Training & Supervision
In most programs, there will be both primary and secondary providers of the SDM. Primary providers are responsible for SDM screening for medical and behavioral eligibility and for counseling clients on how to use the SDM. There may be clinically trained staff offering other methods of family planning, or they may be community-based providers with limited family planning experience and counseling skills. Secondary providers often are community motivators or health educators who offer general information and support to clients, but do not screen or counsel clients on the SDM. Nevertheless, they need to know enough about the SDM to be able to answer basic questions about the method and who can use it.
The learning objectives for training providers are standard, but the length and content of the training will depend on the trainees’ counseling skills. Well qualified personnel experienced in family planning counseling may require a brief 2 hour training. Other types of providers, such as non-health personnel and community-based workers, may need up to two days of training to acquire the knowledge and skills needed to appropriately counsel clients. Training of secondary providers may consist of formal training or more informal briefings during meetings or workshops.
A variety of materials have been developed for training providers in the SDM. They vary in the level of skills they intend to achieve, and training length and methodology. In cases where providers have little experience and skills in family planning counseling the curriculum must address key family planning content and provide opportunities for practicing new skiils and receiving feedback. Consideration also should be given to incorporating SDM into pre-service curricula to impart an understanding of SDM to nursing and medical school students.
Provider job aids have been tested, adapted and used in diverse programs. To ensure that providers are familiar with these job aids —and eventually use them in their work sites— the trainers should make these available and use during training exercises, role plays, and general discussions. Peer-feedback and self-evaluation tools also are effective strategies for strengthening counseling skills.
Follow-up actions should be considered as an integral component of the training effort. When training of trainers (TOTs) are conducted for example, plans should be developed to training providers and ensure that resources, such as a dedicated cadre of trainers, are available for the training. Although cascade training, (training trainers to train providers) offers a potentially efficient approach to in-country SDM training, it only works where there are training professionals who devote most of their time to training. Where a cadre of trainers does not exist, personnel will need to be drawn from the ranks of providers, thus burdening the service delivery system. When providers are trained, plans should be made for addressing the factors necessary to support service delivery, such as provider and client materials. The availability of personnel trained in SDM must be accompanied by organizational commitment to offering SDM, and systems in place to support SDM services. These systems include IEC to inform women about the availability of a new family planning option, SDM materials for providers and clients, an adequate supply of CycleBeads, and policies and procedures for incorporating SDM into the service delivery system.
Effectiveness of SDM training can be assessed through immediate evaluation of changes in knowledge and skills, and evaluation of the training room the participants’ perspective. SDM training curricula include a pre- and post-test and a participant evaluation. Responses should be analyzed after the training to determine whether the training met the objectives and participants are competent to provide the method to clients. The training evaluation can also help identify areas where reinforcement or adjustments are needed as well as:
- Providers’ acceptability of the SDM
- Provider competence in offering the method
- Whether providers find the service delivery tools appropriate and can use them correctly