Infection prevention and control multi-level capacity building for health workers-a cascade training and mentorship approach

Introduction: Structures established during outbreak preparedness tend to diminish post-outbreak requiring rapid re-activation, re-training and re-orientation at the detection of a new outbreak. Sustainable Infection Prevention and Control (IPC) structures are required to offset rapid preparedness activities. Implementation of a district led IPC capacity building approach during the 2018 Ebola outbreak in Kasese, Uganda registered improved IPC compliance for majority of the health facilities. The same approach was scaled up to national level to enhance preparedness activities for COVID-19. Objectives: a) To build and strengthen IPC capacity at regional, district and health facility levels. b) To build and strengthen IPC structures through establishment of IPC committees at district and facility levels. Methods: Didactic, practical and video IPC training materials were developed. The approach was piloted in 3 regions;each regional team underwent a training of trainers (TOT). At district level, the TOTs conducted a 3-day training of the district IPC committee and 10-20 selected mentors per district. The mentors were supported to conduct facility mentorship visits. A handbook endorsed by the director general of health services was developed to guide the mentorship sessions at facility level. Results: 114 TOTs from 3 regions were trained, cascading the training to 29 districts. 557 district IPC committee members and district mentors attended the district level training and were attached to 1-3 facilities. 976 health facilities were reached and a total of 13,455 health workers were mentored. The mentors continue with the sustainability phase visiting a facility once a month. Conclusion: The sustainability of IPC practices among health workers has an aspect of attitude and behavioural change and therefore cannot be achieved with a one-off training. This strategy provides suggestions for the Ministries of Health to maintain a functional and robust IPC structure at national, regional, district and health facility levels. Impact evaluation assessments are recommended periodically.