Training in PMTCT: From the classroom to successful implementation

1. Training in PMTCT: From the classroom to successful implementation Theresa Ndoro(1), Zivanai Kapamurandu (1), Sophia Mkundu(2), Winnie Murigagumbo (2) Diana Patel (1), Barbara Engelsmann (1) 1 Organization for Public Health Interventions and Development Trust (OPHID), Harare, Zimbabwe2 Ministry of Health and Child Welfare Zimbabwe Zimbabwe National HIV&AIDS Conference, Harare, 5-8 Sept 2011

2. Background • Adequate and appropriately trained staff form a critical component for successful PMTCT programmes in Zimbabwe • Training an on-going process to: - accommodate staff turnover - introduce new policy changes

3. Issues • Training diverts staff from routine duties • Increasing number of training workshops (PMTCT and others) • Ulterior motives of HCWs for attending workshops (“perdiemitis”) • Monitoring of quality of service delivery post-training • Lack of post-training follow up and support • Training generally expensive

4. Introduction • The Organisation for Public Health Interventions and Development (OPHID) as a partner in the FAI consortium, has been supporting MOHCW PMTCT programmes since 2001 • OPHID supports the National PMTCT Programme mainly in the following areas: - Financial and technical support during trainings for health workers in key PMTCT courses - Post-training follow up and constant support and supervision to sites - Community mobilisation - Bi-annual PMTCT review and planning meetings - Medical supplies support to sites - Operational research

5. Approaches • In September 2010 OPHID supported training of 50 nurses from UMP and Mudzi districts (Mashonaland East Province) • Using standardised national training materials • In collaboration with MOHCW trainers • In EID/MER/M&E tools • In November/December 2010 systematic clinic based post-training follow up conducted by district co-ordinator together with MOHCW trainers • to assess implementation of the new regimen • to initiate corrective measures as and when necessary

6. Outcomes

7. Observations • The most commonly reported reasons for failure to implement the new regimen at health centre level included: - Lack of confidence in implementing the new regimen, especially calculation of infant AZT regimens and DBS collection for EID - Perceptions of additional workload - Lack of will, “just another workshop” - Lack of relevant logistics and supplies

8. Observations • Provision of and quality of service improved after post training follow-up in all sites • Increased confidence of HCWs to deliver services • Ability to deliver service improved e.g. calculate the dosage for the infant AZT regimens, even in bigger sites already implementing • Motivation improved • Appreciation of supplies delivered

9. Lessons Learnt For site level HCWs training alone is not enough - need post-training follow-up From Health workers’ perspective: • Presence of trainers at the sites reinforces the serious intent of the training and acknowledges the important role of HCWs at each site “Now that you have come I realise the importance of implementing the new regimen”

10. Lessons Learnt For site level HCWs training alone is not enough - need post-training follow-up From Trainers’ perspective: • Trainers better understand trainees working environment/local challenges and can identify gaps in individual knowledge and improve training approaches “Now you see where I am working”

11. Conclusions • Systematic post training follow-up of trainees by trainers • reinforces changes of practice • optimises site performance • increases staff confidence and morale • guides modification of training approach and content

12. Recommendations • Ensure standardized regular, timely mentoring and supervision • of recently trained staff (particularly relevant in view of extensive IMAI/IMPAC training) • Need for development and dissemination of on the job aids e.g. calculations of infant ARV prophylaxis dosages • Ensure logistical availability of relevant resources soon after training • Review cost effectiveness of various training approaches

13. Acknowledgements • Financial support (USAID, EGPAF) • Implementing partner (OPHID) • Provincial and district health executives • Nurses of health care institutions • Mothers

14. Thank you HIV positive mother and her HIV negative son (Josphat) from a PMTCT program in Murewa, Zimbabwe 2009