Video by Joel Bobeck / Jhpiego

 

Building Competencies, Confidence and Collaboration:
An Innovative Capacity-Building Program Expands Access to Quality Family Planning Services in Uganda

By Gillian Leitch

Ntungamo, Uganda—It is approaching midday at the Butare Health Center in southwestern Uganda where a large sign hanging at the entrance of the compound advertises “Family Planning Services Available Here Today.” Nearby, a group of women with their newborns have gathered under a tree to listen to a nurse talk about the various contraceptive methods available to them.

Resty, a midwife from the neighboring Rweikiniro Health Center, is busy inside the maternity ward, helping to prepare sterile kits and clean the room where family planning services will be delivered. Resty is at the Butare Health Center today to learn more about how to safely and easily remove contraceptive implants as well as manage side effects associated with implant use. It’s all part of her continuous professional education through a new learning approach pioneered by Jhpiego that emphasizes hands-on clinical skills building in facility-based settings. Referred to as low-dose, high-frequency (LDHF) training, the method offers intense, but short learning sessions that allow health workers to build their skills without leaving their health facilities for long periods of time.

Today’s training is focused on contraceptive implants, which is just what Resty needs.

For the last nine years, she has been the only midwife at her health facility responsible for providing all maternal and reproductive health care services, including a range of family planning methods. Her tireless work keeping mothers and newborns healthy has not left her much time to devote to family planning services. Even though she was trained early in her career to provide and counsel women on a wide range of contraceptive methods, inconsistent practice has left Resty less confident in providing long-acting contraceptive methods such as implants.

 

Resty, a Ugandan midwife, stands outside of the Butare Health Center where she is learning from expert trainers how to provide essential reproductive health services like contraceptive implant removal. Photo by Gillian Leitch, Jhpiego.

Implant use increased from 10.4 percent to 18.1 percent among married Ugandan women using contraception from 2011 to 2016.

And, with increasing numbers of women showing up at her health facility asking to have implants inserted and removed, Resty was eager for a refresher course—one that wouldn’t require her to leave her patients stranded.

Jhpiego’s LDHF approach is tailored to meet the needs of busy midwives like Resty. LDHF training delivers clinical information during short, simulation-based learning activities that are spaced over a few weeks to optimize learning. These lessons take place on site at either the provider’s own facility or a nearby clinic or hospital—as opposed to the traditional weeklong courses typically taught in a hotel conference room in a faraway city. Jhpiego introduced this method of capacity-building in Uganda in 2013.

Over the last four years, Jhpiego has used the LDHF methodology to build the capacity of more than 700 nurses, clinical officers and midwives in a number of technical areas, including managing postpartum hemorrhage and integrated pediatric HIV care. Jhpiego has also assessed improvements in the skills and knowledge providers gain through the LDHF method compared to traditional training approaches. As a result, Jhpiego is working with the Ugandan Ministry of Health to formalize LDHF as a nationally recognized approach.

For Resty, her desire to update her skills coincided with Jhpiego’s work to improve public-sector health care providers’ ability to safely and easily remove contraceptive implants.

A key factor in reducing maternal and infant death is ensuring that all women, irrespective of economic status, have access to midwifery care.

Women with children gather outside of the Butare Health Center to learn about contraceptive options. Photo by Gillian Leitch, Jhpiego.

When a woman dies, her children’s risk of dying within 2 years increases tenfold.

—United Nations Population Fund

From 2011 to 2016, implant use increased from 10.4 percent to 18.1 percent among married Ugandan women who are using contraception. These implants effectively prevent pregnancy for up to three or five years, depending on the brand, an attractive option for women interested in preventing or spacing pregnancies. They can easily be removed by a trained midwife, like Resty, for any reason—whether the implant is no longer effective or the woman would like to become pregnant, switch methods or stop using contraception.

Resty and the other midwives and nurses from her district participated in two half-day theoretical trainings on contraceptive implants at a health facility that was a convenient commute for them. To allow for practice, they all received training kits containing arm models as well as the instruments and materials needed to safely remove contraceptive implants.

Resty bears witness to the impact of the LDHF approach on her and her community in Ntungamo District in southwestern Uganda. Mothers used to have to wait for outreach days—which were scheduled intermittently—to get the reproductive health services they needed. “I now have the proper instruments to do removals,” Resty said, “and have been able to successfully do so for a few clients who have come to my health facility.”

She now has the confidence to tell patients, “Don’t worry, we can help you manage any side effects caused by contraceptive implants and when you’re ready, remove your implant as well.”

Almost all maternal deaths are entirely preventable given proper medical surveillance and intervention.

—United Nations Population Fund