Strengthening healthcare providers’ capacity for safe abortion and post-abortion care services in humanitarian settings: lessons learned from the clinical outreach refresher training model (S-CORT) in Uganda, Nigeria, and the Democratic Republic of Congo

Abstract

Background Fragile and crisis-affected countries account for most maternal deaths worldwide, with unsafe abortion being one of its leading causes. This case study aims to describe the Clinical Outreach Refresher Training strategy for sexual and reproductive health (S-CORT) designed to update health providers’ competencies on uterine evacuation using both medications and manual vacuum aspiration. The paper also explores stakeholders’ experiences, recommendations for improvement, and lessons learned. Methods Using mixed methods, we evaluated three training workshops that piloted the uterine evacuation module in 2019 in humanitarian contexts of Uganda, Nigeria, and the Democratic Republic of Congo. Results Results from the workshops converged to suggest that the module contributed to increasing participants’ theoretical knowledge and possibly technical and counseling skills. Equally noteworthy were their confidence building and positive attitudinal changes promoting a rights-based, fearless, non-judgmental, and non-discriminatory approach toward clients. Participants valued the hands-on, humanistic, and competency-based training methodology, although most regretted the short training duration and lack of practice on real clients. Recommendations to improve the capacity development continuum of uterine evacuation included recruiting the appropriate health cadres for the training; sharing printed pre-reading materials to all participants; sustaining the availability of medication and supplies to offer services to clients after the training; and helping staff through supportive supervision visits to accelerate skills transfer from training to clinic settings. Conclusions When the lack of skilled human resources is a barrier to lifesaving uterine evacuation services in humanitarian settings, the S-CORT strategy could offer a rapid hands-on refresher training opportunity for service providers needing an update in knowledge and skills. Such a capacity-building approach could be useful in humanitarian and fragile settings as well as in development settings with limited resources as part of an overall effort to strengthen other building blocks of the health system.

Effectiveness of implementing evidence-based guidelines on nurses' knowledge regarding caring of aborted women

“…This result is in line with Hassan, [21] , who studied ''Nurses' Knowledge and Practice Regarding Post-Miscarriage Care in Omdurman Maternity Hospital, Khartoum State, Sudan '' and reported that most of the studied nurses had poor knowledge regarding the first intercourse Post-Miscarriage. Moreover, This result comes in agree with Tran et al, [22] , who studied ''Strengthening healthcare providers' capacity for safe abortion and postabortion care services in humanitarian settings: lessons learned from the clinical outreach refresher training model (S-CORT) in Uganda, Nigeria, and the Democratic Republic of Congo'' and reported that the knowledge of the health care provider had improved after the workshop. Regarding the knowledge about waiting time for second pregnancy after abortion, the present study illustrated that the minority of the studied nurses had good knowledge regarding the waiting time for second pregnancy after abortion increased to the majority of them immediately after application of guideline then decreased to be the most of them post guideline application.…”

Outcome of Manual Vacuum Aspiration (Mva) in Management of Incomplete Abortion

“…Additionally, no statistically significant relationship was found between gravida and the effectiveness of MVA in achieving complete evacuation. (13)(14)(15)(16).…”

Adaptations to comprehensive abortion care during the COVID-19 pandemic: case studies of provision in Bolivia, Mali, Nepal, and the occupied Palestinian territory

“…NGOs and other organisations providing MA services frequently emphasise the inclusivity of their reach, for example, to those in humanitarian settings or to adolescents 18 , 52 . The adaptations highlight an opportunity for organisations to strengthen their focus, reach, and communication to engage with people in vulnerable settings and draw upon grassroots’ insights and strategies, such as partnership strengthening.…”

“…Despite limiting CAC provision, the COVID-19 pandemic also created opportunities to expand services. Guided by past lessons from emergency-settings 18 and advances in telemedicine 19–25 , both international and national non-profit and non-governmental organisations (NGOs) in the field of SRH adapted their CAC programmes to maintain access to services, while keeping their clients, providers, and communities safe from COVID-19 26 . Furthermore, owing to efforts from SRH advocates, policymakers enacted innovative emergency SRH protocols to ensure safe continuity of CAC access within the COVID-19 restrictions 27 .…”