TRAINING MANAGEMENT GUIDELINE

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• FAMILY PLANNING

• SAFE MOTHERHOOD

• HEALTH LOGISTICS

• INFECTION PREVENTION

• HEALTH FACILITY OPERATION AND

MANAGEMENT COMMITTEE

• OPERATION THEATER TECHNIQUES AND

MANAGEMENT

• CLINICAL TRAINING SKILLS

SECOND EDITION

TRAINING MANAGEMENT

GUIDELINE

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Executive Summary

National Health Training Center was established in July 1993 as the focal apex for coordinating all training activities under MoHP. The overall goal of NHTC is to develop a health personnel training system which can respond to the requirement of all categories of health workers and enable them to deliver primary health care according to the National Health Policy.

The Ministry of Health has a network training institution through out the country. It is designed to meet National, Regional and local training needs. The National Health Training Center oversees the work of Regional Training centers, which support district training activities. In addition, there are clinical training sites i.e. Chhetrapati Family Welfare Center (CFWC), Paroparakar Maternity and Womens' Hospital (PMWH), Koshi Zonal Hospital (KZH) Training site, Institutionalize Clinic and Training Center (ICTC)/Nepalgunj, , Tribhuan University and Teaching Hopital (TUTH)/FPFCC, under NHTC and supporting NGO, Family Planning Association of Nepal (FPAN) for the conduction of Family Planning trainings. Similarly, there are 18 SBA training sites and 6 Regional Health Training Centers to conduct other trainings such as CoFP and Counseling, Health logistics, HFOMC, Initial trainings, Upgrading trainings (for ANM, AHW, MCHWs, VHWS) etc.

The National Health Training network offers several courses each year depending on training requirements identified by the different program units. They fall under several categories: Basic Training, Upgrade Training, In-service training for additional skill/updating, Health Management, Trainers of Trainers and Community Mobilization etc. This guideline mainly focuses on the training management of the in-service training for additional skill/updating of service providers in which Family Planning (FP), Safe Motherhood (SM), Health Logistics, Infection Prevention,Health Facility Operation Managemetn Committee, Infectin Prevetnion training, Operation Theatre Technique and Management and Clinical Training Skills fall under this category. This guideline refers on administrative procedure on participant selection from service sites, management of training events and post training supervision and monitoring activities.

This guideline is specially developed for Regional, district (D/PHOs and Hospitals) and training site managers to help in management for conduction of quality training. This guideline summarizes the key information of different trainings, tasks that should be completed by key institutions, district managers and trainers to ensure an effective training course and follow-up during and after training. This guideline will assist in offering quality training by clearly outlining for its partners the rules and regulations of training courses organized by NHTC and the expectations of the participants in these courses.

This second edition is developed to meet the growing need of additional training management information on Family Planning, Safe Motherhood, Health Logistics training, Infection Prevention, Health Facility Operation Management Committee, Operation Theatre Technique and Management and Clinical Training Skills and information regarding training follow-up during and after training under NHTC.

The guideline is divided into five sections: Section A: Introduction

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C-4: Infection and prevention (IP)

C-5: Health Facility Operation Manangement Committee (HFOMC) C-6: Operation Theatre Techniques and Management (OTTM) C-7: Clinical Training Skills (CTS) Training

Section D: Procedure for Conducting Follow up Visits during and after training Section E: Roles and Responsibilities of different organizations

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Table of Content

Acknowledgement Executive Summary Section A Introduction 1 Objective 1

Who use this Guideline 1

Section B

Training management process and general administrative process and procedures for conduction of training

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Training Implementation 2

Provision of Administrative Management 2

Provision of training program 2

Selection of participants 2

Identification of training need through PI Approach 3

Alternative Learning Approach 4

Estimating Training Need 5

Selection and invitation of participants 5 Notification of trainers/training sites 6

Training Supplies 7

Conduction of the course 7

Monitoring during the training course conduction 8

Certification 8

Documentation of training 8

Section C

Course Description for training management 10

C-1: Family Planning Training

C-1.1: Comprehensive Family Planning and Counseling 12 C-1.2: Intra-Uterine Contraceptive Device (IUCD 13 C-1.3.1: Implants training for Nurses and Paramedics 14 C-1.3.2: Implants training for Physicians 15 C-1.4: Minilaparotomy (ML) Training under Local Anesthesia 16 C-1.5: No- Scalpel Vasectomy (NSV) Training 17

C-2: Safe motherhood Training

C-2.1: Skill Birth Attendant (SBA) In-service Training Course (60 days) for ANMs and Staff Nurses

19 C-2.2: Skill Birth Attendant (SBA) In-service Training Course (30 Days) for

ANMs and Staff Nurses (MRT-Trained Participants)

20 C-2.3: Skill Birth Attendant (SBA) In-service Training Course (15 Days) for

ANMs and Staff Nurses (BEOC-Trained Participants)

21 C-2.4: Skill Birth Attendant (SBA) In-service Training Course (45 days) for

Medical Officers

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C-3: Health Logistic Training

C-3.1: Basic Logistics Training –BLT 26

C-3.2: Health Logistics and EPI Cold Chain Management Training (for district and below district)

27 C-3.3: Pull System Training on Health Logistics Management Training (for

district and below district)

28 C-3.4: Public Procurement Training (for district level) 29 C-3.5: Basic Health Logistics Training for MCHW/VHW 30 C-3.6: Self Paced Basic Logistics Training through CD-ROM 31

C-4: Infection Prevention and Health Care Waste Management

C-4.1: Infection Prevention(IP) and Health Care Waste Management (HCWM)Training (5 day) for district hospital

32 C-4.2: Infection Prevention (IP) and Health Care Waste Management (HCWM)

Training (3 day) below distric level

Training/Workshop (3 days) in hospitals

Training (1-half day) in below district Health Facility Level:

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C-5: Health Facility Operation and Management Committee (HFOMC) Training 36 C-6: Operation Theater Techniques and Management (OTTM) Training 37 C-7: Clinical Training Skills (CTS) Course 38

Section D

Procedures for Conducting Follow-up Visits During and After Training 40 The Purpose and Objectives of a Follow-up Visit 40

How to Conduct a Follow-up Visit 40

Tools for use on Follow-up Visits 42

Section E

Roles and Responsibilities of Different Organizations 44 National Health Training Center (NHTC): 44

Family Health Division (FHD): 44

Logistics Management Division (LMD) 44

Regional Health Directorate (RHD) 44

Regional Health Training Center (RHTC) 45 District Public/Health Office (D/PHO) 45 Training Sites (clinical and non clinical) 45

Appendices

Appendix A: Participant Registration Form 46 Appendix B: Participant’s pre-registration form 47 Appendix C: Process of Participant Selection (Conduction of Central Level

Training)

48 Appendix D: Sample of training invitation letter 49

Appendix E: Training information form 50

Appendix F: Sample of training invitation letter for Health Logistics Training 51 Appendix G: Sample of Attendance Sheet 54 Appendix H: Sample of Evaluation form (Use during TOT) 55 Appendix I: Training Quality Improvement tools 56

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Appendix J-1: Checklist for assessing trainers in facilitating skills 61 Appendix J-2: Checklist for assessing trainers in Clinical Demonstration Skills 62 Appendix J-3: Checklist for assessing trainers in Coachng for clinical skills 63 Appendix K: List of training manuals for FP, SM, Health Logistics Training,

Infection and prevention, HFOMC, OTTM and CTS

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Section A

INTRODUCTION

This training management guideline is meant to serve as a guide to NHTC, Regional Health Training Centres, Training sites, Districts, Health Facilities and its partners for managing quality training by standardizing the training regarding on Family Planning, Safe Motherhood, Health Logistics training, Infection Prevention, Health Facility Operation Management Committee, Operation Theatre Technique and Management and Clinical Training Skill Course at different training sites. This guideline summarizes the key tasks that should be completed to ensure an effective training course.

Objective

The objective of the Training Management Guideline is to guide smooth and effective management for the conduction of quality training and standardizing the training through concerned training sites under NHTC.

Who use this Guideline?

This guideline is to help in management for conduction of quality training. Clinical and non-clinical trainig sites such as FP Training sites i.e. Institutional Clinic and Training Center (ICTC)/Nepalgunj, Chhetrapati Family Wwlfare Center (CFWC), Paropakar Materntiy and Womens' Hospital (PMWH), Koshi Zonal Hospital (KZH), Tribhuwan University and Teaching Hospital (TUTH), Skill Birth Attendant (SBA) Training sites, Regional Health Training Centres (RHTCs), District managers (D/PHOs and Hospitals) and trainers to ensure conduction of an effective training. Users of this guideline could be summarized as given below:

 All the training institutions or training sites under NHTC

 Managers of the training site

 Trainers or facilitators or resource persons or any body involved in the training as mentioned in this guideline.

 Supporting partners (Internal or external) in training implementation, regarding Family Planning, Safe Motherhood, Health Logistics training, Infection Prevention, Health Facility Operation Management Committee, Operation Theatre Technique and Management and Clinical Training Skill Course and information regarding training follow-up during and after training

 District's managers and service sites

Note: This guideline does not describe details of the actual conduction of the training session or operation of training sites.

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SECTION B

TRAINING MANAGEMENT PROCESS AND GENERAL ADMINISTRATIVE PROCESS AND PROCEDURES FOR CONDUCTION OF TRAINING

Training Implementation

National Health Training Center offers several trainings each year depending on training requirements identified by the different program units. The number of providers to be trained annually in all courses is established by the Family Health Division (FHD), Logistics Management Division together with the National Health Training Center (NHTC), and is based on a strategic plan for supporting and expanding quality family planning/Safe motherhood services in Nepal. As well, it must take into consideration the training capacity of government training sites. FHD will share information to RHD and other concerned health offices at district level regarding process of service site expansion/establishment and selection of participants. LMD will share information to RHD and other concerned health offices at district level regarding process of implementation of improved supply chain management system and selection of participants from different level of store personnal. Provision of Administrative Management

Travel expenses for all training related to FP, SM, HL, IP, committee HFOMC , OTTM and CTS Course are provided according to the Travel expenses Regulation 2064 or as agreed with sponsoring agencies or as per decribed in letter sent by NHTC. In addition to this, additional guideline from the central level as per requirement of the type of training is sent to the training sites for administrative procedure during training e.g. trainer expenses, participants allowance, purchase of training materials, procedure of detail expenses of local and central level resource person etc.

Provision of training program covers:

Basically following provision (not limit) is made in the training program: Subject to change as nature of the training program.

 Trainers allownce

 Participants allowance

 Participant Travel & DA during Travel (Reimburshment in actual basis)

 Meeting cost (Khaja)

 Stationery for participants

 Training materials –Theory (including trainers stationery)

 Support person allowance

 Transportation cost to move from Theory class to clinical practicum site: This will apply only to clinical training

Selection of participants:

In case of FP, SM, OTTM, service delivery points (HF) will request for training to DHO/DPHO and DHO/DPHO will forward these request to RHD. RHD will collect the

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detail of personal information (brief CV) required for selection with recommendation (form provided by NHTC- See Appendix B). FHD and NHTC will review the personal detail information about the recommended candidate before making final selection of the participants for the training. (See Appendix C for flow diagram for training implementation process).

For Health Logistics training districts will send requesting training to Logistics Management Division (LMD) and NHTC. LMD and NHTC will review the personal detail information about the recommended candidate before making final selection of the participants for the training.

In case of IP and HFOMC training, please refer to respective section. Identification of Training need through PI approach

"There are many factors that affect the performance of healthcare workers. It is often hard to know why healthcare workers are not providing high quality services. A performance needs assessment (PNA) will identify performance gaps or problems and give us the information as we need to determine what can be done to improve job performance. A Performance Need Assessment (PNA) is part of a process called performance improvement that is used to solve performance problems by involving healthcare providers, their facilities, clients, and the community in improving services. The purpose of a PNA is to identify performance gaps or problems and determine the most appropriate interventions to improve worker performance1" After conduction of Performance Need Assessment (PNA), if the cause of poor performance is lack of knowledge or skills, then only training is the appropriate intervention.

Steps of Performance Improvement

1_{Training works, second printing March 2004}

Get and Maintain Stakeholder Agreement Step 1: Desired Performane Step 2: Actual Performane

Step 6: Monitor and Evaluate Performance Step 3: GAP Step 4: Find Root Cause Step 5 (a): Select Intervention Step 5 (b): Implement Intervention

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Alternative Learning Approach

Coaching

National Health Training Center (NHTC) has been conducting various group based training for capacity building for quality service delivery. After receiving training, the service providers start the service at their worksite immediately. However, some of the newly trained clinicians hesitate (due to lack of confidence) to provide services on their own independently, they seem to loose their skills. Though limited in number, the post training follow made so far has revealed that some of the service providers are not being able to start the service or are not providing services according to national standard. In this case, on-site coaching would be an appropriate approach to address the performance gaps. Coaching would be need based therefore would help service provider to improve the particular skill(s) in which s/he is not competent. Providing on-site coaching would not only reduce the cost as well as overall duration but would also provide opportunity to learn skills in their setting. It would help them to develop the needed confidence. Coaching approach would also help standardize the VSC service at peripheral level. In addition, Coaching organized at their sites or district would help in reducing unnecessary absenteeism from their regular work, as they do not need to travel out from their work station/ district.

Designing interventions to improve the performance is as given below in Table 1. Under NHTC, coaching is provided in Implant, IUCD and VSC (NSV and ML/LA).

Table 1: Designing Interventions to Improve Performance Performance

Assessment

Gaps Action

Is done using QI tools e.g.

 IUCD QI tools

 Implant QI tools

 SBA QI tools

Idenfitied could be

Capability (Know how to do)

a) Minor gap in Knowledge and skills

b) Major gap in Knowledge and skills

a) Coaching b)Training

Opportunity

(Be enabled to do)

Management of resources Motivation (Want to do) Incentives, Rewards, VSC coaching:

In order to address knowledge and skills gap after VSC training, NHTC has developed

"Strategy for Strengthening Capacity of VSC Service Providers Through Coaching"-March 2006). Therefore, VSC coaching should be done according to the strategy.

IUCD and Implants coaching:

Coaching approach could also be used for IUCD and Implant services. The process of identification and conduction of coaching is as same as VSC coaching. Before conduction of

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Current Self-paced NSV training could be used for learning theory portion at service providers’ worksite and once they complete it (attaining 85% score in knowledge) they would come to training site for practicum session for skills. The key steps are;

1. Enrolled in NHTC NSV self paced training

2. NHTC selects the training site and communicates for self paced training

3. NHTC sends out training package along with the course outline to be followed by the participant and the training sites/trainer's contact number.

4. Participant completes pre-course questionnaire and sends to the training site.

5. Participant completes theory portion at his/her worksite and communicates with the trainer if any confusion.

6. After completion of theory, send mid-course questionnaire to training site and if scores 85% or more, training site informs NHTC to call for practicum at the training site.

7. NHTC invites the participant for practicum for 7 days. The participant gets clinical exposure and become competent in skills. But due to limited practice and is not competent, then trainer communicates with NHTC. In coordination with the trainer, training duration is extended for few days (2-3 days).

8. When the participant gets competent s/he is certified by NHTC for NSV. Estimating Training Need:

The district should prioritize the selection of participants according to the service demand, caseload of the health facility, demand from the health facilities and the expansion of new programs. The district should give priority to the site where there is no trained service provider and hampering in service delivery and select service providers where there is demand for the services. After the identification of the training need and the service providers to be trained, D/PHO should demand for training to RHD, FHD and/or other relevant divisions or centers.

Selection and Invitation of participants:

To maximize ability of NHTC to coordinate training, monitor appropriateness of candidates and field experience, NHTC should get the names of service sites and districts where staff needs to be trained so that it could invite the participants. NHTC must get names/cadres of the individuals' information who needs to be trained from District Health Offices (through RHD) before the beginning of the training season or twice a year (July and January). This allows NHTC, RHTC, Training sites and FHD to coordinate training, follow-up and mobile outreach services.

Three to four weeks before a course is due to begin; FHD/NHTC or LMD/NHTC finalize names of the participants nominated by DHO/DPHO and/or RHD. NHTC sends out invitations to the office of the Regional Health Director with a copy to the DHO/DPHO/Hospital and concerned institutions at least two weeks ahead of time for training.

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The letter should include

 Reference number of letter sent by DHO/DPHO/RHD nominating candidates (mentioning post /name/work place)

 Dates of the course (training)

 Date on which and location to which participants are to report

 Duration of the course

 Venue of the course

 Selection criteria for participants

 Per diem allocated for the training program if applicable

 A description of the course, including the objective of the course

 Forms of personal detail (to be filled out by the participants) approved by District Health Office/ District Public Health Office or if applicable

The invitation letter clearly states that participants (a) should arrive at the training site on the first day of the training (b) arriving late, or (c) not meeting the criteria WILL BE SENT BACK (The training site is not responsible to pay for the cost of travel and other expenses of the participant). Participants arriving late due to circumstances of travel beyond their control (e.g. plane flight cancellation, motor broken on the way) will be considered for admission to the course "within the second day of the training, this is only applicable for 7 days course or more". No participants will be admitted to the course if they arrive on or after the third day of the course.

If training duration is less than 7 days, no participants will be admitted to the course if they do not arrive on the firstday of the course.

NHTC will monitor appropriateness of participant based on criteria with the help of FHD or respective divisions and center. NHTC and FHD or respective divisions and center will not be responsible for expenses incurred if candidate sent is not appropriate.

The letter also clearly states that the DHO must reply to NHTC by phone or fax one week

before the course starts (specific date should be given) if the participant selected will not be able to attend the course or participants selected from other service sites. A sample letter is included as Appendix D (in Nepali).

NHTC follow-up districts (D/PHO) by phone or fax before the training begins to establish how many & which participants will attend the planned course.

If any of the selected participants are unable to attend the course, the NHTC will review its list of training candidates and select an alternative candidate for the training. This/these candidate(s) and their supervisor(s) will be notified by phone of the details of the course at the same time that an official letter is sent by the NHTC. These candidates are given three (working) days to respond to the invitation.

Notification of trainers/training sites:

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7 Training supplies:

The training sites (RHTC and clinical training sites) training supplies (flip chart paper, markers, transparencies, training package etc.) one week before the course is scheduled to begin.

NHTC provides with course books and stationery, to the training site where the course will take place. Training centers should have adequate number of course books (participant handbook, reference manual) for different training they conduct in stock (at least for five batches) for emergencies. This should be provided by NHTC at the beginning of the training season and periodically maintain sufficient of the stock during the course of the training season. The training packages are printed in collaboration with different donor organization as per their need.

Conduction of the course:

 Participants should be present at the training site on the first day of the training course.

 Training site needs to follow the Training Management Guideline to ensure participant selection criteria before enrollment of participants before starting training.

 In case of wrong participant selection, the training site should send the participant back and it should be reported to NHTC. The cost of travel and other expenses are the responsibility of the participant.

 Training sites should report to NHTC on the 1st or 2nd day of the training for administrative purpose.

 Training (theory portion) runs from 9:00am to 5:00pm at clinical or hospital based training (six hours with half an hour lunch break per day) and from 10:00 am to 5:00 pm at non-clinical training sites (RHTC) or as per described in course outline. In case of clinical courses, the timing for practicum portion it depends upon the availability of the case therefore, trainers and participants are encouraged to be fexible to maximize learning opportunity

 In each batch of training, participant registration form (PRF) should be filled properly (See Appendix A).

 Trainers should ask the participants to fill participant registration form on the 2nd day of the training course.

 The trainers should complete the PRF after the midcourse questionnaire and send it to NHTC for certification but before sending the forms it should be reviewed and reconfirm that the forms are complete. If any information is missing, then the trainer should ask the participants to complete. If training sites are certifying participants themselves, then a copy of the PRF and the copy of the certificate should be sent to NHTC.

 Trainer should make sure that all the participants fill the attendance registration in the beginning of the training course. The complete attendance registration form should be submitted to NHTC after completion of the training course (See Appendix G).

There is budget support for one support staff to assist with training logistics at the training site. The training site manages the refreshments for participants, trainers, and support staff from the budget.

The basic course is conducted at the designated training site. With the prescribed number of participants per batch, the need for using satellite-training facilities should be minimal, but they can be used, where appropriate, at the discretion of the trainers. If satellite facilities are required, there is budgetary support for staff at those facilities (maximum two additional

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trainers if they are actively involved in supervising/training the participants) for the days applicable, and there is also budget for transportation to these satellite facilities.

Monitoring during the training course conduction:

A staff member from NHTC or concerned trainer of relevant course from supporting agencies those who are providing technical support closely will visit all training sites at least one time during each course. The person who goes for supervision of the training course will monitor the quality of training using the Quality Improvement (QI) tools (Specific QI tools i.e. FP, SBA, Health Logistics). Feedback should be provided on the basis of the findings of the QI tools and make action plans to improve the quality of training.

For Health Logistics training, during conduction of the training, supervision and monitoring is conducted by central level trainers from concerned program division (Logistics Management Division), National Health Training Center and Regional Health Directorate Office. As per the requirement of the nature of the training, trainers from Regional Health Training Centers are also involved in these activities. Use Training QI tools during the supervision and monitoring of the training (See Appendix H, I,) for the quality of the training. After the observation of the training course of each day, the supervisors (trainers) should provide feedback to the trainers for quality training.

Certification:

For FP, SM and OTTM training once the participants score more than 85% in knowledge and have achieved competency in skills, the trainers submit the participant registration forms with information regarding the skill competency and the results of the midcourse questionnaires to NHTC as proof of the participants’ successful completion of the course. On the last day of the course/attainment of competency, certificates will be given to the participants by NHTC, at NHTC or training sites.

In case of not being compentent participants should be allowed to be competent durintg the training period or extending if possible. If participants are not competent after this process, then trainers should not give the certificate2 and communicate with NHTC. Trainers should also have one to one communication with the participants why s/he is not being certified. If there is need to extend training days to obtain competency, training site should communicate with NHTC and get approval.

Certification for CTS training (see CTS sectiom), the participants are not provided with the certification unless; the trained candidate trainer completes his/her practicum (get involved in one batch of CTS training or clinical training). The Advance/master trainer evaluates her/his performance during classroom teaching/transfer of clinical skills during clinical practicum session and provides feedback and reports to NHTC as well for certification if found competent.

Documentation and Reporting of training

By the end of the course, the Participant Registration Forms (PRF) should be submitted to NHTC. This form gives important immediate feedback to NHTC on the participants and the course.

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In addition, the NHTC keeps a record of training details for each batch, and record this information in the database. Theseinclude:

 Participant’s full name

 Posting at the time of training

 Dates of training

 Trainer and training site

 Other pertinent data managed by the database (TIMS).

Training sites (for example FP, SBA, MLP, RHTCs, Hospitals, D/PHO, NGOs and sponsoring agencies) should properly filled NHTC training reporting forms along with PRF attendance sheet.

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SECTION C

COURSE DESCRIPTION FOR TRAINING MANAGEEEMENT

Training Programs

National Health Training Center has classified inservice training for additional skill/updating of service providers training programs into the following categories:

C- 1 Family Planning (FP) Training:

There are different types of training related to Family Planning under NHTC. They are: C-1.1 Comprehensive Family Planning and Counseling Course (COFP/Counseling including

RH component)

C-1.2 Intra-Uterine Contraceptive Device (IUCD) C-1.3 Implant

C-1.4 Minilaparotomy (ML)

C-1.5 No-scalpel Vasectomy (NSV)

C-2 Safe Motherhood (SM) Training:

Following are different types of training related to Safe Motherhood Trainings under NHTC: C-2.1 Basic Skill Birth Attendant (SBA) In-service Training for Auxiliary Nurse Midwives

and Staff Nurses/Medical Officers

C-2.2 Advanced Skill Birth Attendant (ASBA) In-service Training for Medical Doctors C-2.3 Advanced Skill Birth Attendant (ASBA) In-service Training for MDGP and

Obstetrician and Gynecologists

C-3. Health Logistics Training:

There are following different types of training related to Health Logistics Trainings under NHTC:

C-3.1 Basic Health Logistics Management Training for below district level

C-3.2 Health Logistics and EPI Cold Chain Management Training for district and below district level

C-3.3 Pull System Training on Health Logistics Management Training for district and below district level

C-3.4 Public Procurement Training for Health commodities C-3.5 Basic Health Logistics Training for MCHW/VHW C-3.6 Self Paced Basic Logistics Training through CD-ROM

C-4. Infection and Prevention (IP) Training:

There are following types of training courses for Infection and Prevention C-4.1 Whole-site On-site Infection Prevention training (district level)

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This training course 3 day long supplemented by 2 review meetings in a year..

C-6: Operation Theatre Techniques and Management (OTTM)

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C-1: Family Planning Training

C-1.1: Comprehensive Family Planning and Counseling (COFP/C including RH component) Training

Course Objective:

To develop a competent and confident counselor and provider of non-clinical (non-surgical) family planning methods (including condoms, pills and DMPA).

Course description:

This is a 8-day course, for ANMs, Nurses, AHWs or HAs to teach them how to counsel clients to make an informed choice for any family planning method and specifically how to provide condoms, pills and Depo Provera. It is intended for nurses and ANMs from a site where family planning services (i.e., one day a week at minimum) are already available or will be started immediately after the training is complete.

Only 16 providers should be assigned to any one clinical training site at a time (one training batch). One training team, of three trainers, is assigned to train each batch of 16 participants. The participant must achieve at least 85% in knowledge and demonstrate all the required skills competently to qualify for the certification.

Participant criteria:

1) Appropriateness of Cadre;

Participants should come from clinical background. Nursing graduate /ANM/ PHN/ Staff Nurse registered with the Nepal Nursing Council; Sr. AHW/HA graduate registered with Nepal Health Professional Council and health institution recognized by CTEVT or the IOM.

2) Permanent staff who has completed probation period and who has not received training and committed to provide the service.

3) Work-site demanding services with potential for adequate (current) caseload (minimum 3-4 cases or 1 dedicated day for this service) per week.

And/or,

Site upgraded (after need assessment) and ready to provide services after the training 1) Priority would be given to those sites, where no other trained service provider is

available to provide such services.

Trainers’ criteria:

1) Service provider (Medical Office/HA/ANM/Nurse) trained in CoFP/C. 2) Medical Officer/HA/ANM/Nurse Trainer with CTS certified.

Certification:

It is a competency-based training, once trainer recommends or certifies NHTC that the participants’ have achieved the required competency, then NHTC provide the certificate to the participants.

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C-1.2Intra-Uterine Contraceptive Device (IUCD) Training

To develop a competent and confident IUCD service provider who is able to offer high quality IUCD services.

This is a 8-day course, for Nurse and Auxiliary Nurse Midwives (ANM) to teach them how to provide clinical IUCD services. It is intended for nurses and ANM from a site where regular IUCD services (i.e., one day a week at minimum) are already available or will be started immediately after the training is complete.

Only four nurse/ANMs should be assigned to any one clinical training site at a time (one training batch). One training team, two nurse/ANM trainers, is assigned to train each batch of four nurse/ANM participants.

As this course is also competency based, if the trainee has become competent in performing the complete procedure and score at least 85% in knowledge part, trainer can recommend NHTC for certification before completion of the defined end day of the course.

1) Appropriateness of Cadre

Staff Nurse or ANM graduate registered with the Nepal Nursing Council

3) Work-site demanding services with potential for adequate (current) caseload (minimum 3-4 cases or 1 dedicated day for this service) per week.

And/or,

1) Service provider (Sr. ANM/Nurse) trained in IUCD. 2) Sr. ANM/Nurse Trainer with CTS certified.

Certification:

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C-1.3.1: Implants Training for Nurses and Paramedics

To develop a competent and confident Implant service provider who is able to offer high quality Norplant services.

This is a 8-day course, to teach Nurses/Paramedics how to insert and remove (U technique) Implants with its components of standard IP practices and counseling. It is intended for Nurses/Paramedics from a site where regular Implant services (i.e., one day a week at minimum) are already available or will be started immediately after the training is complete.

Only four Nurse/Paramedics should be assigned to any one clinical training site at a time (one training batch). One training team, of two Physician/Nurse trainers is assigned to train each batch of four nurses/paramedics.

As this course is also competency based, if the trainee has become competent in performing the complete procedure and score at least 85% in knowledge part, trainer can recommend NHTC for certification before completion of the defined end day of the course.

1) Appropriateness of Cadre

StaffNurseorANMgraduate registered with the Nepal Nursing Council;

Health Assistant (HA) or Senior Auxiliary Health Worker (Sr. AHW) or AHW registered with Nepal Health Professional Council.

3) Work-site (current) providing services with potential for adequate caseload (minimum 3-4 case or 1 dedicated day for this service) per week.

And/or,

1) Service provider (Medical Officer/Nurse) trained in Implant. 2) Medical Officer/Nurse Trainer with CTS certified.

Certification:

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C-1.3.2:Implants Training for Physicians

To develop a competent and confident Norplant implant service provider who is able to offer high quality Norplant services.

This is a 5-day course to teach doctors how to insert and remove (U technique) Norplant Implants with its components of standard IP practices and counseling. It is intended for a doctor from a site where regular Norplant services (i.e., one day a week at minimum) are already available or will be started immediately after the training is complete.

Only four doctors should be assigned to any one clinical training site at a time (one training batch). One training team, of one physician-trainer and one nurse trainer, are assigned to train each batch of four doctors.

As this course is also competency based, if the trainee has become competent in performing the complete procedure and score at least 85% in knowledge part, trainer can recommend NHTC for certification before completion of the defined end day of the course

Doctor: Medical graduate registered with the Nepal Medical Council

3) Work-site demanding services with potential for adequate (adequate) caseload (minimum 3-4 case or 1 dedicated day for this service) per week

And/or,

1) Service provider (Medical Officer/Nurse) trained in Implant. 2) Medical Officer/Nurse Trainer with CTS certified.

Certification:

(32)

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C-1.4: Minilaparotomy (ML) Training under Local Anesthesia

To develop a competent and confident Minilaparotomy service provider who is able to offer high quality Minilaparotomy services.

This is a competency based 12-day course, to teach doctor & nurse teams how to perform Minilaparotomy under local anesthesia. It is intended for a team of doctor & nurse from a site where regular Minilaparotomy services (i.e., one day a week at minimum) are already available or will be started immediately after the training is complete.

Only two doctor/nurse teams should be assigned to any one clinical training site at a time (one training batch). One training team, of one physician-trainer and one nurse trainer, are assigned to train each batch of two doctor/nurse participant teams. During this 12 day course, clinical practicum must be conducted under the supervision of an approved and standardized clinical trainer or clinical field coach and at an approved high-volume site.

As this course is competency based, if the trainee has become competent in performing the complete procedure and score at least 85% in knowledge part, trainer can recommend NHTC for certification before completion of the defined end day of the course.

Doctor: Medical graduate registered with the Nepal Medical Council;

Staff Nurse and ANM: Nursing graduate registered with the Nepal Nursing Council 2) Permanent staff who has completed probation period and who has not received training

and committed to provide the service.

3) Work-site demanding services with potential for adequate (current) caseload (minimum 3-4 cases or 1 dedicated day for this service) per week

And/or,

1) Service provider (Medical Officer/Nurse) trained in ML. 2) Medical Officer/Nurse Trainer with CTS certified.

Certification:

(34)

(35)

C-1.5:No- Scalpel Vasectomy (NSV) Training

To develop a competent and confident NSV service provider who is able to offer high quality NSV services.

This is a self-paced course, which should run approximately 12 days, to teach doctors how to perform NSV under local anesthesia. It is intended for doctors from a site where regular vasectomy/NSV services (i.e., one day a week at minimum) are already available or will be started immediately after the training is complete.

Only two doctors should be assigned to any one clinical training site at a time (one training batch). One physician-trainer is assigned to train each batch of two doctors. During this 12 day course, clinical practicum must be conducted under the supervision of an approved and standardized clinical trainer or clinical field coach and at an approved high-volume site As this course is also competency based, if the trainee has become competent in performing the complete procedure and score at least 85% in knowledge part, trainer can recommend NHTC for certification before completion of the defined end day of the course

Doctor: Medical graduate registered with the Nepal Medical Council

3) Work-site demanding services with potential for adequate (current) caseload (minimum 3-4 cases or 1 dedicated day for this service) per week

And/or,

1) Service provider (Medical Officer) trained in NSV. 2) Medical Officer Trainer with CTS certified.

Certification:

(36)

(37)

C-2: Skill Birth Attendant (SBA) In-service Training

Background

Development of SBA LRP (2007) by National Health Training Center (NHTC) incorparted all the necessary skills included in existing Basic Essential Obstetric Care (BEOC) and Midwifery Refresher Training (MRT) and there was no need for continuing those training. As these training covered several core skills but not all, so there was need to train providers based on earlier trainings they received. Based on these, following curricula developed are as follows:

1. Skill Birth Attendant (SBA) In-service Training (15 days) for , Staff Nurses and doctors those were already received BEOC training

2. Skill Birth Attendant (SBA) In-service Training (30 days) for Auxiliary Nurse Midwives and Staff Nurses those were already trained on MRT-Training

3. Skill Birth Attendant (SBA) In-service Training (60 days) for Auxiliary Nurse Midwives and Staff Nurses who have no any additional midwifery training.

4. Skill Birth Attendant (SBA) In-service Training (45 days) for medical officers

5. Advanced Skill Birth Attendant (ASBA) In-service Training (10 weeks) for Medical officers.

The first two curricula for MRT and BEOC-trained participants were developed first by analyzing the gaps between the set of skills contained in the MNC LRP and the skills previously acquired—considering those skills taught in preservice education, MRT and BEOC training. These curricula were developed to address the short-term need to upgrade providers who had received previous inservice trainings. And now these two training are not being conducted as almost all the service providers who had received MRT and BEOC have been trained using the curriculum.

To fulfill the longer term need to train thousands of practicing ANMs and staff nurses in the GoN healthcare system to be able to function as SBAs, the 10-week curriculum was developed to upgrade those providers who have not receive any inservice training related to the maternal and newborn care. It also took into account content covered in preservice education programs.

These training curricula will be fully utilized as an important tool for teachers and trainers to deliver quality competency-based clinical training that will result in sufficient numbers of SBAs delivering appropriate maternal and newborn care in communities and healthcare facilities throughout Nepal.

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C-2.1 Skill Birth Attendant (SBA) In-service Training Course (60 days) for ANMs and Staff Nurses

Course objective:

To develop healthcare providers (Staff Nurses and ANMs) who are competent in all Skilled Birth Attendant (SBA).

Course Description:

This course is designed to deliver competency-based training covering knowledge and skills as defined by the National Policy on SBAs. It emphasizes both theory and clinical practice. Participants' pre-existing knowledge and skills are assessed using tools at the beginning and throughout the course to develop or strengthen skills for all the competencies outlined in the training course. Clinical exposure will be addressed through clinical practice with supervision in real clinical setting after becoming competent in the model. At the end of the training competency is assessed in overall knowledge and skills.

This competency-based training is based on the MNC LRP. The duration of this training is 10 weeks course (60 days); however acknowledging the nature of competency-based training allows the trainers to release any participants (in coordination with NHTC) up to one week early than the course duration if s/he fulfills all evaluation criteria. Alternatively, the trainers are able to add an additional week for any participant who is unable to achieve competency by week 10.

StaffNurseorANMgraduate registered with the Nepal Nursing Council;

2) Permanent staff who has completed probation period and who has not receive training.( First priority)

3) Work-site demanding services with potential for adequate (current) caseload

4) Site upgraded (after need assessment) and ready to provide the service after the training.

5) Priority would be given to those sites, where no other trained service provider is available to provide the services.

Trainers’ criteria for basic SBA Training:

3) Service provider (Nurse or doctor) trained / update on SBA core skills. 4) Trained SBA (Nurse/ doctor) with CTS certified.

5) Clinical experts with CTS certified can be utilized as trainer for specific components of the course like neonatal care, PMTCT, Family Planning, and Anesthesia etc.

Certification:

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C-2.2Skill Birth Attendant (SBA) In-service Training Course (30 Days) for ANMs and Staff Nurses (MRT-Trained Participants)

To develop healthcare providers (Staff Nurses and ANMs those have already attained Midwifery Refresher Training) competent in all skills for Skilled Birth Attendant (SBA).

This competency-based training is based on the MNC LRP. The duration of this training is 9 days classroom sessions followed by 23 days of supervised clinical practice.

Staff Nurse or ANM graduate registered with the Nepal Nursing Council who have received 30 days course on Midwifery Refresher Training (MRT);

2) First priority would be given to the permanent staff who has completed probation period and who has not receive training.

Trainers’ criteria for 30 days course SBA training (for MRT Trained staffs)

1. Service provider (Nurse or doctor) trained / update on SBA core skills. 2. Trained SBA (Nurse/ doctor) with CTS certified.

3. Clinical experts with CTS certified can be utilized as trainer for specific components of the course like neonatal care, PMTCT, Family Planning, and Anesthesia etc.

Certification:

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C-2.3 Skill Birth Attendant (SBA) In-service Training Course (15 Days) for ANMs and Staff Nurses (BEOC-Trained Participants)

To develop healthcare providers (staff nurses and ANMs) who are competent in all Skilled Birth Attendant (SBA) skills.

This competency-based training is based on the MNC LRP. The duration of this training is 2 weeks (15 days). Five days are required for theory and 5 days will be sent in classroom for developing competency in model. Participants will be deployed in clinical areas for 5 days (2 days at the beginning, 1 day during the course and 2 days at the end) to gain competency on specific skills based on the identified gaps. Additional one week is needed to address the identified gaps during the skills assessment in day 2 and 3.

Staff Nurse or ANM graduate registered with the Nepal Nursing Council who have received Basic Essential Obstetric Care Training (BEOC)

Trainers’ criteria for 15 days course SBA Training: (for BEOC Trained staffs)

Certification:

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C-2.4 Skill Birth Attendant (SBA) In-service Training Course (45 days) for Medical Officers

To develop healthcare providers (Medical officers) who are competent in all Skilled Birth Attendant (SBA).

This competency-based training is based on the MNC LRP. The duration of this training is 45 days; however acknowledging the nature of competency-based training allows the trainers to release any participants (in coordination with NHTC) up to one week early than the course duration if s/he fulfills all evaluation criteria. Alternatively, the trainers are able to add an additional week for any participant who is unable to achieve competency by 45 days.

Medical officer registered with the Nepal Medical Council;

2) Permanent staff who has completed probation period and who has not receive training (first priority)

Trainers’ criteria for basic SBA Training:

Certification:

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C-2.5Advanced Skill Birth Attendant (ASBA) In-service Training (Course10 weeks)

Course Objectives:

 To provide participants with the knowledge and clinical skills to manage obstetric emergencies and work effectively as SBAs with advanced skills (EmOC) in collaboration with other SBAs in their workplace

 To provide the participants with the decision making skills needed to respond appropriately to obstetric emergencies

 To reinforce the participants with the interpersonal communication skills needed to respect the right of women and newborns to life, health, privacy and dignity

This competency based clinical training course is designed to prepare participants to manage obstetric emergencies and work effectively as SBAs with advanced skills (EmOC) as defined in the GoN National Policy on Skilled Birth Attendants. The first portion of the course will be dedicated to updating evidence based information on advanced SBA core competencies and practicing and achieving competency on models. Trainees will then have opportunity to assist in and perform basic and advanced SBA skills in practical situations under supervision. During the clinical training, study blocks will be integrated to give participants an opportunity to share their experience and cover additional topics through other methods including case studies and role plays

Course Duration:

During the 10 week duration, the participants will rotate in different clinical areas of the hospital to acquire competency in basic and advanced SBA core skills.

After didactics are presented for all five of the advanced SBA modules, the trainees will transition from observing care (in weeks 2-3), to first assisting in care/surgery (in weeks 4-6), to performing surgery with supervision and assistance (in weeks 7 through completion of course. The specifics of this will differ based on available case loads, the competency and confidence of individual trainees.

The trainees will assist with 15 Cesearean Section (CS), and perform 15-20 CS under supervision before performing independently. The duration of clinical training and acknowledgment of clinical competency in advanced SBA skills will depend on individual trainee experience, confidence and competence. Duration of the training cannot compromise less than 10 weeks but being competency based training. In certain situations, if participant is competent enough, he/ she can be certified by trainer before 10 weeks. Similarly the length of clinical training may be extended by 1-2 weeks in order to provide further supervised training. At the end of the training, trainees will be provided with a provisional certificate.

Participant selection Criteria:

 Participants must be practicing physicians (MBBS, MD/GP or MD/GYN) with at least one year of experience in Obstetrics.

 Participants must be have core SBA skills, either through participation in in-service SBA training course, or self-study through direct use of the Maternal and Newborn

Care Learning Resource Package for Skilled Birth Attendants

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24

Trainers' Criteria:

 Trainers must be qualified consultant Obstetrician/Registrars actively practicing full scope emergency obstetric care at a site with adequate clinical case load to support advanced SBA training

 Trainers must be core SBA trainers (including having participated in CTS course and SBA training orientation) and working at a training site actively providing SBA training

 Trainers must be willing to take responsibility for surgical training and competency evaluation of physicians in advanced SBA skills

Certification

Participants who successfully complete this course will be given provisional certificate and are expected to return to their workplace and document advanced SBA-related service provision. Only after meeting service provision requirements participants will receive full SBA certification from NHTC.

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C-3: Training Implementation For Health Logistic Training

Most of the Health Logistics training is blanket coverage implementing training program. As per the Annual planning LMD identifies or selects the logistics training needed districts, with coordination of LMD, NHTC will inform concerned District Health Offices (DHO/DPHO/ Hospitals) through Regional Health Directorate (RHD) to recommend appropriate candidates as per selection criteria.

Regarding the Basic Health Logistics training, National Health Training Centre sends letter to all districts for assessing participants as per criteria then NHTC prepare a final list to be trained by the selection process.

Training Target:

As per request of Logistics Management Division, NHTC incorporate annual work plan accordingly. Prime responsible of the district selection is the concerned division (LMD) for implementing program activities. After selecting the districts by LMD, NHTC is responsible to set training target and specific details including training planning & implementation. Invitation of Participants:

Generally four weeks prior to start the training NHTC sends the invitation letter to DHO/DPHO, Regional Health Training Centers, through Regional Health Directorate to send the appropriate participants as per the training schedule (See Appendix F for sample letter).

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C-3.1: Basic Logistics Training –BLT

Course Objectives:

The main objective of this training is to enhance/updates the knowledge & skills on BLT for storekeepers who are newly appointed or transferred from other sectors.

This is a 3-days course for Storekeeper from RMS, District (Hospital, D/PHO), PHC, Health Post and Sub Health Post who are involved in Health Logistics Management. The course of the training is Introduction to Logistics Management, Responsibilities of Store Personnel, Storing medicine and devices, Conduction Physical Inventory and Recording & Reporting. 18-20 Participants and 3 Trainers should in each training group. Trainer should have taken Training of Trainer on Health Logistic Management.

Appropriateness of Cadre:

1. Newly appointed storekeeper who has not received this training before

2. Storekeeper from RMS, District (Hospital, D/PHO), PHC, Health Post and Sub Health Post who are involved in store Management

3. Priority is given to permanent staff under Ministry of Health and Population

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C-3.2: Health Logistics and EPI Cold Chain Management Training (for district and below district)

The main objective of the course is to update and increase the knowledge & skills and run those health facilities/offices effectively which under the integrated Health Logistics Management by determining the required medicine, vaccine and devices on the basis of the maximum and minimum stock level approach by supervising regular demand, stock status, and stock out and over stock.

This is 3 days training for those personnel who work in the field of Health Logistics Management and EPI Cold Chain Management at District and Health Facility. Participants should be from EPI sub-centre who works logistics management related works, Cold Chain Assistant from District Health Office/ District Public Health Office, Logistics personnal from Health Post, AHW from Sub Health Post or the personnel assigned by authorized personnel are eligible for this training.

The course of the training are Introduction to Logistics Management, Storing vaccine, medicine and devices, Conduction Physical Inventory, Recording & Reporting, Setting Authorized Stock Level & Emergency Order Point, Determine Order Quantity, Review Stock Status and Responsibilities.

In this training the participants will be 18 to 20 in each group and there will be 3 trainers who already trained as TOT for the training.

Appropriateness of Cadre:

1) Newly appointed storekeeper who has not received this training before

2) The participants from EPI Cold Chain Centers, Personnel from Primary Health Care Centers should have logistics management experiences, Cold Chain Assistant from District/Centers, Health Posts, Sub Health Post or the personnel assigned by authorized personnel are eligible for this training.

3) Priority is given to permanent staff under Ministry of Health and Population.