report on the training for health care providers … training... · components of post abortion...

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REPORT ON THE TRAINING FOR HEALTH CARE PROVIDERS FROM GATSIBO DISTRICT ON COMPRENSIVE PACKAGE

INTEGRATING POST ABORTION CARE, SAFE ABORTION AND FAMILY PLANNING.

Lemigo hotel, October 21 – 25, 2019

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I. Introduction

The training on post abortion care, safe abortion and family planning took place in Kigali, Lemigo hotel from 21 to 25 October 2019. The expected

participants were from the catchment area of Ngarama and Kiziguro D.H. The participation was 5 days 100% (36/36 invited).

The table below shows the qualification of invited participants and their work places.

Invited healthcare providers

Hospital catchment

area

Health facility

Number of

participants

Qualification or position

Kiziguro district

hospital

Gasange H.C 2 1 Nurse and 1 Midwife

Gitoki H.C 1 Nurse or Midwife

Kabarore H.C 2 1 Nurse and 1 Midwife

Kibondo H.C 1 Nurse or Midwife

Kiziguro H.C 2 1 Nurse and 1 Midwife including the one from FP secondary post

Kiziguro D.H 4 1 GBV Officer , 1 Medical Doctor,1 Midwife and 1 Nurse

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Muhura H.C 2 1 Nurse and 1 Midwife including the one from FP secondary post

Rwimitereri H.C 2 1 Nurse and 1 Midwife

Bugarura H.C 1 Nurse or Midwife

Humure H.C 1 Nurse or Midwife

Rugarama H.C 1 Nurse or Midwife

Rwembogo H.C 1 Nurse or Midwife

Ngarama district

hospital

Nyabiheke camp

H.C

1 Nurse or midwife

Gatsibo H.C 1 Nurse or Midwife

Nyagahanga H.C 2 1 Nurse and 1 Midwife

Gituza H.C 1 Nurse or Midwife

Kageyo H.C 2 1 Nurse and 1 Midwife

Ngarama D.H 4 1 GBV Officer , 1 Medical Doctor, 1 Midwife and 1 Nurse

Ngarama H.C 1 Nurse or Midwife

4

Nyagihanga H.C 1 1 Nurse and 1 Midwife

Rangiro H.C 1 1 Nurse and 1 Midwife

Total 36

Among 36 participants, 22 were nurses, 2 medical doctors and 12 midwives with 77.8% (28/36) participation from heath centers. After expressing

their expectations for the training which mostly were related to the acquisition of knowledge and practice of insertion of IUD and implants, practice

of MVA for PAC and safe abortion, the participants fixed some norms to follow during the training period. They selected also the team leader, social

affairs and time keeper.

In his opening remarks, Dr. Ngoga Eugene the RSOG president gave a brief background of Baho Neza project which is implemented by Imbuto

foundation as the leading implementer, in collaboration with RSOG and RBC. The project’s focus is on education (training and mentorship). He

reminded the participants of the objectives of the training and requested them to pay attention on practice, and also to share knowledge and skills

with their colleagues so as to improve women’s health by preventing the complications due to the unsafe abortion. He highlighted that the increasing

rate of family planning users is the most and best prevention of unsafe abortion. He reminded the participants to adopt the good attitudes while

rendering health services, otherwise they will be punished by medical, nurses, or midwives’ councils for any professional misconduct.

II. Activities

The training activities were conducted during 5 days as planned (refer to agenda in annex 1). Participants performed a pretest before the training

and results are shown in the table below:

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Marks Pre-test Post -test

Mean mark 15/ 30 (50 %), 21/30 (70 %),

Lowest mark 8/30 (26.7. %) 15/30 (50 %),

Highest mark 23/30 (76.7 %), 25/30 (83.33 %)

Number of participants scored

below mean mark

16 (44.4%) 0

Number of participants scored

equal and above 60 % marks

13 (36.1%) 33 (91.6%)

Number of participants scored equal

and above 70 % marks

2 (5.5%) 23 (63.8%)

Number of participants scored equal

and above 80 % marks

0 13 (36.1%)

The presentation on PAC, safe abortion and family planning took less time than practice of MVA, insertion and withdraw implants and interval and

post-partum IUD. Participants were very motivated to apply those procedures.

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For the continuity of MVA practice at health center level, the participants were given one Kit of MVA. In addition to the exercises on the use of

MEC wheel participants were given more time to insert and withdraw IUD and Jadelle.

The last day of the training was allocated to the post test, making action plans and formulate recommendations on the side of participants.

Before the closing remarks of RSOG president who insisted on more practice of what they learned and share knowledge with their workmates, the

participants designed and presented to facilitators the action plan as presented in the table below.

D.H action plan after training on PAC, safe abortion and family planning

Detailed activities Expected

outcome

Responsible Resources Period Means of

verification

Presentation on PAC , safe

abortion and F.P

Reinforce staff

knowledge on

PAC, safe

abortion et F.P

Trainees Administration November 2019

Participants attend

list.

Management of abortion

according to the national

protocol

Reduce the

complications

and death due to

abortion

Trainees Hospital October 2019

Register and PAC

report

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Provide health education with

regard to the creation of

awareness of safe abortion

Reduce

abortion rate and

complications

Trainees

Hospital

November 2019

Register of Heath

education

Avail family planning methods

Prevent stock

out

Pharmacist and

trainees

Hospital 30 /10 /2019 Request and store

registers

Provide health education on

post abortion and post-partum

family planning methods

Improve the rate

PPFP use

Trainees Hospital November 2019 PPFP register and report

Admission / orientation of

clients who desire a safe

abortion

Reduce the

number of

unsafe abortion

Trainees including

medical doctor

and GBV officer

hospital November 2019 Safe abortion register

and report

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Health centers’ action plan after training on PAC, safe abortion and Family planning

Detailed activities Expected

outcome

Responsible Resources Period Means of

verification

To help everyone ,in our

institution (nurse/midwife) to be

able to perform Post-abortion

care

Every nurse/

midwife will be

able to manage

post abortion

care

Trained health

care provider

-Knowledge from

Training

MVA kit

Training modules

3 months -Attendance list

- Continuous

training register

Give health education and

sensitize staff members , clients

and community about the

difference between safe

abortion and unsafe abortion

Increased cases

of safe abortion

and reduce cases

of unsafe

abortion

Trained health

care provider

-Knowledge from

Training

-Training modules

- Means of transport

3 months

-Register IEC

- mission order

photos

Promote PPFP and post

abortion family planning with

women’s encouragement about

longue acting and reversible

family planning methods

Increased

number of

women using

PPFP and post

abortion care

Trained health

care provider

--Knowledge from

Training

-Training modules

-Methods of family

planning

Ordonogramme (pictures)

3 months -PPFP register

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Success story

Since March 2019, the Rwandan healthcare providers are trained on Post abortion care (PAC), safe abortion and Family planning ( F.P) by RSOG

in close collaboration with Rwanda Biomedical Center/Ministry of Health (RBC/MoH) with the support of Imbuto foundation through the Baho

Neza project. This training is planned for the 30 districts.

Mr. Tuyishime Valens, a midwife working at Humure health center is among 36 invited healthcare providers from Gatsibo district to participate in

the 10th training. He expressed his feelings.

“When I was receiving an invitation to attend training on post abortion care (PAC), safe abortion and family planning at lemigo hotel, at this time

I was very and very happy because it is the first time I attend the training which is conducted by higher level like RBC (Rwanda Biomedical Center)

and RSOG (Rwanda Society of Obstetricians and Gynecologists).

During this time, I expected the following:

To know safe abortion and unsafe abortion, to classify safe abortion, management and treatment of abortions, rules and regulations to conduct safe

abortions, to practice manual vacuum aspiration (MVA), to know the indications and contraindications of MVA, to practice insertion of intrauterine

device (IUD) and other methods of family planning like: implanon and jadelle, to know the management of side effects of family planning methods.

During the training, my expectations were achieved because there is so much information on abortion I have learnt like: safe and unsafe abortion,

induced abortion, classifications of abortion (complete abortion, incomplete abortion, missed abortion, threatened abortion and septic abortion),

components of post abortion care, post abortion care protocol, treatment of incomplete abortion based on protocol of Rwanda (600 mcg oral single

dose),values clarifications for post abortion care and women’s rights, legal aspects and procedure of termination of pregnancy, I have also learnt

WHO 2018 regimens for medication abortion(mifepristone and misoprostol combination and misoprostol only).

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In family planning I have learnt physiology of menses and physiology of lactation, I have learnt different methods of family planning, their indications

and contraindications and their mechanisms of actions.

After this training:

-I’m going to teach my colleagues or workmates what I have learnt in this training like insertion of IUD as one of best method of family planning

which have effective and efficient.

-I’m going to create awareness on the legal aspects and procedure on the termination of pregnancy to the population living in Humure area

especially women’s and young girls

-I’m going to improve my competence on the management of abortions and family planning methods insertions”.

Said Tuyishime Valens

III. PARTICIPANTS’ RECOMMENDATIONS FROM GATSIBO DISTRICT

After the training on Safe abortion, post-abortion care and Family planning, the healthcare providers from Gatsibo district recommended to:

Participants themselves

Improve quality care through PAC, safe abortion and F.P

Change behavior and mind towards safe abortion

Avail register for safe abortion for data reporting

Provide information, education and communication about PAC, safe abortion and F.P

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RSOG/RBC

Advocate for availability of PAC equipment

Increase the number of healthcare providers trained in PAC, safe abortion and F.P

Facilitate the supervision of health centers and supervise the district hospital

Prepared by: Catherine Musabyimana checked by: Speciosa Kantengwa Approved by: Dr. Ngoga Eugene

Family Planning Officer RSOG Project Manager RSOG President

Kigali, October, 28th 2019

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Annex 1. Training agenda of Gatsibo district

Date Time Topic Facilitator

Day 1,

Monday 21

October 2019

7:30 – 8:00 Registration RSOG

8:00 – 08:30 Introduction of participants

Setting training norms

Expectations from participants

Mr. KANYAMANZA Eugene

8:30 – 9:00 Pre-course assessment Dr. MUGANDA John

09:00 – 09:30 Objectives of the training,

opening

Dr. NGOGA Eugene

09:30 – 10:30 Anatomy and Physiology of reproductive systems Dr. NDAHAYO Philbert

10:30 – 11.00 Coffee break RSOG

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11:00 – 11:45 Overview of PAC Program: Introduction, Definition, Role of

PAC in the Prevention of Maternal Mortality and

Components of PAC

Mr. KANYAMANZA Eugene

11:45 – 13:00 Overview of PAC Protocol….. Dr. MUGANDA John

13:00-14:00 Lunch RSOG

14:00 - 15:00 Overview of PAC Protocol:

Diagnosis and Management, Pain management, Patient

assessment, Methods of Uterine evacuation, Medical

Methods and Surgical Methods.

Dr. SITINI Bertin

Dr. MUGANDA John

15:00 - 17:00 MVA practice on anatomic models Mrs. Kantengwa Immaculée

Dr. MUGANDA John

Dr. SITINI Bertin

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Day 2,

Tuesday 22

October 2019

7:30 – 8:00 Registration RSOG

8:00 – 8:30 Recap Day 1 Mr. KANYAMANZA Eugene

8:30 – 9:30 Criteria of selection of Methods for treatment of incomplete

abortion and Miscarriage, Management of complications,

Values clarifications, Post Procedures follow up and

Infection Prevention.

Dr. HAKIZIMANA Augustin

Dr. MUGANDA John

Mrs. UMUTESI Sharon

9:30-10:30 Legal aspect of Safe abortion Dr. SITINI Bertin

Dr. HAKIZIMANA F Xavier

10:30 – 11:00 Coffee break RSOG

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11:00 - 12:00 Safe Abortion Dr. SITIN Bertin

12:00 – 13:00 Monitoring and Evaluation: Checklist

PAC & safe abortion

Mr. KANYAMANZA Eugene

13:00 - 14:00 lunch RSOG

14:00 - 17:00 MVA Practice on Anatomic Model for

both Safe abortion and Post abortion care

Mrs. Kantengwa Immaculée

Dr. MUGANDA John

Dr. SITINI Bertin

Day 3,

Wednesday

23 October

2019

7:30 – 8:00 Registration RSOG

8:00 – 8:30 Recap Day 2 Mr. KANYAMANZA Eugene

8:30 – 9:30 Physiology of reproductive systems Dr. NDAHAYO Philbert

9:30 – 10:30 Menstrual cycle and lactation Dr. HAKIZIMANA Augustin

10:30 – 11:00 Coffee break RSOG

11:00 – 12:00 Progesterone only methods : pills,

injectable, implants

Dr. MUHIRWA Bonfils

12:00 - 13:00 Combined hormonal methods Dr. MUHIRWA Bonfils

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13:00-14:00 lunch RSOG

14:00 - 15:00 IUD Dr. NGOGA Eugene

15:00 - 1700 Practices on anatomic models/use of

ordinogramme and checklists

Mr. NIYONSENGA Donatien

Mrs. MUSABYIMANA Catherine

Day 4,

Thursday 24

October 2019

7:30 – 8:00 Registration RSOG

8:00 – 8:30 Recap Day 3 Mr. KANYAMANZA Eugene

8:30 – 9:10 Post- partum Family Planning (PPFP) Dr. MUHIRWA Bonfils

9:10 – 10:30 Post -partum Family Planning (PPFP Dr. MUHIRWA Bonfils

10:30 – 11:00 Coffee break RSOG

11:00 – 11:30 Family Planning in PAC Dr. MUGANDA John

11:30 - 12:10 Family Planning in Post-natal Care Dr. MUGANDA John

12:10 - 13:00 Safe Abortion Counseling Dr. HAKIZIMANA F.Xavier

13:00 - 14:00 Lunch RSOG

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14:00 - 17:00 Practices on anatomic models/use of

ordinogramme and checklists

Mr. NIYONSENGA Donatien

Mrs. MUSABYIMANA Catherine

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Day 5,

Friday 25

October 2019

7:30 – 8:00 Registration RSOG

8:00 – 10:00 General recap

Post –Training assessment

Training evaluation

Mr KANYAMANZA Eugene

Dr. SITINI Bertin

10:00-10:30 Coffee Break RSOG

10:30 – 12:30 Plan for next steps and

Recommendations

Mrs. UMUTESI Sharon

Dr. SITINI Bertin

12:30 – 13:30 Lunch RSOG

13:00 - 14:00 Official closing Dr. NGOGA Eugene

14:00 Departure

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Annex 2. Attendance list of participants from Gatsibo district

N0 Participant Names Place Work Qualification Phone email

1 Uwamwezi Peruth Kabarore H.C Nurse 0788868878 uwamweziperuth@gmail.com

2 Mukabwimba Adeline Muhura H.C Midwife 0784730300 bwimbaddy6@gmail.com

3 Maniraguha Odile Gasange H.C Midwife 0786956642 Maniraguha Odile@gmail.com

4 Nyirabagabe Donatille Rwimbogo H.C Midwife 0785800433 nyiradonatille2020@gmail.com

5 Dukuzuwaturemye Egide Kageyo H.C Nurse 0788378409 dukuze1992@gmail.com

6 Tuyishime Valens Humure H.C Midwife 0782567126 tuyivalens20@gmail.com

7 Mukashimwe Anathalie Ngarama D.H Clinical psychologist / GBV

officer

0788421875 mukashimweanathalie@gmail.com

8 Nyinaimanzi Petronille Ngarama H.C Nurse 0788800105 petenyina05@gmail.com

9 Muberampuhwe Lyliose Ngarama D.H Midwife 0788509202 muberampuhwe@gmail.com

10 Nyirabakiga Jeannette Bugarura H.C Midwife 0781333400 nyirabajanet@yahoo.com

11 Nyampundu Beata Rugarama H.C Midwife 0785755995 nyabe04@gmail.com

12 Nseniyumva Jean Damascene Nyabiheke H.C Midwife 0785037922 nsengadamascus@yahoo.com

13 Hishamunda Alphonse Ngarama H.C Midwife 0785792547 hishalphonse123@gmail.com

14 Natukunda Patience Nyagahanga H.C Midwife 0786905455 natupeshe@gmail.com

15 Muhire Bienvenue Gakenke H.C Nurse 0783595367 muhirebien@gmail.com

16 Musengimana Janet Gakenke H.C Midwife 0787126390 musengimanajanet@gmail.com

17 Abayisenga Divine Gitoki H.C Midwife 0782251159 abayisengadivine@gmail.com

18 Muhoza Clarisse Gatsibo H.C Midwife 0785842389 cmuhoza1@gmail.com

19 Musindikazi Eugenie Muhura H.C Nurse 0783302149 eugeniemusindi@yahoo.com

20 Batamuliza Annonciatha Rwimitereri H.C Nurse 0788646088 annonciathabatamuliza@gmail.com

21 Uwamariya Dorothee Rwimitereri H.C Midwife 0783391413 dorthuwamariya@gmail.com

22 Uwitonze Marie Aimee Nyagahanga H.C Nurse 0786964754 aimeeuwitonze@gmail.com

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23 Mutsinzi Fred Kiziguro H.C Midwife 0787539784 fmutsinzi@gmail.com

24 Umuhire Immaculee Kiziguro H.C Nurse 0788739747 marieimaculeeumuhire@gmail.com

25 Mukabasinga Pauline Kabarore H.C Midwife 0783201856 mukabasingapauline@gmail.com

26 Kabatesi Beatrice Gasange H.C Nurse 0782328267

27 Munyambibi Leopold Gituza H.C Midwife 0788691787 munyaleop@gmail.com

28 Uwiringiyimana Eunice Nyagihanga H.C Nurse 0783338829 jeanlucnseng02@gmailcom

29 Habineza Robert Kibondo H.C Midwife 0782439241 kibondohealthcenter22@yahoo.com

30 Dr. Steve Fyiroko Ngarama D.H Medical doctor 0780273659 stefyiroko85@yahoo.fr

31 Mukarusibira Antoinette Kiziguro D.H Midwife 0783648891 mukantonny@gmail.com

32 Niyomufasha Ellessa Kiziguro D.H GBV officer / Nurse 0788221011 elessaniyomufasha@gmail.com

33 Iragena Zena Kiziguro D.H Nurse 0788217829 iragenazena5@gmail.cm

34 Muhemedi Mbuyi Clement Kiziguro D.H Medical doctor 0782026675 clementmuhemedi@gmail.com

35 Sherif Theoneste Ngarama D.H Nurse 0788573281 chertheo2021@gmail.com

36 Muhorakeye Pelagie Ngarama H.C Nurse 0782505037

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Annex 3. Photos

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