Applying TRH Best Practices
in the Field
Ron Magarick
The Training in Reproductive Health
Project (TRH) at JHPIEGO
29 November 2001
1
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. . .
2
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
3
Best Practice:
Strengthening Preservice
Education and Training
4
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)
5
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
6
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)
7
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
Graduates From Strengthened
Schools Performed Better on
Licensure Examinations
Nursing Licensure Examination Passing Rates: Philippines
100
90
Nursing: National Rate
Percentage
80
Nursing: Rate for 4 Program Schools
70
60
50
40
30
20
10
0
1998
1999
Year
9
Best Practice:
Competency-based Training
Using Anatomic Models
10
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
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)
12
Competency-based
Learning Packages
Chulalongkorn University: Using Anatomic
Models Can Increase Training Efficiency
IUD Insertion: Number of Clients Needed to Achieve Competency
100
90
80
70
60
50
40
30
20
10
0
2-week course with
models
6-week traditional
course
1st
3rd
5th
8th
Client Number
Source: Ajello et al, 1994.
16th
Humanistic Approach
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
16
Best Practice:
Competency-based Training in
Postabortion Care Using
Structured On-the-Job Training
17
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
18
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
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 selfpaced computer-assisted learning approach
– Oriented to trainer’s role in the PAC/OJT package
– Received supportive supervision visits to initiate training
20
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
Surprise Best Practice
22
Establishment of the Regional
Centre for Quality of Health Care
Institute of Public Health,
Faculty of Medicine,
Makerere University,
Kampala, Uganda
23
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 HEALTH
KAMPALA, UGANDA
KAMPALA, UGANDA
24
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
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
26
Centre Accomplishment:
Strengthening Technical Skills
in the Region
.