Trainer`s Guide for 2-Day Basic Sangini Training
Contents
1. Heavy bleeding Severe headache Severe lower abdominal pain Depression USAID NEPAL w Heavy Bleeding Identify cause of heavy bleeding Give OC Nilocon White or Sunaulo Gulaf 1 tab per day for 3 weeks If not recovered then refer to Doctor S USAID NEPAL Who can use Sangini injection 15 to 49 years women who are not pregnant Woman who can not use contraceptives containing oestrogen such as combined oral pills who is over 35 and smoker who neither want to have more children nor want to do permanent operation Who are not satisfied with other methods Who wants to keep privacy Who wants to use reliable and easier method Who are or have been anaemic who are HIV whether or not on anti retroviral medication USAID NEPAL w Side Effects of Sangini Irregular bleeding and spotting within first 3 to 6 months of menstruation may stop menstruation after using 9 to 12 months Headache Depression Weight gain USAID NEPAL Management and Treatment of Sangini Side Effects Light bleeding Spotting Inform client that light bleeding spotting is normal at the beginning and it does not effect health Ifclient is not comfortable give one packet OC Sunaulo Gulaf of Nilocon White S USAID NEPAL Amenorrhoea Inform that amenorrhea while using Sangini is normal side effect and does not require to do pregnancy test Brief on benefits to health if menstru2. Hand washing e Proper disposal of sharps and waste management USAID NEPAL Session Content e Overview of Infection Prevention What is Infection Prevention Objective importance e Hand washing e Disposal of sharps and waste materials USAID NEPAL Objective The main objective is to protect clients patients service providers and other staff from transmission of any kind of communicable diseases while providing service USAID NEPAL How do you feel this facility Hand Washing Why is hand washing important USAID NEPAL USAID NEPAL Simple Hand Washing Procedure Hand Washing Procedure Wet both hands K with clean water Rub both hands A with soap and e Simple hand washing water for 15 30 e Alcohol hand rub seconds Rinse with clean water Soak with clean towel or dry air USAID NEPAL USAID NEPAL Alcohol Hand Rub What do you service providers do in e Mix 2ml glycerin in 100 ml Rectified Spirit 60 90 to your Sangini Clinic Facility now prevent cracks in hands Take 3 5 ml or one tea spoonful rectified spirit with Set imani mesnin counter indie ekine glycerin Equip with bucket with tap bucket soap and clean towel Rub in both hand until it dries If water not available prepare rectified spirit solution mix Alcohol hand rub is not appropriate if hands are visibly with glycerin as mentioned above soiled they must be washed with soap and water Practice hand
3. USAID NEPAL FROM THE AMERICAN PEOPLE w E san Ona oe Trainer s Guide ure fodi A Trainer s Guide for Two Day Sangini Basic Training VW Rta Sas Sam a Contents Participants Learning Objectives Training Approach Training Materials Participants Trainers Course Duration Evaluation Methods Course Schedule Introduction of participants Clarification on Participant Expectations Overview of Training and Setting Ground Rules Pre test of course USAID Population Policty Training materials Power Point slides Session One Population and Family Planning in Nepal Session Two Basic Facts of Sangini DMPA Session Three Concept of Quality Assurance Session Four Counseling and Informed Choice Session Five Screening Assessment Session Six Infection Prevention IP Session Seven Sangini DMPA injection Administration Session Eight Sexually Transmitted Infection STI Session Nine Self Assessment Session Ten Product distribution and role of Sangini Network members Audio ViSUal SHOW wicicssissnacdnaincwdinsctiwienecndinenneaaneme lO POSt Test OF COUISE isis vivcnssaressiarcnenidanssasieruneiianinsesbened CIOSING OF THRAMMNG iissssisidesnancncaincckindnassasassanseaweee aide ko Chapter II D sisssidsisssvnciienidccdsediedieasniadicsnstereentccesewsesicensicniees lO Power Point Presentation of each session PREM GS scacicastnucccciiacvessoumisiasrcsstapiecisensnr
4. abdominal pain severe depression Correctly explain what to do if the client experiences a warning sign Ask the client to repeat all instructions in her own words NA Steps Encourage the client to return anytime she has any questions or problems and to return immediately if she has any of the warning signs above Politely say goodbye to the client and invite her him to return again Observation Checklist for Sangini DMPA Clinical Skills To be completed by participants Instructions Each task activity is observed using the following rating scale Needs improvement Step or activity not performed correctly and or was out of sequence if a sequence is required or was omitted Competently Performed Step performed correctly in proper sequence but participant didn t progress from step to step efficiently Proficiently Performed Step efficiently and precisely performed in proper sequence if a sequence is required Participant Course Date Sangini DMPA Clinical Skills Observation 1 2 34 Activities Steps Step 1 Getting Ready Gather necessary equipment Check expiry dates on Sangini DMPA vial Position the client appropriately Step 2 Preparing the injection area Wash hands with soap and water and dry hands Clean skin with cotton and rectified sprit alcohol wiping with a circular motion moving outwards from the injection side Allow skin to dry before giving the inject
5. counseling is on the feelings and needs of the client Sangini DMPA is composed of estrogen Mechanism of action of Sangini is only inhibition of ovulation The standard dose and schedule for Sangini DMPA is 150mg every 8 weeks The dose of Sangini DMPA depends on the weight of the client Sangini can be initiated anytime that pregnancy is ruled out You may safely give a subsequent Sangini DMPA injection to a woman who comes back 14 weeks after the previous injection N IN XK XXIX S After completing the cycle woman should wait another 5 days to continue subsequent cycles of Pill x If the chosen contraceptive method is not available for the client give the contraceptive method whichis available in your facility A good quality for a counselor is to listen attentively Hand washing is the most important practice in infection prevention To properly dispose of used disposable needles and syringes the needles should be recapped and thrown into the garbage Condoms are highly effective in preventing pregnancy The most common side effect of Sangini DMPA injection is changes in menstrual cycle Depo provera Sangini is the trade name for depot mexdroxy progesterone acetate Vomiting is not a possible side effect of emergency contraception A new oral contraceptive user should begin taking her first pack of pills within the first 7 days of her menstru
6. egg can not travel from ovary to uterus Can be performed anytime if client is not pregnant Small incision is made in the lower abdomen for this operation Can be done right after delivey as well w USAID NEPAL Advantages i C Very good method for those who do not need children Performed with simple and small surgery Highly reliable Once operated it is for life long USAID NEPAL Disadvantages e Very difficult for re canalization Required trained manpower Do not protect STI and AIDS Aiet Natural Family Planning methods Advantages Independent of supplies and disruptions Can be used in conjunction with more effective methods during fertile periods No significant side effects Involves close attention to body s natural signals or functions e g breast feeding Encourages close cooperation and communication with partner USAID NEPAL Disadvantages Less effective especially with typical use Requires cooperation in husband and wife Many misconceptions regarding fertile period viet Classification of Emergency Contraception Ss Conditions to use ECPs Emergency Contraceptive Pill ECP Intra Utewrine Copper Device UCD USAID NEPAL Useful when contraceptives are not used or used incorrectly Forget to take Pills continously for 3 days Delay of Depo DMPA more than 14 days Miscalculation of periodic abstinence method Ejaculation in
7. for women having menstrual cycle vite USAID NEPAL Advantages Other advantages Highly effective safe easy Decreases chances of to use and reversible Effective for 3 months Privacy Useful for lactating mothers Can be used by woman over 35 years who smoke Decrease PID Beneficial for anaemic woman conception outside uterus Protects against endometriosis ovarian cyst ovarian cancer uterine fibroid lumps in breast etc dite USAID NEPAL Disadvantages Changes to menstrual bleeding are common and cause anxiety but are not harmful Irregular and heavy bleeding for some women until 6 months of use Menstrual periods often stop completely after 9 to 12 months of use Return of fertility can be delayed after stopping injection 10 months on average from last injection Some women experience headache generally mild and depression at the beginning Weight gain is likely using depo Provera Most side effects are most marked at the beginning and diminish or disappear with time Do not protect from STIs Aft and AIDS S USAID NEPAL gt w Who should take precaution when using Sangini Pregnant and doubt for pregnancy Lumps in breast Abnormal bleeding during menstruation Clinically apparent liver disease Poorly controlled high blood pressure Diabetes Severe headache Depression USAID NEPAL Warning Signs The followings are the conditions which may require immediate treatment
8. from syringe An advantage of condoms is a They never break or tear b They are inexpensive and generally available c Any type of lubricant can be used with them d They are less effective in preventing pregnancy The most common side effect of Sangini DMPA injection is a Changes in menstrual cycle b Severe migraine headache c High blood pressure d Jaundice and liver damage Depo Provera Sangini is the trade name for a Combined oral contraceptives pills b Depot mexdroxy progesterone acetate c A brand of mini spermicidal pills d Progestin only mini pills Which of the following is not a possible side effect of emergency contraception a Nausea b Amenorrhea c Menstrual spotting d Vomiting Anew oral contraceptive user should begin taking her first pack of pills a Within the first 5 days her menstrual cycle b Only on the first day of her menstrual period c When she finishes her menstrual period d Whenever it is convenient for her A possible sign of STI in a woman is a Leg ulcer with swelling b Chest pain with shortness of breath c Absence of period d Lower abdominal pain Emergency Contraception Can prevent pregnancy Not useful if woman is already pregnant Aborts established pregnancy Can be used continuously Post course answers Note answers are in italics Family Planning counseling is a Giving information on the benefits of family planning b Promoting the use of family
9. injection Within 7 days of mensturation Ensuring that she is not pregnant Ifshe is using LAM less than 6 months and has not returned her monthly bleeding then any time between 6 weeks and 6 months if her monthly bleeding has not returned or Just before she starts weaning the baby and stops exclusive breast feeding or diet USAID NEPAL w When to start Sangini first injection Ifshe is exclusively breast feeding but interested in using Sangini for additional protection then she can take injection after 6 weeks of delivery If she is not a lactating mother she can take injection as soon as 3 weeks after delivery soon after or within 7 days of abortion w S USAID NEPAL What is Sangini Sangini trade name for Depot Medroxy progesterone Acetate 150 mg Prevents conception for 3 months Effectiveness is 99 7 percent when taken in every 3 months USAID NEPAL Time interval for Sangini injection Every three months But can also be administered 2 weeks before to complte 3 months and 2 weeks after completion of 3 months USAID NEPAL When to start Sangini first injection Ifshe is using LAM more than 6 months and has not returned her monthly bleeding then it can be administered anytime it is reasonably certain she is not pregnant she will need a back up method for first 7 days after the injection if her monthly bleeding has returned she can start as advised
10. participants to practice injection Make available two sets of required materials like auto disable syringe Sangini vial antiseptic rectified spirit and cotton balls Discuss in panel their experiences and clarify questions if they have any Make sure that syringes needles cotton wipes are disposed of correctly Training Materials The Training materials are Sangini learning guide soap with a soap dish towel glycerin and water auto disposable syringe vials with water rectified spirit cotton balls in a container and puncture proof container Make sure two sets for injection supplies are available for injection practice Time Allocation 20 minutes for video show and demonstration 55 minutes for participants return demonstration discussion and clarification Session Evaluation Re demonstration Session Eight Sexually Transmitted Infection STI Time required 30 minutes Objectives By the end of the session participants will be able to Identify common Sexually Transmitted Infections Define syndromic approach Treat urethral vaginal discharge and PID Identify referral cases for further treatment Content This session covers the following topics e Definition Syndromic Approach Identification of common STIs Treatment Referral Training Approach Brief in aforesaid topics using the Power Point presentation Use a participatory approach Training Materials The Training materials are Sangini referenc
11. percent effectiveness in case of Postiner 2 gt USAID NEPAL How and How much to use ECP First dose Within Second dose 120 hrs of unsafe 12hrs after sex first dose Name of Pills Nilocon White or cece ecco Sunaluo Gulaf 4 tablets 4 tablets Postiner 2 e e 1 tablet 1 tablet Postiner 2 eo Conventional dose 2 tablets S USAID NEPAL Thank You USAID NEPAL How does ECP work Delays release of an egg from the ovary by several days Block fertilization of ovum Does NOT work if sperm and ovum have already implanted in the uterus aie USAID NEPAL w What kinds of ECPs are available in Nepal Postinor 2 Combined Oral Contraceptive Pills Nilocon White and Sunaulo Gulaf USAID NEPAL w EC within 5 days of unprotected sex The uncertain pregnancy can be prevented inserting IUCD if woman has unprotected sexual intercourse with in 5 days Woman can continue IUCD if she wants USAID NEPAL Session Two Basic Facts of Sangini Depot Medroxy Progesterone Acetate DMPA USAID NEPAL Session Content Definition Mode of Action Advantages Disadvantages Indication and Precaution Warning signs Common side effects and management USAID NEPAL Mechanism of Action Suppress ovulation Thickens cervical mucus Change endometrium It acts after 12 hours of injection USAID NEPAL s When to start Sangini first
12. prevention Help the client make a decision Explain to the client how to use the chosen method aie USAID NEPAL Steps of Counseling ABHIBADAN NA Steps Encourage the client to return at anytime she has any questions or problems e Politely say goodbye to the client and invite her him to return again USAID NEPAL Day End Thank You S USAID NEPAL w Content Client assessment Infection Prevention Sangini DMPA administration Sexually Transmitted Infections Self assessment CRS distribution system and role of Sangini members S USAID NEPAL USAID NEPAL Ss Thank You Session Five Client Assessment USAID NEPAL USAID NEPAL S Session Content What is Client Assessment What is client assessment It is a process to determine client is pregnant or Objective not eligible for chosen method or not for How to be Reasonably Sure that a Client is NOT contraceptive use Pregnant Clinical Assessment Afiat S USAID NEPAL USAID NEPAL How to be reasonably sure that the client is Objective NOT pregnant You can be reasonably sure that the client is not pregnant if The objective of client assessment is to determine she has no symptoms of pregnancy and has not had intercourse since last menses has been correctly and consistently using another reliable Client is not pregnant method is within the first 7 days after the start of her menses is within 4 week
13. washing before and after sangini injection Should wash with soap and water in every 5 10 alcohol hand washing diet USAID NEPAL USAID NEPAL w Disposal of Sharps and Waste Management Objectives To prevent infection To protect from accident and injury caused by waste Keep healthy environment at working site Sangini clinic Prevent odour produce from waste Prevent problems from flies insects mouse dogs and other animals attracted by waste USAID NEPAL USAID NEPAL Disposal of Sharps Dispose soiled needle and syringe into puncture proof container right after use e General or non ty A Do not bend or separate needle syringe contaminated waste Ifyou play them it increases risk A Grea aE our PPC in the convenient place near to service delivery Most of the accidents from injection occurs after injection and before disposal of sharps Do not keep PPC with full of sharps Dispose it when it is filled with 2 3rd space Types of waste Afo USAID NEPAL USAID NEPAL Types of PPC Session Seven Sangini DMPA Injection Administration USAID NEPAL Ss Steps of Sangini Injection Step 1 Getting Ready Gather necessary equipments Check expiry dates on Sangini DMPA vial Position the client appropriately USAID NEPAL Step 3 Preparing the injection e Shake the vial of Sangini thoroughly and gently Remove plastic cover from vial without touching the rubber stopper Open
14. Hobby Clarification on Participant Expectations Time required 30 minutes Objective Clarify participant expectations and course objective Approach Trainer will distribute a meta card and a marker to each participant and ask them to write their expectations from the 2 day training Allow them 5 minutes to write their expectations Collect all the Meta cards from participants and pin them on soft board Clarify their expectations and course objectives Training materials soft board marker pen meta cards masking tape or thumb pin _ Q j Q 0 C U 2 i Overview of Training and Setting Ground Rules Time required 15 minutes Objective Discuss course objectives agenda and course materials and set ground rules Approach Brief on course objective and agenda using power point Share course materials Ask participants for their ground rule recommendations so that a learning environment is created Set three to four major ground rules discussing and obtaining consensus from participants Training materials Prepared slide or flip chart paper with course objectives Pre test of course Time required 15 minutes Objective To assess the knowledge level of participants in relevant topics Approach Distribute the pre course questionnaire ask participants to respond without interchanging ideas with their colleagues Inform them that it is not important if they do not know the answers They are here to lea
15. ID NEPAL USAID NEPAL Recording and Reporting How to fill up Sangini Logbook ren here ewe we tn oot ee USAID NEPAL USAID NEPAL USAID NEPAL USAID NEPAL Thank You USAID NEPAL Session Content Define Clients Right and Providers Need e Importance of Quality in Sangini Service Deliver G USAID NEPAL Advantages of Quality FP service Increases in clients flow in the clinic Satisfies clients in service provided Increases self satisfaction in service providers Recognizes name of clinic Strengthens relationship between client and service provider Provides safe service Helps clinic to be independent and sustainable USAID NEPAL USAID NEPAL Session Three Concept of Quality Assurance USAID NEPAL K What is Quality in FP service Clients get full information and counseling from trained service providers so they are able to chose contraceptives by themselves in quality FP service delivery Fulfills client s expectations and needs based on their interest medical standard available resources and environment In addition it also attracts potential clients Fulfills client s rights and service provider s needs S USAID NEPAL Ss Client s Rights Service Provider s Needs Information Accessibility to service Informed choice Safety Logistics supplies and proper place for service delivery Management and Privacy and confidentiality superv
16. Norplant Depot Medroxy progesterone Acetate DMPA Sangini USAID NEPAL Condom Condom is only one temporary contraceptive for male 98 effective when use properly USAID NEPAL Group Discussion USAID NEPAL Advantages Not only for Family Planning but also prevents sexually transmitted infections like AIDS HIV Easily accessible and use Cost effectiveness and cost benefit Disadvantages Few people complain on sexual dissatisfaction Can break if not used properly and that decrease in it s effectiveness Require to use new condom in each sexual contact USAID NEPAL Oral Contraceptives Pills Composed of both estrogen and progesterone hormone Effectiveness 99 Mechanism of Action Suppress ovulation Thickens cervical mucus Change endometrium USAID NEPAL Advantages e Effective Easy to use Do not interfere with intercourse May improve anaemia and protect against some cancers Decrease menstrual bleeding in both volume and time period Decrease menstrual cramp Regular menstruation Disadvantages Required to take each day May have some minor side effects Is not appropriate for breast feeding mothers women who are fully breastfeeding a baby less than 6 months of age Is not appropriate for woman who smokes more than 10 cigarettes a day and is over 35 years oie S USAID NEPAL Mechanism of Action of Hormonal Metho
17. Verbal questions and answers Session Seven Sangini DMPA injection Administration Time required 75 minutes Objectives By the end of the session participants will be able to e Describe steps of Sangini injection e Demonstrate simple hand washing e Administer Sangini injection correctly Content This session covers the following topics e Steps for Sangini injection e Administering Sangini injection Getting ready Preparing the injection area Preparing the injection Post injection task Training Approach Demonstrate Sangini injection step by step on the arm model Show the video film on administration of Sangini injection including hand washing Encourage participants to use a personal towel to dry hand as much as possible and not to share the towel Air dry if a clean towel is not available Rub hands with alcohol if water is not available Discuss how hand washing practice can be improved at their work site Ask participants for return demonstration Divide participants into two large groups Each trainer handles each group Conduct two practical sessions simultaneously In each group one participant will act as a service provider another will act as a client and the rest are all observers The observers should act as coaches guiding the process according to the learning guide provided to them Participants should be given adequate time for repeated practice to achieve competency Provide an opportunity for all
18. act card and in the logbook Training Materials Training materials are Sangini Logbook Contact Card Sangini brochure flip chart paper marker and LCD PP presentation Session Evaluation Verbal questions and answers Audio visual show Time required 30 minutes Objective To reinforce the QoC in service provided by Sangini network members Approach Show video films and hold a discussion Clarify any queries participants might have Training materials CD Laptop LCD Screen Post test of course Time required 10 minutes Objective To assess the level of knowledge of participants in relevant topics after the training Approach Distribute the post course questionnaire ask participants to respond without interchanging ideas with their colleagues Share pre and post test results Clarify if participants have common mistakes Material Post course questionnaire Training Evaluation Time required 10 minutes Objective To get feedback for improvement of the next training Approach Distribute the evaluation questionnaire ask participants to respond without interchanging ideas with their colleagues Material Evaluation questionnaire Closing of Training Acknowledge all participants trainers and organizers Distribute certificates to participants Power Point Presentation of each session DAY 1 USAID NEPAL Two day Sangini Basic Training aie USAID NEPAL Training Objective e P
19. al cycle A possible sign of STI in a woman is lower abdominal pain XINI xX X N NIN XK TN OINY X Emergency Contraception can abort established pregnancy Post course questionnaire Family Planning counseling is a Giving information on the benefits of family planning b Promoting the use of family planning methods c A two way communication between counselor and client that focuses on the client s needs and feelings and that helps the client make decisions about the best methods of contraception Objective and honest advice from the provider about which method the client should use The main focus of family planning counseling is on the a Feelings and needs of the client b Methods that are available in the pharmacy c Rules and regulations of the clinic d Family planning program and its objectives Good qualities for a counselor are a Listening attentively b Encouraging the client to ask questions c Using positive non verbal communication d All of the above Sangini DMPA is composed of a Estrogen only b Progesterone only c A combination of estrogen and progesterone d None of the above Mechanism of action of Sangini is a Inhibition of Ovulation b Thickening of cervical mucus c Atrophic endometrium d All of the above The standard dose and schedule for Sangini DMPA is a 150mg every week b 100mg every 12 weeks c 150mg every 8 weeks d None of the ab
20. amily planning services methods and procedures Afio USAID NEPAL w No Incentives or Financial Rewards Individuals may not be offered incentives for becoming an acceptor Program personnel may not receive incentives for achieving a target or quota of acceptors USAID Clarification Provider payments violate the amendment only when payment is based on a quota or target set as a predetermined number Permitted Small value items given to providers special training opportunities Per case payment to providers if number not predetermined Standard commercial discounts in social marketing programs FUGI S USAID NEPAL w Comprehensible Information Clients must receive comprehensible information about risks benefits side effects and contraindications of their chosen method Clarification Comprehensible does not guarantee information is comprehended Information should be provided in accordance with local standards Requirements can be met through counseling posters and or package inserts S USAID NEPAL The Tiahrt Amendment A 1999 amendment to the US Foreign Assistance act to ensure that international family planning programs receiving USAID funding operate in a voluntary manner Applies to Family Planning service delivery projects Funds technical assistance commodity assistance Governments NGOs and commercial partners USAID NEPAL No Quotas or Targets Prohibits use of numer
21. angini DMPA injection to a woman if incase she comes back at a 10 weeks after the previous injection b 12 weeks after the previous injection c 14 weeks after the previous injection d All of the above During menstruation a woman is a Most likely to become pregnant b Can not undergo for sterilization c Should wait for 7 days before starting contraceptive pills d Can safely use Sangini DMPA If the chosen contraceptive method is not available for the client Refer client to a facility where the chosen method is available Give a contraceptive method that is available in your facility Do not give a contraceptive method Do not say anything Hand washing Is the most important practice in infection prevention Is not necessary after removing gloves Cannot be done if there is no running water in the facility No need to wash hands TO properly dispose of used disposable needles and syringes the needles should be a Recapped and thrown into the garbage b Bent or broken c Disposed of in puncture proof container d Flushed with water and removed from syringe An advantage of condoms is a They never break or tear b They are inexpensive and generally available c Any type of lubricant can be used with them d They are less effective in preventing pregnancy The most common side effect of Sangini DMPA injection is a Changes in menstrual cycle b Severe migraine headache c High blood press
22. ant Clinical Assessment Training Approach Explain client assessment and its objectives Discuss on how to screen client using job aid How to be reasonably sure that client is NOT pregnant using Power Point and Job Aid Explain the clinical criteria to assess whether client is eligible for Sangini injection Training Materials The Training materials are Job Aid How to be reasonable sure that client is NOT pregnant laptop LCD Session evaluation Verbal questions and answers Session Six Infection Prevention IP Overview of Infection Prevention Time required 15 minutes Objectives By the end of the session participants will be able to e Define infection and prevention e Describe infection prevention objectives e Explain the importance of infection prevention Content This session covers following topics e Overview of Infection Prevention What is Infection Prevention Objectives Importance e Hand washing e Disposal of sharps and waste materials Training Approach Define infection prevention briefly and describe its objectives using Power Point e Definition and Objectives e Importance of Infection Prevention Describe using lecture method the role of IP in reducing post procedure infection and minimizing the risk of Hepatitis B Virus and HIV AIDS transmission Explain the importance of IP Training materials The Training materials are Sangini reference manual for service providers PP presentation LCD l
23. aptop trainers guide Hand Washing Time required 10 minutes Objectives By the end of the session participants will be able to e Explain the purpose of hand washing e Describe the hand washing process Training Approach Discuss why hand washing is important When to wash hands How to wash hands e Simple hand washing e Alcohol hand rub Note Demonstration for the hand washing is in the next session Training Materials The Training materials are Sangini Manual powerpoint slides trainers guide Disposal of Sharps and Waste Management Time required 20 minutes Objectives By the end of the session participants will be able to e Identify the different types of waste e Describe various waste disposal methods e Demonstrate how to use a puncture proof container Training Approach Ask participants the following questions What does waste management mean in your opinion How is waste disposed in pharmacies and clinics Brainstorm on waste management for a private clinic Then show the Power Point presentation on waste segregation of waste and management of different types of waste Discuss waste disposal whether burial or burning would be more feasible to pharmacies or clinics Demonstrate how to use puncture proof container Training Materials Training materials are Sangini reference for service providers waste bucket with cover puncture proof container and utility gloves Session Evaluation
24. ased on complete information obtained Client obtains complete information through good counseling which helps him or her to be able to decide voluntarily on his or her own interest Aiat gt USAID NEPAL Strategies to support Informed Choice Provide information on a variety of methods Conduct in a private comfortable setting that fosters trust Focus on client s needs Adhere to client s rights and social equality Exhibit respect and mutual understanding S USAID NEPAL Steps of Counseling ABHIBADAN A Step e Greets the client e Offer the client a seat e Ask the client why she has come to the clinic Steps of Counseling ABHIBADAN BHI Steps e Obtain Medical History relevant to methods woman is interested in Diabetic Jaundice Heart Disease Obtain Menstrual History LMP Menstrual pattern duration scanty heavy vite USAID NEPAL i s Steps of Counseling ABHIBADAN DA Step e Correctly explain the warning signs e Correctly explain what to do with the client s experiences a warning sign e Ask the client to repeat all instructions in her own words oie Role play on Counseling S USAID NEPAL Two day Sangini Basic Training Day II S USAID NEPAL Steps of Counseling ABHIBADAN BA Steps Tell the client about method available mode of action advantage disadvantage and side effects STD and HIV infection
25. ation stop S YSAID NEPAL USAID NEPAL Monitoring of Sangini clients Questions that need to be asked during follow up or next visit Never forget that Sangini should be taken every 3 months Provide contact card to client mentioning date for next Are you satisfied with Sangini injection injection Have you ever experienced it s side effects Remind client again to come back in the day and date mentioned in contact card Incase client could not come back on same date it can be given within 2 weeks of that very date Do you have any queries on Sangini When did you have your first injection When did have your last injection diet USAID NEPAL USAID NEPAL Solutions Storage of Sangini She can continue Sangini to prevent unwanted pregnancy if she answered yes Manage side effects appropriately if she has Clarify her queries if she has any and if could not solve her queries refer to higher level rack cupboard Protect it from direct sun and keep Give Sangini injection if she came in right day as recorded Keep in upward direction so that it can be dissolved in contact card If she came either before or after due date easily take necessary action as per suggestion Required quantity of Sangini should be balanced estimating a number of clients visit in clinic Check for expiry date Do not use expired Sangini Always read Sangini instruction sheet when store it Keep Sangini in cold but dry place and in clean USA
26. ays training utilizes the following approaches Mini lecture Brain storming Group discussion Group exercise Role play Demonstration and return demonstration Training Materials Following training materials are mainly used Flip chart papers and markers Sangini Trainer s Guide Sangini DMPA as well as other contraceptives and arm models Job Aid for pregnancy rule out Penis model Audio Visual CD Laptop LCD Posters flip charts Reference Manual for Sangini Service Providers Participants Ideally there will be 15 to 20 participants in each session Participants for this course are technicians Health Assistants Staff Nurses Auxiliary Nurse Midwives Auxiliary Health Workers and Community Medicine Auxiliaries CMA working in Sangini Franchised Health Clinics or outlets Trainers This training course is handled by two experienced trainers who are trained on Clinical Training Skills CTS Course Duration The course is for 2 full days from 9 30 AM to 5 00 PM 12 hours in total Evaluation Methods Two kinds of evaluation take place One is evaluation of participants before and after the course and another is evaluation of the entire course e Pre post and final evaluation questionnaire Time Period Course Schedule Activities 09 00 9 15 Opening Welcome 9 15 9 30 Introduction of participants 9 30 10 00 Clarification on participant expectations 10 00 10 15 Overview of tra
27. ds Suppression of hormones responsible for ovulation thus suppressing ovulation Thickening of cervical mucus thus blocking sperm USAID NEPAL Managing missed Pills continue If missed one or two pills Take a missed Pill as soon as possible Continue taking pills one each day If missed three or more Pills in the 1st or 2nd week Take a hormonal pill as soon as possible e Use a back up method for next 7 days e If she had sex in the past 5 days can consider ECPs viet USAID NEPAL w Managing missed Pills If missed three or more Pills in the 3rd week Take a hormonal pill as soon as possible Finish all hormonal pills in the pack Throw away the USAID NEPAL w Norplant Six thin flexible capsules are inserted just under the skin It has progesterone hormone Mechanism of action is same as the oral pills Works for 7 years Effectiveness 99 7 non hormonal pills iron tablets Start a new pack the next day Use a back up method for next 7 days If she had sex in the past 5 days can consider ECPs puni USAID NEPAL Jedelle Jedelle is two rods implant Is kept in V shape in arm as Norplant Works for 5 years It has progesterone hormone Mechanism of action and side effects are same as that of Norplant Generally easier to insert and remove Advantages Disadvantages Highly reliable m Irregular bleeding but no Easy to use any risk Long term method Do n
28. e has side effects or Wash hand thoroughly with soap and water problem with bleeding Instruct client about warning signs and need to return to clinic USAID NEPAL gt USAID NEPAL i w Thank You Session Eight Sexually Transmitted Infection STD Afi S USAID NEPAL USAID NEPAL w Session Content What is Sexually Transmitted Infection STI Definition Sexually Transmitted Infections are infectious diseases Syndromic Approach that are transmitted through Identification of common STI e Unsafe sexual contact with infected person Treatment Infected blood and blood products Referral Using un sterilized needles and equipments Infected mother to newly born baby G USAID NEPAL USAID NEPAL Types of STIs Based on discharge Genital Ulcer Bacterial Vaginosis Chancroid Candidiasis Syphilis Trichomoniasis Lymphogranulama Gonorrhoea Venereum Chlamydia Granuloma Inguinale Genital Herpes Herpes Genitalis Genital Wart HIV AIDS SYSAID NEPAL Primary syphilis chancre of anus USAID NEPAL LGV lymphadenopathy USAID NEPAL W Welcome E Encouragement to talk L Look at the patient L Listen carefully History taking Physical examination Syndromic treatment Chancroid Male regional adenopathy S USAID NEPAL Congenital syphilis Secondary syphilis perforation of palate USAID NEPAL w Syndromic Treatment The syndromic treatment follows
29. e manual for service providers PP presentation LCD laptop flip chart paper marker and masking tape Session Evaluation Verbal questions and answers Session Nine Self Assessment Time required 30 minutes Objectives By the end of the session participants will be able to e Define self assessment e Explain the importance of self assessment e Understand self assessment techniques Content This session covers the following topics e Definition e Importance e Process Training Approach Briefly explain in a short mini lecture the above mentioned topics using the Power Point Presentation and the self assessment checklist Training Materials The Training materials are self assessment checklist flip chart paper marker PP presentation Laptop and LCD Session Evaluation Verbal questions and answers Session Ten Product distribution and Role of Sangini Network members Time required 30 minutes Objectives By the end of the session participants will be able to e Understand the CRS product distribution channel e Understand the role of Sangini Network members e Do Recording reporting Content This session covers the following topics e Distribution channel of CRS products e Role of Sangini Network members e Recording reporting Training Approach Use the Power Point Presentation Provide participants with the Sangini Logbook contact card and brochure Ask participants write their names on the cont
30. ed choice Show the Clients Rights poster and explain why it is necessary to display in their clinic Training Materials The Training materials are Sangini service providers reference client s rights poster flip chart paper marker PP presentation and laptop LCD Session Evaluation Observing the activity during group work and occasional verbal questions and answers Session Four Counseling and Informed Choice Time required 90 minutes Objectives By the end of the session participants will be able to Describe counseling and informed choice Describe principles of counseling List steps of counseling Perform counseling using ABHIBADAN approach Describe importance of counseling Content This session covers the following topics Definition Principles Steps ABHIBADAN Approach Importance Training Approach Ask participants to brainstorm on what is counseling and informed choice and discuss briefly Correct the supplementary information given by participants Briefly describe the following topics using Power Point e What is counseling and informed choice e Principles of counseling e Importance of counseling Show a video on counseling or demonstrate by trainers for the steps of counseling and discuss on it Then conduct a role play on counseling for Sangini using ABHIBADAN approach Make a group of three persons Assign one participant to become a client who is visiting a Sangini Outlet for FP se
31. eerie He Pil Gre RMereryrrrererrerrer err rrr rrr rrr rrr i rrrrirer eri rr rr iii errr ee Observation Checklist for Sangini DMPA Counseling PUTO ecivccisvsins E T A E E i Observation Checklist for Sangini DMPA Clinical Skills ANNEX V oidertiidirrbkersir n in n ei Aakn eane nee Course Evaluation Introduction Course Description This training course is designed for service providers nurses pharmacists and other paramedics It includes basic information on the benefits of family planning and birth spacing methods available in Nepal and a brief chapter on Sexually Transmitted Infections STI and prevention of HIV AIDS Sangini DMPA Depot Medroxy Progesterone Acetate is discussed in depth including essential knowledge based service provision skills and management counseling clients managing problems referrals and infection prevention practices A participatory and task oriented training methodology includes small group discussion demonstration practice and role play Pre Post test and learning guides are included to aid the trainer in training evaluation Course Goal The major goal of this course is to train participants as quality Family Planning service providers Course Objectives This course has the following objectives e Positively influencing participant attitudes towards various family planning methods e Providing participants with skills for counseling so that they are able to assist client in making an
32. ginal pessary each night for 3 nights GiGi USAID NEPAL Lower Abdominal Pain Syndrome in Women continue Patient complains of lower abdominal pain Take history Examine abdomen amp Do bimanual examination Missed or overdue period or Recent delivery abortion or Abdominal guarding or USAID NEPAL Lower Abdominal Pain Syndrome in Women Fever gt 38 degree celcius or vaginal discharge l yes Treat for PID 4Cs Follow up in 3 7 days or sooner if necessary E USAID NEPAL Thank You USAID NEPAL Session Content Definition e Importance e Process USAID NEPAL Why is self assessment important It is a part of quality improvement Satisfies clients Increases client flow in the clinic Increases self satisfaction USAID NEPAL Recommended Treatment Treatment for Outpatient Cefixime 400 mg single oral dose or Ceftrixone 250 mg IM single dose plus Doxycycline 100mg 2 times daily for 14 days Azithromycin 1g oral single dose plus Metroniadazole 400mg three times daily for 14 days plus Fluconazole 150 mg oral single dose Afi S USAID NEPAL Session Nine Self Assessment S USAID NEPAL What is self assessment It is a process of assessment of own performance by own self with a help of self assessment tool to improve in quality service delivery USAID NEPAL USAID NEPAL Thank You USAID NEPAL Session Content e Dist
33. ical performance targets for providers and referral agents including numbers of births family planning acceptors and acceptors of a particular method Permits numerical estimates for planning Manufacturer distributor retailer sales targets permitted USAID Clarification Quota or target a predetermined number of births FP acceptors or acceptors of a certain method that a service provider or referral agent is required to achieve USAID NEPAL No Denial of Rights or Benefits Based on Decision not to Accept FP Examples Food assistance or health benefits not dependent upon accepting FP services Employment positions or privileges not limited to FP users Full Disclosure for Experimental Contraceptive Methods Experimental FP methods and procedures to be provided only in the context of a scientific study Client s rights to informed consent to participate in the study including the knowledge of the risks and benefits as well as other options for services must be ensured USAID Clarification USAID regulations on human subjects 22 CFR 225 provide necessary guidance USAID NEPAL Thank You S USAID NEPAL Session Content Introduction of Population and Family Planning Family Planning methods Emergency Contraception Natural Family Planning USAID NEPAL Knowledge and Use of Family Planning Couples willing for spacing or Sterilization 72 Method users 48 unmet
34. informed decision Sharing effective and standard infection prevention practices Teaching knowledge and skills needed for administration of pills condom Sangini DMPA and ECP Providing information on managing side effects and health problems related to method usage Standardizing up to date information on family planning methods and basic FP service management knowledge Participants Learning Objectives When they complete the training participants will be able to e Update clients on the benefits of family planning and list all family planning methods available in Nepal Describe their effectiveness advantages disadvantages how to use where to obtain and the cost of the methods available at franchised health outlets Counsel potential clients on contraceptive methods and empower them to make an informed decision Explain how Sangini DMPA prevents pregnancy Explain the indications and the common side effects of Sangini DMPA Apply standard infection prevention practices that minimize the risk of transmission of serious diseases such as Hepatitis B and HIV AIDS to clients and providers Q j Q U a U 2 i Manage simple side effects of Sangini identify and refer serious complication to higher centers Provide Sangini DMPA service from Sangini Franchised Health Clinics and manage Sangini logistics ordering and storing properly Keep records and report to NFCC and CRS staff Training Approach The two d
35. ining objective schedule and course materials Setting ground rule 10 15 10 30 Pre test 10 30 10 45 Short Break 10 45 11 00 USAID Population Policy 11 00 12 30 Session 1 Introduction of Population and Family Planning in Nepal 12 30 13 30 Lunch Break 13 30 15 00 Session 2 Basic facts of Sangini DMPA 15 00 15 30 Session 3 Concept of Quality Assurance 15 30 16 50 16 50 17 00 09 00 9 30 Session 4 Counseling amp Informed Choice Summary of the day Recap Day Two Agenda and Warm up 9 30 9 45 Session 5 Client Assessment 9 45 10 30 10 30 10 40 Session 6 Infection Prevention Short Break 10 40 12 00 Session 7 Sangini DMPA injection administration 12 00 13 00 Lunch Break 13 00 14 00 Session 8 Sexually Transmitted Infections 14 00 14 30 Session 9 Self assessment 14 30 14 40 Short Break 14 40 15 00 15 00 15 30 Session 10 Product distribution and role of network members Summary Video film show 15 30 16 00 Post test Course evaluation 16 00 16 30 Closing Detail Session Plan Introduction of participants Time required 15 minutes Objective Ice breaking among participants and trainers Approach Welcome all participants Participants will introduce themselves individually using following criteria Name the name they are addressed by Work place address Working experience
36. ion Step 3 Preparing the injection Shake the vial of Sangini DMPA thoroughly and gently Remove plastic or metal cover from vial without touching the rubber stopper Appropriately open the sterile pact containing AD needle and syringe attach the needle to syringe Insert needle thorough rubber stopper turn vial upside down and draw fluid into the syringe Remove the needle from vial hold the syringe vertically and gently force air bubbles out of the syringe using the plunger Step 4 Giving the injection Insert the needle into muscle deltoid on arm or upper outer quadrant of gluteal area Slowly pull back on plunger before injecting to check if needle is well place If there is no blood inject Sangini DMPA slowly and remove needle Step 5 Post Injection Task Apply pressure to injection area with cotton but do not rub Discard assembled needle and syringe into a puncture proof container Wash hands thoroughly with soap and water Step 6 Post Injection Counsel Client Instruction Instruct client to return for another injection in 12 weeks give exact appointment date on client s card Review side effects change in menstrual pattern headache dizziness weight gain breast tenderness Encourage clients to return if she has side effects or problem with bleeding Instruct client about warning signs and explain that she would need to return to clinic if she experiences heavy bleeding or delayed menstrual period after interva
37. ipants into five groups Assign each group one of the following assignments Group 1 Condom and Oral Pill Definition mode of action effectiveness usage advantages disadvantages Group 2 IUCD Definition mode of action effectiveness usage advantages disadvantages Group 3 Norplant Definition mode of action effectiveness usage advantages disadvantages Group 4 Emergency Contraceptives Definition and types when and how to use doses and effectiveness Ask them to discuss their topic in their group and write down the outcome on flip chart paper Then ask one of the group members to make a presentation Finally summarize the presentations made by participants highlighting important points Talk on male and female sterilization Demonstrate use of condom on penis model Ask one or two participants to do a redemonstration 60 minutes 10 min for group work 5 to 7 min for each group for presentation 25 min discussion summary and demonstration of condom by facilitator Natural Family Planning A brief Power Point presentation 10 minutes Coitus interruptus Calendar method Symptom Based Method Two day Standard Method Lactational Amenorrhea Method LAM Training materials Sangini trainers guide PP presentation poster flip chart FP real objects Penis model flip chart paper and marker Session Evaluation Observation of participants during group activity on their participation and content discussion que
38. ision Respect expression of Infection Prevention opinion and rest Training Continuity of service vite USAID NEPAL Thank You USAID NEPAL Session Content What is counseling and Informed Choice Principles of Counseling Importance of Counseling Steps of Counseling gt USAID NEPAL Sa Principles of Counseling Counseling is conducted in a respectful way using interpersonal communication process that seeks to understand the clients needs and personal circumstances Decisions are based on complete and accurate information and must be made free of pressure intimidation enticements coercion or incentives Enables client to recognize and use of individual rights The discussions during counseling must never be shared with other staff or visitors without client s consent to keep confidentiality Verbal consensus is required to ensure client made decision on their own knowing complete and accurate information on FP before providing FP method after USAID NEPAL Importance of Counseling Increase in number of satisfied clients Able to chose an appropriate method Use contraceptives effectively Increase in continue use or methods Eliminate rumor and negative attitudes S USAID NEPAL S Session Four Counseling and Informed Choice S USAID NEPAL gt w Counseling and informed Choice A process of two way communication which help client to be able to decide on his or her fertility b
39. l of regular periods Course Evaluation Please indicate your opinion rating on 1 5 scale in the following table 5 Strongly Agree 4 Agree 3 No Opinion 2 Disagree 1 Strongly Disagree S No Course Component Rating 1 The Pre course questionnaire helped me to study more effectively 2 The role play sessions on counseling skills were helpful 3 The practice session with the arm models made it easier for me to inject Sangini DMPA on the clients The interactive training approach used in this course made it easier for me to learn how to provide Sangini DMPA services Two days were adequate for learning how to provide Sangini DMPA service I feel confident in providing Sangini DMPA injection I feel confident about following infection prevention practices recommended for Sangini DMPA services The course made me feel more competent and skillful in my work The sessions were well organized The trainer used a variety of training methods Additional Comments use the backside of the paper if needed 1 What topics if any should be added and why to improve the course 2 What topics if any should be deleted and why to improve the course i 2 gt gt K O C C L
40. med in proper sequence if a sequence is required Participant Course Date Steps Tasks Observation A Step 1 2 Greet the client Offer the client a seat Ask the client why she has come to the clinic Assure client all conversations are kept confidential BHI Steps Obtain Medical History Diabetic Current or recent liver disease with Jaundice Heart Disease Severe headache Depression Obtain Menstrual History Starting day of the LMP Was this period on time and normal Is she currently using a method of family planning BA Steps Tell the client about available methods based on the clients knowledge about family planning including mode of action advantage disadvantage side effects degree of protection from STIs and HIV AIDS Sangini does not protect a woman from STIs and HIV AIDS Help the client make a decision by focusing on the potential side effects of the method she is considering for Sangini common side effects are significant changes in bleeding pattern probable eventual stopping of menses some headache and nausea which will get better with time and weight gain Correctly explain to the client how to use the chosen method DA Step Correctly explain the warning signs for Sangini there are very heavy or prolonged heavy bleeding repeated severe headache severe
41. need 24 DHS survey 2006 USAID NEPAL Advantages of Family Planning continue Decrease in Maternal Mortality Rate MMR MMR 281 per 100 000 live birth DHS 2006 Six women die in each day Awoman die in every four hour USAID NEPAL w Session One Introduction of Population and Family Planning in Nepal Ait USAID NEPAL w Population and Family Planning Population 26 000 000 Annual Growth Rate 2 23 percent Total Fertility Rate TFR 3 1 Target is to reduce TFR into 2 1 in by the end of 2017 AD Nepal Demographic and Health Survey 2006 S USAID NEPAL Advantages of Family Planning e Decrease in Infant and Child Mortality Rate Under 5 Mortality Rate 61 1000 live birth Infant Mortality Rate 48 1000 live birth Birth Spacing less than 2 years 2 years 3 years 4 years Child Mortality Rate USAID NEPAL Advantages of Family Planning continue Conditions of pregnancy that is risk to mother and child Pregnancy below 20 years Pregnancy after 35 years Multigravida more than 4 times Spacing less than 2 years Unsafe abortion for unwanted pregnancy Provides more resources to each planned child Ensures healthier and happier family life USAID NEPAL Family Planning Methods Permanent No Scalpel Vasectomy Male Sterilization e Minilap Female Sterilization Temporary Condom Oral Contraceptives Pills IUCD Copper T
42. ni DMPA injection to a woman who comes back 14 weeks after the previous injection After completing the cycle woman should wait another 5 days to continue subsequent cycles of Pill If the chosen contraceptive method is not available for the client give the contraceptive method whichis available in your facility A good quality for a counselor is to listen attentively Hand washing is the most important practice in infection prevention To properly dispose of used disposable needles and syringes the needles should be recapped and thrown into the garbage Condoms are highly effective in preventing pregnancy The most common side effect of Sangini DMPA injection is changes in menstrual cycle Depo provera is the trade name for depot mexdroxy progesterone acetate Vomiting is not a possible side effect of emergency contraception A new oral contraceptive user should begin taking her first pack of pills within the first 7 days of her menstrual cycle A possible sign of STI in a woman is lower abdominal pain Emergency Contraception can abort established pregnancy Pre course answer sheet Participants Name a v if the statement is true and tick X if the statement is false in the answer column S N Statement Answer Family Planning counseling is giving information regarding the x benefits of family planning The main focus of family planning
43. ot protect STIs Immediate return of Require trained provider fertility on removal for insertion and removal Can use after postpartum Do not available Can use by breast feeding everywhere women vite USAID NEPAL S USAID NEPAL IUCD Copper T 380 A Small flexible device made a Highly effective of plastic covered by copper Easy to use with English letter T shaped Long term benefit for 12 i Interfere with ability of years sao appropriato women sperm to pass through Do not interfere with susceptible to STIs and HIV uterine cavity and fuse with intercourse m May expel it spontaneously oviin Return fertility immediately Require trained provider for p on removal insertion and removal ag for 12 years once More appropriate for breast feeding women Effectiveness 99 6 ania suffering from hormonal side effect can use it Utter Advantages Disadvantages May occur heavy menstrual bleeding initially S USAID NEPAL S Male Sterilization No Scalpel Vasectomy Female Sterilization Minilap It is the vasectomy a simple operation done without using any scalpel by trained doctor The tubes leading from the testicles to the penis the vas deferens along which sperm travel is blocked After vasectomy men can work normally as before Does not affect in sexual pleasure Not effective immediately contraception or abstinence needed for 3 months continuously A small surgery By blocking fallopian tubes so that
44. ove 7 The dose of Sangini DMPA depends on a The age of the client b Parity of the client c Weight of the client d None of the above When to initiate Sangini a Within 7 days of menstruation b Anytime that pregnancy is ruled out c The 6 weeks post partum of breast feeding d All of the above You may give a subsequent Sangini DMPA injection to a woman if incase she comes back at a 10 weeks after the previous injection b 12 weeks after the previous injection c 14 weeks after the previous injection d All of the above During menstruation a woman is a Most likely to become pregnant b Can not undergo for sterilization c Should wait for 7 days before starting contraceptive pills d Can safely use Sangini DMPA If the chosen contraceptive method is not available for the client a Refer client to a facility where the chosen method is available b Give a contraceptive method that is available in your facility c Do not give a contraceptive method d Donot say anything Hand washing a Is the most important practice in infection prevention b Is not necessary after removing gloves c Cannot be done if there is no running water in the facility d No need to wash hands To properly dispose of used disposable needles and syringes the needles should be a Recapped and thrown into the garbage b Bent or broken c Disposed of in puncture proof container d Flushed with water and removed
45. planning methods c A two way communication between counselor and client that focuses on the client s needs and feelings and that helps the client make decisions about the best methods of contraception Objective and honest advice from the provider about which method the client should use The main focus of family planning counseling is on the a Feelings and needs of the client b Methods that are available in the pharmacy c Rules and regulations of the clinic d Family planning program and its objectives Good qualities for a counselor are a Listening attentively b Encouraging the client to ask questions c Using positive non verbal communication d All of the above Sangini DMPA is composed of a Estrogen only b Progesterone only c Acombination of estrogen and progesterone d None of the above Mechanism of action of Sangini is a Inhibition of Ovulation b Thickening of cervical mucus c Atrophic endometrium d All of the above The standard dose and schedule for Sangini DMPA is a 150mg every week b 100mg every 12 weeks c 150mg every 8 weeks d None of the above 7 The dose of Sangini DMPA depends on a The age of the client b Parity of the client c Weight of the client d None of the above When to initiate Sangini a Within 7 days of menstruation b Anytime that pregnancy is ruled out c The 6 weeks post partum of breast feeding d All of the above You may give a subsequent S
46. ribution channel of CRS product e Role of Sangini Network members e Recording reporting USAID NEPAL Role of Sangini Network Members gt USAID NEPAL Sangini Network Service Delivery Self evaluation Purchase Order S USAID NEPAL Session Ten CRS distribution system and Role of Sangini network members USAID NEPAL w Distribution channel of CRS products USAID NEPAL Recording Reporting How to fill Sangini Logbook USAID NEPAL NFCC Monitoring Support Visit gt am i USAID NEPAL USAID NEPAL CRS Monitoring Support Visit Video show and discussion Post test Course Evaluation Closing USAID NEPAL Day End Thank You Annex I Pre course questionnaire Participant s Name W v if the statement is true and tick X if the statement is false in the answer column S N Statement True False 1 Family Planning counseling is giving information regarding the benefits of family planning The main focus of family planning counseling is on the feelings and needs of the client Sangini DMPA is composed of estrogen Mechanism of action of Sangini is only inhibition of ovulation The standard dose and schedule for Sangini DMPA is 150mg every 8 weeks The dose of Sangini DMPA depends on the weight of the client Sangini can be initiated anytime that pregnancy is ruled out You may safely give a subsequent Sangi
47. rn and refresh their knowledge and skills Training materials Pre course questionnaire USAID Population Policy Time required 15 minutes Objective To enlighten the participants about the USAID population policy Approach Brief on USAID Population Policy using PP presentation Training materials Power Point slides Session One Population and Family Planning in Nepal Time required 90 minutes Objectives By the end of the session participants will be able to e Describe the status of demography population and family planning in Nepal e List the available contraceptive methods e Describe advantages and disadvantages indications contraindications of condom and pills e List different types of natural family planning methods Content This session covers following topics e Introduction of Population and Family Planning 10 minutes e Family Planning methods and Emergency Contraception 70 minutes e Natural Family Planning 10 minutes Training Approach A brief Power Point presentation that describes the demography and population status in Nepal and addresses the population problem These topics are covered e Vital statistics e Importance of family planning Training materials Power Point slides Modern contraceptives Brainstorm Ask participants how many FP methods are available in Nepal List all methods suggested by participants on flip chart paper or white board Small group work Divide partic
48. rovide participants knowledge and skill for counseling to assist client in making informed choice decision effective and standard infection prevention practices administration of condom pills Sangini DMPA and ECP manage side effects and health problems related to method usage up to date information on family planning method and basic FP service management viet USAID NEPAL Day II Client Assessment Infection Prevention Sangini DMPA administration Sexually Transmitted Infections Self Assessment CRS product distribution system and role of Sangini service provider USAID NEPAL USAID NEPAL Training Goal The major goal of this course is to make participants able to provide quality Family Planning services viet Content of Training Day I USAID Population Policy e Introduction of Population and FP in Nepal e Basic Facts of Sangini e Concept of Quality Assurance Counseling and informed choice USAID NEPAL Thank You Cnapter III 5 USAID NEPAL Ss US Government Policies USAID NEPAL What does it require No quotas or targets Provide comprehensive information on health benefits and risks of the chosen gratuities or financial method plus inadvisable rewards for clients or conditions and adverse side program staff effects No incentives bribes Full disclosure for experimental contraceptive No denial of rights or benefits for not accepting f
49. rvice Assign another participant to become a service provider and to counsel client using ABHIBADAN approach Ask the third one to observe and provide feedback to role players based on the observation checklist Provide checklist to observer Each person plays each role At the end give a big hand to all participants for their active participation Then discuss on large group about experiences Reinforce the counseling steps as per ABHIBADAN using slides Time Allocation 20 minutes for the brainstorm powerpoint presentation 20 minutes for the counseling video and trainer demonstration of counseling and 50 minutes for small group role plays additional demonstration if required Training Materials The Training materials are Sangini trainers guide flip chart FP posters flip chart paper markers masking tapes contraceptive observation checklist and laptop LCD Session Evaluation Verbal questions and answers re role play DAY II Session Five Client Assessment Time required 15 minutes Objectives By the end of the session participants will be able to e Identify potential client using Job Aid on How to be reasonably sure that client is NOT pregnant e Identify potential client s medical eligibility for Sangini e Describe the process of screening using Job Aid Content This session covers the following topics What is Client Assessment Objectives How to be Reasonably Sure that a Client is NOT Pregn
50. s in relation to Sangini quality of care service e Explain the importance of displaying clients rights poster in their clinic Content This session covers the following topics e Defining Client Rights and Providers Needs e Importance of Quality in Sangini Service Delivery Training Approach Conduct dreaming exercise to take session on the following topics e Clients rights e Providers needs Divide participants into two panels Ask one panel to act as client and another as service provider Ask the client panel to dream as what would you as a client expect from service provider and clinic in terms of quality service Ask service provider panel how would you as a service provider assure that you are providing quality service to the clients who are coming to you and your clinic Then ask each panel to write down one or two points individually in their notebook Ask client panel to share their expectations and write those down on the white board Next ask the service providers panel their expectations and note those down on white board At the end discuss and highlight on clients rights and service providers needs framework using Power Point Simultaneously explain clients rights in relation to Sangini Quality of Care QoC service with examples that includes Proper information Access to service Privacy and confidentiality Safe Service Dignity and respect Continuity of care e Inform
51. s of postpartum for non breast feeding Whether client has any medical problem women is within the first 7 days of miscarriage or abortion is less than 6 months postpartum is fully breast feeding and has had no menses since delivery Client is eligible for the chosen method USAID NEPAL USAID NEPAL Clinical Assessment Ask the client if she has any of the following Thank You Breast lump or cancer Diabetes e Unexplained vaginal e High Blood Pressure bleeding more than 160 90 Jaundice Severe headache Depression If she has none of these conditions then client is eligible for use of Sangini USAID NEPAL Session Six Infection Prevention IP USAID NEPAL What is Infection Prevention e Prevent transmission of any communicable diseases to clients patients and service providers and other staff members e Provide safety to clients and service providers following standard Infection Prevention remedies USAID NEPAL w Importance of Infection Prevention One of the major component of Quality of Care Protects clients patients and service providers from life threatening and other communicable diseases Prevents transmission of non curable diseases like HIV AIDS and Hepatits B from one person to another Help clients to be sastisfied with service using the standard IP practice and build trust with service provider Witter USAID NEPAL Remedies of Infection Prevention
52. side vagina When the woman has been a victim of sexual assualt When condom ruptures or breaks or is not used When the woman has been a victim of sexual assualt When condom ruptures or breaks or is not used vite USAID NEPAL i w Natural family planning Coitus Interruptus Withdrawal Method Calender Rhythm Method Lactational Amenorrhoea Method LAM Symptom Based Method Two Day Method Aiet USAID NEPAL w Emergency Contraception Prevent pregnancy from unsafe sexual intercourse Easily available Prevent unwanted pregnancy Decrease maternal mortality USAID NEPAL Emergency Contraceptive Pills ECP Emergency Contraceptive Pill is used to prevent uncertain pregnancy occured from unplanned or unprotected sex USAID NEPAL When to take Emergency Contraceptive Pills When woman is not willing to continue possible conception due to unprotected sexual intercourse As soon as possible after the unprotected sexual intercourse increases effectiveness Within 120 hours up to 5 days of unprotected sexual intercourse Witte S USAID NEPAL S Is Emergency Contraceptive safe Even women who are not eligible for Pills can use it Lactating mothers also can use it USAID NEPAL Effectiveness of ECP For a woman who has unsafe sex within the second and third week of her menstruration using ECP has 98 percent effectiveness in case of Combined Oral Pills 99
53. stions and answers Session Two Basic Facts on Sangini DMPA Time required 75 minutes Objective By the end of the session participants will be able to Define Sangini Identify mode of action advantages side effects disadvantages and indications precautions Identify warning signs and referral conditions Understand management of common side effects Explain Sangini DMPA information in simple non technical language to potential clients Content This session covers the following topics Definition 5 minutes Mode of action 5 minutes Advantages side effects disadvantages indications and precaution 20 minutes Warning signs 10 minutes Common side effects and management 15 minutes Training Approach Introduce Sangini program in Nepal Define Sangini and mode of action using Power Point slides Brainstorm and describe on advantages side effects disadvantages indications precaution of Sangini using a participatory approach Describe warning signs and explain how to manage common side effects in a participatory way Training materials Sangini reference for service provider poster sample of Sangini flip chart paper markers LCD and laptop Session Evaluation Questions and answers Session Three Concept of Quality Assurance Time required 30 minutes Objective By the end of the session participants will be able to e Define clients rights and providers needs e Describe clients right
54. the principle of e Prescribing single dose as possible Effective treatment and Complete treatment S USAID NEPAL The 4 C s C compliance complete Treatment C client education Counseling C contact tracing amp Treatment C condom promotion USAID NEPAL Case Management of Urethral Discharge continue USAID NEPAL Recommended Treatment Urethra Discharge Syndrome e Azithromycine 1 gm oral single dose plus e Cefixime 400 mg oral single dose or Ceftriaxone 250 mg IM single dose or Spectinomycin 2g IM single dose USAID NEPAL Recommended Treatment Azithromycin 1g oral single dose plus Cefixime 400 mg single oral dose or Ceftrixone 250 mg IM single dose plus Tinidazole 2gm single oral dose or Metroniadazole 400mg 3 times daily for 7 days plus Fluconazole 150 mg oral single dose or Clotrimazole 200 mg vaginal pessary each night for 3 nights USAID NEPAL Lower Abdominal Pain Syndrome Types of micro organisms e Neisseria gonorrhoea e Chlamydia trachomatis e Anaerobic bacteria USAID NEPAL Case Management of Urethral Discharge USAID NEPAL Case Management of Vaginal Discharge e Treat for cervical infection Treat vaginal infection Cs S USAID NEPAL Recommended Treatment Vaginitis Treatment Tinidazole 2gm single oral dose or Metroniadazole 400mg 3 times daily for 7 days plus Fluconazole 150 mg oral single dose or Clotrimazole 200 mg va
55. the sterile pact containing AD needle syringe Insert needle through rubber stopper and turn vial upside down and draw fluid into the syringe Remove the needle from vial and hold the syringe vertically and force air bubbles out the syringe using the plunger gently viet Thank You USAID NEPAL Session Content e Steps for Sangini injection e Administer Sangini injection Getting ready Preparing the injection site Preparing the injection Post injection task USAID NEPAL Step 2 Preparing for injection site e Wash hand with soap and water and dry e Clean skin with cotton and rectified sprit alcohol wiping with a circular motion moving outwards from the injection side Allow skin to dry before giving the injection USAID NEPAL Step 4 Giving the injection Insert the needle into muscles deltoid on arm or upper outer quadrant of gluteal area Slowly pull back on plunger before injecting to check for appropriate placement of needle If not blood seen inject Sangini DMPA slowly and remove needle viet USAID NEPAL USAID NEPAL Step 6 Post Injection Counsel Client Step 5 Post Injection Task instrictian Apply pressure to injection site with cotton but do not rub Instruct client to return for another injection in 12 weeks give exact appointment date Discard assembled needle and syringe into a puncture Explain side effects proof container Encourage clients to return if sh
56. ure d Jaundice and liver damage Depo Provera Sangini is the trade name for Combined oral contraceptives pills Depot mexdroxy progesterone acetate A brand of mini spermicidal pills Progestin only mini pills Which of the following is not a possible side effect of emergency contraception a Nausea b Amenorrhea c Menstrual spotting d Vomiting Anew oral contraceptive user should begin taking her first pack of pills a Within the first 5 days her menstrual cycle b Only on the first day of her menstrual period c When she finishes her menstrual period d Whenever it is convenient for her A possible sign of STI in a woman is a Leg ulcer with swelling Chest pain with shortness of breath c Absence of period d Lower abdominal pain Emergency Contraception a Can prevent pregnancy b Not useful if woman is already pregnant c Aborts established pregnancy d Can be used continuously Observation Checklist for Sangini DMPA Counseling Using A BHI BA DA NA steps To be completed by participants Instructions Each task activity is observed using the following rating scale 1 Needs improvement Step or activity not performed correctly and or was out of sequence if a sequence is required or was omitted Competently Performed Step performed correctly in proper sequence but participant did not progress from step to step efficiently Proficiently Performed Step efficiently and precisely perfor
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