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Training Providers
Training serves three key purposes for integrated programs. First, training can prepare staff members to offer a wider range of services. For example, family planning specialists can learn about STIs, including HIV/AIDS. Similarly, AIDS experts can learn about contraceptive technology.
Second, training can introduce a holistic approach to counseling—that is, an integrated approach that explores the full range of a young client’s reproductive health needs, rather than focusing on a single service. For example, providers can stress the need for dual protection against pregnancy and STIs regardless of the specific service that the client is seeking (9, 36).
Third, training can prepare staff members to work with young people under age 20. Training can help staff members understand the process of physical, emotional, and social development during adolescence and sensitize them to young people’s need for reproductive health care. It can encourage staff members to adopt non-judgmental attitudes, listen without criticizing, and protect young clients’ privacy. It can also teach specific strategies for working with youth so that staff members feel comfortable and confident with young clients.
To help program managers develop an effective training program to support integrated services for young people, this section describes model curricula for providers. All of the curricula include a full set of training materials, teaching aids, and participant handouts.They employ best practices in training, such as setting clear learning objectives, presenting material in an orderly fashion, and using participatory training techniques (31, 48). And they can be used for pre-service or continuing in-service training, both of which are essential to an effective training program.
Before selecting and adopting a curriculum, managers should adapt it to the local setting and the program’s training needs.The following questions can help determine which staff members to train, what topics to cover, and which information and skills to focus on.
- What reproductive health issues are most important for young people in the program’s service area?
- What factors deter young people from using existing family planning, HIV/AIDS, and maternal and child health services?
- What type(s) of providers will attend to young clients? How well prepared are they to work with youth? What services is the program equipped and ready to offer to young people? How well prepared are providers to offer these services? How well prepared are they to make referrals for services the program does not provide?
- Who will supervise the providers who attend young clients? How well prepared are they to oversee and support integrated services and services for young people?
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Tailoring Reproductive Health Counseling to Young People’s Diverse Needs
Young people are a diverse group, whose reproductive health needs vary with their age, gender, marital status, and whether or not they are sexually active, among other factors. For example, boys and girls entering puberty have far different concerns than sexually active teenagers who may already have contracted an STI.
To be effective, programs must recognize this diversity and tailor counseling and clinical services accordingly (26). Customizing services to the needs of individual young people becomes even more challenging when providers offer multiple, integrated services. The training curricula and job aids featured in this section can help with this task.
When counseling younger adolescents, who are unlikely to be sexually active, the focus should be on delaying sexual debut and establishing healthy patterns of behavior (46). In contrast, when counseling older, unmarried but sexually active youth, the focus should be on how to reduce the risks of infection and pregnancy—whether through abstinence, faithfulness to a single partner, or the use of condoms and other family planning methods—and on diagnosing and treating infections (10, 32).
Gender roles and marital status are also important considerations. In many developing countries girls marry and begin childbearing at an early age. Reaching them with safe motherhood services, including family planning, is essential, but so is providing STI/HIV services given the continuing risk of infection from their husbands (8). Because marriage limits girls’ mobility and social networks, programs may need to involve their husbands, mothers, and mothers-in-law (16, 26). In contrast, the challenge in reaching young men may be overcoming gender norms that encourage them to dismiss their need for reproductive health information and services and to reject family planning and other health clinics as girls’ spaces (26).
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Model curricula. The four curricula described in this section can train service providers of all kinds—including doctors, nurses, midwives, and counselors—in integrated services for young people.They can be used during either pre-service or in-service training. All of the curricula cover the core topics of adolescent development; youth reproductive health needs; youth-friendly services; interpersonal counseling and communications skills; and family planning, STI, and HIV services.The curricula vary in length from several hours to one week, and also vary in the range of subject matter, the approach to training, and whether they include job aids.
Family Health International. Reproductive health of young adults training module. Contraceptive Technology and Reproductive Health Series. Research Triangle Park, NC, FHI,2003.
Unlike the other curricula mentioned here, this electronic training resource can be used for interactive self-study if computers are available. Presenters also can use the module as the basis for conventional group training.The module is the shortest of the curricula described here,taking 120 to 150 minutes for providers to complete online orfromaCD-ROM.Itcoversfamilyplanning,STIs,andHIV,aswellasadolescent programming for an integrated approach.The modules are available in English, French, and Spanish.
Available at: http://www.fhi.org/en/Youth/YouthNet/rhtrainmat/Reprohealthyoungadults.htm
For copies on CD-ROM: e-mail requests to youthnetpubs@fhi.org or contact Family Health International, YouthNet Program, 2101 Wilson Blvd, Suite 700, Arlington, VA 22201 USA. Tel: 703-516-9779. Fax: 703-516-9781.
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Mozambique: Training Providers
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| Mozambique: Training Providers In Mozambique, the Gera‹o Biz (“Busy Generation”) project emphasizes an integrated and comprehensive approach to meeting young people’s reproductive health needs in all of its activities. Clinical counseling stresses dual protection, contraceptive supplies, STI diagnosis and treatment, HIV prevention, and antenatal care. HIV testing and treatment and prevention of mother-to-child transmission of HIV have been added to the approach, as well. To provide integrated youth-friendly services, Gera‹o Biz renovated and equipped 49 government health centers and hospitals in seven provinces, trained over 230 nurses and doctors, reached out to communities to explain the need, and publicized the new services widely. During the first three years after services began in 1999, youth attendance at project clinics increased by 70%. |
A nurse provides care at a youth-friendly clinic in Mozambique. Providers need training both to prepare them to work with young clients and also to offer a wider range of services.
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To train nurses and doctors how to deliver youth-friendly services, Gera‹o Biz adapted training materials produced by Pathfinder International (see Senderowitz et al. 2002). The 10-day training covers the concept of a youth health clinic, program objectives, clinical knowledge, and communication skills for working with young people. An evaluation of Gera‹o Biz’s clinical services in 2001 found that providers were well-informed, motivated, respectful, and friendly and that the quality of clinical and counseling services was high. The evaluation recommended adding refresher training for providers and training other personnel, including pharmacists, receptionists, and cleaners, to ensure that the entire experience at health centers is youth-friendly.
Source: Kane and Colton 2005; World Bank 2003
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Levack, A. and Campos, H. Youth-friendly services: A manual for service providers. New York, EngenderHealth, 2002.
Initially developed for a project in Nepal, this manual has been field tested in Mongolia, Russia, and the US. In addition to the core topics that are essential to integrated counseling (adolescent development, youth reproductive health needs, youth-friendly services, interpersonal counseling and communication skills, and family planning, STI, and HIV services), the four-day workshop prompts providers to reflect on gender issues and on their own values, beliefs, and attitudes regarding young people. It includes useful job aids, such as handouts on HIV transmission risks and proper condom use. The manual contains a full set of COPE© self-assessment guides (see p. 6 for a description of the COPE process and the self-assessment guides).
Available at: http://www.engenderhealth.org/res/offc/qi/yfs/index.html
For print copies: Complete the order form at http://www.engenderhealth.org/pubs/form.html and mail to EngenderHealth, 440 Ninth Avenue, New York, NY 10001 USA.Tel: 212-561-8000. Fax: 212-561-8067. E-mail: info@engenderhealth.org.
Senderowitz, J., Solter, C., and Hainsworth, G. Reproductive health services for adolescents: Participant’s manual. Comprehensive Reproductive Health and Family Planning Training Curriculum, Module 16. Watertown, MA, Pathfinder International, 2002.
Originally developed for African Youth Alliance activities in Botswana, Ghana,Tanzania, and Uganda, this training module now forms part of a comprehensive reproductive health training curriculum published by Pathfinder International.The six-day workshop covers all of the core topics that are essential to integrated counseling, including adolescent development, youth reproductive health needs, youth-friendly services, interpersonal counseling and communication skills, and family planning, STI, and HIV services. It also covers life skills, pregnancy care, and sexual abuse. Unlike the other curricula, it offers detailed instructions on how to screen young people by taking a comprehensive medical and social history and conducting a thorough physical exam. The screening covers age-appropriate development, sexual activity and its risks, substance abuse, sexual abuse, and other health problems.The module includes many job aids, such as a reproductive health history form, contraceptive selection guidelines for youth, and checklists to assess counseling skills. (For an example of how the curriculum has been used, see the box on Mozambique.)
Available at: http://www.pathfind.org/site/PageServer?pagename=Publications_Training_Modules
For print copies:Technical Services, Pathfinder International, 9 Galen Street, Suite 217,Watertown, MA 02472, USA. Tel: 617-924-7200. Fax: 617-924-3833.
World Health Organization. WHO orientation programme on adolescent health for health-care providers. Geneva, WHO, 2003.
Unlike the other three curricula listed in this section, this training program covers a full range of health services for young people, not just family planning, HIV/AIDS, and reproductive health. It is designed as a series of independent modules, from which trainers can pick and choose to meet a program’s needs. It is this combination of modules that makes the curriculum useful for integrated services.WHO conducted participatory development workshops and field tests in every region of the world as part of the preparation of the curriculum. Core modules cover the implications of adolescence for public health, youth reproductive health, youth-friendly health services, and adolescent development. Optional modules address specific health needs, including pregnancy prevention, maternal care, STIs, substance use, mental health, and nutrition. Modules on HIV, chronic and endemic diseases, and injuries and violence are under development.To give providers a deeper understanding of youth perspectives, the course is designed to include young people along with adult trainees.
A sample module on STIs is available at: http://www.who.int/child-adolescent-health/publications/ ADH/ISBN_92_4_159126_9.htm
For print or CD-ROM copies: Department of Child and Adolescent Health and Development, World Health Organization, 1211 Geneva 27, Switzerland. E-mail: cah@who.int.
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