Background Preintroduction
strategy for any new product lays a great deal of emphasis on sensitization of
users and providers. Past experience in the field of Family Planning methods especially
in relation to intra-uterine devices and oral pills calls for a great deal of
preparation, before the actual availability of product for wider usage.
A survey of healthcare providers has revealed poor awareness of even postgraduates
in Obstetrics and Gynaecology about the methods of Emergency Contraception, their
correct timing and doses, mechanism of action etc. Thus, if EC is going to be
introduced in India, for successful prescribing of emergency contraceptives, a
great degree of sensitization, preparation and training of both Government and
private healthcare-providers is needed. Questions
to be Answered
The Group needed to answer the following questions:
A. Who will be trained? B. Who will provide
the training? C. Where will the training be
conducted? D. What will be the duration of training?
The training curriculum for different levels of healthcare workers including indications,
timing, dosage, history, examination, counselling about side-effects, efficacy
and follow-up needs to be decided. The model
training modules prepared by WHO and Population Council were made available as
background material. Views
of the group
The Group divided the issue of training in three levels depending on the level
of the healthcare functionary, and identified the trainees, the trainers, the
venue, the, duration of training and training curriculum at each level.
Level I - Training at Primary Healthcare Facilities
• This will include training of Primary Health Centre
(PHC) doctor, Lady Health Visitor (LHV) and Auxillary Nurse Midwife (ANM), as
these form the backbone of National Family Planning Programme. Traditional birth
attendants (TBA) and Anganwari workers may also be included. Each one of these
health functionaries will need training in Emergency Contraception before making
it available for wider use. • The training to
PHC doctors can be provided by District level Health officials, while others can
be trained by the PHC doctor at PHC itself. •
Training can be spanned over 1-2 days in split sessions and at this level, periodic
refresher training will be required. • There
is need to provide a training manual written in simple local language with answers
to probable clinical problems and situations that may arise in the field. This
will act as a source of ready reference for trained providers.
Level II - Training of General Practitioners
• This group should include all private practitioners,
district medical officers, CGHS/ESI dispensary doctors, medical officers and all
primary care and family physicians. • The training
can be provided by Obstetrics and Gynaecology specialists as well as Indian Medical
Association (IMA) members who are providing contraceptive services.
• Professional bodies can play a lead role in this training
by building it into their monthly, quarterly and/or annual meetings as well as
by conducting specific workshops or focussed CMEs. Training session can also be
conducted during monthly block level meetings at the District level.
• A one-day session is adequate; a follow-up session can be
done at the next monthly meeting to clarify doubts and to answer questions.
• Written material needs to be provided in advance to officials
attending these training sessions. • Information
on EC should also form an integral component of Undergraduate Medical, Nursing
and Pharmacy courses. Level
III - Training to Specialists
• This group will primarily include obstetricians and gynaecologists, IMA members
involved in providing contraception, postgraduates, etc. •
The training is to be provided by a core group of experts, from medical colleges,
FOGSI, ISoPARB etc. • This training can be conducted
at zonal or state level and can be built into workshops being conducted for RCH
training by the Ministry of Health & Family Welfare. •
Usually, a half-day session will be adequate for this level of healthcare functionaries.
• Providing written material is important for successful training.
A curriculum for training of doctors and health workers in EC was also defined
by the Group considering this issue. They decided that the curriculum should comprise
the following components: (i) introduction –
it should define what is Emergency Contraception, emphasize usefulness of such
a method and highlight major plus points about this method as well as mention
about the negative aspects. (ii) Indications
for EC use need to be defined properly. (iii)
Methods of EC including their mechanism of action, dosage, side-effects, efficacy,
etc. (iv) Pre-therapy work-up of clients including
history-taking, examination and counselling with special emphasis on date and
time of unprotected intercourse, date of last menstrual period and use of other
contraception. Pelvic examination is not necessary. All the potential users should
be counselled about failure rates and side- effects.
(v) Inclusion and exclusion criteria need to be clearly explained.
(vi) Expected side-effects, remedial measures, follow-up and management of Emergency
Contraception failures. Discussion
During discussions, the Expert Forum emphasized
on the need of involving all organizations in the training programme, including
even the Gram Panchayats. It was decided to train a group of doctors initially
as trainers, who can then train others in their state and family planning units.
Incorporating EC training into existing RCH training was considered to be a better
option. • Need was expressed for periodic refresher
courses at District and PHC level. A multipoint, multilevel training was considered
more appropriate. Continuous CME programmes were considered to be more useful
than snapshot training. The Expert Forum also emphasized the need of having supportive
supervision, where a supervisor is present during the actual prescription sessions
and gives suggestions or solves problems. •
A more problem-oriented training curriculum was considered more appropriate for
grassroot level functionaries. It was decided to adapt the already available training
modules to Indian flavour. Training modules should include solutions to practical
problems on EC prescription which may be encountered in the field.
• Initially training of master trainers needs to be carriedout,
selecting them from each state/zone, followed by zonal workshops and subsequently
dissemity the knowledge till the grass root level. •
Training should not confuse grass-root workers with multiple products and should
be focussed on the dedicated product. Unresolved
issue Targeted
training is possible only when a dedicated EC pill is made available. Starting
training without ensuring availability of drug is of no use. Recommendations
2.3.1 Multiple-level training is required involving all healthcare providers.
2.3.2 It is important to involve all professional organizations and train the
trainers first, who would then train others. 2.3.3 International standard
training modules can be adapted to suit the Indian context. 2.3.4 The training
curriculum needs to be more problem-oriented than theoretical. 2.3.5 A
standard training kit with a slide-show to be prepared for standardized training
throughout India. 2.3.6 Lectures on EC to be included in Medical, Nursing
and Pharmacy college curriculum. 2.3.7 Periodic refresher training needs
to be built into the existing RCH training. |
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