Prepared by 

Susan J. Griffey Brechin, DrPH, BSN Rick Sullivan, PhD

Tamara Smith, MPH  Maryjane Lacoste, MA

March 1999

Through its work with the Zimbabwe National Family Planning Council and the Kenya Ministry of Health/Division of Primary Health Care, JHPIEGO facilitated the adaptation of materials to improve the performance of IUD service providers through structured on-the-job training (OJT). In Zimbabwe, providers at 14 sites learned IUD/genital tract infection skills by means of structured OJT. At the same time, in August 1996, JHPIEGO began pilot testing this structured OJT in Kenya at 6 provincial hospitals. Although the pilot test was intended to train about 40 service providers in both countries (2 per site), it actually produced 50 providers who achieved competency during 4 to 6 weeks of self-paced learning.

The structured OJT course for IUD clinical skills was based on the instructor-led IUD clinical skills course. It covered the same content and used a detailed program outline (with approximate time estimates for completion) to guide the training. The OJT course materials included the essential elements found in other JHPIEGO learning packages (i.e., a reference manual, a trainee¹ workbook and a trainer guide).

The Zimbabwe/Kenya pilot test found that structured OJT for IUD insertion skills:

• Ensured competency because learning was self-paced—no one finished training without the requisite knowledge and skills

• Accommodated a variety of learning styles and clinic caseloads

• Reduced risk to clients during IUD insertion because participants were able to spend more time practicing skills using an anatomic model than in instructor-led training

• Imposed no time constraints on the training period so that higher client caseloads were available to participants

• Facilitated efficient transfer of training (i.e., enabled providers to utilize newly acquired skills on the job immediately) because learning occurred in the providers’ own clinic settings

• Allowed for decentralization of training including decentralization of decision-making about who would be selected for training (in contrast to instructor-led courses)

• Expanded training access to a wider range of service providers because selection was decentralized to the site

• Offered a closer and formalized relationship between the trainer and participant because the trainer was on site and, therefore, was available to provide guidance on a regular basis even after the training period was finished

The pilot-test evaluation looked at feasibility as well as acceptability of structured OJT as an intervention to improve the performance of providers. In the future, once the structured OJT approach has been implemented in an ongoing program, it will be important to evaluate and compare this training intervention for clinical skills training to the traditional instructor-led course approach.

The pilot test of the IUD structured OJT program in both Zimbabwe and Kenya was very successful. It was especially successful in Kenya where it stimulated and transferred to the provinces a decentralized responsibility for FP skills training. The various models of the structured OJT approach that were applied in Zimbabwe and Kenya demonstrated its flexibility as a learning approach that could be adapted to various work settings. Additional efforts in sexually transmitted infection and postabortion care training are also showing that the flexibility and responsiveness of structured OJT can improve provider performance and ensure the delivery of quality services.

At the country level, continuation and expansion of structured OJT will ensure that resources invested thus far are maximized. JHPIEGO is continuing to promote the structured OJT approach along with other learning approaches. Structured OJT is also being used as a guide for other training interventions such as the Zimbabwe and Kenya preservice nursing programs where the Student Clinical Placement Guide has been modeled on the OJT program.

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¹During the initial design of the structured OJT model for Zimbabwe and Kenya, the word "trainee" was used to describe those who participated in the OJT courses. In this report, "participant" will be used unless "trainee" is part of a title.

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CREDITS

Editors: Chris Davis, Jane Zadlo Sudbrink

Copyright © 1999, 2000 by JHPIEGO Corporation. All rights reserved.

JHPIEGO, an affiliate of Johns Hopkins University, is a nonprofit corporation dedicated to improving the health of women and families throughout the world. JHPIEGO works to increase the number of qualified health professionals trained in modern reproductive healthcare, especially family planning.

We would like to acknowledge the following organizations and individuals:

Zimbabwe

• ZNFPC: Directorate, Training Unit and ERU

• MOH/CW

• City Health

• Director of Health Services and Provincial Medical Directors of all provinces

Kenya

• Division of Primary Health Care, Training Unit

• Division of Nursing

• Nursing Council of Kenya

• Kenya Medical Training College

• Peris Muruiki, UNFPA

Funding for this assessment was provided through the generous support of USAID/Zimbabwe and USAID/Kenya. JHPIEGO would like to thank Mary Pat Selvaggio, HPN Officer, and Roxana Rogers, Family Planning Administrator, at USAID/Zimbabwe.

Special thanks to JHPIEGO/Kenya staff including:

• Nancy Toroitich, Training Coordinator, JHPIEGO/Kenya

• Dorothy Andere, Regional Training Advisor, JHPIEGO/Kenya

• Mrs. Lydia Cege, Consultant, JHPIEGO/Kenya

Support was provided at JHPIEGO by Lois Schaefer, Valerie Okrend, Susan Janoski and the Information Resources Office, especially Dana Lewison, who helped with materials editing.

TRADEMARKS: All brand and product names are trademarks or registered trademarks of their respective companies.

ZOE^® is the registered trademark of Gaumard Scientific Co., Inc., for gynecologic simulators.

Financial support was provided by the Office of Population, Center for Population, Health and Nutrition/Global Programs, Field Support and Research Bureau/CMT Division, US Agency for International Development, under the terms of Award No. HRN-A-00-98-00041-00. The opinions expressed in this report are those of JHPIEGO and do not necessarily reflect the views of the US Agency for International Development.