23/24 September Debriefing Ricky Lu, MD, MPH FP/RH/CECAP Director Jhpiego/Baltimore BREAST AND CERVICAL CANCER PREVENTION ACTIVITIES INTEGRATED ON FP/RH SERVICES Sept 2009 MAPUTO, MOZAMBIQUE

ACTIVITY PREPARATION: 9-10 SEPT  Stakeholder meetings  MOH  HCM  USAID/CDC  Facilitators and Trainers Meeting  Site Visit  Matola 2  Polana Caniço  Classroom Preparation

MEETING PURPOSE  Review the 6 day clinical skills course schedule  Discuss plans for the conduct of classroom and clinical practice  Discuss Common Clinical Skills Standards for VIA and Cryotherapy integrated on FP/RH services  Discuss the approach to competency based clinical training  Identify roles and responsibilities for training  Discuss next steps

CLASSROOM PREPARATION

Week 2: Providers and Supervisors Training 14 – 19 SEPT 2009 Maputo, Mozambique

WEEK 2: PROVIDER TRAINING  Training Venue – Information Technology Training Center  Participants: 25  Providers – 17  Supervisors – 8  Facilitators – 10  14 – 19 Sept 2009 Institutions and Sites: MOH HCM Polana Caniço Matola II Boane HG Jose Macamo HC da Beira CS Macarrungo CS Pontagea HC da Nampula CS de 25 de Septembro CS 1 de Maio DPS Zambezia

Provider Training GOALS  Influence attitudes on the benefits and appropriate use of VIA and cryotherapy.  Develop counseling skills to talk with women about Breast and Cervical cancer screening  Develop competence to perform breast examination and VIA and Cryotherapy on FP/RH services  Manage side effects or other problems related to cryotherapy.

Clinical Training Design  Competency based/Hands on Training  Classroom and Clinic sessions:  Educating and Counseling clients  Infection Prevention practices  Clinical breast examination  VIA and Cryotherapy  FP/RH services organization  Progress in learning measured through practice 14 Sep M 15 Sep T 16 Sep W 17 Sep Th 18 Sep F 19 Sep Sa LUNCH HW CLINICAL PRACTICE CLASSROOM PRACTICE P L A N’ G I N T R O D U C TI O N

Criteria for Completion  Qualification is based on achievement in three areas:  Knowledge—A score of at least 85% on the  Decision making  Psychomotor Skills  Certificates of Participation and Qualification

CLASSROOM ACTIVITIES

CLINICAL ACTIVITIES

OTHER ACTIVITIES

Results Number of Clients screened at FP service – 166 or 40/day Number of VIA Positives – 6 Number treated at same day – 6 1 IUD inserted and many other contraceptives distributeds (oral, injectables and condoms) Training Results  Knowledge Assessment – 3 particip. with < 70 % score  Image Identification - 1 particip. with < 60 %  Skills for Breast and Pelvic Exam – all competent  Skills for VIA steps– competent  Skills for Cryo steps – each needs practice on site

Recommendations  Transfer of Learning Activity in the next 3 months: (Providers)  Assist in starting services  Provide opportunity for supervised practice with cryotherapy  Orient to correct use of forms and log book  Introduced updated national service delivery guidelines  Supervisory visits (supervisors)  Use a standardized supervisor visit template  Oriented to performance standards for breast and cervical cancer screening on FP/RH services  Schedule visits as soon as feasible

Week 3: SUPERVISORS Meeting SEPT 2009 Maputo, Mozambique

MEETING PURPOSE  Review performance standards for screening and treatment on FP/RH cervices  Develop common framework for supervision  Finalize monitoring forms  Finalize IEC materials and plans for testing  Finalize National Guidelines  Review referral process  Discuss supervision plans and next steps

Meeting Activities

MEETING ACTIVITIES: Site Visit Boane Director Meeting FP Clinic Visit Observe DiscussRecommend

RESULTS  Performance standards for screening and treatment on FP/RH services updated  Final draft of supervision framework developed  Additional input to finalize monitoring forms  Additional input for IEC materials and plans for testing drafted  National Guidelines updated and finalized  Referral steps drafted  Supervision plans developed  Next steps identified

ITEMWHOWHEN GUIDELINES CARLA MANUELA 2 OCT FORMS OLGA ISABEL 2 OCT IEC DEOLINDA JORGE 2 OCY ROTEIRO ANA DAI JORGE 2 OCT PERFORMANCE STANDARDS RICKY/ISABEL/ VERONICA/JANEEN 05 OCT TASK MATRIX

ADDITIONAL RECOMMENDATIONS  Technical Working Team – to lead and coordinate the implementation (MOH, HCM and MCHIP)  Additional part time technical staff to support the roll out of services  Conduct an assessment in 18 th month to review service start up and progress  Update National Cervical Cancer Management Protocols  Strengthening of the referral points in both equipment, staff capabilities  Community mobilization plan needs to be developed

Recommendations  Resupply of consumables  Repair and maintenance of equipment  1 Day National Meeting-Sharing Successes and Lessons Learned Conference  Prepare for the development of next generation of trainers and providers  Develop prototype job aids

MUITO OBRIGADO High Quality Training---High Quality Services