Amid a global pandemic, people around the world have learned to adapt from in-person meetings and trainings to more nimble and flexible digital platforms—and healthcare providers are no exception.
COVID-19 restrictions forced organizations to reimagine new ways to equip providers with the necessary information for them to deliver high-quality access to healthcare services. For service providers who counsel and train clients to self-inject the hormonal injectable contraceptive, subcutaneous DMPA (DMPA-SC), the prospect of switching from an in-person to a virtual format presented both a challenge and an opportunity to innovate.
In Uganda, the Delivering Innovation in Self-Care (DISC) program—led by Population Services International (PSI)—was able step in and support this transition by collaboratively designing and piloting an alternative, virtual model to DMPA-SC training that directly speaks to private sector providers’ business interests.
Fusing elements of PATH’s Kaya-based online course on self-injection and add-ons piloted by PSI-Uganda, the DISC team designed a richer training and practicum around five key components: impart knowledge of DMPA-SC; equip providers withhone method mix counseling skills that that incorporate DMPA-SC as an option; support clients to self-inject; and teach providers how to generate demandraise awareness of SI; as well asand report uptake of self-injection.
Continual learning and an adaptive implementation approach are baked into PSI-Uganda’s culture. The team set out to learn directly from providers regarding the type of learning content that would best meet their needs. The team made a point of incorporating content on demand generationawareness creation and reporting. These are both topics that are of utmost interest to private sector providers, which had been omitted from the previously available training content.
Consistent with DISC’s emphasis on customization to meet client needs, the team consulted with trainees during the planning process and made a set of adaptations to ensure the content and means of delivery were fit for purpose:
- Digital debriefs: DISC’s training team and technical SRH staff used Microsoft Teams for real-time dialog as participants completed PATH’s Kaya modules. Trainees were able to ask experts clinical questions and gain clarity on anything they didn’t understand in the materials. Support staff also provided IT help as needed via WhatsApp.
- Practice: An innovative practicum allowed participants to first test themselves—on video—then share with peers via WhatsApp to receive feedback. This provided them with a ‘safe space’ to gain experience with counseling clients on selecting a contraceptive method, and practice injections using a condom filled with salt—to mimic the fat under skin.
- Power in partnerships: The team realized that navigating new apps such as Kaya without support would be a hurdle for trainees. Thus, PSI partnered with PATH to bring on staff to presence to support trainees in navigating the platform.
- Reflection sessions: Daily individual and group ‘reflection’ sessions further afforded participants the opportunity to share both positive and constructive feedback about their experiences, and to engage with peers.
Lessons learned and implications for future programming
Piloting synchronous virtual training for self-injection has demonstrated that e-learning is an efficient way to leverage existing tools for strengthening the capacity of providers.
Participants appreciated how the e-training was minimally disruptive to their work routines. Several of them also remarked that the experience further developed their IT skills. E-learning brings the advantages of being lower-cost than in-person training and more feasible for scaling up quickly, which can be beneficial even under non-pandemic circumstances.
DISC recommends that moving forward, trainers and trainees invest additional time for mentoring and coaching post-training, to ensure provider skills are well grounded in the real work environment and to maximize knowledge retention. Another suggestion is to give participants the flexibility to complete some modules on their own time, since different learners proceed at different paces (and have different schedules)! Additionally, incorporating a virtual pre- and post-training assessment tool would support with measuring training efficacy and gauging viability for further scale-up.
Ultimately, we learned that digital channels can effectively (and safely) deliver comprehensive self-injection training. Our approach left providers feeling more confident not only to initiate new clients, but also to generate demandcreate awareness and report data. If brought to scale, this type of capacity strengthening has the potential to drive improvements in clinical care and data visibility across the health system.
Access Collaborative (August 2021). Building capacity through digital approaches: Can eLearning replace in-person training? Results from the evaluation and implementation of eLearning for DMPA -SC self-injection in Senegal and Uganda. Presentation
Population Service International-Uganda (August 2021). After Action Review (AAR) Program Report on Virtual Learning.