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Training, Supervision & Clinical ServicesActivities In collaboration with other components of the project and the district health teams, Training and Clinical Services (TCS) focused on key aspects of DISH priority areas. It placed more attention on health facility performance by emphasising regular supervision, on-the-job training, distance learning and whole site support. Client and goal oriented ANC: The component promoted client-oriented care in selected public and private health facilities. TCS developed support materials for goal-oriented antenatal care, defining key procedures to be performed and information to be given at each of the four antenatal care (ANC) visits. The component supported the implementation of intermittent presumpture treatment (IPT) for malaria and supported the training and supervision of providers in updated guidelines for malaria treatment and prevention during pregnancy in a distance learning (DL) course. Trainings for providers of antenatal care providers included counseling and referral for voluntary counseling and testing (VCT). During training and supervision activities, the component oriented service providers about new guidelines related to preventing mother-to-child transmission of HIV/AIDS (MTCT). Emergency obstetric care: Following the development of the emergency obstetric care (EOC) strategy and training package, INTRAH and JHPIEGO collaborated to strengthen EOC services in at least 30 public and NGO health facilities, including 23 HC IV facilities and 7 hospitals. Criteria for selecting facilities included client load, commitment of health staff, and availability and commitment of senior OB/GYN consultants for regular support and supervision. Agreements were signed with supervisors to ensure scheduled supervision. The TCS component assisted facilities to review and implement best practices to ensure facility and provider readiness to address EOC cases. Life-saving skills: The component continued to support training and supervision of HC III and HC IV midwives, as well as private midwives with no medical officer supervisors, to strengthen referral and ensure immediate resuscitative care. This support focused primarily on midwives from health units with a high maternal-health client load. Practicum sites were at regional or district hospitals where patient load for obstetric emergencies is high. Post Abortion Care (PAC): The component increased the provision of Post Abortion Care or PAC services from 70 to 110 health facilities. Seventy midwives were trained and received regular technical supervision. Within the TCS component, INTRAH collaborated with JHPIEGO to package on-the-job support materials. Health facilities with higher client loads were established as PAC training sites. At these sites, mentors were nominated to provide on-site skill transfer to three or four midwives. The project conducted a pre-training performance assessment, helped mentors to tailor training to trainee needs and conducted exit skills performance assessments and certifications of midwives who successfully completed the training.
Adolescent Friendly Reproductive Health Services (AFRHS): Building upon the Jinja adolescent reproductive health model, the TCS component expanded the development of AFRHS to one or two health facilities in each of the 12 districts. To help develop adolescent-friendly services in other districts, the component trained the service providers and established proven health facility management practices.
Long-Term and Permanent Family Planning Methods: The component focused on expanding the availability and use of Norplant, TL, and vasectomy services, in collaboration with districts and networks of private service providers such as the Uganda Private Midwives Association. The component established outreach TL clinics, training and supplying midwives to provide Norplant services at selected sites, improving the quality of vasectomy services at five sites. The component supported three regional doctor/nurse teams to provide scheduled outreach services to 44 health units. Community Health Workers (CHWs) received a three-day training on educating and encouraging clients to opt for LTPMs. Service providers from selected host facilities will be oriented to support outreach services. The component focused on HC III and IV facilities with high client load, or demand for Norplant, and facilitated linkages with existing CHWs where possible. Outreach services also provided an opportunity to maximize skill acquisition and hands-on experience of trained providers.
Norplant Training: The component provided training of both physicians and non-physicians from the 12 districts in Norplant. The non-physicians included nurses, midwives and clinical officers. This was in line with the national policy for reproductive health services and this approach increased access to the quality Norplant services in the country. The training course was a 5-day course and prepared participants to counsel clients and provide quality Norplant services. The DISH Project together with district training supervision teams provided support and trainee follow-up.
Safe Motherhood: Training and Clinical Services (TCS) provided training to various cadres of staff in safe motherhood skills. These trainings included emergency obstetric care, life saving skills and integrated reproductive health. The providers were supported with regular supervision, supplies and basic equipment. Through performance needs assessment and whole site support conducted by the DISH II Project and district staff, 2 sites in each of the 12 districts were prepared to provide quality safe motherhood practices that include goal-oriented antenatal care, counseling for birth preparedness, client focused delivery assistance and improved facility and drug management. The providers at each of the sites identified their performance gaps and were oriented to these practices. Support and monitoring of the performance improvement activities was done on a regular basis. Community mobilisation to use the improved safe motherhood services at these sites was done by trained community resource persons (CORPS).
Family Planning: Training and Clinical Services provided training in family planning to various cadres of staff including nursing assistants, nurses, midwives, clinical officers and medical officers. Part of this training took place under the 4-week course in integrated reproductive health (IRH) and 3-day update in IRH. The Nursing Assistants were trained using the DL approach. All the providers trained were given regular support supervision by the DISH II trainers and district training and supervision teams. Nursing aides typically require more training to improve their skills. Since nursing aides provide over 50% of the services at primary health care facilities, the component designed and implemented a 12-week distance-learning course for nursing aides in the 10 of the 12 project districts. This course required a well functioning learner support system and created an opportunity to reduce the learner's time spent away from the health centre.
Integrated Reproductive Health (IRH): Training and Clinical Services provided training for nursing aides, nurses, midwives and clinical officers in integrated reproductive health. This training took the form of either a 4-week course or 3-day update. This was followed by regular support supervision and post training skills assessment. Capacity in training and supervision in IRH was built in all the 12 districts of the project area.
Immunization: During supervision, the component focused on disseminating the MOH immunization policy guidelines. TCS worked with UNEPI to develop a facility-management system that facilitates networking among outpatient providers and the staff of MCH departments. The component also focused on improving cold chain and vaccine management for routine immunization and providing guidance for effective immunization outreach. Malaria During Pregnancy - Distance Learning Program for Health Care Workers: In Uganda, one in every four or five persons attending out-patient clinics do so because of malaria and one in every seven deaths occurring among patients admitted in hospitals is due to malaria. The most at risk are the pregnant women and children under 5 years. This special module of the self-directed distance learning program has been prepared to help inform health care workers about the main points in the control of malaria during pregnancy as outlined in the national guidelines. It consists of IPT use of insecticide treated nets and care management of clinical cases of malaria occurring during pregnancy. The DISH II Project initiated this course in 5 districts (Luwero, Ntungamo, Nakasongola, Masaka and Ssembabule) and trained 150 health care workers of various cadres including medical officers.
Supporting supervision systems and QOC-Improvement: During the workplan year, the TCS component supported the use of National Supervision Guidelines. The project supported regular assessment of supervisors' capacity to perform tasks according to standards. Findings from these assessments helped identify each team's TA needs. It helped institutionalize basic standards of quality as part of the projects Quality of Care initiative and support for regular supervision. Enhancing Interpersonal Communication (IPC)
Skills: Creating awareness of health issues
and attempting to change behavior through Information,
Education and Communication (IEC) efforts and the
improvement in quality at the service delivery point
(SDP) have been significant steps in increasing access
to and utilization of health services. |