experienced individual (the mentor) and a novice
employment is their classroom. This capacity-building (the mentee). In addition to imparting new skills and
strategy lends itself to a greater continuity of care for the knowledge base, mentoring assists the mentee in estab-
patients while providers continue to practice and expand lishing clear and defined learning goals, fosters individual
their clinical skills. growth and development, and facilitates strong profes-
sional relationships.

NATIONAL MENTORSHIP GUIDELINES

The National Guidelines for Mentoring are designed to pro- Mentorship Guidelines and
vide guidance to mentors participating in mentorship pro-
gramme for proper integration of RH/HIV services and effec-
Programme Organization
tive capacity-building. The guidelines describe a programme The mentorship programme is based on a flexible model
designed to mentor health workers and emphasizes the that allows providers to learn while at the same time to
provision of quality care as well as ensuring appropriate continue providing much-needed RH/HIV services in their
documentation, referrals, and client linkages to services. respective health facilities.

Upon deciding that a hospital or province will initi-

Programme Objectives
ate a Mentorship Programme, experienced nurses and
1. Strengthen the provision of quality integrated HIV and healthcare workers in HIV/FP/PNC are selected to be
RH services mentors. This selection is based on a range of character-
2. Improve the health services provider’s skills and istics including the candidate’s extensive experience with
knowledge on RH/HIV integration including the long- integrated RH/HIV services and the Balanced Counselling
term methods of family planning Strategy, as well as his/her enthusiasm for mentoring and
3. Build understanding of the concept of mentoring and appropriate attitudes towards training others. Mentors
its potential role in capacity building are trained during a five to ten day induction workshop to
4. Provide user-friendly guidelines for the implementa- ensure that their skills are up-to-date and comprehensive
tion of a mentorship programme for integrated RH in all areas of integrated services. Further details about
and HIV services

1
MOH Division of Reproductive Health. 2007. National Reproductive Health Training Plan
2007–2012. Nairobi: Ministry of Health.
1
the contents of this Mentorship Induction are outlined in National Documents and Guidelines
the Mentor’s Guide.
to Be Used in Mentorship Programme
Upon receiving certification after Induction, mentors
The National Mentorship Guidelines document is not
return to their facilities where they begin working directly
intended to be a training document itself but serves as a
with approximately five mentees for three to six months
guide to mentors through the RH/HIV Integration lessons
in the Mentorship Programme. During the mentorship
and topical areas that will be addressed during the Men-
programme, mentors and mentees establish a one-on-
torship Programme. Content of each of these lessons
one professional relationship where the mentor teaches
should be drawn from existing national guidelines and
the mentee important RH/HIV integration skills and
documents listed below. Referring to these documents
knowledge. A total of 14 sessions are included in the
throughout the mentorship process will ensure that
mentorship course. Topics include physical assessments,
mentors are imparting the most up-to-date, relevant, and
family planning counselling, HIV testing and counselling,
accurate knowledge and skills to their mentees.
documentation and referral, among others. Content for
each session is based on existing Kenya’s Ministries of Balanced Counselling Strategy Plus: A Toolkit for Family
Health national trainings and guidelines which outline Planning Service Providers Working in High HIV/STI
specific information necessary for effective integration of Prevalent Settings, Population Council and Ministry of
services. Mentors must have these documents available Public Health and Sanitation, Kenya, 2012.
during the mentorship programme.
Family Planning: A Global Handbook for Providers, WHO
Mentors observe mentees practice skills from each and Johns Hopkins Bloomberg School of Public Health
session with clients in their facility and provide guidance Centre for Communication Programs, 2011
and correction when appropriate. Mentees graduate from
Guidelines for the Prevention of Mother-to-Child Trans-
the Mentorship Programme when mentors consider them
mission (PMTCT) of HIV/AIDS in Kenya, National AIDS &
competent and able to complete each task individually.
STI Programme (NASCOP), Kenya, 2009
Healthy Timing and Spacing of Pregnancy:
Sequence of National Mentorship Programme Implementation A Trainer’s Reference Manual, USAID
2008
Need identified for Integrated RH/HIV Integrated Counselling and Testing for
and Capacity-Building Programme
Development of HIV into Family Planning Service Trainers
Mentorship Manual, Ministry of Public Health & Sani-
Advocacy meetings held; Programme
financial and political support garnered tation and Ministry of Medical Services,
Kenya, 2007
Situation analysis National, county and
district level Integrating the Management of STIs/RTIs
Materials, tools, supplies developed and collected into Reproductive Health Services Pocket
Handbook for Providers, Ministry of Public
Health & Sanitation and Ministry of Medi-
cal Services, Republic of Kenya, 2010

Mentors selected Medical Eligibility Criteria for Contracep-

Mentorship tive Use, 4th Ed. World Health Organiza-
Mentor Induction Workshop Programme tion, 2009
5 days implementation
Minimum Package for Reproductive
Mentorship Programme with mentees Health and HIV Integrated Services,
3 to 6 months County and
facility level Ministry of Public Health & Sanitation and
Facility managers support and supervise Ministry of Medical Services, Kenya, 2012
National Family Planning Guidelines for
Service Providers, Division of Reproduc-
tive Health in the Ministry of Public Health
and Sanitation, Kenya, 2010
Mentee–mentor internal evaluation
Mentorship
Programme National Guidelines for HIV Testing and
Mentee assessment and certification assessment and Counselling in Kenya, 2nd Ed., National
evaluation AIDS & STI Programme (NASCOP), Kenya,
Programme evaluation National, county and 2010
facility level
Dissemination of results

2
Components and Tools of the Mentorship Guidelines Package
GUIDELINES AND MANUALS
National Mentorship Guidelines to Strengthen Executive summary of National Mentorship Guidelines and
Integrated RH/HIV Services Programme
Mentor’s Guide Guidebook and reference guide to relevant national documents
and training materials for mentors to use during the Mentorship
Programme
Mentee’s Guide Guidebook and reference manual including all sessions and
course content to use during and after Mentorship Programme
TOOLS
Mentor’s Pre- and Post-Induction Workshop Multiple-choice test that evaluates the mentor’s knowledge and
Assessment skill level before and after participation in the Mentor Induction
Workshop
Mentee’s Initial Assessment Form Assessment form completed by the mentee before mentorship
documenting prior trainings attended and self-perceived skill set
in integrated services
Mentee’s Clinical Protocol: Skills Assessment Checklist completed by mentor evaluating mentee’s performance
Checklist during observation of specific clinical activities.
Mentee’s Clinical Protocol: Comprehensive Final checklist completed by mentor to evaluate mentee’s overall
Integrated RH/HIV Skills Assessment performance of all clinical activities over the entire mentorship
Checklist period. A score of 85% indicates a passing grade.
Mentee’s Log Book Patient logbook for the mentee to document each time he/she
completed a clinical activity. Logs to be turned in to mentor for
evaluation purposes.
Mentor’s Monthly Summary Sheet Log of all monthly activities related to mentoring programme
completed by mentor
Evaluation Form Form completed by mentees at completion of mentorship pro-
gramme to evaluate performance of the mentor, and quality of
reference materials and programme overall.

National Guidelines for Prevention and Management of Sexually Transmitted and Other Reproductive Tract
Cervical, Breast and Prostate Cancers, Ministry of Public Infections: A Guide to Essential Practice, World Health
Health & Sanitation and Ministry of Medical Services, Organization, 2005
Kenya, 2012
National Guidelines for Quality Obstetrics and Perinatal Mentorship Programme Course
Care, Ministry of Public Health & Sanitation and Ministry Organization
of Medical Services, Kenya, 2012
Below is an outline of the topical sessions included in the
National Infection Prevention and Control Guidelines for Mentorship Induction workshop and also then practiced
Health Care Services in Kenya, Ministry of Public Health by the mentee during the Mentorship Programme. During
& Sanitation and Ministry of Medical Services, Kenya, the Mentorship Induction workshop, competencies and
2010 skill sets of mentors is validated and approved. During
National Orientation Package for Targeted Postnatal the mentorship programme, the mentor provides theo-
Care: Orientation Manual for Health Providers, Power- retical and practical instruction and the skills in each
Point, Ministry of Public Health & Sanitation, Kenya 2011 session are practiced and evaluated. Content for each
session is based on information from national guidelines
National Training Manual on Integrating Counselling and and trainings listed above.
Testing for HIV into Family Planning Services, Ministry of
Health, Kenya, 2008

3
Sessions • STI Prevention and Management
• Basic Concepts in Mentoring • Postnatal/Postpartum Care
• RH/HIV Integration • Family Planning and Healthy Timing and Spacing of
Pregnancy
• Infection Prevention
• Balanced Counselling Strategy Plus (BCS+)
• Normal Anatomy and Physiology of Reproductive
System • HIV Counselling and Testing (HC&T)
• Physical Exam • Referral and Service Linkages
• Pelvic Exam • Documentation and Recordkeeping
• Cervical Cancer Screening

REQUIREMENTS FOR SUCCESSFUL IMPLEMENTATION

National-, regional-, and county-level HIV and RH manag- healthcare workers to train as mentors and to select as
ers need to be involved in all aspects of the develop- mentees, as well as gaps in current service delivery that
ment, implementation, and evaluation of the Mentorship should be emphasized in programme. This information
Programme in order for it to be successful and have can be derived from existing data sources as well as
the desired impact. In its development, programme primary data via data collection methods such as:
planners and implementers benefit from a supportive • provider interviews
and enabling environment where decision makers and
• health facility assessments
managers demonstrate support of the activities as well
as facilitate their implementation. This means that all • client–provider observations, or
involved parties must maintain open communication and • client flow analysis
mutual respect for one another while also ensuring that
Thirdly, adequate supply of space, equipment, materi-
all parties involved are well aware of ongoing activities
als, and tools necessary for teaching and demonstrating
and expectations.
all clinical and theoretical lessons within the Mentorship
Because RH/HIV integration and capacity-building Programme is of great importance. The Mentor Induction
through mentorship is a relatively new process, aware- workshops and didactic mentee trainings may take place
ness and advocacy meetings should be conducted with in classrooms in health facilities with adequate chairs
managers at all levels of the healthcare system, includ- and tables for all participants while also being close
ing the health facilities where the mentoring is to be to clinical areas where practical sessions will be con-
conducted. The aim of these advocacy meetings should ducted. Required materials during classroom sessions
be to ensure the comprehensiveness of the mentoring may include flip charts, paper, pens, markers, and other
process, to enlist support, and to garner buy-in from facil- teaching materials; copies of the Mentorship Guidelines,
ity managers and decision makers. Mentor’s Guide, Mentee’s Guide, and relevant national
Secondly, adequate data must be available before guidelines and training materials are also required to en-
programme implementation to determine the most sure an effective and successful mentorship programme.
appropriate facilities for implementation, and which

4
 ANNEX 1 Additional Resources

Ali, P. and W. Panther. 2008. “Professional development Republic of Kenya Ministry of Public Sanitation and
and the role of mentorship,” Nursing Standard 22: Health. 2006. Reproductive Health Checklists for
35–39. Trainers: Kenya National Comprehensive Reproduc-
tive Health Curriculum for Service Providers. Nairobi:
Hardee, K., J. Gay, and E Dunn-Georgiou. 2009. A Practi-
Ministry of Public Sanitation and Health.
cal Guide to Integrating Reproductive Health and HIV/
AIDS into Grant Proposals to the Global Fund. Wash- Republic of Kenya. 2009. National Reproductive Health
ington, DC: Population Action International. and HIV&AIDS Integration Strategy. Nairobi: Ministry
of Public Health and Sanitation and Ministry of Medi-
Interagency Working Group on SRH and HIV Linkages.
cal Services.
201). “SRH & HIV Linkages Resource Pack.” Available
at http://www.srhhivlinkages.org/en/index.html Republic of Kenya. 2009. National Reproductive Health
Strategy 2009–2015. Nairobi: Ministry of Public
Jhpiego. 2012. “Reproline Plus: The Source for Techni-
Health and Sanitation and Ministry of Medical Ser-
cal Expertise in Global Health Practice.” Available at
vices.
http://reprolineplus.org/
Republic of Pretoria. 2005.Clinical Mentorship Manual
Johnson, G. 2005. Mentoring for Nurses in General
for Integrated Services. Ed. by Department of Health
Practice: Opportunities and Challenges. Melbourne:
ROSA. Pretoria: Pretoria DOH.
Australian Mentor Centre.
UNFPA and IPPF. 2004. “Integrating HIV Voluntary
Knowles, M.S. 1990. The Adult Learner: A Neglected
Counselling and Testing Services into Reproductive
Species. 4th ed. Houston, TX: Gulf Publishing Company.
Health Settings: Stepwise Guidelines for programme
McKimm, J, C. Jollie, and M. Hatter. 2003. “Mentoring: planners, managers, and service providers.” Available
Theory and practice,” in Preparedness to Practice, at: http://unfpa.org/upload/lib_pub_file/245_file-
mentoring scheme. Edited by Medicine Nisco. name_hiv_publication.pdf
http://www.faculty.londondeanery.ac.uk/e-learning/
UNICEF, UNFPA, WHO, Worls Bank. 2010. “Packages
feedback/files/Mentoring_Theory_and_Practice.pdf
of interventions for family planning, safe abortion
Mills JE, Francis KL, Bonner A.  Mentoring, clinical su- care, maternal, newborn and child health.” Avail-
pervision and preceptoring: clarifying the conceptual able at: http://whqlibdoc.who.int/hq/2010/WHO_
definitions for Australian rural nurses. A review of the FCH_10.06_eng.pdf.
literature. Rural and Remote Health 5: 410. (Online)
World Health Organization. 2005. “WHO recommenda-
2005. Available: http://www.rrh.org.au
tions for clinical mentoring to support scale-up of HIV
Mwangi, A. et al. 2008. “Strengthening postnatal care in- care, antiretroviral therapy and prevention in resource-
cluding postpartum family planning in Kenya-FRONTIERS constrained settings.” Geneva and Kampala, Uganda:
Final Report.” Washington, DC: Population Council. WHO.
PATH. 2004. “Course in visual methods for cervical can- World Health Organization. 2011. Family Planning: A
cer screening: Visual inspection with acetic acid and Global Handbook for Providers. Baltimore and Gene-
Lugol’s iodine.” Seattle, WA: PATH. va: Johns Hopkins Bloomberg School of Public Health/
Center for Communication Programs and World Health
Population Council. (2010). Planning and Implementing an
Organization.
Essential Package of Sexual and Reproductive Health
Services: Guidance for Integrating Family Planning and World Health Organization. 2008. “Service integration,
STI/RTI with other Reproductive Health and Primary linkages, and triage,” Chapter 3 in Operations Manual
Health Services. Washington, DC: Population Council. for Delivery of HIV Prevention, Care and Treatment at
Primary Health Centres in High-Prevalence, Resource-
Population Council. 2012. “Fact Sheet: Reproductive
Constrained Settings, Ed. 1. Geneva: WHO.
Health-HIV Integration Activities in Kenya.” Nairobi:
Population Council.

5
 ANNEX 2 Abbreviations and Acronyms

ANC Antenatal Care

BCS Balanced Counselling Strategy
DRH Division of Reproductive Health
FP Family Planning
HC&T HIV Counselling and Testing
HIV Human Immunodeficiency Virus
NASCOP National AIDS and STIs Control
Programme
PNC Postnatal Care
RH Reproductive Health
STI Sexual Transmitted Infection
SRH Sexual Reproductive Health
WHO World Health Organization

ANNEX 3 Definitions and Glossary

Supportive/facilitative supervision: A management Mentee: Someone who seeks assistance with their pro-
approach used in systems improvement and/or quality- fessional development or personal growth from a more
of-care improvement of a healthcare facility. This type of experience colleague, peer, or expert.
supervision is hierarchical yet supportive, whereby the
On-the-job training: Professional training provided at and
supervisor/manager serves as a liaison between the
created by one specific institution to advance skills and
staff and external support in efforts to improve level of
knowledge of its employees. On-the-job training is many
skills and knowledge among staff members.
times a component of new employee orientation and en-
Mentor: Someone who helps another person through an tails a variety of training techniques, including mentoring,
important transition, e.g., career development, personal coaching, practical, and supportive.
growth, or coping with a new situation. A mentor facili-
tates professional development of his/her mentee by
adopting the role of a counsellor and a confidant (e).

6
ANNEX 4 List of Contributors

Name DESIGNATION / ORGANIZATION EMAIL

1. Dr Issak Bashir Head , DRH MOPHS drbashirim@yahoo.com
2. Dr Shiphrah Kuria Programme Manager - MOPHS shiphonk@yahoo.com
3. Betty Chepkwony NASCOP f.chepkwony@yahoo.com
4. Bernard M. Nyakundi UON bnyakundi_2003@yahoo.com
5. Jane M. Kanja DTC-Nakuru janemumbi58@yahoo.com
6. Bellita Musau Machakos DMOH bellincs@yahoo.com
7. Assumpta Matekwa MOPHS-Western assumatekwa@yahoo.com
8. Paul Nyachae Jhpiego-Tupange pnyachae@tupange.or.ke
9. Fatuma Dubow MOPHS-DRH telagewe2002@yahoo.com
10. Ruth Muia DRH truth20057@yahoo.com
11. Averie Baird LSHTM averie.baird@gmail.com
12. Lucy Ndwiga Thika Level 5 Hospital ndwigalucy@yahoo.com
13. Ruth Maithya AMREF ruth.maithya@amref.org
14. Dr Rose Masaba FHI360 rmasaba@fhi360.org
15. Joyce Lavussa WHO lavussaj@ke.afro.who.int
16. Purity Karimi MOMS-POMS Office Embu puritybaruthi@yahoo.com
17. Beatrice Muriithi MOMS-POMS Office Nyeri beatricenthumbi@yahoo.com
18. Dr Jahonga Ruth RH/FP Advisor Aphiaplus Kamili rjahonga@aphiapluskamili.org
19. Dr Julius Rogena MOPHS-PASCO jrogena@yahoo.com
20. Rose Micheni MOPHS-Eastern gakiimicheni@yahoo.com
21. Muthoni Mugo Population Council munimugo@gmail.com
22. Charity Ndwiga Population Council cndwiga@popcouncil.org
23. Mary Ngutu MOPHS-PASCO mngutu@gmail.com
24. Paul Nzioki MOPHS-DDPHN pnthei@gmail.com
25. Charlotte Warren Population Council cwarren@popcouncil.org
26. Wilson Liambila Population Council wliambila@popcouncil.org
27. Edwin Odoyo Population Council eodoyo@popcouncil.org
29. Agnes Gichoho MOPHS Central province agnesgichogo@gmail.com
30. Irene Kasyoki Population Council imkasyoki@gmail.com
31. Dr Muraya Joram PASCO MOPHS-Central Muraya30@gmail.com
32. Dr Marsden Solomon RH Advisor FHI360 msolomon@fhi360.org
33. Jones N. Abisi Senior Tech Officer FHI360 jabisi@fhi360,org
34 Dr Fred Akonde OBG.GYNE Marie Stopes –Kenya Fred.akonde@mariestopes.or.ke

7
Republic of Kenya
MINISTRY OF HEALTH

The production of this publication was supported by:

www.popcouncil.org

For enquiries, please contact:

National AIDS and STI Control Programme (NASCOP)

P.O. Box 19361 - 00202, Nairobi Kenya. Tel: +254 202 263 0867
email: info@nascop.or.ke, website: www.nascop.or.ke

Division of Reproductive Health, Ministry of Health

P.O. Box 43319 - 00100, Nairobi Kenya. Tel: +254 020 272 5105
website: www.drh.go.ke

© 2013 Kenya Ministry of Healtrh