Manual Vacuum Aspiration (MVA) Refresher Outreach Module: Pilot Report Bill Powell Ipas As told by… Wilma Doedens UNFPA 30 November 2010

Manual Vacuum Aspiration (MVA) A signal function of EmONC for basic & comprehensive facilities A recommended method for uterine evacuation by WHO for: Postabortion care (PAC) Induced abortion (to the full extent of the law) Targeted by Training Partnership for development/piloting of outreach module

The MVA Outreach Module Drawn from existing training materials Contextualized to refugee settlement / crises settings Designed as: 1.5 – 2 day session Refresher Clinicians with previous training Pelvic model practice, but not clinical practicum

The Pilot Kenya – May 2010 40 “refreshed” Dadaab – 29 Kakuma – 11 Held in UNHCR compounds adjacent to settlements Enthusiastic response and evaluations from participants Working with UNHCR and UNFPA, Ipas arranged trainings in May 2010 in MVA for 40 providers in the refugee settlements of Dadaab (Northeastern) and Kakuma (Northwestern) Kenya, where rape is a major problem. UNHCR funded transportation; Ipas funded the trainer (a Kenyan midwife who is a master trainer). The course was designed as a “refresher” for providers who had past experience with MVA. We piloted a “short-course,” 1.5 – 2 day agenda, conducting the trainings in the UNHCR compounds adjacent to the respective settlements. This approach allowed providers to minimize time away from their duty stations; several of them reported working an evening shift in their health facilities after the training sessions ended in the late afternoons. Attendees were primarily nurses and midwives, as well as a few clinical officers and physicians, providing health services in NGO managed facilities in the settlements. The selection of participants comprised of a mixture of doctors, Clinical officers and Nurses in all the camps as indicated in the table below: Overall there was a very enthusiastic response from participants and UN personnel on the content, training methods and their comfort level after the sessions.

Challenges / Lessons Learned Many never trained in MVA/PAC Escort time in Dadaab 29 participants in Dadaab sharing only three pelvic models Have a seasoned trainer! Challenges: Most of the participants had not been trained in MVA slowing down the training as the facilitator took time to discuss other components of post abortion care. Escort time in Dadaab due to security reasons affected the training program as it was extended to three days instead of the earlier planned two days. There were 29 participants in Dadaab sharing only three pelvic models that were available for the training. Lesson Learned It was essential to the success of this pilot and I would propose all such endeavors in these settings, that seasoned trainers are used. When faced with the challenges above, the trainer was able to easily adjust on her feet… draw on her own expertise and experience to add content where needed and adjust to surprises in the daily schedule.

Recommendations / Next Steps Strictly enforce “refresher” criteria (previous training) or increase training time Consider pre-training & follow-up field visits Consider content on 2nd trimester PAC and misoprostol for PAC Re-pilot in Uganda mid-December Finalize curriculum and tools Increase training time frame for future refresher trainings to cater for the participants who have not been previously trained in post abortion care or strictly select providers already trained in MVA for refresher training. , Consider field visits prior to the training to assess MVA services at the facility (availability of kits, care of the instruments, staff offering services, support systems and data management). Ipas in collaboration with UNHCR should consider follow up visits to monitor the implementation of MVA services Some participants requested including Post abortion care in second trimester (which is common) in future refresher trainings Inclusion of Miso for PAC… either embedded into the agenda, or as a stand-alone short module Other recommendations: Monitoring and Evaluation tools to be availed in all the facilities for quality data management and reporting Work to include abortion indicators in the UNHCR HMIS Need for development of a participant handbook…with copies of slides and other handouts/tools Avail a few pelvic models in the two settlement camps to be used for on job training at the facility to ensure continuity of services to bridge the gap created by high staff turnover. In addition consider having more pelvic models for training. Allocate time for DVDs or Videos shows during future training Values Clarification exercise is an essential in a refresher training