Scaling-up a program for Liberian pregnant and parenting teens: Using organizational and systems leadership

The life course outcomes of pregnant and parenting adolescent girls living in Monrovia, Liberia, is influenced by their age, where they live, their access to health care, schooling and economic resources. Challenged to improve their life course, the Parenting the Parent (PTP) program of Monrovia’s JFK Medical Center (JFKMC) sought strategies, from an American public health maternal/child health nurse leader, to scale up their program.   

In September 2013, a two week formative inquiry assessment of the PTP program was conducted.  Utilizing face-to-face interviews, observations, and service delivery participation, the assessor examined organizational policies and structure, current and desired program services, service delivery, and defined goals, objectives and outcome measures. 

Utilizing organizational and systems leadership skills, quality improvement strategies requiring organizational and policy changes, and a systematic process of implementation were recommended:

• Organizational Structure:  Develop a strategic plan to create a shared vision between administration and staff; implement improvements that fit within the resources of JFKMC and meets community needs; use formative inquiry assessment data to launch comprehensive formative and process evaluation for continuous quality improvement.
• Program Services: Revise participant eligibility policy; develop clinic appointment calendar to follow-up on missed appointments; standardized health education; conduct psycho-social assessments and develop/implement needed community-based program services.
• Program Delivery: Move services from a public clinic hallway to private room; provide differentiated health education for the girls at different stages of pregnancy/parenting; and actively engage participants during the educational sessions.
• Outcome Evaluation Methods: Develop program logic model and a method to collect, analyze and disseminate all program data based upon available resources.

To make a transformational change in the PTP program leading to improved life outcomes of adolescent Liberian mothers, information produced from the formative inquiry assessment should be used as a catalyst to conduct an extensive comprehensive formative and process evaluation using a community-based participatory research approach.