The Obstetric Safe Surgery (OSS) Program in Kenya: Co-designing surgical training and mentoring programmes with local teams

Under the Johnson & Johnson funded Obstetric Safe Surgery (OSS) Program in Kenya, Jhpiego has been working to improve access to safe, quality, respectful obstetrical and anesthesia care through team-based workforce capacity development, as well as community engagement and strengthened referral systems in five high-volume health facilities in Makueni County, Kenya.

In 2020, Proximie formed a dynamic public-private partnership with Jhpiego, with the support of the Ministry of Health in Kenya, to implement, adapt and scale-up the OSS Program by layering in the Proximie technology to stretch the boundaries and capabilities of digital technology to augment surgical workforce capacity development and support quality improvement efforts. Proximie is now being used to digitally connect these five facilities through a hub and spoke model to ensure more equitable access to timely and safe obstetric surgical care.

Dr. Doris Nthenya Mbithi, Medical Superintendent of the Mother and Child Hospital in Makueni County and a partner in the OSS Program, shares her personal reflections about the experience and use of Proximie.  

“One of the challenges encountered during in-person mentorship visits was that after traveling sometimes long distances you could never predict if there would be a scheduled case. This is no longer an issue since the introduction of Proximie being layered into the powerful OSS Program. I can now scrub in-virtually anytime from anywhere and work with the team with greater consistency and frequency which is critical in mentorship and upskilling. There is now the opportunity to share best practices regularly at our convenience and build upon in-person mentorship with greater efficiency.”

Dr. Doris Nthenya Mbithi continues: “Thanks to Proximie, I’m also able to remotely review recorded cases from the library on the platform with the team at the sub-county district level facilities and have a dynamic interactive discussion around their strengths, identify gaps and therefore correct the course according to performance. This would not have been entirely possible with traditional file audits. The first day I remotely reviewed a case with one of the teams at a distance, it was exhilarating! The discussion felt so real – like we were together in the same room.

“Our mentorship has gone a notch higher since we are now able to reach a bigger team through simulations and live cases. We can even have multiple facilities dial in to watch simulations and live cases. I can’t wait to see the next steps as we take on the challenge to see how technology can enhance and augment important clinical training. I am excited at how our county and surgical teams are leading the way to new approaches.”

Local ownership of the program has been critical from the start.  Surgical teams have had the opportunity to trial, adapt and ultimately adopt Proximie through hands-on learning and problem solving, ensuring the technology is fit for purpose for the local context. Together, partners have worked hard to ensure that everyone feels comfortable using Proximie.  

Mr. James Ndungu, Proximie IT Lead for Africa, explains: “Not only is sensitization of all the parties concerned critical for successful clinical ownership and subsequent uptake of any technology but investing time and energy into developing context-specific change management processes and facility level standard operating procedures for use, is the cornerstone to success. Technology is not a ‘drop and run’ endeavor. Its deployment requires thoughtful co-creation and reinforcement with local champions.”

As the work continues to unfold, there is growing excitement on the ground about the potential to demonstrate the impact of layering in technology to best in practice surgical workforce capacity development.  

Dr. John Varallo, Global Director of Safe Surgery at Jhpiego, says: “I’m so excited to be working with Proximie and building on our OSS work. The co-design approach to implementation and learning is allowing us to take our training and mentoring to another level. The amazing thing about it is you see the teams embrace the technology – where they are owning it and driving the way forward. They see how powerful technology can be to make them better surgical teams and to improve care for women and babies in their communities. This can truly be a game changer, and I’m glad to be a part of it.”