Train one, train all: The cascade training model
How do you tackle family planning educational needs at both service provider and community levels with limited human and financial resources?
The solution: Cascade training!
Rural remote south west Uganda faces many health challenges: unwanted teenage pregnancies, large family size, maternal mortality, HIV and other sexual health issues, which all present major health problems for the local population. In addition to this, access to proper family planning training for healthcare staff is limited, and family planning misinformation and cultural misconceptions are common within communities.
Presented with this reality, a solution is needed that can be both cost-effective and sustainable, which is where the Cascade Training Model is useful.
Cascade training is not an entirely new concept, and has been utilized through ‘Train the Trainer’ programs in other fields. The USHAPE training program uses this existing model and expands it to apply to the challenge of multi-level health education issues in resource poor settings.
Graduates of USHAPE training go on to consolidate their learning and many become teachers themselves. This helps to enhance the adult learning process for them as individuals, as well as building motivation and a sense of achievement.
UK GPs and Ugandan Family Planning Providers have worked together to develop the training program. This has enabled quality family planning training methods to be combined with local cultural context. By providing high quality dynamic workshops, the USHAPE training program not only delivers training but it introduces new methods of interactive teaching, which is enjoyed by participants and teachers alike.
The Whole Institution Approach
The USAHPE training methodology delivers two levels of training for both in-service staff and pre-service nursing students.
1) Family Planning Advocate training is a 5 hour program, targeted at ALL staff at a healthcare institution, regardless of their role, and aims to emphasize:
- the importance of family planning in preventing maternal and child mortality and morbidity,
- the positive impact smaller family sizes and birth spacing can have on individuals, families, and communities,
- facts about family planning and its side effects, which help to dispel widely held community myths and misconceptions,
- the importance of screening patients for unmet need for family planning and, when appropriate refer those individuals for services.
2) Family Planning Provider training is a 30 hour program which includes one-to-one follow up, targeted at selected clinical staff. The program aims to:
- ensure in-depth knowledge and understanding of unmet need, different methods, and sensitive groups (such as men, adolescents, HIV/AIDs, post-partum),
- increase confidence and skills in family planning counselling,
- increase confidence and skills in delivering methods, including IUDs and implants,
- build teaching skills to enable graduates to engage in health promotion and outreach activities.
Institution wide training to increase advocacy and provision, combined with routine point-of-care screening for unmet need and community outreach, fosters a widespread positive attitude towards family planning. Horizontal integration into all programs and departments increases screening, opportunities for counselling and method initiation, and a greater rate of attitudinal and cultural shift.
Creating Community Level Demand for Family Planning
USHAPE graduates in turn go on to train and support generic health workers, teachers and village health teams. It is vital that these valuable and respected members of the community are able to explore and resolve any misinformation and cultural misconceptions prevalent in their communities.
The process comes full circle when these respected community members and health workers go on to talk to their communities, including engaging males and adolescents. They are also able to screen and refer women who have unmet family planning needs.
As the demand for family planning goes up, healthcare workers gain experience and motivation, and a growing cycle of supply and demand develops.
Invest in One, Invest in All!
USHAPE has been delivered a various sites across south west Uganda, by just a handful of Ugandan and UK Family Planning trainers. To date, hundreds of healthcare staff, village health workers and adolescents have received high quality health educational messages in interactive environments, which has led to increases in knowledge and skills.