Best Practices in Training Private Providers

December 2008

1. INTRODUCTION Training of health care providers is one of the most common interventions used in development strategies to improve the quality of reproductive health and family planning (RH/FP) services in developing countries. Decades of experience have produced an abundance of information, guidelines, and best practices on how to effectively train health providers, but most of this relates to public sector providers. In recent years, however, private sector providers have been recognized increasingly as an important source for delivery of RH/FP and other health services in developing countries, even for the poor. Yet the inclusion of private providers in training interventions or even the acknowledgement of their unique needs in discussion forums on training are still not common practices.

The purpose of this primer is to document and promote best practices gleaned from worldwide experience in training private sector providers. The U.S. Agency for International Development (USAID)-funded Private Sector Partnerships-One (PSP-One) project has reviewed literature and developed case studies of recent private provider training events to collect and analyze lessons learned (see Table 1, Training Case Studies, at the end of this primer). The findings will aid donors, program managers, curriculum designers, and trainers to successfully design and implement training of private providers. Again, because

numerous resources exist on general aspects of training, this primer does not address those topics but rather focuses on aspects that are unique to training private providers.

2. HOW ARE PRIVATE PROVIDERS DIFFERENT? The first step in designing effective training programs for private health providers is understanding how they differ from public sector providers. In this primer, the term “private providers” refers to any formal or informal health provider who works in a private, for-profit (commercial) practice (see Box 1).

Box 1. Who are “private providers”?

In this primer, the definition of “private providers” includes only for-profit (commercial) providers of preventive or curative health services or products, such as:

Individual private providers – e.g., doctors, nurses, midwives, and traditional healers;

Staff in private, for-profit facilities – e.g., private clinics, hospitals, nursing, and maternity homes;

Private pharmacists and chemists; and

Staff in private, for-profit diagnostic facilities – e.g., laboratories and radiology units.

Although the term often is used for all providers outside the public (government) sector, including nonprofit entities such as nongovernmental and faith-based organizations, nonprofit entities are not addressed in this primer because their conditions of practice differ significantly from those of private commercial providers.

PRIMER

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Several factors make private providers unique, and have implications for their training. The most salient is that, in addition to being health providers, the providers are business owners or employees of a for-profit business. Unlike public sector providers, who continue to receive their salary while attending training courses, private providers forgo revenue when they are away from their practice, particularly if they are sole practitioners or in a small practice, and this lost revenue cannot easily be recovered. Therefore, private providers must weigh the potential benefits of training against this opportunity cost. This directly influences the marketability of training (and quality improvement efforts in general) for private providers and underscores the need to have appropriate incentives in place to motivate private providers to attend a training event. As will be seen below, these incentives may be tied directly or indirectly to benefits to their practice, such as increased clientele or consumer satisfaction.

A second characteristic is the lack of effective supervisory structures in most private sector settings. Public health systems may not always operate optimally, but they nevertheless can mandate public sector staff to attend a training event. In contrast, many private providers own small, independent practices and even those who work in large private sector facilities such as hospitals and clinics likely have only an internal supervisory structure on site; while these providers may be licensed and regulated by the government, they do not report to a government authority. This means that mandating participation in a training event is usually not an option. Again, a program must rely on other incentives to attract providers to a training event.

The lack of a supervisory or organizational structure poses still other challenges: Prior to training, there is no obvious mechanism to help training organizers identify and access groups of potential training participants. Afterward, there is no structure to facilitate follow-up with participants, ensure application of knowledge learned, and build quality structures to monitor

the application of new practices. Nevertheless, there are alternative private sector structures that, even if less robust than public sector systems, may exert some influence on private providers’ knowledge, skills, and quality of care, and may help with training. These private sector structures—professional associations, provider networks or franchises, and health insurance or contracting mechanisms—are discussed in section 3.

It should be noted that some private providers also operate in the public sector. Thus, interventions targeting public sector providers, including training interventions, may reach some private providers. However, because different factors influence provider behavior in the different sectors, post-training, the same provider may perform differently in the public and private practices. In private practice, providers are more likely to perceive patients as customers they need to satisfy and they may be more sensitive and responsive to patient expectations, even when this requires they deviate from best treatment practices (Bruga and Zwi 1998). For example, in the public sector, a provider may prescribe oral rehydration solution for child diarrhea, whereas in a private clinic he/she may prescribe an antibiotic (Berman and Hanson 1993). Therefore, even public sector-oriented training events should be complemented with interventions specifically targeting private settings.

3. BEST PRACTICES This section describes the best and most promising practices identified in the case studies for each step in the process of planning and implementing a private provider training. Figure 1 outlines the steps in this process, which can begin when (1) a service gap is identified; or (2) a new skill or technology needs to be introduced into the private sector. Just as in the public sector, it is important to determine if training is indeed the most appropriate intervention to address the private sector service gap (see Learning for Performance for guidance on this process, Capacity Project 2007). If it is, the subsequent steps in Figure 1 can be taken to train private providers.

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Figure 1. Steps to Planning and Implementing a Private Provider Training Program

The following sections discuss each of these steps. Box 2 summarizes the best practices and can be used as a quick reference.

3.1 How do you identify and access private providers?As discussed in section 2, the unique characteristics of private providers present challenges that can emerge at the very first step in planning a training event: how do you find and select the providers you want to train? While public sector providers work in government facilities and can be recruited through this structure, it is often a challenge to identify the universe of private providers and to access

and recruit them. Many strategies have been successfully applied to overcome this challenge.

The most common strategy is to work with and through professional associations. Most countries and provider cadres – physicians, midwives, pharmacists, and others – have some type of professional association, although their levels of activity and authority can vary greatly. Most associations can at least provide a list of members or registered providers for use in identifying the initial selection pool of providers for training and many of them can play a larger and crucial role in the training process. Pharmaceutical companies often hire professional

Identify service gap

Will training solve the problem?

If providers not known

If providers known

No Yes

Introduce a new skill or

technology

Identify and access providers

Assess training needs

Assess private provider

incentives

Determine training format and

methodology

Maximize attendance

Maximize sustainability

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HOW DO YOU IDENTIFY AND ACCESS PRIVATE PROVIDERS?• Workwithprofessionalassociations• SelectproviderscontractedbyanNGOorthepublicsector• SelectproviderswhoparticipateinHMOsorhealthinsuranceschemes• Selectproviderswhoarepartofafranchiseornetwork• Obtainalistofregisteredprovidersfromthepublicsector• Beginwithaparticipantrosterfromprevioustrainingactivitiesofotherprojects• Partnerwithpharmaceuticalcompaniestousetheirsalesanddetailingforce

HOW DO YOU ASSESS THE TRAINING NEEDS OF PRIVATE PROVIDERS?• Conductarapidassessmentwithtargetproviders,usesurveys,focusgroups,keyinformants• Conductadesktopreviewofexistingresearch,statistics,orprojectreports• Collectinformationonoptimaltraininglogistics(day,time,location)• Determinewhichtopicsprovidersareinterestedinlearningabout• Involverepresentativesoftargetprovidersintheentireplanningprocess• Workcloselywithprofessionalassociations,NGOs,orHMOs• Hirealocalconsultantfamiliarwithtargetproviders

WHAT ARE INCENTIVES THAT ENCOURAGE PRIVATE PROVIDERS TO ATTEND TRAINING EVENTS?

Financial incentives:• Forfinancialmanagementtopics,clearlylinktrainingcontentandincreasedincome• Connectcompletionoftrainingwithmembershiptonetworkorfranchise• Highlightlinkbetweenimprovedservicequalityandpotentialtoincreasenumberofclients

Professional development:• Mostprivateproviderswelcometheopportunitytolearnanewskillorreceiveknowledgeupdates• Choosetrainingtopicofinteresttoproviders

WHICH TRAINING METHODOLOGIES ARE APPROPRIATE FOR PRIVATE PROVIDERS?• Minimizetimespentawayfrompractice

• Ifusingexistingcurriculum,separate,consolidateorotherwiseadapttoprivateprovidersetting• Usepeer-supportapproach• Useself-study• Useon-the-jobtraining

• Ifcaseloadisneededforclinicalskillstraining,usepublicsectororNGOfacilities• Useassociations,NGOs,orHMOstofollowupwithproviders

HOW DO YOU MAXIMIZE ATTENDANCE?• Selectconvenientday,time,andlocation• Invitewell-knownspeakers• Providecontinuingmedicaleducationcredits• Provideacertificateordiploma• Providereferencematerialssuchashandbooksandjobaids• Deliverinvitationsbyhand,inperson• Usevisuallyattractiveinvitationssignedbyrespectedleaders(i.e.,associationpresident)• Highlightthebenefitsofthetrainingintheinvitation• Followuponinvitationindividuallywithprovidersbyphone

HOW DO YOU ENSURE SUSTAINABILITY?• Applyrigorousselectioncriteriatofilteroutless-motivatedproviders• Trainseveralstaffperfacility,includingstaffwithauthoritytoimplementtrainingcontent• Createcapacityofprofessionalassociations,NGOs,HMOs,networks,orfranchisestotakeover

training• Chargeafeetoparticipants• Leverageinvestmentfrompharmaceuticalcompaniestofundtrainingevents• Institutionalizetrainingwithinexistingpre-servicetrainingprograms• Maketrainingavailableon-line• Linktrainingrequirementtolicensureorrelicensure

Box 2. Summary of Strategies and Best Practices for Training Private Providers

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associations to help introduce a new drug therapy. The advantages to working with professional associations, beyond the issue of provider selection, are discussed throughout this primer.

InGuatemala,themedicalandthebiochemistassociations allowed PSP-One to attend some of their regularly scheduled meetings, where the project conducted sensitization talks about HIV/AIDS and recruited participants for its training course on HIV/AIDS. Population Services International (PSI)/Benin used a similar strategy: PSI organized pre-training information days with the pharmacists’ association to orient pharmacists to national RH guide/guidelines, sensitize them on FP/social marketing programs, and recruit potentialparticipants.InGhana,thelicensedchemicalsellers’(LCS)associationconductedtheinitialscreeningofparticipantsforaGhanaSocialMarketingFoundation(GSMF)trainingevent,by facilitating the completion of screening forms among its members.

In addition to professional associations, there may be other structures that link private providers and provide a way to identify and reach them. One is private doctors who are contracted by an nongovernmental organization (NGO): In Honduras, PSP-One used such a structure to gather participants for training on the no-scalpelvasectomy(NSV)technique.TheNGOwas responsible for selecting participants from among its contracted providers and for contacting and recruiting them. Similarly, in Nigeria, PSP-One trained private providers participating with Total Health Trust, a health maintenance organization (HMO) enrolled in the National Health Insurance Scheme (NHIS). The Trust provided a list of its participating private providers and played an active role in selecting and contacting potential participants. Other variations of these scenarios include private providers who are contracted by the public sector or those who are part of a franchise or network. Recruiting through these types of structures ensures that the providers have already met some performance criteria and facilitates the introduction to the providers.

The public sector may also be a vehicle for identifying private providers, as nearly all governments have some kind of registered provider list. However, the utility of these lists varies tremendously. In countries where the public sector plays a strong and active role regulating the private health sector, government registers of providers are more likely to be updated and to contain useful information. In Ethiopia, the Private Sector Program (PSP-Ethiopia) worked closely with regional health bureaus (RHBs), which provided PSP-Ethiopia a pre-selected list of potential providers to train. Training planners may refer to rosters from previous training activities from their own and other projects/organizations to identify and select trainees for the current training. In Romania, the Banking on Health project reached out to private doctors who had previously been trained on RH/FP by a different project to train them on business and management skills for their private practices. Recently, other innovative strategies for reaching private providers have emerged.InGuatemala,PSP-One brokered partnerships with pharmaceutical companies to identify and contact private doctors through their sales and detailing force.

The best strategy for identifying potential trainees will depend on the program objectives, selection criteria (see section 3.6), and the available resources and structures in the country. In many cases, a combination of strategies is most effective.InGuatemala,PSP-One’s multi-pronged approach to recruitment – using professional association lists and events and leveraging pharmaceutical companies’ reach of private providers – was very successful in attracting training participants.

Despite these options, challenges may remain. For example, even when professional associations exist, they may have relatively few members and limited reach, or may be unwilling to collaborate. Listsandregistriesprovidedbyassociationsorbythe public sector could be outdated in terms of provider names and/or contact information, and many include both public and private providers,

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in a way that makes it difficult or impossible to tease out the private ones. When this is the case, the only solution may be a less efficient approach, conducting a field assessment of the appropriate private health facilities (e.g., clinics, hospitals, pharmacies, labs) in a pre-determined geographic area to define the universe of potential trainees.

3.2 How do you assess the training needs of private providers?A variety of methods can be used to determine the training needs of providers. In many cases, the instruments can be used to gather information to help decide training logistics.

Many of the training programs studied conducted a training needs assessment (TNA). In Romania, the Banking on Health project commissioned a TNA of the business development needs (particularly regarding finance and training) of private doctors. The TNA used desk research, focus group discussions and key informant interviews, and in-depth market research. The focus group discussions and interviews were conducted nationwide, with 1,215 family doctors in all districts of the country; in addition to surveying training needs, the TNA asked providers for the days of the week and hours when training would best fit theirschedules.InGhana,aTNAconductedbythePRIMEprojectandtheGhanaRegisteredMidwivesAssociation(GRMA)withGRMAmember midwives found the need for an RH/FP update, improved counseling and client−provider interaction skills, increasing adolescents’ access to services, and introduction and application of the national service policies, standards, and protocols.

InGuatemala,thePSP-One project conducted a rapid assessment of the HIV counseling and testing (CT) training needs of private doctors and biochemists. The project administered a semi-structured questionnaire to 38 doctors and 21 biochemists using convenience sampling in its target geographic areas. Findings indicated low levels of knowledge of HIV CT norms and guidelines, and helped determine the most appropriate days and times for scheduling the

training events. In Jordan, after USAID identified a general area of concern – women’s health with emphasis on RH – the Private Sector Project for Women’s Health in Jordan (PSP-Jordan) staff designed and administered a questionnaire to identify the topics that private female doctors were interested in knowing more about, and then tailored training sessions to address those topics (e.g., hypertension and bleeding of women during pregnancy).

Other simple tools can be used to conduct rapid assessments, such as a survey, a quality improvement self-assessment tool to identify knowledge gaps, or observations of providers while interacting with patients. In Nigeria, a survey conducted with physicians belonging to an HMO revealed the need to build the providers’ skills on FP counseling and to highlight existing motivations for providing this service. Based on these findings, PSP-One designed a training program that covered both FP counseling and the NHIS capitation and reimbursement system.

In some cases, a desktop review of existing research, statistics, or project reports can be a very cost-effective way of assessing training needs. However, such information is not always available and up to date.

Regardless of the methods used, it is important to also involve representatives of the target providers in the entire assessment and planning process, so that the provider perspective is considered in every aspect of the training. This involvement can be done by contacting a sample of providers directly and/or by working closely with professional associations, NGOs, HMOs, or other organizations. For some countries, there may be consultants who have experience working with the target providers, and/or may themselves be providers. The challenges to assessing training needs and logistics and to involving target providers in the planning process are similar to those related to identifying and accessing private providers, discussed above. While it may not be feasible to incorporate into the training program

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all of the suggestions collected from providers – organizers must balance their input with what is realistic to implement – their contribution to training design and implementation is vital.

3.3 What are incentives that encourage private providers to attend training events?Having the right incentives in place is crucial to getting private providers to participate in a training event. To ensure selection of the appropriate incentives, identification of providers’ motivations for participating should be done during the TNA. Ideally, incentives for private providers should address two levels of participation: (1) physical attendance to the training; and (2) learning the training material and applying it in their everyday practice.

Incentives for maximizing attendance are usually easier to address (see section 3.5). To pique provider interest in learning and applying the material, it is often assumed that the training must offer potential for financial gain, which appeals to private providers’ profit motive. Several case studies confirmed this, especially when training curricula included financial topics. The private doctors participating in the Banking on Health training in Romania clearly saw how their private practices could benefit from training on financial management and access to credit. Similarly, feedback from the private doctors in Nigeria who participated in the PSP-One HMO/NHIS training showed that they appreciated the link between better understanding and management of the NHIS’ capitation payment system and their own revenue stream. In both cases, providers cited financial benefit as the main incentive for participation.

Training programs don’t always have such direct financial incentives built in, but the case studies revealed other incentives that encourage private providers to participate in training events. Franchises and networks can offer members indirect financial benefits such as discounted prices on health products and increased clientele due to higher perceived quality (Chandani et al. 2006).InGhana,successfulcompletionofthe

GSMFtrainingforLCSresultedinmembershipto the CareShop franchise of chemical shops. The benefits of membership were clear to potential participants: easier access to products through the franchise and branding of their shop with the prestigious CareShop name, indicating high-quality services to customers. Other training programs that resulted in membership to a network include the PSP-One/India training events for obstetrician/gynecologists for the Depot Medroxyprogesterone Acetate (DIMPA) injectable network, as well as their trainings of chemists and indigenous systems of medicine providers (ISMPs) for the Saathiya network. However, these benefits work as incentives only if potential participants clearly see the linkage between training, membership, and financial gain; this may require significant educational and advocacy work until the franchise or network brand is well recognized.

It is important to clarify that the “financial incentives” discussed in this section relate to increasing the profitability of the private provider’s practice, and should not be interpreted as paying providers to attend a training event. Paying sitting fees is not recommended – while it may increase attendance in the short run, it is more likely to attract providers who are not interested in the training content and therefore not likely to apply it in their practice (see section 3.6 for a discussion of selection criteria and charging a fee to participants).

While financial incentives are important, the most-often cited incentive in all the case studies is the opportunity for professional development, and improved knowledge and skills. These incentives are often underemphasized by programs, donors, and governments, which assume the predominance of private providers’ profit motivation. In fact, private providers express a need and desire for clinical updates and professional development, and cite frustration over their exclusion from public sector training. In most of the case studies, the mere fact that someone was reaching out to private providers to improve their knowledge

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and skills was enough of an incentive for them to participate, as many had not received any training on the particular health topic (or on any topic) since completing their formal education. Some private providers also recognized the link between a new skill, service, or quality improvement in existing services, and the potential to attract more clients; if they do not, training organizers should clearly explain the link.

Although the desire for professional development is an encouraging finding, the learning incentive usually is only effective when the providers find the training topic relevant to their practice. Often, providers do not find RH/FP topics of interest. Therefore, it is important to assess providers’ interest in the topic prior to planning the training. If that interest is low, one solution is to add to the curriculum topics that do interest the providers. Ultimately, the incentives must be strong enough to offset any costs or perceived costs for the private providers to participate in the training.

3.4 Which training methodologies are appropriate for private providers? Many of the methodologies that are used for public sector training events can be used with private providers. However, it is important to include private provider stakeholders when planning and developing a training event to ensure that the curriculum and methodology are appropriate to their unique characteristics (see section 2), especially the need to minimize time away from their practice. When using an existing public sector curriculum, it is imperative to adapt the curriculum to the specific private provider setting.

One way to adapt is to separate the training modules and deliver them at separate times. For example, instead of conducting training on six consecutive days, a program could hold day-long workshops, one day a week for six weeks. In Honduras, PSP-One adapted the NSV training module used in the public sector in Mexico to the private provider setting in Honduras. The original curriculum involved two weeks of full-

time training that included both theory and practice. Because the Honduran providers could not be away from their private practices for two weeks, the theory portion of the training was given in a 2.5-day workshop (Friday-Sunday), and the practical portion was stretched out over a period of several months and conducted individually with each doctor according to his or her availability. Another common strategy used to adapt public sector curricula to the private sector is consolidation. PSP-Ethiopia condensed three modules of a public sector training curriculum that took place over 10 days into six consecutive days. Whenever adapting a public sector curriculum, it is important to consult with public sector trainers and in some cases obtain their approval on the proposed changes to ensure that no essential material is lost. In terms of training methodologies, most case studies found that a combination of workshops and participatory adult learning principles are especially appropriate for private providers as they help minimize “in-classroom” time. Forexample,inGhanathePRIMEprojectandGRMAdevelopedaself-directed learning model for midwives that included multiple learning approaches: self-assessments, printed self-study modules, facilitator visits, group peer-review meetings, and paired learning with a nearby peer. The introduction of each trainingmoduletookplaceduringGRMA’smonthly meetings, where midwives were paired with a partner. In this approach, two midwives who were geographically close to one another completed the training material and then reviewed it together with occasional visits by a supervisor. This self-directed model with support from peers helped compensate for the lack of a constant supervision. It also greatly minimized the time the midwives had to spend away from their practices.

The midwife training by the ACQUIRE project in Kenya also relied heavily on the peer-support approach. Through peer-support clusters, the midwives provided each other with peer supervision, client referrals, joint problem-solving,

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and even loans. PSP-Ethiopia is developing a self-study portion that providers will complete prior to the lectures. The self-study is designed to help minimize the duration of the lectures and engage theprovidersinthetrainingtopic.InGhana,theGSMFtrainingofCareShopLCSincludedfivemodules presented in workshops of 2-5 days each that alternated with one week of on-the-job training, when participants were expected to apply in their shops what they learned in the workshops, and to provide and share feedback with their peers.

When clinical skills are being taught, the private sector may not have an adequate caseload on which trainees can practice their new skills. In this situation, in addition to using models for initial practice, a program can arrange to conduct clinical training in public sector or NGO facilities, where the caseload is usually greater. Participants in the PSP-Jordan training completed the practical portion at Ministry of Health-approved training sites. In Honduras, participants in the PSP-One training conducted many NSVs at NGOfacilities,whichhadahigherpatientloadthan did private sector facilities. Practicums for private provider training can be complicated to arrange and are often the most challenging aspect of organizing a clinical training. It is important to have local staff available to coordinate the providers’ schedules and to stay flexible and adjust as needed.

Consistent follow-up with providers after training is another essential component of enhancing effectiveness and keeping providers engaged, in both the public and private sectors. However, it can be especially challenging to do with private providers in the absence of a professional organization or supervisory structure, or sufficient resources. Following the PSP-One training of private midwives on a quality improvement tool in Uganda, Uganda Private Midwives Association (UPMA) supervisors provided periodic support to midwives using the tool through monthly association meetings. InGuatemala,thePSP-One project sends out monthly newsletters to all training participants

describing project activities and training events to keep them informed and motivated.

3.5 How do you maximize attendance? To maximize attendance at training events, programs use various strategies aimed at reducing potential barriers and enhancing perceived benefits. Selecting a training time, duration, and location that minimizes providers’ time away from their practices is essential. A convenient location is one that minimizes travel distance and costs for providers. Some programs also take into account the overall attractiveness of the location and specific training venue. Most of the case studies found that the appropriate time and location often were determined early on, during the TNA, with input from local partner organizations such as professional associations and HMOs. Close monitoring and flexibility is also important, as some barriers to attendance emerge only after the training starts. PSP-Ethiopia found that attendance at workshops was inversely related to travel distance. In response, the program further decentralized training locations to decrease travel distance, and attendance improved. PSP-One/India noticed that many chemists arrived at their training workshop on time at 1 pm, but left halfway through, after lunch was served. The project changed the start time of subsequent workshops to after lunch, at 2 pm, and instead of lunch served high tea after the day’s training ended. Having well-known speakers, such as a well-respected and regarded peer, also boosts attendance. In PSP-One training events in Guatemala,themainlecturerisoneofthebest-known HIV experts in the country.

Private providers also value the ability to obtain continuing medical education (CME) credits for the training. Some countries require a certain number of CME credits to renew a professional license or to maintain membership in a professional association, so providers welcome events that allow them to earn credits. It is important to approach the organization that grants CME credits (usually a professional

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association or council) early on, as the approval process may take time. PSP-One inGuatemalaand India obtained CME accreditation for their training programs from the medical and biochemist associations, and this proved to be a strong incentive for participation. Similarly, PSP-Jordan’s training of private doctors was accredited by the Jordan Medical Council. Whether or not CME credits are given, awarding a certificate or diploma that providers usually value and enjoy displaying in their practices encourages attendance. Providers also appreciate receiving educational materials such as handbooks and job aids at training events.

The importance of the mode of invitation to private provider training events should not be underestimated. While in the public sector a notification from a supervisor might suffice to ensure attendance, a simple notification to private providers most likely will not attract them – the invitation must convince them of the importance of the training. The case studies show that the invitation must make the provider feel valued, and sufficiently highlight the training benefits. PSP-One/India produced high-quality, attractive invitations for the ISMP and chemist training events, which communicated respect for the providers and prestige for the training. The invitations were signed by the heads of professional associations and hand-delivered by project staff to potential participants. The project staff then followed up with providers by phone prior to the training to encourage them to attend. The PSP-One projectinGuatemalaandPSP-Jordan also successfully used this strategy of personal follow-up by phone to recruit training participants. In Nigeria, PSP-One developed a marketing brochure to promote the Access to Finance training course and describe the benefits that providers could gain from attending.

3.6 How do you ensure sustainability?Sustainability of training programs is perhaps their most challenging aspect, and may be described at different levels:

Retention and use of the new skills learned by the participating providers;

Retention of the new skills at the facility level; and

Sustainability or continuation of the training program itself.

The level of sustainability that a training program strives to achieve will depend on the program objectives. All training programs should strive to attain at least the first level of sustainability: skill retention at the provider level. This can be especially challenging with private providers, who lack a supervisory structure. A good strategy to overcome this challenge is to apply rigorous criteria to participant selection. This immediately filters out participants who are less likely to retain and apply the new skills due to lack of interest, to lack of skill applicability to their practices, or to other barriers. By minimizing waste of resources on participants who will not deliver results, rigorous selection improves training efficiency.

While these selection criteria will depend on the context, it is advisable to include some kind of measurement of provider motivation and commitment to the training content. For example, the main selection criteria for participating in the PRIME project self-directed learning program onRH/FPformidwivesinGhanawasregularattendanceatGRMAmonthlymeetings.InKenya,the ACQUIRE project focused the selection of midwives for voluntary CT training on those with positive attitudes toward the topic. Another way to identify the more motivated providers is to use a “competitive” selection process whereby potential participants go through an application process.ProspectiveparticipantsintheGSMFCareShoptrainingofLCSinGhanahadtofillout an application form and attend an onsite interview.

Other selection criteria address issues other than provider motivation. In India, the private providers participating in the PSP-One DIMPA training were required to have a separate waiting room in their office/clinic so that clients could be counseled in privacy, as instructed in the training. It is a good idea to work closely with local

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organizations such as professional associations, HMOs, or even the public sector to determine the most appropriate selection criteria for a particular training.

The next level of sustainability, skill retention at the facility level, can also be difficult to achieve. Just as in the public sector, high staff turnover in the private sector often leads to the loss of trained staff. To minimize this loss, the PSP-One project in Nigeria is training several staff per facility; if one of them leaves, some capacity is retained. The project also includes the medical director of the facility in the training; training such a person of authority helps to ensure that the training content is implemented and sustained at the facility level.

In addition to sustainability at the provider and facility levels, some programs attempt to put in place a sustainability strategy that will allow the training program to continue once project funding ceases. The most common approach to maximize training program continuity is to work closely with professional associations, building their ownership and capacity to continue the training ontheirown.InGhana,thePRIMEprojectinitialtrainingofmidwiveswasimbeddedwithinGRMA,which then conducted an additional training round after the project ended. The same approach was used by PSP-One in Uganda to train members of UPMA on using a quality improvement self-assessment tool.

HMOs and franchises may also have the capacity to take over training activities. The financial incentives that are usually built into these structures may make them more viable providers of sustained training programs than associations, although a strong professional association with an active dues-paying membership may also be able to sustain training activities. In Nigeria, PSP-One worked closely with partner HMOs from the beginning of the program and trained at least one trainer per HMO to conduct future trainingevents.TheGSMFtraininginGhanawasconducted under the CareShops franchise. In Romania, where the Banking on Health training

of private doctors included access to credit, the project was able to leverage interest from financial institutions to continue funding the course after project funding ended.

Although structures such as professional associations, HMOs, and franchises/networks usually have membership fees and a budget, this is often not enough to cover the costs of training activities. Charging a fee to the training participants provides some cost recovery. Doing this is only feasible when private providers recognize the value of the training. PSP-Jordan charged a small fee to doctors to cover clinical supplies required for training related to Pap smearsandultrasounds.InGhana,GSMFchargedafeetoparticipatingLCS,whicheventuallycovered an increasing share of the training costs. Even if charging a fee is not feasible initially, it should be explored in the mid to long term, once the training is well known and valued.

InRomania,theNGOthatimplementedtheBankingon Health training of private doctors used an exit survey to determine how much doctors would be willing to pay for the training if it were offered on a fee basis, and determined it was a price that would cover the training costs. The HMOs working with the PSP-One project in Nigeria plan to charge a training fee to doctors, once the HMOs take over the program and it is valued and recognized more broadly. (The HMOs currently cover the part of the training costs that eventually will be covered by provider fees.) To prepare the private providers for this approach, the project requires providers to pay their own transport to the workshop and does not pay the per diems or “sitting fees” that are usually paid to providers in public sector training programs. In addition to enhancing the financial sustainability of a training program, charging a fee for participation can also act as a rigorous selection criterion, as providers who are willing to pay are much more likely to be genuinely interested in the training topic and in applying their new knowledge and skills.

When existing structures and training fees cannot sustain training, private investment may be an option. PSP-Jordan and the PSP-One

12

projectsinGuatemalaandIndiahavesuccessfullyleveraged investment from pharmaceutical companies for their current training programs; they hope to expand this investment to cover an increasing proportion of training costs. The companies’ incentives for contributing can be to market their products through the training, or contribute to their corporate social responsibility program. The marketing incentive may provide a more sustainable source of funding, as it relates to the company’s commercial interests, but it may also be more difficult to accomplish.

The PSP-One projectinGuatemalaisalsoexploring two other strategies to ensure that the HIV training program for doctors and biochemists continues beyond the life of the project. Project staff are currently in talks with professional associations and universities to explore the possibility of institutionalizing the course within the pre-service training programs at the universities, making it part of the medicine and biochemistry programs. The project is also considering developing an online version of the training modules, and housing it on the professional associations’ Web site so that it is widely available to anyone with an Internet connection.

Perhaps the most robust sustainability strategy for training programs, and also one of the most difficult to achieve, is making it a training requirement for licensure or relicensure. InGhana,theNationalPharmacyCouncilwasinterestedinmakingtheGSMFCareShoptrainingarequirementforobtainingaLCSlicense.Todate this has not been achieved, as it requires a change in legislation. In Nigeria, PSP-One is devoting significant effort to obtain CME credits for its training program and link this CME requirement to relicensure of doctors.

These strategies to improve sustainability of training programs for private providers each have limitations, and it remains to be seen whether any of them show results in the long term. The most common strategy, working

with professional associations, may work well at first, but experience shows that the level of engagement and commitment often diminishes in the face of competing priorities, change or lack of leadership, or lack of resources. The most promising new strategies appear to be those that are tied to financial incentives, such as working with HMOs and franchises, using the commercial interest of private companies (often pharmaceutical) to invest, and tying training to licensing requirements.

4.SUMMARY:COMMONELEMENTSOFSUCCESSFULPRIVATEPROVIDERTRAININGThis primer illustrates the many issues to consider at each step of planning and implementing a successful private provider training program. Perhaps the most universal element found in the PSP-One case studies is addressing private provider motivations and incentives. Because private providers cannot be obliged to attend training, they must be persuaded. When motivation is properly assessed and incentives are effectively incorporated into every aspect of the training and communicated to providers, the chances of achieving success are greatly increased.

Another common element is collaboration with local organizations or structures, such asprofessionalassociations,NGOs,orHMOs.Such collaborations greatly facilitate each step in implementing a private provider training program:

Identifying and accessing providers;

Assessing their training needs;

Assessing and applying appropriate incentives;

Implementing the best training methodologies;

Maximizing attendance; and

Achieving sustainability.

Finally, the case studies showed the importance of conducting a needs assessment and of consulting with, and involving the target private providers in the planning process.

13

Doing so will ensure that the first element, motivations and incentives, is properly addressed.

Many strategies are discussed in this primer for developing a successful private provider training program. As no two programs are the same, the key to success is to assess each context and apply or adapt the relevant strategies. It is important to note that training alone may not suffice to achieve improved quality of RH/FP and other health services offered by private providers (Peters et

al. 2004). As stressed earlier, it is important to assess whether training is the appropriate solution for an identified service quality gap (see Figure 1). Programs should examine all of the factors that may influence private provider behavior and service provision (Brugha and Zwi 1998) and determine which interventions, such as health financing or policy and regulatory reform, instead of or in addition to training, are likely to have a positive impact on quality of care.

14

Tab

le 1

. Sum

mar

y o

f Tra

inin

g C

ase

Stu

dies

Basic

Info

rmat

ion

Trai

ning

Nee

ds A

sses

smen

t (T

NA)

and

Rec

ruitm

ent

Trai

ning

Str

uctu

re a

nd L

ogistics

Ince

ntiv

esSu

stai

nabi

lity

of

Trai

ning

Pro

gram

Less

ons

Lear

ned

Co

untr

y: B

enin

Yea

r: 1

998

Org

aniz

atio

n/P

roje

ct:

PRIM

E an

d Po

pula

tion

Serv

ices

Intl.

(PS

I)/Be

nin

Lo

cal P

artn

er: N

atio

nal

Ass

ocia

tion

of P

harm

acis

ts

Tra

inee

s (#

): P

harm

acy

agen

ts (

80)

To

pics

: Con

trac

eptiv

e T

echn

olog

y U

pdat

e (C

TU

), qu

ality

of c

are

and

acce

ss t

o se

rvic

es

as a

pplie

d to

pha

rmac

y se

ttin

g

Dur

atio

n: 3

hal

f-day

s

A s

hort

ass

essm

ent

indi

cate

d th

at p

harm

acis

ts w

ere

not

avai

labl

e fo

r tr

aini

ng a

nd t

hat

phar

mac

y ag

ents

are

the

mos

t pr

esen

t pe

rson

nel i

n th

e ph

arm

acy

duri

ng t

he d

ay. P

RIM

E an

d PS

I/Ben

in t

hen

cond

ucte

d an

“in

form

atio

n da

y” fo

r 76

pr

ivat

e ph

arm

acis

ts t

o di

scus

s R

H, i

nfor

m t

hem

of u

pcom

ing

phar

mac

y ag

ent

trai

ning

, and

en

cour

age

them

to

send

the

ir

staf

f to

the

trai

ning

.

Com

bina

tion

of s

elf-s

tudy

and

st

anda

rd c

lass

room

ses

sion

s (3

hal

f-da

ys).

Tra

inin

g do

cum

ents

sen

t to

pa

rtic

ipan

ts p

rior

to

trai

ning

to

read

be

fore

eac

h se

ssio

n to

red

uce

time

away

from

wor

k.

Part

icip

ants

rec

eive

d tr

aini

ng m

ater

ials

, lu

nch

follo

win

g ha

lf-da

y tr

aini

ng s

essi

on, a

nd

tran

spor

tatio

n. M

ain

ince

ntiv

es w

ere

foun

d to

be

val

ue o

f kno

wle

dge

acqu

ired

, und

erst

andi

ng

that

impr

oved

ser

vice

qu

ality

cou

ld b

ring

mor

e cl

ient

s to

sho

p, a

nd b

eing

pa

rt o

f a n

etw

ork

that

was

to

rec

eive

PSI

sup

port

.

The

invo

lvem

ent

of

PSI/B

enin

tra

iner

s an

d av

aila

bilit

y of

tra

inin

g m

ater

ials

was

the

mai

n st

rate

gy fo

r su

stai

nabi

lity.

PS

I tra

iner

s w

ere

coac

hed

by In

traH

ealth

st

aff f

or s

ome

refr

eshe

r co

urse

s fo

r th

e ph

arm

acy

agen

ts. P

SI/B

enin

tr

aine

rs h

ave

cond

ucte

d fu

rthe

r re

fres

her

cour

ses

with

out

outs

ide

assi

stan

ce.

Use

a t

rain

ing

appr

oach

th

at m

inim

izes

tim

e aw

ay o

f pr

ovid

ers

from

the

ir w

ork

site

; inv

olve

pha

rmac

ists

or

the

asso

ciat

ion

in p

rovi

ding

in

cent

ives

for

exce

llent

le

arne

rs.

Co

untr

y: E

thio

pia

Yea

r: 2

007-

2008

Org

aniz

atio

n/P

roje

ct:

Priv

ate

Sect

or P

rogr

am

PSP-

Ethi

opia

Lo

cal P

artn

er: R

egio

nal

heal

th b

urea

us (

RH

Bs)

Tra

inee

s (#

): P

hysi

cian

s,

nurs

es, a

nd la

b te

chs

(306

)

To

pics

: Pre

vent

ion

and

trea

tmen

t of

TB

and

HIV

ca

re

Dur

atio

n: 6

day

s

Ass

essm

ent

cond

ucte

d in

180

pr

ivat

e fa

cilit

ies

in 3

reg

ions

to

det

erm

ine

inte

rest

in a

nd

need

for

trai

ning

, to

expa

nd

acce

ss t

o af

ford

able

HIV

and

T

B he

alth

car

e. R

HBs

hav

e a

list

of a

ll re

gist

ered

pri

vate

he

alth

faci

litie

s. F

acili

ties

that

m

et p

re-d

eter

min

ed s

elec

tion

crite

ria

wer

e in

clud

ed in

the

as

sess

men

t; a

seco

nd s

et o

f cr

iteri

a sh

ortli

sted

the

faci

litie

s an

d th

ose

part

icip

ants

wer

e se

nt

a le

tter

of i

nvita

tion.

In-c

lass

room

lect

ures

with

on-

the-

job

trai

ning

and

men

tori

ng. P

SP-E

thio

pia

also

pla

ns t

o ad

d se

lf-st

udy

prio

r to

le

ctur

es.L

ectu

res

are

sche

dule

don

6

cons

ecut

ive

days

(co

nsid

erab

ly

shor

ter

than

sim

ilar

wor

ksho

p of

fere

d to

pub

lics

ecto

rst

aff).

Loc

atio

nof

w

orks

hop

dece

ntra

lized

to

regi

ons

to

min

imiz

e tr

avel

tim

es.

Part

icip

ants

rec

eive

d pe

r di

em, t

rans

port

atio

n co

sts,

tra

inin

g m

ater

ials

, re

sour

ce m

ater

ials

suc

h as

nat

iona

l gui

delin

es a

nd

man

uals

, and

cer

tifica

te

of a

tten

danc

e si

gned

by

pro

ject

and

RH

Bs.

Cer

tifica

tes

wer

e fo

und

to b

e st

rong

ince

ntiv

e.

Com

petit

ive

proc

ess

to

part

icip

ate

also

con

veye

d va

lue

to t

rain

ing.

PSP-

Ethi

opia

is w

orki

ng

clos

ely

with

RH

Bs t

o bu

ild t

heir

cap

acity

to

cont

inue

tra

inin

g st

aff.

Mak

e th

e tr

aini

ng lo

catio

n as

nea

r an

d co

nven

ient

as

poss

ible

to

min

imiz

e co

st t

o pa

rtic

ipan

ts; a

pre

-wor

ksho

p se

lf-st

udy

port

ion

on

back

grou

nd t

opic

s is

a g

ood

stra

tegy

to

redu

ce t

rain

ing

time

and

allo

w in

-cla

ssro

om

time

to fo

cus

on c

ore

topi

cs

of in

tere

st.

15

Basic

Info

rmat

ion

Trai

ning

Nee

ds A

sses

smen

t (T

NA)

and

Rec

ruitm

ent

Trai

ning

Str

uctu

re a

nd L

ogistics

Ince

ntiv

esSu

stai

nabi

lity

of

Trai

ning

Pro

gram

Less

ons

Lear

ned

Co

untr

y: G

hana

Yea

r: 1

999-

2001

Org

aniz

atio

n/P

roje

ct:

PRIM

E

Lo

cal P

artn

er: G

hana

R

egis

tere

d M

idw

ives

A

ssoc

iatio

n(G

RM

A)

Tra

inee

s (#

): M

idw

ives

(5

9)

To

pic:

Ado

lesc

ent

RH

and

clie

nt-p

rovi

der

inte

ract

ion

Dur

atio

n: 5

mon

ths

(abo

ut 1

mod

ule

per

mon

th)

A T

NA

was

con

duct

ed in

19

97 b

y pa

rtne

r or

gani

zatio

ns.

Mid

wiv

es w

ho r

egul

arly

pa

rtic

ipat

ein

GR

MA

mon

thly

m

eetin

gs w

ere

recr

uite

d.

A “

self-

dire

cted

lear

ning

” m

odel

ad

min

iste

red

thro

ugh

GR

MA

co

mbi

ned

prac

tice

exer

cise

s, s

elf-

asse

ssm

ents

, pai

red

lear

ning

with

a

near

by p

eer,

faci

litat

or v

isits

, and

m

onth

ly g

roup

pee

r-re

view

mee

tings

. T

his

appr

oach

min

imiz

ed t

he t

ime

for

grou

p le

arni

ng t

o on

ce a

mon

th

mee

tings

, aft

er a

2-d

ay k

ick-

off

mee

ting.

Part

icip

ants

rec

eive

d pr

int

mat

eria

ls (

6 m

odul

es),

info

rmat

ion,

edu

catio

n an

d co

mm

unic

atio

n (IE

C)

and

FP s

uppl

ies,

and

faci

litat

or

visi

ts. M

ain

ince

ntiv

e fo

r pa

rtic

ipat

ion

was

foun

d to

be

incr

ease

d kn

owle

dge

that

was

the

n us

ed t

o at

trac

t bo

th n

ew c

lient

s as

w

ell a

s a

new

typ

e of

cl

ient

(ad

oles

cent

s).

The

tra

inin

g pr

ogra

m w

as

to b

e in

stitu

tiona

lized

w

ithin

GR

MA

.It

is

know

nth

atG

RM

A

cond

ucte

d on

e m

ore

roun

d of

tra

inin

g fo

r an

ad

ditio

nal 5

2 m

idw

ives

an

d of

fere

d th

e or

igin

al

6 m

odul

es p

lus

a ne

w

one

GR

MA

dev

elop

edo

nH

IV C

T.

Con

duct

TN

A s

o th

at t

he

trai

ning

pro

gram

res

pond

s to

id

entifi

ed n

eeds

; inv

olve

all

stak

ehol

ders

in t

he d

esig

n of

th

e tr

aini

ng p

rogr

am; b

uild

on

an e

xist

ing

stru

ctur

e(G

RM

A

and

its m

onth

ly m

eetin

gs),

whi

ch c

an p

rovi

de t

he t

rain

ers

and

supe

rvis

ory/

faci

litat

ion

visi

ts; b

uild

in p

eer

supp

ort

to

keep

par

ticip

ants

eng

aged

.

Co

untr

y: G

hana

Yea

r: 2

002-

2004

Org

aniz

atio

n/P

roje

ct:

Gha

naS

ocia

lMar

ketin

gFo

unda

tion

(GSM

F),S

EAM

pr

ojec

t

Lo

cal P

artn

er: L

icen

sed

Che

mic

alS

elle

rs(

LCS)

A

ssoc

iatio

n

Tra

inee

s (#

): L

icen

sed

chem

ical

sel

lers

(ap

prox

. 23

0)

To

pics

: Car

eSho

p fr

anch

ise

busi

ness

mod

el,

busi

ness

and

man

agem

ent,

drug

man

agem

ent,

man

agin

g si

mpl

e ai

lmen

ts,

busi

ness

pla

nnin

g

Dur

atio

n: 1

6 da

ys

dist

ribu

ted

over

10

wee

ks

GSM

Fus

eda

nex

tens

ive

TN

A

cond

ucte

d by

a p

rior

pro

ject

an

d de

velo

ped

cont

ent

to

resp

ond

to t

hose

nee

ds. T

hey

wor

ked

clos

ely

with

the

LC

San

d lo

cal t

radi

tiona

l pol

itica

l st

ruct

ure

(vill

age

chie

fs)

to

pres

ent

Car

eSho

p co

ncep

t an

d sc

reen

pot

entia

l app

lican

ts,

usin

g an

app

licat

ion

proc

ess

to

scre

en a

nd r

ecru

it pa

rtic

ipan

ts.

Con

tent

was

org

aniz

ed in

to 5

m

odul

es o

f 2-5

day

s ea

ch. M

odul

es

wer

e of

fere

d du

ring

the

wee

k (M

onda

y th

roug

h Fr

iday

or

a po

rtio

n of

the

wee

k in

con

secu

tive

days

), 4

hour

s/da

y. A

fter

eac

h m

odul

e, t

here

w

as a

1-w

eek

brea

k w

hen

part

icip

ants

w

ere

expe

cted

to

appl

y w

hat

they

le

arne

d (o

n-th

e-jo

b tr

aini

ng),

then

pr

ovid

e fe

edba

ck t

he fo

llow

ing

wee

k.

The

firs

t m

odul

e w

as o

ffere

d fo

r fr

ee, a

fter

whi

ch t

hose

inte

rest

ed

coul

d ch

oose

to

pay

and

cont

inue

the

tr

aini

ng t

o be

par

t of

the

fran

chis

e.

Part

icip

ants

rec

eive

d ho

tel

acco

mm

odat

ion,

food

, tr

aini

ng m

ater

ials

, and

pr

otoc

ols.

A c

ertifi

cate

an

d m

embe

rshi

p in

the

C

areS

hop

fran

chis

e w

ere

awar

ded

upon

co

mpl

etio

n of

tra

inin

g.

Part

icip

ants

als

o re

ceiv

ed

sign

age

to b

rand

the

ir

shop

s as

Car

eSho

ps

and

a lic

ense

num

ber.

Q

ualit

y of

the

tra

inin

g pr

ogra

m a

nd C

areS

hop

bran

ding

wer

e fo

und

to

be t

he m

ain

ince

ntiv

es fo

r pa

rtic

ipat

ion.

Par

ticip

ants

pa

id a

tok

en fe

e.

Dec

entr

aliz

ed t

rain

ing

to m

inim

ize

cost

s (e

limin

ated

nee

d fo

r ho

tel a

ccom

mod

atio

n),

so t

hat

toke

n fe

e ch

arge

d to

par

ticip

ants

cov

ered

m

ost

of t

he t

rain

ing

cost

s in

curr

edb

yG

SMF.

Cle

arly

exp

lain

the

pro

fit-

rela

ted

bene

fits

of t

he t

rain

ing

to in

tere

st p

riva

te p

rovi

ders

; un

ders

tand

the

ince

ntiv

es fo

r pr

ovid

ers

– on

e of

the

mai

n be

nefit

s of

the

Car

eSho

p m

embe

rshi

p is

free

pro

duct

de

liver

y to

the

sho

ps –

thi

s w

as a

str

ong

ince

ntiv

e fo

r ru

ralL

SCs,

less

so

for

peri

-ur

ban

LSC

s,a

sth

eyc

ane

asily

ob

tain

pro

duct

s el

sew

here

.

16

Basic

Info

rmat

ion

Trai

ning

Nee

ds A

sses

smen

t (T

NA)

and

Rec

ruitm

ent

Trai

ning

Str

uctu

re a

nd L

ogistics

Ince

ntiv

esSu

stai

nabi

lity

of

Trai

ning

Pro

gram

Less

ons

Lear

ned

Co

untr

y: G

uate

mal

a

Yea

r: 2

007-

pres

ent

Org

aniz

atio

n/P

roje

ct:

PSP-

One

Lo

cal P

artn

er:

Prof

essi

onal

ass

ocia

tions

Tra

inee

s (#

): D

octo

rs

(267

+)

and

bioc

hem

ists

(8

6+)

To

pics

: HIV

CT

Dur

atio

n: 4

hou

rs

Rap

id a

sses

smen

t co

nduc

ted

thro

ugh

inte

rvie

ws

with

do

ctor

s an

d bi

oche

mis

ts

indi

cate

d th

e ne

ed t

o im

prov

e th

eir

know

ledg

e of

HIV

CT

no

rms

and

prot

ocol

s. U

sed

mul

ti-pr

onge

d ap

proa

ch t

o id

entif

y an

d re

crui

t pa

rtic

ipan

ts:

obta

ined

a li

st o

f pro

vide

rs

from

pro

fess

iona

l ass

ocia

tions

, th

en “

snow

balle

d” fr

om t

here

to

rea

ch a

dditi

onal

pro

vide

rs;

cond

ucte

d “s

ensi

tizat

ion”

ta

lks

in a

ssoc

iatio

n m

eetin

gs

whe

re m

uch

recr

uitin

g al

so

occu

rred

; and

par

tner

ed w

ith

phar

mac

eutic

al c

ompa

nies

to

leve

rage

the

ir s

ales

/det

ailin

g fo

rce

to d

istr

ibut

e in

vita

tions

to

trai

ning

s to

the

pri

vate

pro

vide

rs

they

nor

mal

ly v

isit.

Stan

dard

wor

ksho

p, w

ith v

ery

part

icip

ator

y ap

proa

ch in

clud

ing

case

st

udie

s, q

uest

ion

and

answ

er, a

nd a

ga

me

show

-like

dev

ice

that

lets

the

do

ctor

s se

lect

the

ir a

nsw

er fr

om

a re

mot

e, w

hich

the

n di

spla

ys t

he

colle

ctiv

e an

swer

s on

a s

cree

n.

Proj

ect

staf

f con

sulte

d w

ith t

he

prov

ider

s on

tim

e/da

y th

at is

co

nven

ient

for

them

, as

wel

l as

loca

tion

and

type

of w

orks

hop

sett

ing.

Se

lect

ed t

imes

whe

n ph

ysic

ians

w

ere

not

wor

king

, lik

e W

edne

sday

af

tern

oons

. Whe

n fe

asib

le, p

lann

ed

trai

ning

to

coin

cide

with

an

exis

ting

even

t/co

nfer

ence

.

Part

icip

ants

rec

eive

d tr

aini

ng m

ater

ials

(p

rese

ntat

ions

, ref

eren

ce

mat

eria

ls)

and

a sn

ack.

C

ME

cred

its w

ere

give

n fo

r al

l wor

ksho

ps. M

ain

ince

ntiv

es w

ere

foun

d to

be

wel

l-kno

wn

expe

rts

who

led

the

wor

ksho

ps

and

part

icip

ants

’ ow

n in

tere

st in

lear

ning

mor

e ab

out

HIV

.

Mod

ules

are

bei

ng h

ande

d ov

er t

o pr

ofes

sion

al

asso

ciat

ions

, so

that

ev

entu

ally

the

y ca

n ta

ke

this

tra

inin

g on

. Pro

ject

st

aff i

s pa

rt o

f a p

ublic

-pr

ivat

e co

mm

issi

on

that

is d

eter

min

ing

the

best

way

to

inco

rpor

ate

this

info

rmat

ion

into

th

e pr

e-se

rvic

e m

edic

al

curr

icul

um. P

roje

ct is

al

so w

orki

ng w

ith a

do

ctor

who

is d

esig

ning

a

cour

se (

“Dip

lom

ado”

) on

thi

s to

pic

for

priv

ate

prov

ider

s, w

hich

will

m

ost

likel

y ch

arge

for

part

icip

atio

n. F

inal

ly,

proj

ect

will

mak

e th

e m

odul

es a

vaila

ble

onlin

e.

Con

duct

a T

NA

to

lear

n to

pics

of i

nter

est

to

phys

icia

ns; k

eep

sess

ions

sh

ort

(not

mor

e th

an 4

ho

urs)

; use

wel

l-kno

wn

expe

rts

as s

peak

ers;

tai

lor

wor

ksho

ps t

o di

ffere

nt

phys

icia

n sp

ecia

lties

; fol

low

up

indi

vidu

ally

(as

by

phon

e) w

ith

prov

ider

s to

ens

ure

that

the

y sh

ow u

p to

the

tra

inin

g.

Co

untr

y: H

ondu

ras

Yea

r: 2

006-

2007

Org

aniz

atio

n/P

roje

ct:

PSP-

One

Lo

cal P

artn

er:

ASH

ON

PLA

FA(

NG

O)

Tra

inee

s (#

): P

hysi

cian

s (9

)

To

pics

: No-

scal

pel

vase

ctom

y (N

SV)

Dur

atio

n: A

ppro

x. 2

m

onth

s fo

r ea

ch p

hysi

cian

to

com

plet

e, d

epen

ding

on

cas

eloa

d

A d

ecis

ion

was

mad

e to

in

trod

uce

the

NSV

met

hod

into

the

pri

vate

sec

tor.

The

co

ntra

ctin

gN

GO

sel

ecte

ddo

ctor

s ba

sed

on t

heir

loca

tion,

sk

ill, a

nd m

otiv

atio

n.

Pha

se 1

: Sta

ndar

d w

orks

hop

form

at fo

r th

eore

tical

par

t (2

.5 d

ay

wor

ksho

p on

wee

kend

)P

hase

2: M

aste

r tr

aine

r ob

serv

ed

5 lo

cal p

hysi

cian

s w

ho h

ad b

een

prev

ious

ly t

rain

ed a

s th

ey p

erfo

rmed

N

SV, a

nd t

hen

cert

ified

the

m a

s tr

aine

rs.

Pha

se 3

: Tra

iner

s th

en a

ssis

ted/

obse

rved

the

9 t

rain

ees

perf

orm

NSV

un

til t

hey

felt

that

the

doc

tors

wer

e re

ady

to b

e ce

rtifi

ed a

s tr

aine

d, u

sing

a

chec

klis

t an

d th

eir

own

judg

men

t. T

his

phas

e to

ok s

ever

al m

onth

s an

d cl

ose

coor

dina

tion

to c

ompl

ete,

sin

ce

case

load

for

NSV

is lo

w. I

n so

me

inst

ance

s tr

aine

es h

ad t

o le

ave

thei

r pr

actic

ean

dgo

to

the

NG

Ofa

cilit

ies

whe

re t

here

is a

hig

her

case

load

.

Wor

ksho

p w

as h

eld

at a

nic

e lo

catio

n, a

nd

all l

odgi

ng, m

eal,

and

tran

spor

tatio

n co

sts

wer

e co

vere

d. M

ain

ince

ntiv

es

for

part

icip

atio

n w

ere

foun

d to

be

inte

rest

in

lear

ning

a n

ew c

linic

al

skill

; per

sona

l inv

itatio

n fr

omt

heN

GO

’sM

edic

al

Dir

ecto

r, w

ho is

in

char

ge o

f con

trac

ting

for

ster

iliza

tion

serv

ices

; kn

owin

g th

at t

he N

SV

they

per

form

will

als

o be

cov

ered

und

er t

he

cont

ract

with

NG

O(

i.e.,

poss

ibly

mor

e re

venu

e du

e to

thi

s ad

ditio

nal s

ervi

ce).

With

the

pre

para

tion

of c

ertifi

ed t

rain

ers,

th

ere

is n

ow in

-cou

ntry

ca

paci

ty t

o tr

ain

othe

r pr

ovid

ers

in N

SV. O

ne o

f th

e tr

aine

rs h

as a

lrea

dy

trai

ned

an a

dditi

onal

pu

blic

sec

tor

doct

or

as r

eque

sted

by

the

Min

istr

y. O

ne t

rain

er

was

als

o ce

rtifi

ed a

s a

supe

rvis

or, s

o th

at h

e ca

n m

onito

r th

e qu

ality

of

the

NSV

ser

vice

s pr

ovid

ed b

y th

e 9

trai

ned

doct

ors.

Con

sult

with

pro

vide

rs p

rior

to

sch

edul

ing

the

wor

ksho

p;

follo

w u

p w

ith t

hem

pri

or

to w

orks

hop

to e

nsur

e at

tend

ance

; cho

ose

a ni

ce

and

cent

ral l

ocat

ion

for

the

wor

ksho

p; s

tay

flexi

ble

whe

n im

plem

entin

g cl

inic

al s

kill

trai

ning

– it

tak

es in

tens

ive

coor

dina

tion

to e

nsur

e th

at

both

the

tra

iner

and

tra

inee

ar

e av

aila

ble

and

pres

ent

whe

reve

r an

d w

hene

ver

ther

e ar

e pa

tient

s; s

ched

ules

cha

nge

cons

tant

ly; e

nfor

ce s

tric

t se

lect

ion

crite

ria

to s

elec

t ou

t pr

ovid

ers

who

are

not

tru

ly

mot

ivat

ed t

o us

e th

e ne

w

skill

.

17

Basic

Info

rmat

ion

Trai

ning

Nee

ds A

sses

smen

t (T

NA)

and

Rec

ruitm

ent

Trai

ning

Str

uctu

re a

nd L

ogistics

Ince

ntiv

esSu

stai

nabi

lity

of

Trai

ning

Pro

gram

Less

ons

Lear

ned

Co

untr

y: G

uate

mal

a

Yea

r: 2

007-

pres

ent

Org

aniz

atio

n/P

roje

ct:

PSP-

One

Lo

cal P

artn

er:

Prof

essi

onal

ass

ocia

tions

Tra

inee

s (#

): D

octo

rs

(267

+)

and

bioc

hem

ists

(8

6+)

To

pics

: HIV

CT

Dur

atio

n: 4

hou

rs

Rap

id a

sses

smen

t co

nduc

ted

thro

ugh

inte

rvie

ws

with

do

ctor

s an

d bi

oche

mis

ts

indi

cate

d th

e ne

ed t

o im

prov

e th

eir

know

ledg

e of

HIV

CT

no

rms

and

prot

ocol

s. U

sed

mul

ti-pr

onge

d ap

proa

ch t

o id

entif

y an

d re

crui

t pa

rtic

ipan

ts:

obta

ined

a li

st o

f pro

vide

rs

from

pro

fess

iona

l ass

ocia

tions

, th

en “

snow

balle

d” fr

om t

here

to

rea

ch a

dditi

onal

pro

vide

rs;

cond

ucte

d “s

ensi

tizat

ion”

ta

lks

in a

ssoc

iatio

n m

eetin

gs

whe

re m

uch

recr

uitin

g al

so

occu

rred

; and

par

tner

ed w

ith

phar

mac

eutic

al c

ompa

nies

to

leve

rage

the

ir s

ales

/det

ailin

g fo

rce

to d

istr

ibut

e in

vita

tions

to

trai

ning

s to

the

pri

vate

pro

vide

rs

they

nor

mal

ly v

isit.

Stan

dard

wor

ksho

p, w

ith v

ery

part

icip

ator

y ap

proa

ch in

clud

ing

case

st

udie

s, q

uest

ion

and

answ

er, a

nd a

ga

me

show

-like

dev

ice

that

lets

the

do

ctor

s se

lect

the

ir a

nsw

er fr

om

a re

mot

e, w

hich

the

n di

spla

ys t

he

colle

ctiv

e an

swer

s on

a s

cree

n.

Proj

ect

staf

f con

sulte

d w

ith t

he

prov

ider

s on

tim

e/da

y th

at is

co

nven

ient

for

them

, as

wel

l as

loca

tion

and

type

of w

orks

hop

sett

ing.

Se

lect

ed t

imes

whe

n ph

ysic

ians

w

ere

not

wor

king

, lik

e W

edne

sday

af

tern

oons

. Whe

n fe

asib

le, p

lann

ed

trai

ning

to

coin

cide

with

an

exis

ting

even

t/co

nfer

ence

.

Part

icip

ants

rec

eive

d tr

aini

ng m

ater

ials

(p

rese

ntat

ions

, ref

eren

ce

mat

eria

ls)

and

a sn

ack.

C

ME

cred

its w

ere

give

n fo

r al

l wor

ksho

ps. M

ain

ince

ntiv

es w

ere

foun

d to

be

wel

l-kno

wn

expe

rts

who

led

the

wor

ksho

ps

and

part

icip

ants

’ ow

n in

tere

st in

lear

ning

mor

e ab

out

HIV

.

Mod

ules

are

bei

ng h

ande

d ov

er t

o pr

ofes

sion

al

asso

ciat

ions

, so

that

ev

entu

ally

the

y ca

n ta

ke

this

tra

inin

g on

. Pro

ject

st

aff i

s pa

rt o

f a p

ublic

-pr

ivat

e co

mm

issi

on

that

is d

eter

min

ing

the

best

way

to

inco

rpor

ate

this

info

rmat

ion

into

th

e pr

e-se

rvic

e m

edic

al

curr

icul

um. P

roje

ct is

al

so w

orki

ng w

ith a

do

ctor

who

is d

esig

ning

a

cour

se (

“Dip

lom

ado”

) on

thi

s to

pic

for

priv

ate

prov

ider

s, w

hich

will

m

ost

likel

y ch

arge

for

part

icip

atio

n. F

inal

ly,

proj

ect

will

mak

e th

e m

odul

es a

vaila

ble

onlin

e.

Con

duct

a T

NA

to

lear

n to

pics

of i

nter

est

to

phys

icia

ns; k

eep

sess

ions

sh

ort

(not

mor

e th

an 4

ho

urs)

; use

wel

l-kno

wn

expe

rts

as s

peak

ers;

tai

lor

wor

ksho

ps t

o di

ffere

nt

phys

icia

n sp

ecia

lties

; fol

low

up

indi

vidu

ally

(as

by

phon

e) w

ith

prov

ider

s to

ens

ure

that

the

y sh

ow u

p to

the

tra

inin

g.

Co

untr

y: H

ondu

ras

Yea

r: 2

006-

2007

Org

aniz

atio

n/P

roje

ct:

PSP-

One

Lo

cal P

artn

er:

ASH

ON

PLA

FA(

NG

O)

Tra

inee

s (#

): P

hysi

cian

s (9

)

To

pics

: No-

scal

pel

vase

ctom

y (N

SV)

Dur

atio

n: A

ppro

x. 2

m

onth

s fo

r ea

ch p

hysi

cian

to

com

plet

e, d

epen

ding

on

cas

eloa

d

A d

ecis

ion

was

mad

e to

in

trod

uce

the

NSV

met

hod

into

the

pri

vate

sec

tor.

The

co

ntra

ctin

gN

GO

sel

ecte

ddo

ctor

s ba

sed

on t

heir

loca

tion,

sk

ill, a

nd m

otiv

atio

n.

Pha

se 1

: Sta

ndar

d w

orks

hop

form

at fo

r th

eore

tical

par

t (2

.5 d

ay

wor

ksho

p on

wee

kend

)P

hase

2: M

aste

r tr

aine

r ob

serv

ed

5 lo

cal p

hysi

cian

s w

ho h

ad b

een

prev

ious

ly t

rain

ed a

s th

ey p

erfo

rmed

N

SV, a

nd t

hen

cert

ified

the

m a

s tr

aine

rs.

Pha

se 3

: Tra

iner

s th

en a

ssis

ted/

obse

rved

the

9 t

rain

ees

perf

orm

NSV

un

til t

hey

felt

that

the

doc

tors

wer

e re

ady

to b

e ce

rtifi

ed a

s tr

aine

d, u

sing

a

chec

klis

t an

d th

eir

own

judg

men

t. T

his

phas

e to

ok s

ever

al m

onth

s an

d cl

ose

coor

dina

tion

to c

ompl

ete,

sin

ce

case

load

for

NSV

is lo

w. I

n so

me

inst

ance

s tr

aine

es h

ad t

o le

ave

thei

r pr

actic

ean

dgo

to

the

NG

Ofa

cilit

ies

whe

re t

here

is a

hig

her

case

load

.

Wor

ksho

p w

as h

eld

at a

nic

e lo

catio

n, a

nd

all l

odgi

ng, m

eal,

and

tran

spor

tatio

n co

sts

wer

e co

vere

d. M

ain

ince

ntiv

es

for

part

icip

atio

n w

ere

foun

d to

be

inte

rest

in

lear

ning

a n

ew c

linic

al

skill

; per

sona

l inv

itatio

n fr

omt

heN

GO

’sM

edic

al

Dir

ecto

r, w

ho is

in

char

ge o

f con

trac

ting

for

ster

iliza

tion

serv

ices

; kn

owin

g th

at t

he N

SV

they

per

form

will

als

o be

cov

ered

und

er t

he

cont

ract

with

NG

O(

i.e.,

poss

ibly

mor

e re

venu

e du

e to

thi

s ad

ditio

nal s

ervi

ce).

With

the

pre

para

tion

of c

ertifi

ed t

rain

ers,

th

ere

is n

ow in

-cou

ntry

ca

paci

ty t

o tr

ain

othe

r pr

ovid

ers

in N

SV. O

ne o

f th

e tr

aine

rs h

as a

lrea

dy

trai

ned

an a

dditi

onal

pu

blic

sec

tor

doct

or

as r

eque

sted

by

the

Min

istr

y. O

ne t

rain

er

was

als

o ce

rtifi

ed a

s a

supe

rvis

or, s

o th

at h

e ca

n m

onito

r th

e qu

ality

of

the

NSV

ser

vice

s pr

ovid

ed b

y th

e 9

trai

ned

doct

ors.

Con

sult

with

pro

vide

rs p

rior

to

sch

edul

ing

the

wor

ksho

p;

follo

w u

p w

ith t

hem

pri

or

to w

orks

hop

to e

nsur

e at

tend

ance

; cho

ose

a ni

ce

and

cent

ral l

ocat

ion

for

the

wor

ksho

p; s

tay

flexi

ble

whe

n im

plem

entin

g cl

inic

al s

kill

trai

ning

– it

tak

es in

tens

ive

coor

dina

tion

to e

nsur

e th

at

both

the

tra

iner

and

tra

inee

ar

e av

aila

ble

and

pres

ent

whe

reve

r an

d w

hene

ver

ther

e ar

e pa

tient

s; s

ched

ules

cha

nge

cons

tant

ly; e

nfor

ce s

tric

t se

lect

ion

crite

ria

to s

elec

t ou

t pr

ovid

ers

who

are

not

tru

ly

mot

ivat

ed t

o us

e th

e ne

w

skill

.

Basic

Info

rmat

ion

Trai

ning

Nee

ds A

sses

smen

t (T

NA)

and

Rec

ruitm

ent

Trai

ning

Str

uctu

re a

nd L

ogistics

Ince

ntiv

esSu

stai

nabi

lity

of

Trai

ning

Pro

gram

Less

ons

Lear

ned

Co

untr

y: In

dia

Yea

r: 2

007-

2008

Org

aniz

atio

n/P

roje

ct:

PSP-

One

Indi

a

Lo

cal P

artn

er: N

one

Tra

inee

s (#

): O

b/G

yns

(1,0

00)

and

nurs

es (

500)

To

pics

: CT

U

with

em

phas

is o

n D

IMPA

(de

pot

med

roxy

prog

este

rone

ac

etat

e) in

ject

able

met

hod

Dur

atio

n: 3

hou

rs

TN

A d

one

thro

ugh

focu

s gr

oup

disc

ussi

ons,

fiel

d te

st o

f Qua

lity

Impr

ovem

ent

(QI)

tool

tha

t id

entifi

ed p

erfo

rman

ce g

aps,

an

d ob

serv

atio

ns. P

roje

ct s

taff

iden

tified

all

Ob/

Gyn

sw

how

ere

wor

king

in p

riva

te c

linic

s in

a

set

geog

raph

ic a

rea

and

field

re

ps fo

llow

ed u

p at

the

ir o

ffice

to

invi

te t

hem

to

the

trai

ning

an

d ex

plai

n ab

out

the

DIM

PA

Net

wor

k.

Thr

ee-h

our

wor

ksho

p (d

ay o

f th

e w

eek

and

loca

tion

sele

cted

in

cons

ulta

tion

with

pro

vide

rs)

usin

g st

ruct

ured

tra

inin

g m

ater

ial f

acili

tate

d by

tec

hnic

al t

rain

ing

dire

ctor

.

Follo

w-u

p fr

om w

orks

hop

with

on-

site

tec

hnic

al s

uppo

rt v

isits

to

supp

ort

coun

selin

g an

d us

e of

inje

ctab

le

met

hod.

Part

icip

ants

rec

eive

d m

eals

, tra

inin

g m

ater

ials

; FP

Glo

balH

andb

ook,

ot

her

job

aids

, DIM

PA

case

reg

iste

r an

d cl

ient

fo

llow

-up

card

s, a

nd

cert

ifica

te a

nd r

ecog

nitio

n as

DIM

PA-t

rain

ed d

octo

r.

Wor

ksho

p to

ok p

lace

in

a n

ice

loca

tion.

Mai

n in

cent

ives

wer

e fo

und

to b

e pe

rcei

ved

valu

e of

ski

ll/kn

owle

dge,

pr

esen

ce o

f exp

erie

nced

, kn

owle

dgea

ble,

and

wel

l-kn

own

doct

or a

nd t

rain

er,

and

inte

ract

ive

sess

ions

.

Ob/

Gyn

ass

ocia

tion

expr

esse

d in

tere

st

in c

ontin

uing

the

tr

aini

ng a

nd t

ying

it t

o ce

rtifi

catio

n, b

ut n

eeds

ou

tsid

e fu

nds

to d

o th

is.

Som

e di

scus

sion

on

offe

ring

CM

E cr

edits

for

the

trai

ning

and

cha

rgin

g a

fee

to p

hysi

cian

s;

how

ever

, sin

ce C

ME

is n

ot m

anda

tory

for

relic

ensu

re, t

here

is li

ttle

in

cent

ive

for

phys

icia

ns

to p

ay t

o le

arn.

Kee

p th

e se

ssio

ns s

hort

(no

t m

ore

than

3 h

ours

); m

ake

sess

ions

inte

ract

ive

to e

nabl

e ph

ysic

ians

to

lear

n ho

w t

o us

e th

e in

tern

atio

nal m

ater

ials

an

d to

ols

and

to d

evel

op t

he

skill

of c

ontin

uous

lear

ning

on

thei

r ow

n.

Co

untr

y: In

dia

Yea

r: 2

007-

2008

Org

aniz

atio

n/P

roje

ct:

PSP-

One

Lo

cal P

artn

er: C

hem

ists

an

d IS

MP

Ass

ocia

tions

Tra

inee

s (#

): C

hem

ists

(1

50)

and

ISM

Ps (

150)

To

pics

: You

th-fr

iend

ly

com

mun

icat

ion

skill

s,

over

view

of c

ontr

acep

tive

met

hods

app

ropr

iate

for

yout

h, b

asic

s of

sex

ually

tr

ansm

itted

infe

ctio

ns a

nd

HIV

/AID

S

Dur

atio

n: 2

day

s

Form

ativ

e re

sear

ch id

entifi

ed a

sp

ecia

l nee

d fo

r co

ntra

cept

ive

know

ledg

e an

d co

mm

unic

atio

n sk

ills

of c

hem

ists

and

ISM

Ps fo

r ad

oles

cent

s an

d m

arri

ed y

outh

(a

ge 1

8-25

). PS

P-O

ne m

appe

d th

e ta

rget

geo

grap

hic

area

and

ob

tain

ed li

sts

of p

rovi

ders

from

pr

ofes

sion

al a

ssoc

iatio

ns. P

roje

ct

dete

rmin

ed a

% o

f pro

vide

rs it

w

ante

d to

tra

in a

nd a

ssoc

iatio

ns

help

ed w

ith o

utre

ach

to s

elec

t pr

ovid

ers.

Proj

ect

field

tea

m v

isite

d ea

ch

prov

ider

to

pers

onal

ly in

vite

hi

m/h

er t

o th

e tr

aini

ng, a

nd

follo

wed

up

with

a p

hone

cal

l th

e ni

ght

befo

re t

rain

ing.

Tw

o 3-

4 ho

ur w

orks

hops

on

cons

ecut

ive

days

in t

he a

fter

noon

(T

hurs

day-

Frid

ay o

r Fr

iday

-Sat

urda

y),

offe

red

sepa

rate

ly fo

r ea

ch p

rovi

der

cadr

e. E

xper

ienc

ed t

rain

ing

cons

ulta

nt

was

in c

harg

e of

tra

inin

g lo

gist

ics

and

desi

gned

wor

ksho

p to

be

offe

red

duri

ng “

less

bus

y” t

ime

for

part

icip

ants

. Site

was

con

veni

ently

lo

cate

d at

loca

l res

taur

ants

or

café

s.

Part

icip

ants

rec

eive

d lu

nch

and

prod

uct

sam

ples

. Mai

n in

cent

ives

wer

e fo

und

to

be p

rofe

ssio

nal i

nter

est

to

incr

ease

kno

wle

dge

and

perc

eptio

n of

opp

ortu

nity

to

att

ract

mor

e cl

ient

s by

be

com

ing

a m

embe

r of

the

Sa

athy

ia n

etw

ork

of y

outh

-fr

iend

ly F

P se

rvic

es, w

hich

in

clud

ed b

rand

ing

and

prom

otio

n of

faci

litie

s.

Sust

aina

bilit

y of

effo

rt

was

not

an

issu

e at

the

tim

e th

e pr

ojec

t w

as

impl

emen

ting

this

tra

inin

g as

a lo

t of

fund

ing

was

av

aila

ble.

Inve

st t

ime

and

effo

rt t

o pe

rson

ally

invi

te p

artic

ipan

ts;

invo

lve

and

wor

k cl

osel

y w

ith p

rofe

ssio

nal a

ssoc

iatio

ns

to h

elp

with

att

enda

nce,

pa

rtic

ular

ly w

ith t

he

chem

ists

; use

inte

ract

ive

trai

ning

tec

hniq

ues

to

keep

the

tra

inee

s en

gage

d an

d pa

rtic

ipat

ing;

use

a

wel

l-kno

wn,

rec

ogni

zed

prof

essi

onal

to

add

cred

ibili

ty

to t

he t

rain

ing.

18

Basic

Info

rmat

ion

Trai

ning

Nee

ds A

sses

smen

t (T

NA)

and

Rec

ruitm

ent

Trai

ning

Str

uctu

re a

nd L

ogistics

Ince

ntiv

esSu

stai

nabi

lity

of

Trai

ning

Pro

gram

Less

ons

Lear

ned

Co

untr

y: Jo

rdan

Yea

r: 2

004-

pres

ent

Org

aniz

atio

n/P

roje

ct:

Jord

an P

riva

te S

ecto

r Pr

ojec

t fo

r W

omen

’s

Hea

lth (

PSP)

Lo

cal P

artn

er:

Prof

essi

onal

med

ical

as

soci

atio

ns a

nd Jo

rdan

M

edic

al C

ounc

il

Tra

inee

s (#

): P

hysi

cian

s (6

00+

)

To

pics

: FP

upda

tes

and

IUD

inse

rtio

n

Dur

atio

n: 3

-4 d

ays

USA

ID p

roje

ct id

entifi

ed

goal

of i

ncre

asin

g co

uple

-ye

ars

prot

ectio

n. P

roje

ct s

taff

desi

gned

que

stio

nnai

re t

o id

entif

y to

pics

on

wom

en’s

he

alth

tha

t ph

ysic

ians

wer

e in

tere

sted

in k

now

ing

mor

e ab

out.

Initi

al p

roje

ct (

Com

mer

cial

M

arke

t St

rate

gies

) de

velo

ped

a lis

t of

phy

sici

ans

in p

riva

te

prac

tice;

sub

sequ

ent

proj

ect

cont

inue

dto

use

list

.Lis

tup

date

d by

con

tact

ing

prof

essi

onal

med

ical

as

soci

atio

ns a

nd Jo

rdan

Med

ical

C

ounc

il (w

hich

reg

iste

rs a

ll ne

w

grad

uate

s) a

nd w

ord

of m

outh

.

Stan

dard

wor

ksho

p fo

rmat

with

in

tera

ctiv

e se

ssio

ns fo

r FP

tra

inin

g, 4

ho

urs

on F

rida

y. F

or IU

D in

sert

ion,

3

days

: 1 d

ay o

f the

ory

and

2 da

ys o

f pr

actic

um. P

ract

icum

s w

ere

arra

nged

at

faci

lity

near

doc

tor’

s lo

catio

n (a

ppro

ved

trai

ning

site

of t

he M

inis

try

of H

ealth

) so

par

ticip

ants

wou

ld n

ot

have

to

trav

el fa

r. P

riva

te p

hysi

cian

s w

ere

aske

d fo

r pr

efer

ence

s on

whe

n to

offe

r co

urse

s; t

hey

indi

cate

d Fr

iday

s (t

heir

day

off)

and

to

be

kept

sho

rt (

not

mor

e th

an 4

hou

rs).

Cou

rses

wer

e of

fere

d at

3 lo

catio

ns

(nor

th, c

entr

al, a

nd s

outh

of c

ount

ry)

to m

inim

ize

trav

el.

Part

icip

ants

rec

eive

d tr

aini

ng m

ater

ials

, lun

ch

and

coffe

e br

eaks

, and

lab

coat

and

oth

er m

ater

ials

fo

r th

eir

prac

tice.

Cou

rse

was

acc

redi

ted

by Jo

rdan

M

edic

al C

ounc

il. M

ain

ince

ntiv

e fo

r pa

rtic

ipat

ion

was

foun

d to

be

perc

eptio

n th

at c

ours

e co

nten

t w

as v

alua

ble

and

wou

ld h

elp

them

pr

ovid

e be

tter

car

e to

th

eir

patie

nts.

Par

ticip

ants

fe

lt th

ey w

ould

get

mor

e cl

ient

s be

caus

e th

ey w

ould

pr

ovid

e be

tter

car

e an

d be

ab

le t

o of

fer

mor

e se

rvic

es

such

as

IUD

inse

rtio

n.

Dis

cuss

ions

with

tw

o or

gani

zatio

ns in

itiat

ed t

o co

ntin

ue w

ith t

his

type

of

tra

inin

g an

d pr

ovid

ing

cert

ifica

tion:

Jord

an

Gen

eral

Pra

ctiti

oner

sA

ssoc

iatio

n an

d Jo

rdan

M

edic

al C

ounc

il, w

hich

cu

rren

tly p

rovi

des

the

site

whe

re t

rain

ing

is c

ondu

cted

and

si

gns

the

cert

ifica

te

of p

artic

ipat

ion.

A

phar

mac

eutic

al c

ompa

ny

that

has

a p

rodu

ct

asso

ciat

ed w

ith t

he

trai

ning

may

sup

port

so

me

trai

ning

s co

urse

s.

Kee

p th

e co

nten

t fo

cuse

d on

kn

owle

dge

that

is o

f int

eres

t to

pro

vide

rs; c

ondu

ct a

TN

A

to d

eter

min

e w

hich

top

ics

inte

rest

the

m; k

eep

the

sess

ions

sho

rt a

nd p

ract

ical

; em

phas

ize

the

need

for

cont

inuo

us le

arni

ng a

nd w

hy

it’s

impo

rtan

t; m

anag

ing

the

prac

tical

por

tion

of c

linic

al

trai

ning

is m

ore

diffi

cult

than

th

e th

eore

tical

(w

orks

hop)

tr

aini

ng d

ue t

o cl

ose

coor

dina

tion

need

ed w

ith

doct

ors’

sch

edul

es t

o le

ave

thei

r cl

inic

s an

d go

whe

re t

he

patie

nts

are.

Co

untr

y: K

enya

Yea

r: 2

001-

2006

Org

aniz

atio

n/P

roje

ct:

PRIM

E an

d A

CQ

UIR

E

Lo

cal P

artn

er: N

atio

nal

Nur

sing

Ass

ocia

tion

of

Ken

ya

Tra

inee

s (#

): N

urse

s an

d m

idw

ives

(63

5)

To

pics

: Pre

vent

ion

of m

othe

r-to

-chi

ld

tran

smis

sion

(PM

TC

T),

volu

ntar

y co

unse

ling

and

test

ing

(VC

T),

post

-ab

ortio

n ca

re (

PAC

), an

d FP

and

con

trac

eptiv

e te

chno

logy

upd

ate

Dur

atio

n: 2

-6 w

eeks

de

pend

ing

on t

he t

opic

Proj

ects

and

USA

ID/K

enya

se

lect

ed t

arge

t ge

ogra

phic

are

as

and

prov

ider

s ba

sed

on k

now

n pe

rfor

man

ce g

aps.

Pot

entia

l pa

rtic

ipan

ts w

ere

cont

acte

d to

ass

ess

thei

r in

tere

st in

the

tr

aini

ng t

opic

s an

d se

lect

ion

crite

ria

focu

sed

on t

hose

who

ha

d po

sitiv

e at

titud

es t

owar

d th

e to

pics

.

Stan

dard

app

roac

h of

cla

ssro

om

pres

enta

tions

with

clin

ical

ski

lls

trai

ning

at

gove

rnm

ent

hosp

ital,

5 da

ys

per

wee

k fo

r 2-

6 w

eeks

. Fol

low

-up

to a

ssis

t pa

rtic

ipan

ts fo

rm a

“pe

er-

supp

ort

clus

ter.

” A

ctiv

ities

of p

eer-

supp

ort

clus

ter

incl

uded

1)

peer

su

perv

isio

n; 2

) co

ntin

uous

pro

fess

iona

l de

velo

pmen

t; 3)

fina

ncia

l loa

n pr

ogra

m

with

rep

aym

ent

by m

embe

rs a

fter

loan

re

ceiv

ed; 4

) re

ferr

al o

f clie

nts

amon

g m

embe

rs; 5

) jo

int

prob

lem

-sol

ving

; an

d 6)

lega

l sup

port

to

mem

bers

. Pa

rtic

ipan

ts h

ad t

o ar

rang

e an

d pa

y fo

r an

othe

r nu

rse/

mid

wife

to

man

age

thei

r pr

actic

es w

hile

the

y w

ere

away

.

Part

icip

ants

rec

eive

d tr

ansp

orta

tion,

mea

ls,

acco

mm

odat

ion,

and

kits

to

impl

emen

t co

urse

co

nten

t (b

ooks

on

FP, t

est

kits

for

VC

T, N

evir

apin

e fo

r PM

TC

T).

Mai

n in

cent

ives

for

part

icip

atio

n w

ere

foun

d to

be

a ce

rtifi

cate

aw

arde

d up

on

com

plet

ion

and

incr

ease

d re

cogn

ition

and

val

ue in

th

eir

com

mun

ity d

ue t

o th

e ne

w a

nd im

prov

ed

serv

ices

pro

vide

d.

New

pro

ject

(A

PHIA

II)

will

con

tinue

to

supp

ort

this

initi

ativ

e of

pe

er-s

uppo

rt c

lust

ers,

as

it w

as p

erce

ived

as

bene

ficia

l and

low

cos

t to

su

ppor

t.

Ensu

re t

hat

cont

ent

is

perc

eive

d as

bei

ng v

alua

ble;

su

ppor

t de

velo

pmen

t of

m

eani

ngfu

l rel

atio

nshi

ps

betw

een

peer

s to

furt

her

add

valu

e to

pro

vide

rs in

pri

vate

pr

actic

e.

19

Basic

Info

rmat

ion

Trai

ning

Nee

ds A

sses

smen

t (T

NA)

and

Rec

ruitm

ent

Trai

ning

Str

uctu

re a

nd L

ogistics

Ince

ntiv

esSu

stai

nabi

lity

of

Trai

ning

Pro

gram

Less

ons

Lear

ned

Co

untr

y: N

iger

ia

Yea

r: 2

007-

pres

ent

Org

aniz

atio

n/P

roje

ct:

PSP-

One

Lo

cal P

artn

er: H

ealth

m

aint

enan

ce o

rgan

izat

ions

(H

MO

s)

Tra

inee

s (#

): P

hysi

cian

s,

nurs

es, a

nd H

MO

co

ordi

nato

rs (

643)

To

pics

: Man

aged

car

e (c

apita

tion

syst

em),

FP,

nutr

ition

, pre

vent

ion

& R

x of

mal

aria

, fam

ily w

elln

ess

Dur

atio

n: 2

day

s

Nee

d de

term

ined

by

cond

uctin

g a

surv

ey w

ith p

rovi

ders

and

an

alyz

ing

enco

unte

r da

ta

form

s fr

om H

MO

s. O

rgan

izer

s w

orke

d cl

osel

y w

ith t

he H

MO

s to

sel

ect

priv

ate

prov

ider

s re

gist

ered

with

the

Nat

iona

l H

ealth

Insu

ranc

e Sc

hem

e w

orki

ng in

tar

get

regi

ons

and

invi

ted

the

trai

nees

thr

ough

the

H

MO

s.

Wor

ksho

p on

2 c

onse

cutiv

e da

ys,

usua

lly b

etw

een

Tue

sday

and

T

hurs

day,

as

Mon

days

wer

e “b

usy”

da

ys a

nd s

taff

finis

h ea

rly

on F

rida

ys.

Tri

ed t

o ha

ve t

rain

ing

at t

rain

ee

wor

ksite

s to

min

imiz

e tr

avel

tim

e an

d tr

ansp

orta

tion

cost

s.

Part

icip

ants

rec

eive

d ce

rtifi

cate

of p

artic

ipat

ion,

C

ME

cred

its, t

rain

ing

mat

eria

ls, c

omm

unic

atio

n m

ater

ials

for

thei

r cl

inic

s,

and

snac

ks. M

ain

ince

ntiv

es

for

part

icip

atio

n w

ere

foun

d to

be

oppo

rtun

ity

for

prof

essi

onal

de

velo

pmen

t an

d fo

r be

tter

in

com

e th

roug

h be

tter

un

ders

tand

ing

of H

MO

ca

pita

tion

paym

ent

syst

em.

Proj

ect

is w

orki

ng

very

clo

sely

with

the

H

MO

s, w

hich

cov

ered

so

me

of t

he c

ost

of

the

wor

ksho

ps a

nd a

re

inte

rest

ed in

tak

ing

over

th

e tr

aini

ng. P

rofe

ssio

nal

asso

ciat

ions

(m

edic

al

and

dent

al)

are

also

in

tere

sted

. HM

Os

are

cons

ider

ing

char

ging

a fe

e to

par

ticip

ants

in fu

ture

tr

aini

ngs.

Invo

lve

loca

l org

aniza

tions

(H

MO

s an

d pr

ofes

siona

l as

soci

atio

ns) f

or s

usta

inab

ility;

in

clud

e so

meo

ne w

ith a

utho

rity

in m

edic

al fa

cilit

y in

the

trai

ning

to

incr

ease

cha

nces

that

new

m

ater

ial w

ill be

impl

emen

ted;

se

t min

imum

att

enda

nce

stan

dard

to r

ecei

ve c

ertifi

cate

(7

5% o

f ses

sions

in th

is ca

se).

Co

untr

y: R

oman

ia

Yea

r: 2

006-

2007

Org

aniz

atio

n/P

roje

ct:

Bank

ing

on H

ealth

(Bo

H)

Lo

cal P

artn

er:

Rom

ania

n So

ciet

y fo

r Ed

ucat

ion

in

Con

trac

eptio

n an

d Se

xual

ity (

SEC

S) a

nd

Nat

iona

l Ins

titut

e fo

r H

ealth

Res

earc

h an

d D

evel

opm

ent

(NIH

RD

)

Tra

inee

s (#

): F

amily

do

ctor

s (1

40)

To

pics

: Fin

anci

al

man

agem

ent

incl

udin

g ac

cess

to

cred

it

Dur

atio

n: 3

day

s

Proj

ect

cond

ucte

d a

TN

A u

sing

m

ultip

le m

etho

ds: 1

) fo

cus

grou

ps, 2

) de

sk r

esea

rch,

and

3)

key

info

rman

t in

terv

iew

s as

wel

l as

4) in

-dep

th m

arke

t re

sear

ch w

ith fa

mily

doc

tors

, O

b/G

ynp

ract

ices

,rur

al

phar

mac

ies,

dis

trib

utor

s, a

nd

med

ical

clin

ics.

Fam

ily d

octo

rs

and

othe

r pr

ovid

ers

of R

H/

FP in

rur

al a

nd u

nder

serv

ed

area

s w

ere

iden

tified

as

mos

t in

ne

ed o

f sup

port

in t

he a

reas

of

acce

ss t

o fin

ance

and

fina

ncia

l m

anag

emen

t sk

ills

in o

rder

to

sus

tain

and

impr

ove

thei

r de

liver

y of

qua

lity

serv

ices

. Ba

sed

on t

hese

find

ings

, BoH

de

velo

ped

a co

urse

with

co

ntri

butio

ns fr

om S

ECS

and

NIH

RD

.

Stan

dard

wor

ksho

p w

ith ti

me

for

case

ex

ampl

es th

at in

clud

ed F

P ex

ampl

es/

case

stu

dies

. Wor

ksho

ps w

ere

sche

dule

d at

a ti

me

that

was

con

veni

ent

for

part

icip

ants

and

did

not

take

th

em a

way

from

thei

r pr

actic

e. B

oH

arra

nged

trai

ning

with

2 o

ptio

ns s

o to

be

flex

ible

: Opt

ion

1: 3

full

days

(Frid

ay,

Satu

rday

, Sun

day)

or

Opt

ion

2: 4

4-

hour

seg

men

ts (3

:00-

7:00

pm

– ti

mes

w

hen

doct

ors

are

not r

equi

red

by th

e go

vern

men

t to

be in

thei

r pr

actic

es).

Tra

iner

s w

ere

med

ical

pra

ctiti

oner

s by

tr

aini

ng, a

nd h

ad b

een

trai

ning

thes

e sa

me

fam

ily d

octo

rs in

the

area

of R

H/

FP. T

hus,

they

kne

w th

e pa

rtic

ipan

ts

and

wer

e ab

le to

spe

ak to

them

in

term

s th

ey c

ould

und

erst

and

and

rela

te

to th

eir

spec

ific

circ

umst

ance

s in

the

trai

ning

roo

m.

Part

icip

ants

rec

eive

d lu

nch,

cof

fee,

and

sna

cks.

T

he t

rain

ers

and

trai

ning

or

gani

zatio

n w

ere

wel

l kn

own

and

resp

ecte

d.

Gue

sts

peak

ers

from

lo

cal fi

nanc

ial i

nstit

utio

ns

wer

e av

aila

ble

at t

he e

nd

to a

nsw

er q

uest

ions

and

pr

ovid

e lo

an a

pplic

atio

ns t

o pa

rtic

ipan

ts.

Mai

n in

cent

ive

was

tha

t th

e tr

aini

ng r

espo

nded

to

a lo

ng-n

egle

cted

nee

d fo

r fin

anci

al a

nd b

usin

ess

skill

s to

ena

ble

phys

icia

ns in

ru

ral c

omm

uniti

es w

ho a

re

serv

ing

the

poor

to

grow

an

d im

prov

e th

eir

prac

tices

in

to v

iabl

e bu

sine

sses

.

Sust

aina

bilit

y st

rate

gy

incl

uded

: ide

ntify

ing

an

inst

itutio

n (C

olle

ge o

f Ph

ysic

ians

) to

acc

redi

t th

e tr

aini

ng c

ours

e so

th

at p

rovi

ders

cou

ld e

arn

CM

E cr

edits

; det

erm

inin

g ho

w m

uch

the

prov

ider

s w

ere

will

ing

to p

ay fo

r th

e tr

aini

ng if

offe

red

on a

fee

basi

s, a

nd t

he

logi

stic

s an

d su

btop

ics

that

wou

ld m

ake

the

cour

se a

ttra

ctiv

e. T

he im

plem

entin

g N

GO

(SE

CS)

ach

ieve

dac

cred

itatio

n fo

r th

e co

urse

with

the

Col

lege

of

Phy

sici

ans

and

dete

rmin

ed t

hat

the

pric

e

Priv

ate

prov

ider

s ar

e in

tere

sted

in b

usin

ess

man

agem

ent

and

part

icul

arly

fin

anci

al m

anag

emen

t tr

aini

ng;

trai

ning

in t

hese

top

ics

(fina

nce,

fina

ncia

l man

agem

ent,

acce

ssin

g lo

ans,

etc

.) in

a

non-

thre

aten

ing

envi

ronm

ent

amon

g ot

her

doct

ors

can

be

very

em

pow

erin

g to

pri

vate

pr

ovid

ers;

con

duct

a T

NA

w

ith fo

cus

grou

ps o

f pot

entia

l pa

rtic

ipan

ts a

nd k

ey in

form

ants

to

tai

lor

the

stru

ctur

e an

d co

nten

t of

the

cou

rse

to t

heir

ne

eds;

the

re a

re p

ros

and

cons

to

usi

ng d

octo

rs a

s tr

aine

rs fo

r fin

anci

al t

opic

s: t

hey

can

rela

te

to t

he p

artic

ipan

ts, a

nd “

spea

k th

eir

lang

uage

,” b

ut t

hey

can

be c

halle

nged

by

the

tech

nica

l

(Rom

ania

Con

t'd)

20

Basic

Info

rmat

ion

Trai

ning

Nee

ds A

sses

smen

t (T

NA)

and

Rec

ruitm

ent

Trai

ning

Str

uctu

re a

nd L

ogistics

Ince

ntiv

esSu

stai

nabi

lity

of

Trai

ning

Pro

gram

Less

ons

Lear

ned

Part

icip

ants

wer

e se

lect

ed

from

the

fam

ily d

octo

rs w

ho

atte

nded

a p

revi

ous

cour

se o

n ba

sic

FP (

this

was

a p

rere

quis

ite

for

part

icip

atio

n).

the

phys

icia

ns w

ere

will

ing

to p

ay w

ould

co

ver

thei

r co

sts.

BoH

w

as a

ble

to le

vera

ge

inte

rest

from

3 fi

nanc

ial

inst

itutio

ns in

Rom

ania

to

con

tinue

fund

ing

the

trai

ning

cou

rse.

T

oda

te,t

heN

GO

’s

relia

nce

on t

he d

onor

-fu

nded

bus

ines

s m

odel

ha

s pr

even

ted

it fr

om

follo

win

g th

roug

h on

in

itial

con

tact

s m

ade

with

co

mm

erci

al s

pons

ors

and

offe

ring

the

cou

rse

on a

com

mer

cial

bas

is t

o do

ctor

s.

cont

ent

of t

he m

ater

ial a

nd

over

ly r

ely

on r

esou

rce

spea

kers

; whe

n po

ssib

le,

obta

in e

arly

buy

-in fr

om

accr

edita

tion

agen

cies

an

d po

tent

ial c

omm

erci

al

spon

sors

to

boos

t lo

ng-t

erm

su

stai

nabi

lity;

ens

ure

that

im

plem

entin

g or

gani

zatio

n ha

s a

long

-ter

m v

isio

n of

in

corp

orat

ing

the

cour

se in

to

thei

r st

rate

gy t

o ac

hiev

e th

e su

stai

nabl

e of

feri

ng o

f the

co

urse

; a w

ell-t

ailo

red

trai

ning

co

urse

can

hav

e lo

ng-t

erm

bu

sine

ss g

row

th r

esul

ts a

s is

ev

iden

t in

the

fina

ncin

g an

d bu

sine

ss im

prov

emen

ts m

ade

by d

octo

rs a

fter

the

cour

se.

Co

untr

y: U

gand

a

Yea

r: 2

004-

2005

Org

aniz

atio

n/P

roje

ct:

PSP-

One

Lo

cal P

artn

er: U

gand

a Pr

ivat

e M

idw

ives

A

ssoc

iatio

n (U

PMA

)

Tra

inee

s (#

): M

idw

ives

an

d su

perv

isor

s (1

89)

To

pics

: Use

of q

ualit

y im

prov

emen

t (Q

I) se

lf-as

sess

men

t to

ol a

nd

prob

lem

-sol

ving

pro

cess

Dur

atio

n: 1

day

for

mid

wiv

es, 3

½ d

ays

for

supe

rvis

ors

UPM

A id

entifi

ed t

hat

serv

ice

qual

ity n

eede

d to

be

addr

esse

d,

so P

SP-O

ne d

evel

oped

the

QI

tool

and

the

tra

inin

g on

the

to

ol. A

ll m

embe

rs in

spe

cific

U

PMA

bra

nche

s w

ere

invi

ted

to

part

icip

ate

in a

1-d

ay w

orks

hop.

M

idw

ives

loca

ted

by h

irin

g m

otor

cycl

es w

ith d

rive

r an

d se

ndin

g no

tes

of in

vita

tions

.

Stan

dard

1-d

ay c

lass

room

tra

inin

g w

ith fo

llow

-up

by s

uper

viso

rs t

o su

ppor

t m

idw

ives

in p

robl

em-s

olvi

ng.

The

tra

inin

g pr

oces

s w

as b

uilt

arou

nd

the

conc

ept

of s

elf-e

mpo

wer

men

t w

ith fo

llow

-up

and

supp

ort

from

U

PMA

.

Plea

sant

wor

ksho

p si

te,

part

icip

ants

rec

eive

d lu

nch

and

tran

spor

tatio

n al

low

ance

, tra

inin

g m

ater

ials

, and

QI t

ool f

or

thei

r cl

inic

s. K

now

ledg

e th

at U

PMA

sup

port

ed t

he

trai

ning

and

app

roac

h to

qu

ality

.

PSP-

One

tra

ined

6 U

PMA

tr

aine

rs t

o bu

ild t

he

orga

niza

tion’

s ca

paci

ty

to c

ondu

ct a

dditi

onal

tr

aini

ng. U

PMA

has

a

stru

ctur

e of

reg

iona

l re

pres

enta

tives

org

aniz

ed

by b

ranc

h (d

istr

ict)

who

ca

n pr

ovid

e fo

llow

-up

to

trai

ned

mid

wiv

es. U

PMA

is

com

mitt

ed t

o th

e pr

oces

s an

d lo

okin

g fo

r fu

nds

to c

ondu

ct m

ore

trai

ning

and

pri

nt m

ore

copi

es o

f the

QI t

ool.

Ensu

re t

hat

part

icip

ants

find

tr

aini

ng t

opic

use

ful;

invo

lve

loca

l par

tner

(pr

ofes

sion

al

asso

ciat

ion)

and

obt

ain

thei

r su

ppor

t to

hel

p ac

cess

tr

aine

es a

nd c

onve

y ad

ditio

nal

valu

e to

tra

inin

g.

21

Basic

Info

rmat

ion

Trai

ning

Nee

ds A

sses

smen

t (T

NA)

and

Rec

ruitm

ent

Trai

ning

Str

uctu

re a

nd L

ogistics

Ince

ntiv

esSu

stai

nabi

lity

of

Trai

ning

Pro

gram

Less

ons

Lear

ned

Part

icip

ants

wer

e se

lect

ed

from

the

fam

ily d

octo

rs w

ho

atte

nded

a p

revi

ous

cour

se o

n ba

sic

FP (

this

was

a p

rere

quis

ite

for

part

icip

atio

n).

the

phys

icia

ns w

ere

will

ing

to p

ay w

ould

co

ver

thei

r co

sts.

BoH

w

as a

ble

to le

vera

ge

inte

rest

from

3 fi

nanc

ial

inst

itutio

ns in

Rom

ania

to

con

tinue

fund

ing

the

trai

ning

cou

rse.

T

oda

te,t

heN

GO

’s

relia

nce

on t

he d

onor

-fu

nded

bus

ines

s m

odel

ha

s pr

even

ted

it fr

om

follo

win

g th

roug

h on

in

itial

con

tact

s m

ade

with

co

mm

erci

al s

pons

ors

and

offe

ring

the

cou

rse

on a

com

mer

cial

bas

is t

o do

ctor

s.

cont

ent

of t

he m

ater

ial a

nd

over

ly r

ely

on r

esou

rce

spea

kers

; whe

n po

ssib

le,

obta

in e

arly

buy

-in fr

om

accr

edita

tion

agen

cies

an

d po

tent

ial c

omm

erci

al

spon

sors

to

boos

t lo

ng-t

erm

su

stai

nabi

lity;

ens

ure

that

im

plem

entin

g or

gani

zatio

n ha

s a

long

-ter

m v

isio

n of

in

corp

orat

ing

the

cour

se in

to

thei

r st

rate

gy t

o ac

hiev

e th

e su

stai

nabl

e of

feri

ng o

f the

co

urse

; a w

ell-t

ailo

red

trai

ning

co

urse

can

hav

e lo

ng-t

erm

bu

sine

ss g

row

th r

esul

ts a

s is

ev

iden

t in

the

fina

ncin

g an

d bu

sine

ss im

prov

emen

ts m

ade

by d

octo

rs a

fter

the

cour

se.

Co

untr

y: U

gand

a

Yea

r: 2

004-

2005

Org

aniz

atio

n/P

roje

ct:

PSP-

One

Lo

cal P

artn

er: U

gand

a Pr

ivat

e M

idw

ives

A

ssoc

iatio

n (U

PMA

)

Tra

inee

s (#

): M

idw

ives

an

d su

perv

isor

s (1

89)

To

pics

: Use

of q

ualit

y im

prov

emen

t (Q

I) se

lf-as

sess

men

t to

ol a

nd

prob

lem

-sol

ving

pro

cess

Dur

atio

n: 1

day

for

mid

wiv

es, 3

½ d

ays

for

supe

rvis

ors

UPM

A id

entifi

ed t

hat

serv

ice

qual

ity n

eede

d to

be

addr

esse

d,

so P

SP-O

ne d

evel

oped

the

QI

tool

and

the

tra

inin

g on

the

to

ol. A

ll m

embe

rs in

spe

cific

U

PMA

bra

nche

s w

ere

invi

ted

to

part

icip

ate

in a

1-d

ay w

orks

hop.

M

idw

ives

loca

ted

by h

irin

g m

otor

cycl

es w

ith d

rive

r an

d se

ndin

g no

tes

of in

vita

tions

.

Stan

dard

1-d

ay c

lass

room

tra

inin

g w

ith fo

llow

-up

by s

uper

viso

rs t

o su

ppor

t m

idw

ives

in p

robl

em-s

olvi

ng.

The

tra

inin

g pr

oces

s w

as b

uilt

arou

nd

the

conc

ept

of s

elf-e

mpo

wer

men

t w

ith fo

llow

-up

and

supp

ort

from

U

PMA

.

Plea

sant

wor

ksho

p si

te,

part

icip

ants

rec

eive

d lu

nch

and

tran

spor

tatio

n al

low

ance

, tra

inin

g m

ater

ials

, and

QI t

ool f

or

thei

r cl

inic

s. K

now

ledg

e th

at U

PMA

sup

port

ed t

he

trai

ning

and

app

roac

h to

qu

ality

.

PSP-

One

tra

ined

6 U

PMA

tr

aine

rs t

o bu

ild t

he

orga

niza

tion’

s ca

paci

ty

to c

ondu

ct a

dditi

onal

tr

aini

ng. U

PMA

has

a

stru

ctur

e of

reg

iona

l re

pres

enta

tives

org

aniz

ed

by b

ranc

h (d

istr

ict)

who

ca

n pr

ovid

e fo

llow

-up

to

trai

ned

mid

wiv

es. U

PMA

is

com

mitt

ed t

o th

e pr

oces

s an

d lo

okin

g fo

r fu

nds

to c

ondu

ct m

ore

trai

ning

and

pri

nt m

ore

copi

es o

f the

QI t

ool.

Ensu

re t

hat

part

icip

ants

find

tr

aini

ng t

opic

use

ful;

invo

lve

loca

l par

tner

(pr

ofes

sion

al

asso

ciat

ion)

and

obt

ain

thei

r su

ppor

t to

hel

p ac

cess

tr

aine

es a

nd c

onve

y ad

ditio

nal

valu

e to

tra

inin

g.

REFERENCES

Brugha R, A. Zwi. 1998. Improving the quality of private sector delivery of public health service: challenges and strategies. Health Policy and

Planning 13(2): 107-120.

Berman, Peter, Kara Hanson. 1993. Consultation on the private health sector in Africa: Summary of Proceedings, September 22-23, 1993, Washington, DC. Boston, MA: Data for Decision Making Project, Harvard School of Public Health. http://www.hsph.harvard.edu/ihsg/

publications/pdf/No-15.PDF

Capacity Project. April 2007. Learning for Performance: A Guide and Toolkit for Health Worker Training and Education Programs. Chapel Hill, North Carolina: IntraHealth International. http://www.capacityproject.org/index.php?option=com_content&task=

view&id=113&Itemid=129

Chandani T, S Sulzbach, M Forzley. April 2006.Private Provider Networks: The Role of Viability in Expanding the Supply of Reproductive Health and Family Planning Services. Bethesda, MD: Private Sector Partnerships-One Project, Abt Associates Inc. http://www.psp-one.com/content/

resource/detail/2941/

Peters D, G Mirchandani, P Hansen. 2004.Strategies for engaging the private sector in sexual and reproductive health: how effective are they? Health Policy and Planning 19(Suppl. 1): i5-i21.

ACKNOWLEDGEMENTS

The authors Denise Averbug and Mary Segall of the PSP-One project wish to thank Jeffrey Barnes, Marc Luoma,CathrynMurphy,MaggieFarrell,andPatriciaMengechfortheircarefulreview,valuableinput,and suggestions on the primer.

KEY INFORMANTS

Benin PRIME/PSI case study:Perle CombaryIntraHealth/PRIME

Ethiopia PSP case study:Wondwossen AssefaAbt Associates/PSP-Ethiopia

GhanaPRIME/GRMAcasestudy:Cathryn MurphyIntraHealth/PRIME

GhanaGSMF/SEAMcasestudy:John IdunGhanaSocialMarketingFoundation(formerly)

GuatemalaPSP-One case study:Ana Maria RodasAbt Associates/PSP-One Guatemala

Honduras PSP-One case study:Denise AverbugAbt Associates/PSP-One

India PSP-One DIMPA case study:Ravi Anand Abt Associates/PSP-One India

India PSP-One Saathyia case study:LenaKolyadaAbt Associates/PSP-One

Jordan PSP case study:Iten Ramadan Abt Associates/PSP-Jordan

Kenya PRIME/ACQUIRE case study:Jim McMahan IntraHealth/ACQUIRE

Nigeria PSP-One case study:Ayodele IrokoAbt Associates/PSP-One

Romania Banking on Health case study:LisaTarantinoBanyanGlobal/BankingonHealth

Uganda PSP-One/UPMA case study:Mary SegallIntraHealth/PSP-One

DISCLAIMERThe author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID)ortheUnitedStatesGovernment.

About PSP-One

The PSP-One project is USAID’s flagship project, funded underContractNo.GPO-I-00-04-00007-00,toincreasethe private sector’s provision of high-quality reproductive health and family planning (RH/FP) and other health products and services in developing countries. PSP-One is led by Abt Associates Inc. and implemented in collaboration with eight partners:

BanyanGlobal

Dillon,AllmanandPartners,LLC

Family Health International

Forum One Communications

IntraHealth International

O’Hanlon Health Consulting

Population Services International

Tulane University School of Public Health and Tropical Medicine

For more information about PSP-One or current publications (available for download) please contact:

Private Sector Partnerships-OneAbt Associates Inc.4550 Montgomery Avenue, Suite 800 NorthBethesda, MD 20814 USA

Tel: (301) 913-0500Fax: (301) 913-9061E-mail: info@psp-one.comhttp://www.psp-one.com