By Dr. Suleiman Alhaji Usman, Clinical Services Manager, PSI Nigeria and Jamee Kuznicki, Senior Associate Project Manager, PSI
In 2012 (most recent data), 212,000 women in Nigeria received medical treatment for complications related to abortion, many of which were unsafe.
Quality post-abortion care (PAC) can mitigate abortion complications. But with gaps in PAC-trained providers, in addition to supply chain challenges and limited consumer awareness of legal PAC options, women too often lack the resources to prevent post-abortion complications.
And COVID-19 hasn’t made things easier.
Which is why we – PSI Nigeria, through the Women’s Health Project, asked: how might we build the capacity of private providers’ PAC services during life in a pandemic?
Our answer: we’ve taken our PAC training online, delivering safe and comprehensive skills building sessions to providers via Zoom.
The practicum, delivered to providers across three states and the Federal Capital Territory of Abuja, blends virtual trainings with in-person testing and certification. In 2020, PSI Nigeria recruited 100 new providers and trained 23 of them before the weight of the global coronavirus pandemic fell on the country.
How did we pivot? What did we learn? And what can you apply in your PAC programming? We share our thoughts below.
Responding to the Reality: Suspending In-Person Training
Nigeria saw its first confirmed coronavirus case in late February 2020, prompting the federal government and several states to enact total lockdowns. Nationwide curfews, bans on gatherings and non-essential travel and physical distancing became the new normal, as the country moved swiftly to curb the virus’s spread.
All of PSI Nigeria’s planned trainings were cancelled. Without access to skilled sexual and reproductive health (SRH) providers, women and girls would be at greater risk of not receiving lifesaving PAC treatment.
Bridging the Virtual and In-Person… at a Distance
Through a cross-department collaboration, PSI Nigeria’s Quality Assurance and IT teams identified potential adaptations to the PAC training curricula through a virtual format, leveraging an online platform that much of the world is now familiar with: Zoom.
As the team piloted the adaptation, they focused the PAC training modules on providing medication, a skill that can be taught in a virtual “classroom” without requiring hands-on practice, before expanding to also include trainings on manual vacuum aspiration (MVA)—a surgical treatment for PAC. The trainers visited providers individually after the virtual training to conduct the MVA practicum and fully certify their clinical skills, while adhering to physical distancing requirements. All trainings included an orientation on Zoom to circumvent any potential technical issues that, undoubtedly, would arise.
Following the virtual training, 57 of the 58 providers trained completed the practical certification in MVA. While movement restrictions were in place, PSI Nigeria also conducted virtual coaching and supervision of these newly trained providers to assess and improve their clinical skills, knowledge, and quality of interactions with clients.
As one participant remarked, “The training has been wonderful from the beginning, to be honest, I for one have not done any training online before but was nice in fact. I am beginning to feel like a computer and PAC guru right now. Kudos to all of you.”
Our Applicable Learnings
What we learned, in three quick bites:
- To retain providers’ focus and interest during virtual sessions, and to effectively manage time during virtual trainings, focus on skills and knowledge acquisition.
- The combined virtual and in-person session is less costly compared to the didactic training; PSI Nigeria spent approximately $2,000 – only 13% of the planned budget – on the trainings, inclusive of the Zoom subscription fee and data reimbursement for participants. And best yet, it doesn’t forgo the quality of the training. In fact, we saw it enhance bonds between PSI Nigeria staff members and providers by stepping into providers’ worlds and being on site to observe them in practice.
- Virtual training allows participants to learn the theory and can be easily adapted from the in-person training since there is no hands-on practice needed. The subsequent in-person visits maximize providers’ time by allowing trainers to stay on-site and at-work while being tested, assessed, and certified on their newly gained skills.
By prioritizing support to providers during this challenging time, PSI Nigeria is building the skills and confidence in these providers to deliver high-quality SRH care. In 2021, the team will explore whether virtual provider engagement can be implemented at scale. The team will continue to take a blended approach, using a combination of digital platforms with some in-person sessions to provide PAC trainings. And they’ll use digital trainings to conduct quality improvement monitoring, remote supportive supervision, remote data sharing – and to facilitate rapid insight gathering to adapt and make adjustments to these interventions.
Our work has helped us to reframe how digital solutions can support not only the delivery of training, but also communication, supervision and insight gathering – leading to more timely evidence-informed program adjustments, increased impact and sustainability and, most importantly, more accessible PAC healthcare care for Nigerian women, everywhere.