Sisi-Kwa-Sisi Coached Nurse Transforms Tanzanian City, Contributing to Increase in LARC Users

Contributors: Owen Mwandumbya, Denis Sama, Rose Mnsava, Kathryn Walsh

Kylie Gyubi is a registered nurse at Movio Dispensary in Arusha District.

It all started for Kylie Gyubi – a registered nurse at Moivo Dispensary in Arusha District, Tanzania – when she was selected to join two other health providers from her district to attend a three-day orientation in Dar-es-Salaam organized by The Challenge Initiative (TCI) on an intervention dubbed “Sisi kwa Sisi,” which when translated means “us for us.”

“We visited [TCI-supported] Ubungo, Kigamboni and Temeke municipalities where we were exposed to various key impact areas such as how they are providing friendly services to youth, empowering unskilled attendants – like watchman, cleaner, and other technical staff – on the basic information needed while attending to clients at the facility [Whole-Site Orientation].  We also learned how they conduct outreach and in-reach services, including having a special day dedicated to working clients who can’t attend services on weekdays,” said Gyubi.

Inspired by her orientation, Gyubi wanted to transform Moivo Dispensary by adopting the same interventions. She started by mentoring her fellow providers on youth-friendly health services. In less than two months, Moivo Dispensary met all the requirements of a TCI youth-friendly health facility and even expanded clinic hours to include Saturdays to accommodate working women. Gyubi decided to create support groups for first-time mothers and one for younger girls, who have not become pregnant (Enyoito Girls Group). She also made sure to involve young men, inviting male partners to the first-time parents group, creating a group for young boys (Moivo Boys Group), and even holding meetings with boda boda drivers in her community.

“I was very ambitious and every day I imagined how helpful this will be if I adopt some of the methods we learned [through Sisi-Kwa-Sisi]. Thank God that our District Nursing Officer, Mrs. Augusta Komba, was very supportive.  She was so happy to see that we are transforming Moivo Dispensary with innovations adopted during Sisi kwa Sisi training,” said Gyubi.

In fact, Komba was elated. When she visited Gyubi at Moivo Dispensary and witnessed all the new innovations, she knew Arusha District needed to diffuse Gyubi’s knowledge and talents to more health facilities.

Arusha District Nursing Officer Mrs. Augusta Komba (right) meeting with Kylie Gyubi (left).

“I wanted something different for my team to commemorate International Nursing Day. This year’s theme was ‘Health for All,’ so the success of the Sisi-kwa-Sisi model at Moivo Dispensary drove my ambition to have all nurses in my district empowered with new skills. I opted to set-up a team to [help other nurses] learn about best practices done in Moivo Dispensary,” said Komba.

In the month leading up to International Nurses Day, Komba assembled a team of nurses to coach and mentor health staff from the region’s 15 TCI-supported health facilities. The sessions focused on how to conduct community dialogues, outreaches, in-reaches, and data management and use. She then led assessments using a government-developed family planning checklist to measure the quality of services provided at each of the 15 health facilities.

It was no surprise that Moivo Dispensary emerged the winner with a score of 80%, but it was encouraging to see so many other facilities close behind – with Mungushi Dispensary and Kioga Dispensary scoring 78%. The district plans to use the family planning quality checklist on a biannual basis to measure quality, award high-performing facilities and identify any gaps.

Increase in Arusha District contraceptive users, 12-month rolling sum (15 health facilities).

Komba and Gyubi’s dedication are making a difference. Data from the 15 TCI-supported health facilities in Arusha District show an increase in contraceptive users in the past year, and particularly in the last quarter. Long-acting reversible contraceptive (LARC) users increased in Arusha District by 28% from December 2019 from the baseline (the period before TCI started implementation). In this timespan, TCI supported eight whole-site orientations, sensitizing 57 health providers, and held 24 integrated outreaches and 46 in-reaches.