In 2013, Soapbox began a partnership with Horizons Trust Gambia (HTG) and the Gambian Ministry of Health to create the Maternal Health Cleanliness Champions Initiative (MCCi).

The focus of this initiative was to create and support a network of health champions to reduce healthcare associated infections (HAIs) at the time of birth in The Gambia. Training materials, resources and needs assessment tools were developed and shared to identify effective and affordable interventions to reduce the risks of HAIs.

The desired outcomes of the MCCi were to:

• improve the knowledge, attitudes and practice of care providers and support workers, including cleaning staff
• evoke a stronger advocacy for infection prevention and control (IPC) at all levels
• improve the monitoring and evaluation of progress to reducing preventable infections at birth
• create safer, woman-centred maternity care.

A Soapbox-designed needs assessment questionnaire was delivered at six participating healthcare facilities and a wide range of practices and conditions on maternity units were highlighted - including a lack of training and knowledge around IPC, resource shortages and the poor cleaning and maintenance of delivery beds.

Health teams and labour ward staff from the six participating facilities attended a 4-day IPC intervention training workshop led by Soapbox and Horizons. The workshop enabled facilities to address some of the challenges identified in the needs assessment by equipping them with the knowledge and skills to revise and strengthen existing hygiene policies and practices to support quality care for mothers and their newborns.

Addressing the Gap in Participatory Training in Basic IPC & Environmental Hygiene for Cleaning Staff in LMICs — Piloting Soapbox’s training manual in The Gambia

One striking finding of the WASH and IPC needs assessments carried out by Soapbox in maternity units in low income countries has been the critical lack of formal training for staff with cleaning responsibilities despite their key role in maintaining environmental hygiene and IPC. To help address this gap, Soapbox developed a training manual, in consultation with experts and with reference to existing national and international guidelines on hygiene and IPC.

A pilot was conducted in The Gambia in April 2016. Nine participants from four focus maternity units took part in a week-long Training of Trainers (ToT) workshop. A ‘CLEAN Box’ approach was used to deliver training, with each box containing instructions and practical resources required to deliver training on one of the seven key training modules. Training was participatory in nature and aimed towards staff with limited literacy skills. These ‘Cleaning Champions’ also learned techniques for training the cleaners and healthcare workers at their own facilities. With support from the IPC Task Group and HTG, the Cleaning Champions rolled out training to cleaning staff at the respective facilities - resulting in the further training of 50 staff.

Results from the training were overwhelmingly positive - changes were made to IPC knowledge and practice of both trainers and trained cleaning staff and the empowerment of cleaning staff through knowledge acquisition and targeting of resources was evident.

Following the pilot, Soapbox have revised and updated the training manual and in November 2018 launched the Training in Environmental Hygiene and Cleaning in Healthcare (TEACH CLEAN) package.

Implementing the TEACH CLEAN package in The Gambia

This short film follows the roll out of TEACH CLEAN in The Gambia. It was produced in collaboration with The Horizons Trust Gambia.