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

2. 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

3. 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

4. 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.

5. 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.

6. 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