Clinical Mentorship Guideline

THE UNITED REPUBLIC OF TANZANIA
MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER,

ELDERLY AND CHILDREN
National Reproductive Maternal

New born Child and Adolescent Health
Clinical Mentorship Guideline
April, 2016
© Permanent Secretary
Ministry of Health and Social Welfare
6 Samora Machel Avenue
P.O. Box 11478 Dar es Salaam Tanzania
Phone: +255-22-2342000/5 | Fax: +255-22-2137951
Website: www.moh.go.tz | E-mail: ps@moh.go.tz
ii National Reproductive Maternal New born Child and Adolescent Health

CLINICAL MENTORSHIP GUIDELINE
TABLE OF CONTENTS
DEFINITION OF TERMS............................................................................................................................................ v
ABBREVIATIONS...................................................................................................................................................... vi
FOREWORD............................................................................................................................................................vii
ACKNOWLEDGEMENT...........................................................................................................................................viii
CHAPTER 1.0
INTRODUCTION....................................................................................................................................................... 1
1.1 Background........................................................................................................................................... 1
1.2 Quality Assurance................................................................................................................................. 1
1.3 Clinical Mentorship Overview.............................................................................................................. 2
1.4 Relationship between Clinical Mentorship and Supportive Supervision............................................. 2
1.5 Rationale............................................................................................................................................... 3
1.6 Goal and Objectives.............................................................................................................................. 3
1.6.1 Goal............................................................................................................................................. 3
1.6.2 Objectives.................................................................................................................................... 3
1.7 About the Clinical Mentorship Guideline.............................................................................................. 3
1.7.1 This guideline is intended to be used; ........................................................................................ 3
1.7.2 The audience for these guidelines includes but is not limited to:............................................... 3
1.7.3 Clinical mentorship guideline embraces the following key components;................................... 3
CHAPTER 2
CLINICAL MENTORSHIP IMPLEMENTATION LEVELS................................................................................................. 4
2.1 Implementation Structure.................................................................................................................... 4
2.2 Roles of National, Zonal/Regional, Council, PMORALG, and Health Facilities...................................... 5
2.2.1 National Level.............................................................................................................................. 5
2.2.2 PORALG....................................................................................................................................... 5
2.2.3 Zonal Level................................................................................................................................... 5
2.2.4 Regional Level.............................................................................................................................. 5
2.2.5 Council Level................................................................................................................................ 5
2.2.6 Health Facilities council............................................................................................................... 5
2.2.7 Community.................................................................................................................................. 6
CHAPTER 3.0
TYPES OF MENTORING APPROACHES AND METHODS............................................................................................ 7
3.1 Types of Mentoring Approaches .......................................................................................................... 7
3.1.1 Downward Mentoring................................................................................................................. 7
3.1.2 Upward Mentoring...................................................................................................................... 7
3.1.3 Peer-to-Peer Mentoring.............................................................................................................. 7
3.1.4 Distance Mentoring..................................................................................................................... 8
3.1.5 Preceptor ship............................................................................................................................. 8
3.2 Types f Mentoring Methods................................................................................................................. 8
3.2.1 Performance standards assessments: ........................................................................................ 8
3.2.2 Bedside/clinic-based teaching: ................................................................................................... 8
3.2.3 Documentary reviews: ................................................................................................................ 8
3.2.4 Clinical meetings: ........................................................................................................................ 8
CHAPTER 4.0
MANAGEMENT OF THE MENTORING PROCESS...................................................................................................... 9
4.1 Trainings in RMNCH Clinical Mentorship.............................................................................................. 9
4.1.1 Training of Trainers and Clinical Mentors.................................................................................... 9
4.1.2 Training of Training...................................................................................................................... 9
4.1.3 Categories and Roles of Trainers................................................................................................. 9
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4.1.4 Selection Criteria of Trainers..................................................................................................... 10
4.1.5 Training of Clinical Mentors ...................................................................................................... 10
4.1.6 Selection criteria of Clinical Mentors......................................................................................... 10
4.1.7 Characteristics of a clinical mentor........................................................................................... 10
4.1.8 Roles of Clinical Mentors........................................................................................................... 11
4.1.9 Recognition of Clinical Mentors and Mentees........................................................................... 11
4.2 Criteria for recognition....................................................................................................................... 11
4.2.1 Mechanisms of Recognition in Clinical Mentorship.................................................................. 11
CHAPTER 5.
IMPLEMENTATION OF CLINICAL MENTORSHIP...................................................................................................... 12
5.1 Creating an Enabling Environment for Clinical Mentors.................................................................... 12
5.2 Resources Required for Mentoring Activities and Budget................................................................. 12
5.3 Implementation Phase....................................................................................................................... 12
5.4 Minimum Timeline of Clinical Mentorship......................................................................................... 13
5.5 For Post Mentoring follow up............................................................................................................ 13
5.6 Coordination of Integrated RMNCAH mentoring activities................................................................ 13
CHAPTER 6.0:
MONITORING AND EVALUATION........................................................................................................................... 14
6.1 Tracking of enabled environment for the implementation................................................................. 14
6.2 Assessment of Performance of the Clinical Mentor........................................................................... 14
6.3 Assessment of Performance of the Mentee...................................................................................... 14
6.4 Improved service delivery uptake....................................................................................................... 15
6.5 Impact................................................................................................................................................. 15
6.6 Tools to be used.................................................................................................................................. 15
6.7 Performance Indicators Framework................................................................................................... 16
CHAPTER 7
ANNEXES
Annex 1: List of Components of RMNCAH Learning Resource Packages.............................................................. 19
7.1 Guideline, Job Aids, and Performance Standards for Newborn and Child Health............................. 19
7.2 Kangaroo Mother Care (KMC)............................................................................................................ 19
7.3 Helping Babies Breathe (HBB)............................................................................................................ 19
7.4 Essential Newborn Care (ENC)........................................................................................................... 19
7.5 Growth Monitoring............................................................................................................................ 19
7.6 Paediatric Quality of Care.................................................................................................................. 20
7.7 Guideline, Job Aids, and Performance Standards for Family Planning:.............................................. 20
7.8 Guideline, Job Aids and Performance standards for Safe Motherhood ................................................
Initiative............................................................................................................................................. 20
7.9 Guideline, Job Aids and Performance standards for Reproductive Cancers...................................... 20
7.10 Guideline, Job Aids and Performance standards for Immunization and Vaccine ........................
Development........................................................................................................................... 20
7.10 Guideline, Job Aids and Performance standards for Adolescent Reproductive ..........................
Health...................................................................................................................................... 21
7.12 Guideline, Job Aids and Performance standards for Prevention of Mother to ...........................
Child Transmission................................................................................................................... 21
7.13 Guideline, Job Aids and Performance standards for Gender................................................... 21
Annex 2: RMNCAH Monitoring and Evaluation Tools............................................................................................ 21
Annex 2: 1 RMNCAH Clinical Mentor Performance Standards.......................................................... 21
Annex 2.2 Clinical mentors’ assessment checklist............................................................................ 25
Annex 2.3 Clinical Mentoring Activity Summary Report................................................................... 26
Annex 2.4 Clinical Mentoring Monthly Summary Report –.............................................................. 27
Annex 3: List of Members who participated in Guideline Development............................................................... 28
Bibliography........................................................................................................................................................... 31
iv National Reproductive Maternal New born Child and Adolescent Health

DEFINITION OF TERMS
i. Competency – is the ability to perform a specific task procedure or activity safely and effectively. It can
also is regarded as a set of related tasks and activities required to perform a job successfully.
ii. Proficient: Implies the expertise/skills/talent/capability that a person/technical person has in
performing a certain tasks.
iii. Checklist: A checklist is list of items required, things to be done, or points to be considered, used as a
reminder.
iv. Objective structured clinical examination (OSCE): is a tool whereby an assessor observes a skills
station which requires performing a task or carrying out an examination with a clearly defined set of
components that the candidate is expected to perform. It is used mostly in evaluating medical student
in training.

v
ABBREVIATIONS
AGOTA Association of Gynaecologist and Obstetricians Tanzania
BIPAI Baylor International Paediatric AIDS Initiative
CCHP Comprehensive Council Health Plan
CHMT Council Health Management Team
CHAI Clinton Health Access Initiative
CHW Community Health Worker
CIFF Children Investment Fund Foundation
CSOs Civil Society Organizations
DRCHCO Council Reproductive and Child Health Coordinator
EGPAF Elizabeth Glasier Paediatric AIDS Foundation
HMIS Health Management Information –System
ITECH International Training and Education for Health
IVD Immunization and Vaccines Development
JICA Japanese International Co-operation Agency
M & E Monitoring and Evaluation
MNCH Maternal, Newborn and Child Health
MOHCDGEC Ministry of Health, Community Development, Gender, Elderly and Children
NACP National AIDS Control Programme
PAT Paediatric Association of Tanzania
PMORALG Prime Minister Office Regional administration and Local Government
PSI Population Services International
RRCHCO Regional Reproductive and Child Health Coordinator
RCHS Reproductive and Child Health Services
RHMT Regional Health Management Team
RMNCAH Reproductive, Maternal, Newborn, Child and Adolescent Health
TAMA Tanzania Mid wives Association
TANA Tanzania Nurses Association
TQM Total Quality Management
UNFPA United Nation Population Fund
UNICEF United Nation Children’s Fund
UNCoLSC United Nation Commission on Life Saving Commodities
URC University Research Company
WHO World Health Organization
vi National Reproductive Maternal New born Child and Adolescent Health

FOREWORD
Tanzania as a member of Global health community, recognizes existing international strategies to reduce
maternal, newborn and child deaths by improving availability of family planning services; EmONC and
care of underfives . Taking this understanding into consideration, the Ministry of Health Community
Development,Gender,Elderly and Children decided to develop Reproductive, Maternal, Newborn, Child ren
nd adolescent Health (RMNCAH) Clinical Mentorship framework to ensure effective transfer of knowledge
and skills to health care providers.To effect the framework into implementation,the Ministry has developed
RMNCAH Clinical Mentorship guidelines,Participants handbook and Facilitators Manual.
This National RMNCAH Clinical Mentorship Guideline is a result of desk review of documents,existing
guidelines, tools, and resource packages. Clinical mentorship system aims to improve the quality of RMNCAH
clinical services in the country. The RMNCAH clinical mentorship system recognizes the existence of other
current quality service improvement systems in the health service provision, such as quality assuarance and
Total Quality Management(TQM). This guideline aligns to the National Road Map Strategic Plan to improve
Maternal, Newborn and Child Health in Tanzania that spells out the provision of quality reproductive and
child health services as one of its priority.This Guideline will assist programming of mentorship framework
at every level of health care system to support the process of quality improvement in the efforts of attaining
the Sustainable development Goals (SDGs)
Development of this guideline emanates from the fact that, having a skilled human resource for health at
workplace, remains an important key for quality, efficient and effective service provision. This component
has been and will continue to be critical especially at this stage when the Government of Tanzania is
continuing to recruiting the entire spectrum of skilled human resource for health ever year.
To sustain achievements of MDG 4&5 and propel SDGs agenda, the Ministry , recommends this guideline to
be used as a standard tool at different levels towards provision of RMNCAH care to enhance mentorship.
Dr. Mpoki M. Ulisubisya

Permanent Secretary

vii
ACKNOWLEDGEMENT
The Ministry of Health, Community Development, Gender, Elderly and Children wishes to
express its gratitude to all parties, which worked hard in the development of the RMNCAH
Clinical Mentorship Guideline. The completion of this book has been possible through extensive
consultations, reviews in collaboration with various stakeholders that included Government
institutions, NGOs and individual experts. The Ministry would like to acknowledge all
stakeholders who contributed in one way or another to accomplish development of this book.
The Ministry particularly wishes to acknowledge invaluable technical support from the
Directorates of Preventive Services, Human Resource Development, Policy and Planning,
Curative Services and Quality Assurance and other Government institutions, which are Regional
Health Management Teams and Council Health Management Teams; local professional
associations, including Paediatric Association of Tanzania, Tanzania National Nurses Association
, and Association of Gynaecologists and Obstetricians Tanzania; United Nations Population
Fund (UNFPA); Jhpiego (local and global office); Elizabeth Glaser Paediatric AIDS Foundation
(EGPAF).
Lastly, we appreciate the financial support from Children Investment Fund Foundation , UN
Commission on Life Saving Commodities and Jhpiego local office for its coordination that
emanated into this book.
Prof. Muhammad B. Kambi

Chief Medical Officer
viii National Reproductive Maternal New born Child and Adolescent Health
CHAPTER 1.0
INTRODUCTION
1.1 Background
Tanzania has mainstreamed several national policy documents targeting improvement of RMNCAH services.
Clinical mentorship comes at the right time when there is global and national level renewed focus on
strengthening the delivery and improvement of the quality of RMNCAH as outlined in the National RMNCAH
policy documents. There are several clinical mentoring programmes in the country on RMNCAH interventions
that have demonstrated effectiveness in building the skills of health care providers and improved service
delivery in terms of clinical outcomes. With integration of RMNCAH services there is a need to harmonize
different clinical mentorship approaches and hence the development of this guideline.
Clinical mentorship through integrated approach will add d value by further reinforcing skills and practice.
RMNCAH services are labour intensive and demand skilled health care providers for delivery of quality
health services. Inadequate skills of health care providers directly affect patient care and the related clinical
outcomes. It is expected that clinical mentorship will compliment supportive supervision to address clinical
knowledge, attitude, and skills gaps of health care providers. This Integrated RMNCAH Clinical Mentoring
will accelerate and scale up comprehensive delivery of quality RMNCAH services.
The full scope of RMNCAH clinical mentorship system in Tanzania is led by the Reproductive and child health
section under the Directorate of Preventive services. The RCHS implements comprehensive RMNCAH
interventions in order to accelerate reduction of preventable maternal, newborn, child, and adolescent
morbidity and mortality rates in Tanzania. . The RCHS implements interventions under the following units:
Family planning, Safe motherhood initiative, Newborn and child health, Reproductive cancers and Elderly,
Prevention of mother-to-child transmission of HIV, Management Information System, Immunization and
Vaccines Development (IVD), Adolescent reproductive health and Gender Reproductive health.
1.2 Quality Assurance

Quality assurance is a systematic process of checking compliance to specifications, requirements or
standards and implementing methods for conformance”. It includes all the processes and sub-processes
of planning for quality, the development of objective for quality, setting standards, actively communicating
standards, developing indicators, setting thresholds, collecting data to monitor compliance with standards
and applying solutions to improve health care. Clinical mentoring, supportive supervision, monitoring and
Evaluation are complementary activities that are necessary to build up quality assurance and therefore
quality care.

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1.3 Clinical Mentorship Overview
Mentoring is a relationship between two people – the “mentor” and the “mentee.” A mentor should be
experienced, knowledgeable, and skilled in the area of his/her expertise that can pass on valuable skills,
knowledge and insights to mentee to help to develop their professional career.
Clinical mentorship is a system of practical training and consultation that fosters ongoing professional
development of mentees to deliver sustainable high-quality clinical care outcomes (WHO 2005 HIV
Clinical Mentoring recommendation). Clinical mentoring should be seen as part of continued professional
development, required to create competent health service providers driven by the learning needs of
mentees. After any initial training, mentees require mentorship to build confidence and competencies to
apply acquired knowledge and skills in clinical practice.
The major objectives of clinical mentoring include:

• To build capacity of less experienced health care providers at all levels of health care.
• To bridge the gap between didactic training and skills.
• To create supportive environment skills development and attitudes learning.
• Improve quality care services provision.
1.4 Relationship between Clinical Mentorship and Supportive Supervision

To understand the difference between clinical mentorship and supportive supervision, refer to the figure
below.
Figure 1.
From the diagram above there are some differences and similarities between supervision and
clinical mentorship.
2 National Reproductive Maternal New born Child and Adolescent Health

1.5 Rationale
Clinical mentorship as part of continuous professional development is needed to provide clinical support,
maintain, and consolidate knowledge and skills of health care providers and address critical health system
challenges. The guide will provide insight on the RMNCAH clinical mentorship structure, clarify responsibilities
and resource allocation at all levels, and provide a standardised RMNCAH clinical mentorship practices.
Clinical mentoring is critical to building successful networks between trained service providers and expert
mentors for RMNCAH technical areas. This guideline provides an optimal environment for comprehensive
clinical mentoring practices in all RMNCAH service areas and therefore enhances efficient use of resources.
1.6 Goal and Objectives
1.6.1 Goal
To strengthen health care providers with the clinical, skills, and attitudes to achieve competence and
confidence in provision of quality RMNCAH services
1.6.2 Objectives
• To create an enabling environment for the implementation of RMNCAH clinical mentoring at all levels
of care.
• To strengthen coordination and collaboration of RMNCAH activities at all levels.
• To improve mentors’ capacity to provide standard clinical RMNCAH mentorship.
• To strengthen RMNCAH clinical skills of health care providers to provide quality RMNCAH services.
• To improve linkages, coordination, and feedback between supervision, clinical mentoring systems,
quality improvement and monitoring and evaluation (M&E).
1.7 About the Clinical Mentorship Guideline
1.7.1 This guideline is intended to be used;

• As a reference guide to complement existing efforts to strengthen and improve providers’ skills to
support desired quality based outcome of RMNCAH comprehensive services.
• To provide guidance to support effective planning, organization, implementation, monitoring and
Evaluation of Clinical Mentorship System.
1.7.2 The audience for these guidelines includes but is not limited to:
§ Policymakers.
§ Managers at national, zonal, regional and council levels.
§ Health facility Management teams.
§ Health service providers.
§ Community beneficiaries.
§ National and International Development Partners.
§ National and International Non-Governmental Organizations (NGOs).
1.7.3 Clinical mentorship guideline embraces the following key components;

• Clinical Mentorship Implementation Levels
• Types of Mentoring approaches
• Management of the Mentoring Process
• Implementation of Clinical Mentorship System
• Monitoring and Evaluation of Clinical mentorship
• All these components are well described in respective chapters.

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CHAPTER 2
CLINICAL MENTORSHIP
IMPLEMENTATION LEVELS
2.1 Implementation Structure

Figure 2 below provides clinical mentoring structure that can be used at National, Regional, Council, facility
and community levels in implementing clinical mentoring .The clinical mentoring operating structure shown
was the outcome of a protracted discussion by meeting participants having looked and analysed various
local and regional models.
In this model, the concept of the clinical mentorship complements other existing systems such as supportive
supervision and M&E to provide a desired synergistic effect. It indicates different levels of Tanzania Health
System at which mentoring process and management will take place.
Figure 2. Clinical Mentorship Implementation Structure
NOTE: Solid lines indicate that there is constant communication, and the dashed line indicates
there is only communication if needed (for instance during upward mentoring).

2.2 Roles of National, Zonal/Regional, Council, PMORALG, and Health Facilities
2.2.1 National Level

The national level will provide normative and strategic guidance, policy formulation, dissemination, and
programmatic support to regions and councils in implementing clinical mentorship programmes. In addition,
the national level will do the following:
• Develop a RMNCAH clinical mentoring learning resource package.
• Create a pool of mentors and sustain the practice
• Define clear roles for clinical mentors at each level.
• Oversee and coordinate the quality of mentoring programme.
• Set clinical mentoring standards and coordinate harmonization of clinical mentoring tools.
• Coordinate semi-annual/annual dissemination meetings and a quality improvement forum to discuss
clinical mentoring feedback.
• Advocate and mobilize resources for clinical mentoring system.
• Tailor database (e.g. TrainSmart) to collect information of national trained clinical mentors with their
competency areas
• Develop a tool to evaluate the clinical mentorship system.
2.2.2 PORALG
To collaborate with PO-RALG to solicit resources for implementation of clinical mentorship at various levels
2.2.3 Zonal Level

The zonal hospitals where available will provide support to regional hospitals in mentorship program:
2.2.4 Regional Level

The regional Health Management Team will do the following to facilitate mentorship:
• Mobilise materials for trainings and establish skills lab.
• Support use of new RMNCAH guidelines and emerging technologies.
• Council coordinate regional level mentorship activities and reporting.
• Mobilise, advocate, and coordinate partners’ support.
• Provide coordination, and support clinical mentorship at council level.
• Identify a person, among existing regional health staff, who will be responsible for clinical mentoring.
council
2.2.5 Council Level

The councils will serve as the implementation hub of the clinical mentoring as follows:
• Identify council clinical mentors’ council to conduct clinical mentoring visits.
• The Council Reproductive and Child Health Coordinator (DRCHCO) will coordinate all council clinical
mentoring activities. council
• CHMT will incorporate clinical mentorship activities in Comprehensive Council Health Plan (CCHP) under
the MNCH priority area in collaboration with stakeholders.
• Assess internal and external resources availability and enlist the support of partners.
• Keep an up to date inventory of mentors, including replacements and new recruitments.
• Coordinate joint supportive supervision and mentorship meetings quarterly to ensure that supportive
supervision is feeding into clinical mentorship and vice versa.
2.2.6 Health Facilities council

The role of health facilities in clinical mentorship include:
• Identifying mentorship needs.
• Maintain communication with the council to coordinate clinical mentoring visit.
• Ensure that all HMIS reporting tools are accurately completed at the proper time and the data is

5
accurately used to identify mentorship needs.
• Assign experienced competent, practicing health care providers from within or any other health facility
to conduct clinical mentoring visits in the relevant speciality or clinical discipline.
• Manage the mentee’s schedule to allow for sufficient time for clinical mentorship activities.
• Participate in feedback session with clinical mentors and health care provider based on the clinical
mentor’s evaluation.
• Arrange, coordinate and manage records of clinical mentoring sessions at the facility and oversee
implementation of recommendations by the mentoring team.
• Coordinate clinical mentoring activities at the community level in consultation with the CHMT.
2.2.7 Community
Community health worker (CHW) role is limited to non clinical preventive services includes Behaviour
change communication interventions, Nutritional counselling, support and referral etc.
The CHW supervisor has the following mentoring roles:
• Council ensures that all community health activities action plans and reporting tools are accurately
completed at the proper time.
• Supports the CHW to maintain and update community level RMNCAH service records, births and deaths:
maternal, newborn and child health deaths register.
• Supports the CHW understanding of RMNCAH community health priority interventions, targets, and
intended outcomes.
• Supports village leaders in collaboration with CHWs to coordinate maternal, newborn, and child health
referral system to identify and support RMNCAH needs within the community.
• Supports knowledge, attitudes and participation of village, opinion leaders and influencers within the
community on RMNCAH health priorities.

CHAPTER 3.0
TYPES OF MENTORING APPROACHES
AND METHODS
3.1 Types of Mentoring Approaches

Different types of clinical mentoring approaches are described, referenced, and practiced by different
programmes within the health care delivery system. The different levels of health care: national; regional,
and council will select clinical mentoring approaches based on operational practicability, cost effectiveness,
and benefits that can be maximized from the selected approach. There are five approaches for mentoring
described in this chapter which are recommended by the MOHCDGEC to support implementation of the
mentoring system;
1. Downward mentoring
2. Upward mentoring
3. Peer-to Peer mentoring
4. Distance mentoring
5. Preceptorship
3.1.1 Downward Mentoring

Downward mentoring uses clinical mentors that are external and come to the facility where the mentee is
stationed. This type of approach can be used in the following scenarios;
• Limited resources in terms of funding and competent human resource.
• Limited time to impart specific skills /intervention to many providers in a short time.
• When the local environment is important to the skill required for mentoring.
• When deliberate intensive mentoring is required to ensure quality RMNCAH services.
3.1.2 Upward Mentoring

Upward mentoring is when mentees receive mentorship at a higher level facility or at an alternate facility for
a certain time period. This type of approach can be used in the following scenario:
• council
• When mentor’s time is limited.
• When specific specialized skills are required for a particular health facility.
• When health facility anticipates establishing a specialized service.
3.1.3 Peer-to-Peer Mentoring

Peer mentoring involves mentoring by colleagues who are at a similar level in their career or may be a year
or two ahead of the mentee. The peer mentoring model can also involve facilities that are at the same level

7
(e.g. dispensary and dispensary within the same council, region); it is less formal and less inhibiting than
other mentoring models. This type of approach can be used in the following scenario:
• Daily work to improve mastery on clinical skill.
• Onsite mentoring or distant mentoring and consultations
3.1.4 Distance Mentoring.

This is a mentoring relationship in which mentor and mentee are in different locations. They rely almost
exclusively on electronic tools (e-mail, online meeting software and platforms, video conferencing),
phones, voicemail, faxes, and mail. This type of approach can be used in the following scenario:
• When following up between site visits
• To reinforce knowledge transfer or new information
• To insure that changes in practice or new standards are implemented by all staff at the facility level.
3.1.5 Preceptor ship

Preceptorship entails a process of clinical mentoring particularly applied to students who are based
in teaching hospitals either at the national, zonal, regional, council, or any other levels. A preceptor is a
health care provider who oversees a student during their pre-service education. The preceptor uses clinical
teaching, coaching, hands-on demonstration, and oversight with the students to ensure clinical competence
and confidence during a students’ clinical education.
3.2 Types f Mentoring Methods

The National RMNCAH Clinical mentorship programme will utilise multiple proven methods to support
mentoring approaches and transform clinical skills into practice to permit competence in clinical management
in RMNCAH services. The seven clinical methods described below can be adapted and used to fill the clinical
skill gap identified in specific RMNCAH technical area.
3.2.1 Performance standards assessments:

Return demonstrations and feedback.
3.2.2 Bedside/clinic-based teaching:

Mentor interacts with mentee through mini-lectures and demonstration by observing her/him perform
procedures on the patient. Patient information gathering: Mentee interacts with patient in taking relevant
history and making physical examination to arrive at a differential diagnosis and then making a patient
management plan. This plan is discussed with the mentor for a feedback.
3.2.3 Documentary reviews:

Search for detailed information in patient files for identifying areas of clinical mentoring focus.
3.2.4 Clinical meetings:

Review patient’s management profiles and records and get feedback by presenting to a mentor and or
other peers.
• On-job mentoring: individual and group coaching on established clinical case management protocol.
• Patient/Client Case Reviews: Clinical mentors must ensure that mentees examine and treat a broad
range of patients, along the continuum of care, from pre-pregnancy, pregnancy, newborn, infants,
child, and adolescent. The mentees must be deemed competent in all aspects of the specialty area
in which they are being mentored.
• Mentees will keep a logbook/checklist of procedures done or patients seen in consultation with the
mentor to assure a broad range of activities. As the mentee gains confidence and competence in
providing quality care and treatment, s/he will require less face-to-face interaction with the clinical
mentor and may use phone consultation as a primary means of support.

CHAPTER 4.0
MANAGEMENT OF THE MENTORING
PROCESS
The design and implementation of council health plans for provision of clinical services should consider
the importance of clinical mentorship activities in collaboration with all relevant stakeholders. Tap the
wealth of knowledge and expertise among nongovernmental, private partners and community-based
organizations. Develop and update a database of clinical mentors at regional and council-level to support
clinical mentorship programmes for improving the quality of care. The National RMNCAH clinical mentoring
programme is designed to give each level the flexibility to respond to their local RMNCAH needs under an
overarching national structure that provides overall guidance, resources, and tools.
Planning, organization, implementation, and M&E are critical for the success of clinical mentorship
programmes.
4.1 Trainings in RMNCH Clinical Mentorship
4.1.1 Training of Trainers and Clinical Mentors

For the clinical mentorship system to provide effective output, it is important to build country capacity
through training of a wide range of health care providers in clinical mentorship skills. The goal of the training
system is to provide a constant flow of competent trainers and mentors who are trained to perform to
standard. In order to maximize the potential of capacity building, the MOHCDGEC recommends that training
occur at both the pre-service and in-service levels. The following section outlines key considerations for
developing trainers and mentors
4.1.2 Training of Training

Selected clinically skilled health care providers in RMNCAH services will be exposed to 5 days course of
training of trainers in order to acquire knowledge and skills to facilitate clinical mentorship. The training
of mentors for RMNCAH mentorship incorporates learning sessions in class and mentorship skills practical
exercise in the clinical setting. Type of selected participants and facilitators depends on the level of the
training i.e. central or council level. In this guideline the recommended facilitator to participant ratio shall
be 1: 4.
4.1.3 Categories and Roles of Trainers

There are two categories of trainers for RMNCAH Clinical mentorship; Master trainers and Council Trainers.
Development of Master trainers will involve participants from health facilities at national level, Zonal resource
Centres and Regional Level. They are facilitated by technical team who developed this national guideline
and training resource package. The role of Master Trainers is to facilitate clinical mentorship trainings at
council level, during development of council trainers. Development of council trainers will draw health care

9
providers from hospitals/health centres/dispensaries in the particular council. The role of council trainer
is to facilitate training of mentors in the council and liaise with council focal person for implementation,
monitoring and evaluation of clinical mentoring activities in the council.
4.1.4 Selection Criteria of Trainers

• Proficient service provider who is currently practicing in RMNCAH technical areas.
• Experienced practitioner demonstrating mastery in at least two or more RMNCAH technical
services.
4.1.5 Training of Clinical Mentors

Clinical mentorship provides technical updates, tools, and harmonizes technical content and skills. The
training of clinical mentors will utilise adult training principles. A full range of methods and techniques are
used, as individuals learn differently. Blended learning techniques should be considered where feasible with
the use of audio (i.e., podcasts), video (telemedicine), and computer modules contributing to attainment of
competencies. The clinical mentorship training contains six sessions as follows:
• Session One: Overview of Clinical Mentorship
• Session Two: Relationship Building
• Session Three: Adult Learning Principles In Clinical Mentorship
• Session Four: Clinical Decision Making Skills
• Session Five: Planning and Conducting Onsite Clinical Mentoring Visits
• Session Six: Monitoring and Evaluation Of Clinical Mentorship
Qualification of a mentor shall be:-
n Able to demonstrate specific clinical mentorship activities and complete mentorship standard
checklists with least 80% or higher score.
n Able to pass the final knowledge assessment with pass score of 85% or higher.
4.1.6 Selection criteria of Clinical Mentors

• A health care provider who is currently practicing, and proficient in the technical area in which s/
he is to mentor.
• An experienced and skilled practitioner who is proficient in delivery of RMNCAH services to assure
adequate skills transfer.
• Ability to coach other health care providers.
• At least 1 year of clinical experience in specific technical area of RMNCAH services.
4.1.7 Characteristics of a clinical mentor

There are key characteristics that a clinical mentor is required to have to assist his/her mentees in attaining
confidence and competence in provision of quality health care, these include:
• Clinical proficiency.
• Ability to identify problems, analyse and make decisions.
• Capacity to motivate mentee to perform well.
• Familiarity with and ability to use clinical standards.
• Ability to facilitate learning and assess technical skills.
• Ability to communicate clearly and effectively with mentee.
• Ability to provide constructive, timely, and interactive feedback.
• Ability to gather and analyse information.
• Willingness to mentor through onsite visits and distance mentoring.

4.1.8 Roles of Clinical Mentors
• Identify the clinical RMNCAH skills gap.
• Promote professional ethics.
• Perform mentoring and modelling in alignment with best practices.
• Advocate for working environments conducive to quality patient care and continuous professional
development.
• Document mentoring activities and mentee’s performance.
• Provide feedback to the mentee and respective authority.
4.1.9 Recognition of Clinical Mentors and Mentees

Recognition means rewarding for achieving a level of performance that result in high-quality outcomes.
This is meant to encourage continuity of efforts by reinforcing the behaviour and practices that should be
consistently demonstrated and practiced. Recognition awards will be given in a written document.
4.2 Criteria for recognition

Performance recognition of mentees and mentors will be accordance to Guidelines for Recognition of
implementation Status of Quality Improvement Initiatives in Health Facilities (2014).
4.2.1 Mechanisms of Recognition in Clinical Mentorship

There are different recognition mechanisms:
• Feedback: Is less expensive but of high impact, it can be oral or written, it must be continual,
timely, specific and interactive
• Social recognition:symbolic rewards (but with predictive value), helps to improve morale,
can adopt the form of congratulations, trophies, certificates, celebrations, conferring of
authority.
• Material recognition: monetary or in-kind benefits such as performance-based salaries/
budgets, professional development opportunities, medical equipment, etc.
• Professional/technical recognition: recognising competency in a particula skill or task.
Ability to independently make a clincial decision regarding patient care; or can teach others
the task or procedure( expert).

11
CHAPTER 5
IMPLEMENTATION OF CLINICAL
MENTORSHIP
5.1 Creating an Enabling Environment for Clinical Mentors

The performance of clinical mentoring, outputs, and outcomes is influenced by the following factors:
• System design in support of a sustainable clinical mentorship.
• Management support at all levels that includes proper planning, organization, and allocation of
resources.
• Established budget line/allocation of funds for RMNCAH clinical mentorship.
• Type of basic training the mentor and mentee received.
• Availability and enforcement of national RMNCAH standards.
• Preceptorship package received during pre-service training.
• Availing opportunities for further learning and self-directed learning (i.e. continuous professional
development) and support access to technical updates.
• Availability of the necessary work performance tools, such as equipment, medicine, and supplies.
• Availability of the necessary staffing in the right place with the right skill mix.
5.2 Resources Required for Mentoring Activities and Budget

Clinical mentoring needs to develop a plan and budget. Planners and organizers for clinical mentoring are
required to mobilize necessary resources to carry out successful mentorship.
These resources include finance, time, personnel, supplies, materials, transport, assessment tools, such as
checklists, interview guide books, procedure manuals, performance standards workbooks, or guidelines,
etc. To make clinical mentoring sustainable, mentoring activities should be included in Comprehensive
Council Health Plan at all level of care.
5.3 Implementation Phase

Recognizing key steps in the implementation of clinical mentorship has great potential in setting momentum
for effective roll out. This section highlights key steps in the implementation process of clinical mentoring.
1. Identification of clinical skill gaps of health care providers from facilities implementing
RMNCAH services using multiple strategies such as;
• Supportive Supervision reports.
• Observation of RMNCAH service delivery gaps.

• Review of M&E reports.
• Follow up after training.
2. Identify clinical mentors at all levels.
3. Conduct planning and preparatory meetings.
4. Conduct mentor’s orientation trainings.
5. Assign and deploy mentors to health facilities
6. Match mentor with mentee.
7. Assess skills; initiate, monitor and conduct mentoring to support the respective skills gap until
proved proficient.
8. Provide immediate constructive feedback to mentees and report to health facility in-charge.
9. Agree on the way forward/develop an action plan in collaboration with the health facility in-
charge; plan next mentoring visit and technical area to be mentored, including planning on
peer-to-peer mentoring.
10. Provide feedback report to the coordinator at the respective level and supportive supervision
team for next visit actions.
5.4 Minimum Timeline of Clinical Mentorship

The amount of time it takes to transfer knowledge, attitude, and skills from clinical mentor to mentee varies
greatly depending on technical area, personnel, client load, and health system factors, including resource
availability. The type of clinical service being mentored will also determine the amount of time.
5.5 For Post Mentoring follow up

Intensive support is provided for the first month, with fewer visits as time goes on, as the mentee develops
the knowledge, attitude, and skills required. Each mentee should have face-to-face contact with his/her
clinical mentor, quarterly mentoring visits, in addition to as-needed telephonic communication.
5.6 Coordination of Integrated RMNCAH mentoring activities

It is essential that the various training and mentoring activities occurring throughout the country are
coordinated and standardized to ensure consistent and high quality training. The coordination of these
training activities will be done by the MOHCDGEC through the Reproductive and Child Health section at
different levels. The Ministry will maintain an inventory of people trained that will include: trainers, mentors
and mentees.
• Coordination at implementation site
• CHMT/DRCHCO will arrange logistics from the council to the site for mentoring
• Areas for mentoring will be highlighted by CHMT/DRCHco/Mentor based on the gaps identified
through supervisions, follow up or any other observations. Areas for mentoring includes;
Maternity ward, Labour and Delivery, Postnatal, RCH servive; ANC, PMTCT, Post-natal, Family
Planning, Immunization, Growth monitoring and Development, Cervical Cancer Screening, care of
Sick Child, etc.
• After completion of mentoring process, the mentor will give feedback to; the mentee (s), head/
incharge of the unit or the facility management incharge, DRCHCO and submit activity report form
to both.
• The mentor will prepare field visit report and submit to CHMT through DRCHco.

13
CHAPTER 6.0
MONITORING AND EVALUATION
Monitoring and evaluation (M&E) of clinical mentorship refers to all processes that track performance and
achievement of intended results. The M&E system for the Clinical mentorship will detail the approaches to
monitor, evaluate and report the clinical mentoring activities based on specific objectives using different
data collection tools to respond to the outlined key performance indicators.
6.1 Tracking of enabled environment for the implementation

In order for health providers to adhere to improved clinical practices, it is important for the M&E system to
track information on the proportion of health facilities that are equipped with a minimum required clinical
and clinical related performance tools such as;
• RMNCAH financing
• RMNCAH workforce
• RMNCAH essential medical supplies and technology
• Health Management Information Systems (HMIS)
This information will be collected through the clinical mentoring activity summary report to be submitted
by a mentor to the council clinical mentoring focal person (DRCHco).
6.2 Assessment of Performance of the Clinical Mentor

Number of health care professionals trained as mentors will be collected through Training tracking tools.
Mentors may be assessed to see their improvement on mentorship competency using checklist.
6.3 Assessment of Performance of the Mentee

Competency of the mentee will be assessed through pre and post-test during clinical mentoring. Mentor
will conduct a pre-test to a mentor in order to identify the skills gaps that need to be addressed during
mentorship. This will be done through checklist of the respective technical area. For example, in the labour
and delivery technical area, a mentor may use a checklist for assessment to assess the skill gap. In other
RMNCAH technical areas, a mentor may use objective structured clinical examination (OSCE) to assess
competency.
The mentee will be assessed by the clinical mentor throughout the clinical mentoring process:
• Clinical practice should be assessed through records review, logbook review, interviews, client chart
review and checklists.
• Core competencies may be used to evaluate the mentee’s own perception of his/her competence
and confidence, as well as by the mentor to evaluate the performance of the mentee.
• The mentee should maintain a logbook of patients examined and treated under the guidance of the
clinical mentor. 8.2.4 Assessment of the Clinical Mentorship
The effectiveness of the clinical mentorship should be monitored at the facility, council, and regional levels.

Output indicators that can be used to measure performance of the clinical mentorship may include:
• Proportion of health providers who received mentorship training.
• Proportion of health providers who successfully completed the basic mentorship training as defined
by the council
• Proportion of facilities selected by councils to receive mentorship.
• Proportion of facilities visited for clinical mentorship
• Proportion of mentees received clinical mentorship
6.4 Improved service delivery uptake

It is expected that the outcomes of clinical mentorship will not only lead to improved technical skills,
knowledge, and clinical decision-making by mentees, but also patient clinical outcomes in RMNCAH.
Other outcomes of clinical mentorship will be improved service delivery data quality.The M&E plan will
track whether the clinical mentorship has influenced an improved change in service delivery in the related
technical area. This will be tracked by using the existing HMIS registers. Data quality will be assessed
alongside data collection activities as well as during routine program data quality assessment visits. In order
to measure the outcomes of clinical mentorship, HMIS reports are expected to show improved trends of
service delivery statistics.
6.5 Impact
The desired impact of the RMNCAH clinical mentoring is to contribute to the reduction of maternal, newborn,
child and adolescent morbidity and mortality.
6.6 Tools to be used

At facility level:
• Pre & Post test for mentees (checklist or OSCE)
• Clinical mentoring activity summary report
• Action Plan
At council level
• Training registers (Training tracking tools and paper forms)
• Activity monthly summary report Mentorship observational checklist –as needed
• DHIS2 reports
Data will be collected on quarterly basis by mentors conducting the clinical mentoring activities who will
hand over the completed data tools to the corresponding council clinical mentorship coordinator. Data will
be entered at the council level where it can be accessed at the regional and national level for analysis.

15
6.7 Performance Indicators Framework
Frequency
Element Indicator Definition Activity Baseline Data source Target
of reporting

Objective: Create an enabling environment for the implementation of RMNCH clinical mentoring at all levels of care
Input; Council 1. #, % of visited health Numerator: # of visited health facilities Clinical Quarterly Facility 80%
Indicator facilities with budget with a budget to support RMNCH mentorship readiness tool
to support RMNCH clinical mentoring. visits.
clinical mentoring
Denominator: Total number of health
facilities received clinical mentorship
visits
Input: 2. #, % of visited Numerator: # of health facilities with Clinical Quarterly Facility 80%
health facilities with adequate number of skilled health mentorship readiness tool
Health facility adequate number care providers for providing essential visits.
Indicator of skilled health RMNCH care.

care providers for
providing essential Denominator: Total number of health
RMNCH care facilities received mentorship visits
Input 3. #, % of health Numerator: # of health facilities which Clinical Quarterly TBD Facility 80%
facilities which have have appropriate materials/equipment mentorship readiness tool
Health facility level appropriate materials/ for provision of RMNCAH care in the visits
equipment for designated areas.
provision of RMNCAH Denominator: Number of health
care in the designated facilities received clinical mentorship
areas. visits
Input: 4. #,% of health facilities Numerator; of health facilities with a Clinical Quarterly TBD Facility 100%
with a complete set of complete set of HMIS RMNCH tools in mentorship readiness tool
Health facility level HMIS RMNCH tools in use visits
Indicator use
Denominator: Number of health
facilities received clinical mentorship
visits.
Objective : Improve mentors capacity to provide standard clinical RMNCH mentorship
16
Output 5. #/% of mentors Numerator: Number of mentors trained Training of Quarterly 0 Training
trained, disaggregated disaggregated by cadre, councils, regional tracking tools
Mentors trained; by cadre, councils, regions .and intervention and council (Train smart
17
regions .and mentors to be and Train
Council level intervention Denominator: number of mentors conducted. tracker etc.)
Indicator expected to be trained Facilitated
by Master
mentors.
6. % of selected mentees Numerator: number of mentee selected Quarterly HRH Data

for mentorship for mentorship base

Denominator: Number of health service
providers in a council
7. % of health facilities Numerator: Number of facilities Clinical Quarterly Master/
selected for selected for mentorship mentorship Council
mentorship visits facility
Denominator: Number of facilities registrar
providing RMNCAH services
Council level 8. #,% of mentors Numerator: Number of mentors with Clinical Mentoring 80%
Indicator improved skills in improved skills in mentoring over time. mentorship checklist
mentoring over time visits.
Denominator: Number of mentors Checklist to be
assessed on mentoring competency administered by
an observer
Objective : Strengthen RMNCH clinical skills of health care providers to provide quality RMNCH services
Output: 9. #health facilities Numerator: Facilities received clinical Team of council Quarterly 0 Mentoring

receiving clinical mentoring visits disaggregated by type mentors Database
Facilities received mentoring visits, of facility, councils, regions providing
mentorship visits: disaggregated by type mentoring visits
of facility, councils, Denominator: Total number of facilities to selected
Council level regions. expected to receive mentorship visits. health facilities
indicator in the councils
Output 10. Number of mentoring Numerator: Number of mentoring Mentoring visits Quarterly 0 Mentoring
visits, disaggregated by visits conducted disaggregated by type Database/
Number of clinical RMNCAH intervention of facility, region and council
mentorship visits: ,disaggregated by Mentoring
type of facility, region reports
Council level

and council
Indicators
Facility and council 11. #, % of mentees who Numerator: # of mentees with Observational Quarterly 0 Mentoring 80%
level improved in specific improved clinical competency as assessment database
RMNCAH clinical skills measured through OSCE for specific of skills
competency. RMNCAH clinical skills competency. competence
Denominator: all mentees received
clinical mentorship
Council level facility 12. % of improved RMNCH Numerator: Number of improved DHIS reports Routine DHIS 60%
service delivery service deliveries disaggregated by data reports
uptake e.g. number RMNACH technical area.
of babies resuscitated
successfully Denominator: Number of technical
areas assessed which have been
mentored.
18
CHAPTER 7
ANNEXES
Annex 1: List of Components of RMNCAH Learning Resource Packages
7.1 Guideline, Job Aids, and Performance Standards for Newborn and Child Health
1. Integrated Management of Childhood Illnesses (IMCI)
2. IMCI Training Modules
3. IMCI Facilitator Guide
4. IMCI Chart Booklet and Recording Form
5. IMCI Follow Up after training Tool (Checklist and Guidelines)
6. IMCI DVDs
7. IMCI Photograph books
8. Diarrhoea Treatment Wall Chart
7.2 Kangaroo Mother Care (KMC)

1. KMC National Guidelines
2. KMC Training Manual
3. KMC Supervision Tools
4. KMC Counselling cards
7.3 Helping Babies Breathe (HBB)

1. HBB Training Flip Chart
2. HBB Action Plan
3. HBB Learners Workbook
4. HBB Mannequin (Neonatalie Pack)
7.4 Essential Newborn Care (ENC)

1. ENC National Guidelines
2. ENC Training Manual
3. ENC Flip Chart
7.5 Growth Monitoring

1. Under-five Growth Monitoring Card (RCH-1)
2. Procedure Manual

19
3. Training Manual
7.6 Paediatric Quality of Care

1. Referral Care Manual
2. ETAT Training Manual
3. ETAT Facilitators Manual
4. Paediatric Quality Improvement Assessment Tool
5. Paediatric Standards
6. Guideline and Checklist For Supportive Supervision on Paediatric Referral Care
7. Guideline for Clinical Mentorship for Paediatric Referral Care
8. Training Guideline for Clinical Mentorship for Paediatric Care
7.7 Guideline, Job Aids, and Performance Standards for Family Planning:
1. Family planning guidelines and standards
2. Basic training skills curriculum
3. Family planning preceptor ship curriculum
4. Family planning curricula
5. Family planning procedure manual
6. Family planning supervision checklists
7. On-the-job curriculum draft
8. Family planning costed implementation plan and CCH.
9. Contraceptive technology updates
7.8 Guideline, Job Aids and Performance standards for Safe Motherhood
Initiative
1. Basic Emergency Obstetric and Newborn Care, Life Saving Skills Manual.
2. Comprehensive Emergency Obstetric and Newborn Care, Life Saving Skills Manual.
3. Post partum Care Guideline.
4. Focused Antenatal Care Guideline.
5. Comprehensive Post Abortion Care Training Guideline.
6. Emergency Obstetrics and Newborn Care Job Aid.
7. Maternal and Perinatal Death Surveillance and Response Guideline.
8. Administration of Antenatal Corticosteroids in Preterm Labour.
7.9 Guideline, Job Aids and Performance standards for Reproductive Cancers
12. Tanzania Service delivery guideline for cervical cancer Prevention and control program.
13. National Cervical Cancer Prevention and Control Program: Guideline of Quality Improvement
for VIA Based Screening Approach.
14. Cervical cancer prevention Training package.
15. Guideline for National prostate cancer screening.
7.10 Guideline, Job Aids and Performance standards for Immunization and Vaccine
Development
1. Kampeni ya chanjo ya pepopunda 2010
2. Yajue magonjwa yanayozuilika kwa chanjo 2014
3. Integrated Measles Campaign Council EAM supervisors Guide 2011
4. Training manual for Rotavirus and Pneumococcal vaccine for Region and District 2012
5. Mwongozo wa mtoa huduma za chanjo, dozi ya pili ya Surua 2014
6. Training manual for introduction of Measles second dose for Region and District 2014
7. Mwongozo wa mchanjaji, chanjo ya Rotavirus na Pneumococcal 2012

8. Mwongozo wa mchanjaji, Kampeni shirikishi ya Surua Rubella 2014
9. Integrated Measles Rubella campaign Regional and Council Guideline 2014
10. Ratiba ya chanjo kwa watoto na wanawake wenye umri wa kuzaa 2014
Reach Every Child Strategy ( REC strategy) 2010 revised 2014
7.10 Guideline, Job Aids and Performance standards for Adolescent Reproductive
Health
1. National Adolescent Reproductive Health Strategy (2011-2015).
2. A National curriculum for Service providers on Adolescent Reproductive Health Services-A
Facilitators Guide.
3. A National curriculum for Service providers on Adolescent Reproductive Health Services-A
hand out for participant.
4. National Standards in Peer Education for Young People.
5. Standards for Adolescent Friendly Reproductive Health Services.
6. Youth in Tanzania-A data from 2010 Tanzania Demographic and Health Survey (TDHS).
7.12 Guideline, Job Aids and Performance standards for Prevention of Mother to
Child Transmission
1. National Guideline for comprehensive Care services for Prevention of Mother to Child
Transmission of HIV and Keeping mothers Alive, 2013.
2. Tanzania Elimination of Mother to Child Transmission of HIV Plan, 2012 – 2015.
3. National Communication Strategy for the Elimination of Mother to Child Transmission of
HIV (e-MTCT) (English and Swahili Version)
4. National Guide for Mentoring Health Care Workers on Early Infant Diagnosisi of HIV
(HEID), 2016.
5. National PMTCT Training Course “Comprehensive PMTCT Participants Manual, 2015.
6. PMTCT Refresher Training Package, 2013.
7. Training Package for LLAPLa Assessment and Response System, 2015.
8. Training Package for PMTCT Mother Child Monitoring System (final stages).
7.13 Guideline, Job Aids and Performance standards for Gender

1. National management for health sector prevention and response to Gender based
violence and violence against children.
2. National guidelines for integration of one stop centre for GBV and VAC services in health
facilities.
3. Gender Based Violence and Violence against children Job Aids.
4. Gender Based Violence and Violence against Children clinical standards.
Annex 2: RMNCAH Monitoring and Evaluation Tools
Annex 2: 1 RMNCAH Clinical Mentor Performance Standards

To be completed by: A Mentor’s Assessor/trainer or supervisor
Submitted to: Council RMNCAH coordinator

Name of Clinical Mentor
Training /mentoring Site:

Council:

21
Date: dd/mm/yyyy
Assessor {Names &Title)
Instructions: Place number 1 - 3 for each criteria; 1 = Needs improvement, 2 = Satisfactory, 3 = fully
Competent
Notes: …..
Performance Standard Verification Criteria 1-3 Notes
1. Develops a reciprocal Observe the clinical practice session for mentees and
relationship through verify that:
sharing experiences,
exploring expectations, 1.1Uses courteous , friendly, easy
and clarifying the roles in communication;
the mentor and mentee 1.2Creates common understanding
relationship for mentoring goal objectives, and
expectations
1.3Continuously demonstrates personal

integrity, honesty and sincerity.
1.4Asks permission of mentee to

mentor or provide feedback in sensitive,
new areas.
1.5 Encourages mentees to share
insights, thoughts and feedback to
identify and prioritize program needs
1.6 Demonstrates ability to clarify

mentor/client expectations
1.7 Imparts local ownership

2.1Demonstrates respect for mentees
2. Recognizes, acknowledges, perceptions, learning style, personal
and builds upon the being.
abilities and contributions 2.2Provides ongoing support and
of mentee to nurture a champions new behaviors and actions,
productive relationship including those involving risk taking and
fear of failure.
2.3 Uses a variety of positive conflict
management strategies to identify and
minimize Impact of conflict on program
and mentoring relationship
2.4 Discusses specific goals and
objectives related to the mentoring
relationship and the novice’s teaching
performance.
2.5 Introduce the mentoring plan and
activities for review, modification and
consensus.

Performance Standard Verification Criteria 1-3 Notes
Observe session during which the clinical mentor is

demonstrating a skill for the mentee(s) and verify:
3. Plan, deliver and evaluate 3.1Plans appropriate progression of

mentorship activities mentorship activities, from the simple
during mentorship to the complex/need for a written
plan?
3.2 Provides clear directions for student
activities and assignments
Promotes on-task student/mentee
behaviour and reinforces desired
behaviour.
3.3 Demonstrates appropriate and timely
feedback and follow up with mentee
3.4 Able to develop effective assessment

tools to evaluate progress objectively
3.5 Helps the mentee identify and access

different resources for learning (e.g.,
books, other professionals).
11. Practices effective 4.1Listens attentively pays close attention
communication to both verbal and body language ,
4.2 Repeats back the most important
points of the mentee’s message
4.3Asks open ended questions that

encourages discussion, creating
greater clarity , new learning , and
more understanding of the client’s
perspective
4.4 Takes time to understand and consider
mentees views.
4.5 Summarizes main points
4.6Does not show passive-aggressive

tones
12. Uses knowledge in 5.1 Supports mentees knowledge,
technical content areas attitude and understanding with up
to help mentee acquire to date references; clinical standards;
and apply new knowledge National policy guidelines and
, skills and appropriate technical documents
attitude
5.2 Maintains evidence based practice and
11.
up to date knowledge in their own
professional practice
5.3 Gathers and delivers instructional
resources
5.4Ability to comprehend ( review;
understand ;interpret) and critique
clinical cases and documents

23
13. Uses appropriate learning 6.1Demonstrate a reflective approach
principles and techniques to teaching, self-evaluation, and
with mentee implementation of new ideas.
6.2Applies adult learning principles
in mentorship activities ( e.g.
encourages expression of ideas,
reasoning and feedback at every
opportunity
6.3Uses a blend of teaching
methodologies appropriately
to promote learning such as
demonstrations, case studies,
simulations, role plays,
6.4Asks questions that evoke discovery,
insight, commitment or action (e.g.,
those that challenge the client’s
assumptions).
6.5Uses various techniques to
demonstrate and support clinical
skills acquisition
6.6Applies different communication
techniques during mentorship
activities (active listening,
paraphrasing, feedback loop etc)
14. Facilitates and documents 7.1 Ability to document, interpret and
mentee meetings and report clinical mentoring activities
dialogue that reflects
purpose and progress of 7.2 Provides immediate feedback to
relationship/goals mentee
7.3 Documents mentees identified gaps,
progress and graduation
7.4 Effectively prepares, organizes, and
reviews with mentee information
obtained during mentorship sessions.
7.5 Positively confronts the client with the
fact that he/she did not take agreed-
upon actions.
7.6 Keeps the mentee on track between
sessions by holding attention on the
action plan and outcomes, agreed-
upon courses of action, and topics for
future session(s).
15. Demonstrates effective 8.1 Plan activities in the appropriate time
time management , frame
Prioritizes gaps according to criticality
8.2 Encourages mentees to share insights,
thoughts and feedback to identify and
prioritize program needs
8.3 Demonstrates flexibility in working
with the changing needs of client/
program, time constraints, resources
and other issues
16. Documentation, record- 9.1Provides comprehensive feedback,
keeping and report records and documents the
writing skills mentorship visit using agreed tools

17. Uses appropriate tools to 10.1 Conduct case discussions on various
provide objective, reliable management topics
and useful information 10.2 Encourage, facilitate and/or attend
of initial and on-going regular rounds series that is open to
needs to assess mentee’s all hospital/clinic staff and mentees
progress
10.3 Demonstrates ability to transfer QI/
QA Knowledge and application of
the QI tools
10.4 Provides the local management
with feedback, and discusses issues
to be addressed in support to clinical
perfomance improvement
Annex 2.2 Clinical mentors’ assessment checklist

To be self -filled by the mentors or a person assessing the mentor
Instructions: Placenumber1‐ 3 for each criteria; 1 = Not done, 2 = Satisfactory, 3 = well done
MENTORING SKILLS 0-3 Comments
BEFORE PRACTICING SESSION
1. Greets the participants
2. Ask the participant to reflect on her/his performance in
previous practice sessions.
3. Asks which steps or tasks the participant would like to
work on during the practice session.
4. Reviews any difficult steps or tasks in the checklist that
will be practiced during the session.
5. Works with the participant to set specific goals for the
practice session.
DURING PRACTICE SESSION
1. Observes as the participant practices the procedure
2. Provides positive reinforcement and suggestions for
improvement as the participant practices the procedure.
3. Refers to the checklist during observation.
4. Records notes about participants performance on the
checklist during observation
5. Is sensitive to the mentee when providing feedback to
the participant during a clinical session
6. Provides corrective comments only when the comfort or
safety of the mentee is in doubt
AFTER PRACTICE FEEDBACK SESSION
1. Set the climate
2. Asks the mentee to share feelings about the practice
session.
3. Asks the mentee to identify those steps performed well
4. Asks the mentee to identify those steps where
performance could be improved.
5. Refers to notes on the checklist
6. Provides positive reinforcement regarding those steps
or tasks the mentee perform well
7. Offers specific suggestion for improvement
8. Works with the mentee to establish goals for the next
mentorship (Action plan)

25
Annex 2.3 Clinical Mentoring Activity Summary Report
To be compiled by mentor
Region: ___________________________________ Council: ________________________________________ Facility Name: _________________________

Facility Type: 1. Hospital 2. Health centre 3. Dispensary 4. Other
Facility Ownership: 1.Government 2. FBO 3. Private
No Name of mentee Cadre Clinical area Key challenges to be Action plan to Time spent Name of mentor /
mentored e.g. addressed address mentoring Signature
Family Planning (hours)
1
2
3

4
5
Facility Readiness questions
Does this facility have adequate number of skilled health care providers for providing essential RMNCH care according to manning level (Ikama)
1. Yes
2. No
Does this facility have appropriate materials/equipment for provision of RMNCAH care in the designated areas?
1. Yes
2. No
Does this health facility have a complete set of RMNCAH/ HMIS tools which are in use?
1. Yes
2. No
26
Any comment/ recommendation
Name of Clinical mentor: ____________________________________________________________ Cadre: _______________________________________________
Annex 2.4 Clinical Mentoring Monthly Summary Report –
To be compiled at council level
Region: _______________________________________ Council: _______________________________
_
Reporting Month: _______________________________ Year: _______________________________
1. Mentors trained
Indicator Cadre Number
Nurse/Nurse midwife
Medical Doctors
Mentors trained AMO
Clinical Officers/Clinical Assistants
Total
2. Health facilities and providers received RMNCAH clinical mentorship.

Number of
Health facilities received clinical mentorship
Facility Type providers
visits
mentored
Hospital
Health Centre
Dispensary
Total
3. Enabling environment for RMNCAH

Indicator Number
Visited health facilities with budget to support RMNCAH clinical mentoring
Visited health facilities with adequate number of skilled health care providers
for providing essential RMNCAH care
Visited health facilities appropriate materials/equipment for RMNCAH care
Visited health facilities with complete set of HMIS RMNCAH tools in use
4. Total number of clinical mentoring visits _________________________
RMNCAH
RMNCAH Intervention Number Number
Intervention
Family Planning GBV
Safe motherhood Reproductive cancer
PMTCT ARH
Newborn &Child health IVD

27
5. Number of improved service deliveries in any of the RMNCAH intervention where clinical mentoring
was provided: Source DHIS
Mention
Mention technical technical area
RMNCAH
RMNCAH Intervention area e.g. provision of e.g. provision
Intervention
uterotonic at AMTSL of uterotonic at
AMTSL
Family Planning GBV
Safe motherhood Reproductive cancer
PMTCT ARH
Newborn &Child health IVD
Annex 3 List of Members who participated in Guideline Development

Name Organization
6. Dr Neema Rusibamayila DPS- MOHCDGEC
7. Dr Georgina Msemo AD-RCH- MOHCDGEC
8. Dr Koheleth Winani SMI- MOHCDGEC
9. Dr Heavengton Mshiu SMI-MOHCDGEC
10. Dr Ahmad Makuwani SMI-MOHCDGEC
11. Dr Mary Azayo NCH-MOHCDGEC
12. Dr Felix Bundala NCH-MOHCDGEC
13. Ms Rachael Kaposwe NCH- MOHCDGEC
14. Ms Joyce Mhando NCH- MOHCDGEC
15. Dr Dafrosa Lyimo IVD-MOHCDGEC
16. Ms Zebrina Msumi IVD-MOHCDGEC
17. Dr Georgina Joachim IVD - MOHCDGEC
18. Ms Christie Hamza ADM- MOHCDGEC
19. Ms Lucy Issarow HIU-MOHCDGEC
20. Ms Neusta Kwesigabo ADM- MOHCDGEC
21. Dr Joseph Hokororo HIU-MOHCDGEC
22. Dr Elizabeth Mapella ARH-MOHCDGEC
23. Ms Isabella Nyalusi FP- MOHCDGEC
24. Ms Zuhura Mbuguni FP- MOHCDGEC
25. Ms Dhamira Mongi MIS- MOHCDGEC
26. Ms Rozina Lipyoga P4P- MOHCDGEC
27. Mr Clement Kihinga MIS-MOHCDGEC
28. Ms Agnes Kinemo HRD-MOHCDGEC
29. Ms Jesca Massanja ARH- MOHCDGEC
30. Dr Michael Msangi PMTCT- MOHCDGEC
31. Dr Deborah Kajoka PMTCT-MOHCDGEC
32. Ms Pellagia Muchuruza PMTCT- MOHCDGEC
33. Ms Levina Lema PMTCT- MOHCDGEC
34. Ms Elizabeth Salle PMTCT - MOHCDGEC

35. Dr Victor Bakengesa RCH- MOHCDGEC
36. Dr Saum Nungu MIS- MOHCDGEC
37. Ms Mary Ngowi RHC- MOHCDGEC
38. Ms Hindu Ibrahim Gender - MOHCDGEC
39. Dr Grace Mallya MOHCDGEC
40. Dr Safina Yuma MOHCDGEC
41. Mr Dulle Nkungu MOHCDGEC
42. Mr Alex Luoga MOHCDGEC
43. Mr Machumu Miyeye MOHCDGEC
44. Ms Notgera Ngaponda MOHCDGEC
45. Ms Martha Shakinyau Zonal RCHCO
46. Dr Issessanda Kaniki DMO- Kibaha TC
47. Dr Mastidia Rutaihiwa DMO- Bagamoyo
48. Dr Sahim Katete David Ag. DMO – Kibaha DC
49. Ms Hilda Kakwezi TAMA
50. Ms Beatrice Mwilike TAMA- MUHAS
51. Ms Salome Kassanga TAMA -
52. Mr Robert Aloyse Mauya MNH
53. Dr Rodrick Kisenge PAT- MUHAS
54. Dr Mwajuma Ahmada PAT -MNH
55. Dr Andrew Pembe AGOTA MUHAS
56. Dr Asia Hussein UNICEF
57. Dr Iriya Neemes WHO
58. Dr Nuhu Yaqoub WHO
59. Dr Mashafi Joseph PSI
60. Ms Furaha Mafuru PSI
61. Ms Salome Mtango World Vision
62. Ms Angasyege Kibona EGPAF
63. Ms Alice Christensen Jhpiego
64. Dr Dunstan Bishanga Jhpiego
65. Dr Chrisostom Lipingu Jhpiego
66. Dr Erica Thomas Jhpiego
67. Ms Gaudiosa Tibaijuka Jhpiego
68. Dr Safila Telatela Jhpiego
69. Dr Happiness Wilbroad Jhpiego
70. Dr Sweetbert Dotto Jhpiego
71. Ms Julieth Sizya Jhpiego
72. Mwarami Selemani Jhpiego
73. Ms Scholastica Chibehe Jhpiego
74. Giulia Besana Jhpiego
75. Mr Victor Mponzi Jhpiego

29
76. Dr Mary Rose Giattas Jhpiego
77. Dr Akwila Temu Jhpiego
78. Ms Rose Mnzava Jhpiego
79. Ms Natalie Hendler Jhpiego
80. Dr Grace Magembe Amref
81. Mr Benatus Sambili Amref
82. Mr John George Amref
83. Dr Elizaberth C.U. Hizza URC
84. Nobi Kadoi NACP
85. Ms Felista Mbwana UNFPA
86. Ms Salome Kassanga TAMA
87. Ms Sia Marandu CHAI
88. Dr Majura Magafu Litembo Hospital
89. Dr Amos Mwakilasa Consultant

Bibliography
1. Clinical Mentorship Manual for Integrated Services. 2011. Republic of South Africa.
2. WHO clinical mentoring guidelines: http://www.who.int/hiv/pub/guidelines/clinicalmentoring.
pdf.
3. A manual of comprehensive supportive supervision and mentoring NACP/MOHCDGEC Tanzania.
http://www.jica.go.jp/project/tanzania/001/materials/pdf/common.
4. Implementation Guide for Clinical and Community Mentoring in Malawi.
5. Guidelines for Clinical Mentorship of Healthcare Workers in Zambia. 2009. First Edition, May 2009
Directorate of Clinical Care and Diagnostic Services Ministry of Health, Ndeke House Lusaka.
6. Generic mentorship training programme for health care practitioners. 2011. Participants manual
2011. Zambia Ministry of Health.
7. Generic mentorship training programme for health care practitioners. 2011. Facilitator’s manual.
Zambia Ministry of Health.
8. Basics of Clinical Mentorship. 2009. Facilitators manual. Republic of Zambia. Ministry of Health.
9. Implementation Guide for Clinical and Community Mentoring in Malawi.
10. Do No Harm. Injection Safety; In The Context Of Infection Prevention And Control. Facilitators
Guide. MOHCDGEC. 2006 Tanzania.
11. Basics of Clinical Mentoring: ITECH Participants Guide.
12. Basics of Clinical Mentoring: ITECH Facilitators guide.
13. Malaria Case Management Updates; Training for Medical Instructors. Training Guide and
Facilitator’s Manual 2013> National malaria control programme.
14. Guideline for HIV Care/ART Clinical Mentoring in Ethiopia. Federal republic HIV/AIDS AIDS
Prevention and Control Office Ministry of Health Ethiopia. August 2007. http://www.etharc.org/
index.php/resources/download/finish/33/72.
15. Reproductive Maternal Newborn And Child Health Integrated Supportive Supervision Tool;
Reproductive and Child Health Section; September 2013.
16. A presentation on: Intensive Mentorship: Improving Practice and Patient Outcome in Zambia.
Samantha Holcombe.

31

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What is the purpose of this guideline?

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What levels of implementation are described for clinical mentorship?

What levels of implementation are described for clinical mentorship?

THE UNITED REPUBLIC OF TANZANIA

MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER,

National Reproductive Maternal

Clinical Mentorship Guideline

ii National Reproductive Maternal New born Child and Adolescent Health

National Reproductive Maternal New born Child and Adolescent Health

iv National Reproductive Maternal New born Child and Adolescent Health

National Reproductive Maternal New born Child and Adolescent Health

vi National Reproductive Maternal New born Child and Adolescent Health

Dr. Mpoki M. Ulisubisya

National Reproductive Maternal New born Child and Adolescent Health

Prof. Muhammad B. Kambi

1.2 Quality Assurance

National Reproductive Maternal New born Child and Adolescent Health

The major objectives of clinical mentoring include:

1.4 Relationship between Clinical Mentorship and Supportive Supervision

2 National Reproductive Maternal New born Child and Adolescent Health

1.6 Goal and Objectives

1.7 About the Clinical Mentorship Guideline

1.7.1 This guideline is intended to be used;

1.7.3 Clinical mentorship guideline embraces the following key components;

National Reproductive Maternal New born Child and Adolescent Health

2.1 Implementation Structure

Figure 2. Clinical Mentorship Implementation Structure

4 National Reproductive Maternal New born Child and Adolescent Health

2.2.1 National Level

2.2.3 Zonal Level

2.2.4 Regional Level

2.2.5 Council Level

2.2.6 Health Facilities council

National Reproductive Maternal New born Child and Adolescent Health

6 National Reproductive Maternal New born Child and Adolescent Health

3.1 Types of Mentoring Approaches

3.1.1 Downward Mentoring

3.1.2 Upward Mentoring

3.1.3 Peer-to-Peer Mentoring

National Reproductive Maternal New born Child and Adolescent Health

3.1.4 Distance Mentoring.

3.1.5 Preceptor ship

3.2 Types f Mentoring Methods

3.2.1 Performance standards assessments:

3.2.2 Bedside/clinic-based teaching:

3.2.3 Documentary reviews:

3.2.4 Clinical meetings:

8 National Reproductive Maternal New born Child and Adolescent Health

4.1 Trainings in RMNCH Clinical Mentorship

4.1.1 Training of Trainers and Clinical Mentors

4.1.2 Training of Training

4.1.3 Categories and Roles of Trainers

National Reproductive Maternal New born Child and Adolescent Health

4.1.4 Selection Criteria of Trainers

4.1.5 Training of Clinical Mentors

Qualification of a mentor shall be:-

4.1.6 Selection criteria of Clinical Mentors

4.1.7 Characteristics of a clinical mentor