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Applying TRH Best Practices in the Field

Ron Magarick

The Training in Reproductive Health Project (TRH) at JHPIEGO

29 November 2001

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Overview: Training in Reproductive Health

The TRH Project works globally to establish integrated (pre- and inservice) education and training systems to improve the performance of reproductive health professionals. . .

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Selected TRH Best Practices

• Strengthening preservice education and training

• Improving provider performance through implementing competency-based training approaches using:– Anatomic models– Structured on-the-job training

• And one more Surprise Best Practice

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Best Practice: Strengthening Preservice

Education and Training

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Reasons to Strengthen Preservice Education and Training for All

Health Professionals

• Prepares students to become skilled FP/RH providers immediately after graduation

• Students start off with “correct” information, attitudes and behaviors

• RH skills perceived as part of basic package of skills• Faculty/preceptors become advocates for RH

services• Can reach more providers than inservice training• Reduces reliance on inservice training by providing

graduates with basic skills (IP, pelvic exam, counseling)

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Essential Elements in Preservice Education and Training

• Linkages between the classroom and clinical practice established and strengthened

• Standardized RH curriculum developed• Clinical knowledge/skills strengthened and training

skills of faculty/tutors/clinical preceptors updated• Clinical practice sites standardized

• Training materials developed and made available to faculty, trainers and students

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JHPIEGO’s Preservice Education and Training Program in the

Philippines

• Decade-long program (1987-1998)– Strengthen preservice nursing and midwifery

education for FP/RH (strengthen curriculum, trainers, clinical training sites)

– 27 nursing and midwifery schools

• Program evaluation (February-March 2001)– Study Sample:16 schools

(8 nursing, 8 midwifery)

Philippines: Summary of Findings

3 years later:• Policy: FP/RH questions incorporated in licensure

examinations• Programmatic: Strengthened nursing and midwifery

schools continue to implement competency-based FP/RH preservice education

• Sustainability: Schools maintaining strengthened program• Trained faculty available• Implementation of FP/RH curricular components

continues• Functioning clinical training sites available• School faculty used as resources for programs at other

schools and in other clinical areas (e.g., HIV/AIDS)• Impact: Graduates better prepared for service delivery

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Graduates From Strengthened Schools Performed Better on

Licensure Examinations

Nursing Licensure Examination Passing Rates: Philippines

0

10

20

30

40

50

60

70

80

90

100

1998 1999

Year

Pe

rce

nta

ge

Nursing: National Rate

Nursing: Rate for 4 Program Schools

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Best Practice: Competency-based Training

Using Anatomic Models

Why Use Anatomic Models?

• Clients are not harmed or inconvenienced if a mistake is made

• Difficult tasks, or parts of a procedure, can be practiced repeatedly

• Practice of a sequence of steps or skills can be repeated at any time and as often as needed

• Several participants can practice simultaneously• Practice is not limited to the clinical situation, or to

a time when clients are available

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Why Use Anatomic Models?

• Promotes learning by doing• Uses a humanistic training approach (i.e.,

uses anatomic models to ensure competency before working with clients)

Competency-based Learning Packages

Chulalongkorn University: Using Anatomic Models Can Increase Training Efficiency

0102030405060708090

100

1st 3rd 5th 8th 16th

Client Number

2-week course withmodels

6-week traditionalcourse

Source: Ajello et al, 1994.

IUD Insertion: Number of Clients Needed to Achieve Competency

Humanistic Approach

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Conclusion

• Clinical training is possible even when the client caseload is low because fewer cases are needed for participants to attain skill competency

• Training time is reduced, resulting in:– Lower costs for training

– Less disruption of services due to provider absence

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Best Practice: Competency-based Training in

Postabortion Care Using Structured On-the-Job Training

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The PAC/OJT, Self-Directed Learning Package

• The postabortion care/structured on-the-job training (PAC/OJT) approach – Reduces the need for group-based courses – Increases training flexibility– Supports decentralized training systems

PAC/OJT Learning Package Addresses the Need for More Flexible Training

• Main advantages– Enables the training of individual or a small

number of trainees without putting undue burden on trainers or training site

– Is much more flexible, and requires less logistic support than traditional group-based training

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Core Group Prepared as PAC/OJT Trainers in Zambia

• Core group of 14 service providers from 3 model clinical training sites prepared as trainers– IP, FP etc. skills updated and PAC clinical skills

standardized to establish model services

– Introduced to the PAC/OJT package

– Trained in clinical training skills using ModCAL, a self-paced computer-assisted learning approach

– Oriented to trainer’s role in the PAC/OJT package

– Received supportive supervision visits to initiate training

PAC/OJT Results in Zambia

• Three teams have begun OJT for staff within their own sites (12 physicians and nurses currently being trained at Kitwe, Ndola and University Teaching Hospital)

• National action plan – to establish PAC services in 100 sites nationwide – based on implementing the self-directed/structured OJT approach

• 16 to 24 new service providers are expected to receive training as OJT trainers in the coming year

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Surprise Best Practice

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Establishment of the Regional Centre for Quality of Health Care

Institute of Public Health,

Faculty of Medicine,

Makerere University, Kampala, Uganda

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RCQHC Mission

The RCQHC was established to provide leadership in building regional capacity to improve quality of health care by promoting better practices through networking, strategic partnerships, education and training.

REGIONAL CENTRE FOR QUALITY OF HEALTHREGIONAL CENTRE FOR QUALITY OF HEALTHKAMPALA, UGANDAKAMPALA, UGANDA

KAMPALA, UGANDA

Regional Centre for Quality of Health Care (RCQHC)

• Based at Makerere University and affiliated with Makerere’s Institute of Public Health

• Opened February 2000• Supported by a consortium of USAID CAs• Staffed by leading African clinicians and trainers

– Reproductive Health Advisor– Maternal Health Advisor– Malaria Advisor– HIV/AIDS Advisor– Nutrition Advisor

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Centre Accomplishments

Worked to develop and pretest short courses (RH, nutrition, HIV/AIDS, malaria) and develop a diploma course in QoC

• Provided technical assistance to MOHs within the region in curriculum and job aid development (e.g nutrition, MNH, RH)

• Organized a State of the Art meeting on Improving Quality of Care in the region (230 participants attended)

• Provided TA to many NGOs in the region

Centre Accomplishment:Strengthening Technical Skills

in the Region

.