Applying TRH Best Practices in the Field

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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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JHPIEGOs 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 Sample16 schools
• (8 nursing, 8 midwifery)

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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
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Best Practice Competency-based Training Using
Anatomic Models
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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)

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Competency-based Learning Packages
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Chulalongkorn University Using Anatomic Models
Can Increase Training Efficiency
IUD Insertion Number of Clients Needed to
Achieve Competency
Source Ajello et al, 1994.
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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

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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 trainers role in the PAC/OJT package
• Received supportive supervision visits to
  initiate training

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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.

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Regional Centre for Quality of Health Care (RCQHC)

• Based at Makerere University and affiliated with
  Makereres 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

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Centre AccomplishmentStrengthening Technical
Skills in the Region
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