Lessons learned from training and support for health workers in the public and private sectors

Malawi has made significant progress in scaling up DMPA-SC and self-injection in the public sector with 100% of service delivery points activated. The country has also learned valuable lessons through private sector pilots and is in the process of finalizing new guidelines to authorize pharmacies and drugstores to provide self-injection training to clients. The country’s approach is widely appreciated as an example of effective government-led and partner-supported scale-up involving both the public and private sector.

This webinar hosted by the PATH-JSI DMPA-SC Access Collaborative Learning and Action Network on August 3, 2022 featured public and private partners’ insights on national scale-up of DMPA-SC and self-injection, with a focus on provider training and supportive supervision as well as strong cross-sectoral partnerships. Speakers included representatives from the Malawi Ministry of Health Reproductive Health Directorate, Clinton Health Access Initiative, FHI 360, and Population Services International.

Drawing from program data and research, panelists discussed practical lessons learned from Malawi’s national scale-up of public-sector provider training, public provider reflections on integrating self-injection, and experiences from a private sector provider training pilot. These lessons may benefit governments and public and private partners in other contexts who are in the process of introducing or scaling up DMPA-SC for self-injection.

Updating family planning and reproductive health preservice training is an important approach to make an impact on the health workforce and foster successful programs. In 2021, the DMPA-SC Access Collaborative, in collaboration with Uganda’s Ministry of Health and Ministry of Education and Sports, conducted a regional training for clinical and health training institutions on the topic of DMPA-SC including self-injection. This training integrated DMPA-SC content into the health provider preservice curriculum, trained tutors, and helped advance national scale-up of self-injection. As a result, 92 Ugandan health training institutions included self-injection content in their preservice curriculum for nurses, midwives, and clinical officers, and 190 tutors were trained—which will help ensure training of many more providers in the future.

During this process, the Access Collaborative gained valuable insights with relevance to other country contexts. This webinar held on January 27, 2022 highlighted lessons learnt, challenges, recommendations, and considerations for the inclusion of self-injection content in provider preservice training. In the Ugandan context, these include:

• How inclusion of self-injection in preservice training can help reach FP2030 country commitments.
• Virtual preservice training approaches during the COVID-19 pandemic.
• Costs for the inclusion of self-injection in preservice training.
• The role of regulators and the Ministry of Health in ensuring availability of DMPA-SC for preservice training.

Using eLearning to train health workers on family planning counseling can be an effective training approach, particularly when carefully planned and coordinated to maximize the benefits. On August 26, 2021, the DMPA-SC Access Collaborative hosted this webinar on eLearning for health workers learning to counsel clients on DMPA-SC including self-injection in Senegal and Uganda. During 2019-2020, this approach was launched and evaluated in four regions of Senegal and four districts in Uganda.

The findings and recommendations from the experiences in Senegal and Uganda may offer lessons for other countries wishing to implement digital learning approaches. The webinar presenters raised important considerations about stakeholder coordination, internet and technology access, eLearning platforms, establishing training targets, training content, and the important role of post-training supervision.

The DMPA-SC Access Collaborative hosted this April 21, 2021 webinar highlighting lessons learned to date through four years of data-driven technical assistance and coordination to ensure that women have increased access to self-injection as a contraceptive option, delivered through informed choice programming. The discussion focused on key topics for the introduction and scale-up of self-injection—and self-care interventions more broadly—at the country level including:

• Policy and advocacy for new product introduction.
• How to coordinate scale-up of a new product.
• Using data to inform program introduction and scale-up.
• Effective innovations and adaptations in provider training.

This discussion was moderated by Monica Mutesa, Zambia Country Coordinator, DMPA-SC Access Collaborative, PATH. Speakers included:

• Caitlin Corneliess, Project Director, DMPA-SC Access Collaborative, PATH
• Adewole Adefalu, Nigeria Country Coordinator, DMPA-SC Access Collaborative, JSI
• Allen Namagembe, Uganda Deputy Director, DMPA-SC Access Collaborative, PATH
• Avotiana Rakotomanga, Madagascar Country Coordinator, DMPA-SC Access Collaborative, JSI
• Alain Kabore, Regional Technical Advisor, DMPA-SC Access Collaborative, PATH

For more information, please contact FPoptions@path.org.

By leveraging digital training tools, family planning programs can integrate new approaches that help reduce the costs, time, and inconvenience associated with traditional classroom training. The PATH-JSI Access Collaborative has recently developed digital training resources for health workers and clients learning to administer DMPA-SC.

A 10-lesson DMPA-SC eLearning course for health workers is available for free in English and French and can be taken on computer or mobile device with internet access. Content includes an emphasis on informed choice counseling, new lessons on calculating the injection date and conducting follow-up visits, and updated information on training clients to self-inject.

In addition to the eLearning course, PATH and JSI have developed short 5- to 7-minute DMPA-SC training videos for both self-injection clients and health workers. Available in English and French, the videos can be translated or adapted to fit in program contexts.

If you are interested in introducing DMPA-SC digital training approaches in your program, please contact the Access Collaborative at FPoptions@path.org.

These short training videos are intended for both self-injection clients and health workers learning to administer the contraceptive DMPA-SC. The 5-minute self-injection training video is intended for women who have made the decision to self-inject DMPA-SC in the context of informed choice counseling. The 7-minute training video is for health workers who are giving injections to women who have chosen to use DMPA-SC in the context of informed choice counseling.

If you are interested in customizing these videos for your family planning program, we can make the voiceover scripts and video files available. To request these files please email FPoptions@path.org.

The Training Resource Package (TRP) for Family Planning offers curriculum components and tools for trainers to design, implement, and evaluate family planning and reproductive health training. The TRP website includes training information and materials for a wide range of family planning methods.

The TRP’s Progestin-Only Injectable module includes sessions V and VI which are focused on DMPA-SC and self-injection, as well as a number of related handouts and resources. The module was developed for training physicians, nurses, and midwives and other health care providers who offer Progestin-Only Injectable Contraception (“injectables”).

DMPA-SC is a three-month injectable contraceptive that is easy to use and uniquely suited for self-injection. Demonstration and practice injections are a key part of training programs for both health workers and self-injection clients. Based on lessons learned in five countries, this memo summarizes PATH’s recommendations regarding devices for injection demonstration and practice, injection practice models, and waste disposal.

These training videos from Global Health Media cover a variety of family planning and other health topics. In addition to DMPA-SC (referred to as Depo SubQ), topics include: contraceptive methods, family planning learning aids, contraceptive method skills (“how-to” films), counseling, reproductive health, and clinic-based infection prevention and control. Videos are tailored for health workers, women, or their partners, and many are available in English, French, Spanish and other languages.

The videos for health workers are also available in the Family Planning Videos app which can be downloaded from Google Play or the App store. Videos for women and partners are available in the Birth & Beyond app, also on Google Play and the App store. If you would like to narrate any videos in your local language, please contact Global Health Media.

With funding from the Catalytic Opportunity Fund (COF), JSI, Inc. evaluated the feasibility of using a low-cost training mechanism, known as OAS or “Orientation, Aide par Fiche Technique (job aid)”, to facilitate DMPA-SC scale-up among injection-experienced providers. It was piloted in four pilot districts in Madagascar, covering 76 basic health facilities.

Respondents had a very positive view of the OAS strategy and agreed it was a good alternative to more traditional training that can be scaled up in areas with injection experienced providers. The most significant impact of the OAS strategy has been correcting errors to ensure proper administration of DMPA-SC, thereby eliminating rumors and previous complaints.

This report covers the background, pilot and evaluation, results, and next steps relating to the OAS strategy in Madagascar.