Family Planning Service: Refresher Training

Family Planning Service: Refresher Training

(VHW and MCHW)

Trainers Guide

Second Edition

Government of Nepal

Ministry of Health and Population

National Health Training Center

Mansir 2066 (December 2009)

Table of Contents

SECTION ONE: PARTICIPANT HANDBOOK

• Training Goal and Objectives

• Course Objectives

• Methods of Training Learning

• Training Materials

• Criteria for Participant Selection

• Participant's Evaluation

• Duration of the course

• Training Facilitators

• Three Types of Family Planning Communication

• Examples for Detail Explanation

• Role Play Exercises

• Family Planning Status in Nepal

• Interpersonal Communication and Family Planning Counseling

• Client assessment

• Condom

• Combined Oral Contraceptives(Pills)

• Depo Injection

• Emergency Contraception

• Infection Prevention

• Lactational Amenorrhea Method

• IUCD

• Implant

• Voluntary Surgical Contraception

• Maternal and Newborn Care

• FP service Refresher Training Counseling Learning Guide( Steps of GREET)

• DMPA clinical skill Learning Guide

SECTION TWO: GUIDE FOR TRAINERS

• Family Planning Status in Nepal

• Interpersonal Communication and Family Planning Counseling

• Client assessment

• Condom

• Combined Oral Contraceptives(Pills)

• Depo Injection

• Emergency Contraception

• Infection Prevention

• Lactational Amenorrhea Method

• IUCD

• Implant

• Voluntary Surgical Contraception

• Maternal and Newborn Care

Brief Introduction of the Training

Before Training

This clinical training is based on the Adult Learning Principles. These Principles are based on the assumption/hypothesis that the participants will participate in the training due to following reasons:

• Interested in the training subjects
• Desire to improve their knowledge and skills for better work performance
• Desire to active participation

Therefore, all the course is designed concentrating on the clients need For example t is has been expected that

Training methods usedin the course

Key Features

Mastery Learning Approachis based on the Adult Learning Principles

• Uses Behavior Modeling
• Competency Based
• Humanistic Training Approach

CourseIntroduction

In the course of refresher training to the service providers (VHW and MCHW) following process are used

• On the first day of the training, trainees describe their knowledge related to counseling and family planning through written examination ( Precourse Questionnaire)

• Training classes and clinical sessions concentrate on the important aspects of the service provisos (for example counseling to clients, how to provide service, and management of common side effects and other health problems.

• The Progress of the knowledge based learning is examined through written examination in the middle of the training (midcourse questionnaire).

• Clinical skills related training is prepared based on the past experience of family planning clinical skills of triteness. Firstly, participants practice on the human anatomic model and thus learnimmediately the essential skill for giving depo injection.

• The progress of learning new skills is written using the detail counseling and clinical skills learning activity guideline.

• In order to make the learning easier, all the participants are given home work and next day trainer clarifies the answers after discussion.

Two Days Exercise:

• Clinical Trainers evaluate the skill based performance of each participants using related checklist
• Simple counseling Skills
• Techniques for Depo injection
  Goal of the Training

The overall goal of this clinical training is to update and increase the current knowledge of the participants related to family panning for the provision of quality services.

Objectives of the Training

• Provide communication skills for counseling service to the participants

• Influence positive attitude towards different family planning methods.

• Provide the participant with un-biased, client focused counseling skills to assist client in making informed choice.

• Provide essential knowledge and skills to the participants on combined oral contraceptive pills, condom and depo.

• Provide essential knowledge and skills to the participants to manage common side effects and health problems related to temporary and permanent methods of family planning and refer to the appropriate health facility as required.

• Provide quality updated information related to family planning to the participants.

• Provide basic family planning management knowledge to the participants.

• Participants will be able to provide pregnancy and postpartum care information and management

Evaluation

This clinical training course is prepared to prepare counseling and family planning service providers. At the end of the training, successful participants will be given a certificate from the National Health Training Center.

The successful completion of the course will be based on three types of evaluation as follows:

• Knowledge: For knowledge Midcourse Training Questionnaire minimum score 85%
• Skills: Counseling and clinical skills satisfactory performance

Exercise: Participantscan demonstrate the clinical skills for providing depo injection in any clinic for example - practice room

Objectives of the Course

Lesson: 1 Population and RH status

Primary Objective:

At the end of this session the participants can explain the status of family planning, in Nepal, population education and family planning based on the concept of RH

Specific Objectives:

• Can explain the population status of Nepal
• can describe the elements of population growth
• Can tell the effects of population growth
• Can define reproductive health
• Can describe about the integrated reproductive health services

Lesson: 2:Female and Male Reproductive System

Primary Objective:

At the end of this session participants can describe the basic facts about menstrual cycle.

Specific Objectives:

• Participants will understand the physical functions of the female and male reproductive system
• Participants will get basic information of female and male reproductive system
• Participants will describe the ovulation function and role of hormones.

Lesson: 3:Interpersonal Communication and Family Planning Counseling

Primary Objective:

At the end of this session participants will providing family planning counseling service using effective communication skills through GREET approach

Specific Objectives:

• Can describe types and elements of communication.
• Can describe elements of behaviour change, media and steps
• Can describe interpersonal communication , advantages, characteristics and importance
• Can describe effective communication skills
• Can clarify the relations and difference of motivation, information and counseling
• Can describe the important elements of family planning counseling
• Can describe important aspects of principles of informed choice and its hindrances
• Can know the individual characteristics, knowledge and skills of the counselors

Lesson: 4: Client Assessment

Primary Objective:

By the end of the session, the participant will be able to assess, screen the client before providing any family planning methods.

Specific Objectives:

• Describe the indications, contraindications and precautions according to the client
• Assess the client to rule out pregnancy prior to providing a family planning method
• Evaluate and assess the client’s appropriateness for specific methods using Reproductive Health Protocol flow chart.

Lesson: 5: Infection Prevention

Primary Objective:

By the end of the session, the participant will have knowledge and skills for effective and safe infection prevention.

Specific Objectives:

• Demonstrate hand washing following step by step procedure.
• Demonstrate the appropriate disposal of syringe, puncture proof in the tin and bucket.

Lesson: 6: Breast-Feeding for Lactation Amenorrhea Method

Primary Objective:

By the end of session, participant will be able to counsel on LAM

Specific Objectives:

• Explain the process of prevention through LAM
• Describe the advantages and disadvantages of ALM
• Can tell three important conditions for the effectiveness of LAM

Lesson: 7: Condom

Primary Objective:

By the end of the lesion, participant will be able to explain the advantage of condom use and demonstrate how to use it properly.

Specific Objectives:

• Can explain the advantages, disadvantage and effectiveness of condom use
• Provide condom after the instructions on demonstration of usage, storage, and disposal of condoms.

Lesson: 8: Combined Oral Contraceptives

Primary Objective:

By the end of the lesson, participant will be able to counsel for and provide COCs.

Specific Objectives:

1. Screen appropriate clients for COCs
2. Identfyclients for medical conditions or problems that may be a precaution to the use of oral contraceptives or require more frequent follow-up, and correctly identify those clients that should not use this method.
3. Provide a client with oral contraceptives and give instructions for use.
4. Educate client about what to do if they forget one or two pills.
5. Provide counseling to a woman using oral contraceptives, including the management of simple side effects and referral for more serious complications.

Chapter-10: EMERGENCY CONTRACEPTION

Primary Objective:

By the end of the session, participant will be able to counsel for and provide Emergency Contraception.

Enabling Objectives:

1. Participant will state dosage of Emergency Contraceptive.
2. Participant will describe side effects of Emergency Contraception.
3. Participant will demonstrate counseling and information giving needed for Emergency Contraceptive.

Chapter-11: DMPA/DEPO-PROVERA

Primary Objective:

By the end of the chapter, participant will be able to counsel for and administer DMPA.

Enabling Objectives:

1. Using cue-cards provide counseling to a client about DMPA/Depo-Provera.
2. Screen clients for medical conditions or problems that may be a precaution to the use of DMPA/Depo-Provera or require more frequent follow-up, and correctly identify those clients that should not use this method.
3. Inject a client safely with DMPA/Depo-Provera using appropriate infection prevention practices.
4. Provide counseling to clients using DMPA/Depo-Provera, including management of simple side effects and referral of more serious complications.
5. Participants will answer questions regarding DMPA

Chapter 12-14: IUCD, Implant, VSC

Primary Objective:

By the end of the session participants will be able to provide counseling, manage minor side effects, recognize and refer serious complications of Norplant, IUCD and VSC).

Enabling Objectives:

1. Provide counseling to a client about IUCD, Implant, Minilap and Vasectomy
2. Screen clients for medical conditions or problems from history that may be a precaution to the use of the clinical method chosen, and correctly identify those clients and refer for the clinical method of their choice.
3. Provide follow up counseling to a client for each of the clinical methods, including management of simple side effects and referral for more serious complications.
4. Participants will answer questions regarding IUCD

Chapter 15-16: Management of Sexually Transmitted Infections/HIV AIDS

Primary Objective:

By the end of the session, participant will be able to screen for and treat STIs (using the syndromic approach).

Enabling Objectives:

1. Identify the four main symptoms of STIs that are used in the diagnostic flowcharts provided in the Reference Manual.
2. Identify the appropriate treatment of STIs using the syndromic diagnostic flowcharts or refer as appropriate.
3. Demonstrate infection prevention practices used in the clinic to prevent the spread of STIs to both client and service provider.
4. Discuss how STI and HIV/AIDS is correlated in spreading the diseases and its mode of transmission.
5. Identify prevention strategies for STIs/AIDS, including the use of condoms.
6. Participants will answer questions regarding STIs/HIV AIDS
7. HIV related common infection and procession
8. Care support and treatment

Chapter 17: Family Planning Counseling and Service Management

Primary Objective:

By the end of the session, participant will be able to provide quality of services using checklists with verification criteria of quality of service.

Enabling Objectives:

1. Clinical set up for providing FP services
2. Find out gaps between desired performance and actual performance and prepare action plan to address the gaps identified to ensure quality services.
3. Practice filling the checklist and finding out gaps

TRAINING LEARNING METHODS

•Illustrated lectures and group discussions

•Individual and group exercises

•Role plays

•Simulated practice with Depo Arm Model

•Guided clinical activities (counseling and Depo administration)

•Take home exercises

•Three days practicum

Training Materials

•This course handbook is designed to be used with the following materials:

•Reference Manual ( Comprehensive Family Planning and Counseling Course)

•Trainers Notebook and Participants Handbook ( Comprehensive Family Planning and Counseling Course).

•Training Videotape: COFP and Counseling

•Infection Prevention Videotape (Infection Prevention for Family Planning Service Programs

•Depo Arm Model

•Condom Model

Participant Selection Criteria

Participants for this course should be individuals with health background such as Public Health Nurse, Staff Nurse, Health Assistant, Auxiliary Nurse Midwife, Auxiliary Health Worker, and Community Medicine Assistant. The facility should have an anticipated caseload sufficient to support the provision of Family Planning Services. Preference should be given to those staff working in family planning clinics, VSC, PHC, Health Post and Sub-Health Post location.

FP Service Refresher Training (VHW and MCHW) Trainers Guide 1

Brief Introduction of the Training

Before Training

This clinical training is based on the Adult Learning Principles. These Principles are based on the assumption/hypothesis that the participants will participate in the training due to following reasons:

• Interested in the training subjects
• Desire to improve their knowledge and skills for better work performance
• Desire to active participation

Therefore, all the course is designed concentrating on the clients need For example t is has been expected that

Training methods usedin the course

Key Features

Mastery Learning Approachis based on the Adult Learning Principles

• Uses Behavior Modeling
• Competency Based
• Humanistic Training Approach

CourseIntroduction

In the course of refresher training to the service providers (VHW and MCHW) following process are used

• On the first day of the training, trainees describe their knowledge related to counseling and family planning through written examination ( Precourse Questionnaire)

• Training classes and clinical sessions concentrate on the important aspects of the service provisos (for example counseling to clients, how to provide service, and management of common side effects and other health problems.

• The Progress of the knowledge based learning is examined through written examination in the middle of the training (midcourse questionnaire).

• Clinical skills related training is prepared based on the past experience of family planning clinical skills of triteness. Firstly, participants practice on the human anatomic model and thus learnimmediately the essential skill for giving depo injection.

• The progress of learning new skills is written using the detail counseling and clinical skills learning activity guideline.

• In order to make the learning easier, all the participants are given home work and next day trainer clarifies the answers after discussion.

Two Days Exercise:

• Clinical Trainers evaluate the skill based performance of each participants using related checklist
• Simple counseling Skills
• Techniques for Depo injection

Goal of the Training

The overall goal of this clinical training is to update and increase the current knowledge of the participants related to family panning for the provision of quality services.

Objectives of the Training

• Provide communication skills for counseling service to the participants

• Influence positive attitude towards different family planning methods.

• Provide the participant with un-biased, client focused counseling skills to assist client in making informed choice.

• Provide essential knowledge and skills to the participants on combined oral contraceptive pills, condom and depo.

• Provide essential knowledge and skills to the participants to manage common side effects and health problems related to temporary and permanent methods of family planning and refer to the appropriate health facility as required.

• Provide quality updated information related to family planning to the participants.

• Provide basic family planning management knowledge to the participants.

• Participants will be able to provide pregnancy and postpartum care information and management

Evaluation

This clinical training course is prepared to prepare counseling and family planning service providers. At the end of the training, successful participants will be given a certificate from the National Health Training Center.

The successful completion of the course will be based on three types of evaluation as follows:

• Knowledge: For knowledge Midcourse Training Questionnaire minimum score 85%
• Skills: Counseling and clinical skills satisfactory performance

Exercise: Participantscan demonstrate the clinical skills for providing depo injection in any clinic for example - practice room

Objectives of the Course