Training of Drug Shop and Private Operators As Sales Outlets for Injectable Contraceptives

TRAINING OF DRUG SHOP AND PRIVATE OPERATORS AS SALES OUTLETS FOR INJECTABLE CONTRACEPTIVES

Training Manual

Duration of training: two (2) days

Session 1: Introduction

Time: 1 hour

GOAL

To equip drug shop and private operators with knowledge and skills to provide family planning, specifically Depo Provera.

TRAINING OBJECTIVES

By the end of the two days training, participants will be able to:-

1.  Define Family Planning

2.  Describe FP methods available in Uganda and how they work to prevent pregnancy

3.  Discuss Counselling for Informed Choice

4.  Demonstrate ability to counsel clients for Informed choice

5.  Screen and initiate clients on Depo Provera

INTRODUCTION EXERCISE

Session Objectives

By the end of the introduction exercise:-

1.  trainers and participants will know each other

2.  participants’ expectations will be outlined

3.  participants will have formulated norms to be followed during the two days training

4.  participants will have selected group leaders for the training

5.  participants will have completed the pre test

Training Method -

·  Brain storming

·  Large group discussion

Resources required

·  News Prints

·  Markers

·  Masking tapes

·  Pre knowledge questionnaires

Instructions

§  ask the participants to stand up in turns to introduce themselves following the guide below:

Names

Name preferred

Place of work

Qualifications

Experience in family planning service delivery

Expectations for the Workshop

Fear of the Workshop

§  Ask each participant to record the name they prefer to use in this workshop on the label and later wear it for identification.

§  Record the workshop expectations and fears on different newsprint which will be hanged in the classroom

Establishing Norms

Brainstorming

§  Ask participants to brainstorm norms to be observed during these two days.

§  Record the responses on the newsprint after reaching a consensus and these will include:

-  Punctuality

-  Speaking one at a time and loudly

-  Putting phones in silence

-  Respecting each other

-  Participate actively in all activities

Repeat the norms to make sure that every one has understood them.

Group Leaders

§  Explain to the participants that it is important to have leaders in a group like this one because they facilitate the smooth running of the workshop.

§  Ask participants to nominate their leaders

§  Write down the names of the nominated trainees on the newsprint after being seconded by other participants

The positions will include; Chairperson, Time keeper and Welfare Officer

Pre – test 30 mins

Objective

To assess the knowledge of participants and identify areas that require more discussion during the training.

Instructions

Reassure participants not to get worried if they do not know because the purpose is to establish the baseline data

Inform the participants that the test will take only 30 minutes

Distribute the pre test and tell the participants to start

Make clarifications if necessary when the participants are doing their pre test

Collect the papers and ask the how it was and acknowledge the responses

Tell the participants that they will get their results before the day closes.

Registration, participation introductions, training objectives, pre test

Session 2: Review of Family Planning Methods

Time: 1 hour

Climate Setting

Trainer

·  Ask trainees to mention the contraceptive methods available in Uganda

·  Record the methods mentioned on NP in their categories i.e. hormonal, non-hormonal, barriers and permanent.

·  Thank trainees for the list of contraceptive methods generated

Introduce the topic and explain that in this session, the trainees will be discussing all the FP methods

Session Objectives

Trainer

·  Present the following objectives.

By the end of session, trainees will be able to:

1.  List by type and category the FP methods available in Uganda

2.  Outline the guide used to describe FP methods

3.  Explain the WHO eligibility criteria for contraceptive use and its application to FP method use.

4.  Dispel myths and misconceptions

·  Ensure clarity of objectives

Experience

Brainstorm/Large Group Discussion

Trainer

·  Recap the information generated by trainees during climate setting on FP methods

·  Using prepared NP on FP methods available in Uganda, add on methods omitted by trainees and classify them according to their categories. (Hormonal methods, IUD, Natural Family Planning methods, Barrier methods and Permanent methods)

·  Allow for and answer questions

Small Group Work

Trainer

·  Explain to participants that they will work in groups to discuss various FP methods

·  Divide participants into 4 small groups of 5’s.

·  Display the NP with Guide for Describing FP Methods

·  Ask one volunteer to read

·  Recap on each statement.

·  Display the group task on NP and ensure it is clear

Small Group Task

Use the given guide to describe the FP method assigned to your group:

Group 1: Describe COC and Periodic Abstinence methods - Moon Beads

Group 2: Describe POP, Implants (Jardelle and Implanon) and Condom

Group 3: Describe DMPA and Lactational Amenorrhea Method

Group 4: Describe IUD and VSC (Tube-ligation and Vasectomy)

Use the given materials and samples of FP methods as references

Be ready to present your work on Newsprint to the large group

Time – 1 hour

·  Distribute Newsprints, markers, Handouts (references to the Trainee Manual), National Policy Guidelines (addendum), samples of FP methods relevant to each group and any other resources.

·  Monitor the groups as they work.

·  Call groups to present in plenary

·  Ask leaders to present group work one by one

·  Use handout to make clarifications and emphasize on the important points on specific methods e.g. similar mechanisms of action for hormonal methods, Dual Method Use and considerations for HIV positive clients.

·  Encourage questions and respond giving realistic examples to reinforce the understanding.

·  Refer trainees to the NP with Questions, Rumours/misconceptions and ask them if these have been clarified or not.

·  Clarify as necessary.

·  Use handout to explain the guide used to describe FP methods

GUIDE FOR DESCRIBING FAMILY PLANNING METHODS
·  What it is
·  Effectiveness in preventing pregnancy including the user’s role
·  Mechanism of action
·  Advantages and non contraceptive benefits
·  Protection against STIs/HIV/AIDS
·  Common side effects and disadvantages
·  Who can use the method
·  Who cannot use
·  Signs of problems that require urgent medical attention

·  Give reasons for each type of information

·  Allow for and answer questions

·  Inform trainees that this guide will be applied when discussing FP methods

·  Ask trainees what would make them decide whether a client is suitable to use a particular FP method or not

·  Allow 2-3 responses

·  Inform trainees that WHO has set criteria for contraceptive use which is used to assess eligibility of clients to start or continue using contraceptives.

·  Use prepared NP to explain the four categories of WHO medical eligibility criteria for contraceptive use. Give examples of each category.

·  Allow and answer questions

·  Inform trainees that this WHO Medical Eligibility Criteria was used to outline who should use and who should not use a particular FP method as indicated in the RH National Policy Guidelines.

·  Distribute case studies on Eligibility Criteria and ask trainees to do the case studies in their own free time.

·  Inform trainees that you will discuss the case studies during the ‘where are we’ sessions

Processing

Trainer

·  Ask trainees to share what they found easy or difficult in the session on describing FP Methods

·  Ask them to mention the new information they have realized about FP Methods compared to what they knew before.

Generalizing

Trainer

·  Ask trainees what they have learnt about FP methods.

·  Record responses on NP

Application

Trainer

·  Ask trainees how they would use the new information learned today

·  Ensure that their applications are relevant to their work situations.

Summary and closure

Trainer

·  Summarize the major points of the session

·  Review the objectives to find out to what extent they have been met.

·  Inform trainees that the next session will be screening clients for FP method use.

Processing

Trainer

·  Find out from trainees what was easy/difficult to understand during the session.

·  Make necessary clarifications

Generalising

Trainer

·  Solicit for trainees’ learnings

·  Record learnings on NP

Application

Trainer

·  Ask how trainees are going to use what they have learnt during the session.

·  Link applications to learnings.

Summary and closure

·  Go over major points covered during the session.

·  Review of objectives, check if they have been achieved.

·  Wrap up and close session linking it to the next session.

Session 4: Screening clients for FP methods (specifically Depo Provera)

Time: 3 hours

Trainer

Climate setting

Trainer

·  Greet and put trainees at ease

·  Ask trainees to share their experiences in medical practice on screening clients/patients before prescribing treatment

·  Allow 2-3 responses

·  Acknowledge trainers for their responses

·  Introduce session topic and inform trainees that before initiating clients on FP methods, it is important to ensure clients’ eligibility to the method through history taking and physical assessment.

Session objectives:

Trainer

·  Present the following session objectives.

By the end of the session trainees will be able to:

1.  Outline the purpose of screening clients for contraceptive use

2.  Explain the procedure of screening clients for FP method use under the following:

- History taking

- Screening for medical eligibility using checklists

- Physical assessment

3.  Demonstrate the ability to screen clients for FP method use following the WHO Medical Eligibility Criteria and Checklists.

·  Involve trainees in reading the objectives

·  Ensure objectives are clear and understood

Experience

Brainstorming/Large group discussion

Trainer

·  Ask trainees what they think are purposes for screening clients for FP methods use

·  Record responses

·  Present purposes of screening clients for FP method use (use handout)

·  Make necessary clarifications

·  Ask trainees which procedures are used to screen clients for FP method use.

·  Acknowledge responses

·  Expected responses to include:

-  History taking

-  Physical assessment

·  Add on information omitted by trainees

·  Make necessary clarifications

Group exercise

Using the DMPA checklist

Trainer

·  Outline the procedure for history taking using the FP client card.

·  Introduce group exercise.

·  Go round and give necessary assistance.

·  Collect all completed forms to check accuracy and completeness of information obtained during history taking.

·  Give necessary feedback.

·  Inform trainees that history on follow up visit is as discussed for each FP method.

·  Inform trainees that even when standard FP client cards are not available at the unit and books are used, efforts should be made to ensure that all relevant histories are obtained from FP clients and clearly recorded.

·  Discuss importance of recording complete client’s history giving examples and sharing experiences of incomplete histories

Role plays

1.  Ms. Flower has had three children in the last three years and now she wants to stop, even if her husband thinks they should have more and immediately, no need to wait. She has been told by her friends, that Depo is one of the methods that she can use and she has come to you requesting that you give her Depo

2.  Ms. Sunshine has received two injections of Depo so far but she is experiencing a lot of bleeding, headache and always feels like vomiting. She has come to you requesting that she changes to another method because she cannot continue living like that.