Phase II: Planning for Demonstration and Scale-up
In addition to being certified by NCK for private practice, nurse-midwives were required to satisfy several other criteria in order to be considered for participation in the pilot program:
- Their facilities had to meet minimum standards for sanitation.
- They had to have running water and essential equipment, adequate space to ensure client privacy and confidentiality and access to the basic infrastructure for restocking supplies and making referrals.
- They had to demonstrate an interest in PAC services and show that they were already integrating other reproductive health care into their prenatal and delivery services.
As part of a strategy to promote the financial sustainability of the pilot program and projected scale-up, the private nurse-midwives shared the cost of training, paying for their own transportation, room and board. Training took place in Nairobi so that the providers could benefit from PAC clinical training opportunities at Kenyatta National Hospital, with its high caseload of postabortion clients. By training providers in groups from the same geographic areas, PRIME endeavored to keep the sessions intimate and encourage post-training peer support. Training concentrated on 13 key components:
- Introduction and clarification of values
- Client-provider interaction and counseling
- Management of complications from unsafe or incomplete abortion
- Manual vacuum aspiration (MVA) procedures
- Infection prevention
- Pain management
- Postabortion family planning and method provision (including emergency contraception pills)
- STI/HIV management
- Legal aspects of providing PAC services
- Introduction to peer supervision
- Community outreach and participation
- Performing practical procedures under supervision