WSOs are short sensitization/orientation sessions for paramedic and support staff at a facility, and are intended to build a supportive environment w.r.t the quality of FP service provision, specifically addressing the prevalent myths and misconceptions among clients and staff related to contraceptive methods. For example, PPIUCD decisions are often influenced by cleaners, ward aayas/boys etc. and their sensitization can help support favorable FP decisions.

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Purpose: To build an enabling environment for family planning among health personnel, including the support staff working at the facility
Duration: Two to three hours with subsequent refresher trainings as needed
Content: Sensitization of staff towards the quality of FP services
Audience: Paramedical and support staff
Frequency: Annually and refresher as needed

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Steps to be taken by CMHO/CDMO/CMO/CMO for conducting WSO:

• WSO is organized on the basis of the type of facility. In a large public or private facility (tertiary and secondary), WSO can be conducted by senior level staff within the facility. In smaller public and private facilities, the doctor-in-charge and the nurses can arrange similar training for their staff during regular meetings (Refer to UHIs Whole Site Training Guideline with links).
• CMHO/CDMO/CMO/CMS should include the number of facilities and the percentage of staff that underwent WSO as indicators in the monthly review meeting in order to monitor the implementation of this particular training.

IP is an essential component in the delivery of quality FP services. Training on IP is provided to doctors, nurses, paramedics and other relevant staff such as sweepers, ayahs etc. to increase their knowledge and skills with respect to IP practices at the facility.

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Purpose:  Improving quality of care in family planning services contributes to the assurance of patient and provider safety, reduction of maternal and newborn morbidity as well as hospital acquired infections in general. Cleanliness and good infection prevention practices are an important element in clients’ satisfaction and their willingness to utilize services.
Duration: Half-a-day
Content: Infection Prevention Reference Booklet for Health Care Providers (EngenderHealth, 2011) and Standards and Quality Assurance in Sterilization Services, Chapter 06, Page No. 53 (Government of India, 2014) 
Audience: Providers, nursing and other relevant staff in both government and private sector facilities.
Frequency: Based on needs assessment but especially recommended at the time of staff turnover.

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Steps to be taken by CMHO/CDMO/CMOs to roll out training on infection prevention practices:

• Identify a qualified and experienced trainer, either from within or outside the district / medical college.
• The trainer should first assess the existing IP practices and the training needs of the facility (Refer to UHI Infection Prevention Checklist).
• The trainer can utilize the UHI training package to conduct half-a-day training, utilizing power-point presentations, group exercises, pre and post knowledge assessment tools, posters and other necessary materials.
• For any large facility, government or private, an IP committee should be formed which develops an action plan. For a small facility, a provider can take the responsibility for this function.
• The IP committee, where present, should meet on a monthly basis following the training to assess the progress in improving IP practices according to the action plan, using the assessment checklist. The committee should then decide on and implement the necessary corrective actions.
• Learnings on IP should be reinforced from time to time.
• In addition to a classroom training, facility visits by trainers are helpful in observing any gaps and encouraging hands-on learning.

Many districts lack sufficient number of NSV surgeons to meet the increase in demand for NSV arising from the awareness building activities among men. Training of surgeons on NSV can be organized in government identified training centers. Potential providers can be identified as per GOI guidelines and their names can be recommended through district CMOs, program managers and NGOs for training. This should be supported with client mobilization by community volunteers at the time of training to ensure that participants are able to get adequate hands-on-practice (Refer to the TCIHC FDS tool for additional guidance).

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Purpose: Increases the pool of trained surgeons available to provide NSV services so as to meet the increasing demand being generated for this method
Duration: Five days
Content: To follow GOI reference manual for male sterilization (Refer Standards & Quality Assurance in Sterilization Services (GOI, Nov. 2014)
Audience: Doctors (MBBS and above)
Frequency: One time training, ongoing post training support/mentoring

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Increasing the pool of providers trained in laparoscopy and minilap sterilization can help fulfill the increasing demand for these services. The CMHO/CDMO/CMO can coordinate with the training centers in their cities, acquire their training calendars and facilitate the participation of trainees for FST (Refer to the GoI manual on female sterilization).The same approach can be taken up by NGOs, initiating and coordinating with the CMOs and other stakeholders to facilitate FST training (Refer to the TCIHC FDS tool for additional guidance).

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Purpose: Increases the pool of trained doctors available to provide female sterilization so as to meet the increasing demand being generated for this method
Content: Follow GOI reference manual for female sterilization (Refer Standards & Quality Assurance in Sterilization Services; GOI, Nov. 2014)
Audience: Doctors (For Minilap – MBBS and above, Specialists in other surgical fields; For Laproscopy – MBBS performing minilap sterilization, Post Graduate diploma or degree in Obstetrics/Gynecology, Specialists in other surgical fields)
Frequency: One time training, Post training support/mentoring

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The Janani Suraksha Yojana (JSY) scheme has resulted in an increased number of institutional deliveries at facilities across India. This has provided the opportunity to provide Long Acting Reversible Contraceptives (LARC) such as PPIUCD to women who desire to use these methods.  However, many of these opportunities are missed because providers in the facilities lack the necessary skills to provide immediate post-partum IUCD insertion. Training a core group of providers at the district women’s hospital and in medical colleges can create the necessary technical capacity among nurses and other doctors to provide this service. Funding is available through the Program Implementation Plan (PIP) to train doctors and nurses from each public facility conducting deliveries.

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Purpose: To impart new skills to the providers for Post-Partum Intrauterine Contraceptive Device (PPIUCD) insertion
Duration: Three-day theoretical and practical training at the clinical training site
Audience: Doctors and staff nurses in govt. and private sector
Content: Follow IUCD, PPIUCD reference manual (Refer to IUCD Manual for Medical Officers and Nursing personnel and GoI PPIUCD training video)
Frequency: One-time training and post training support/mentoring

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Steps to be taken by CMHO/CDMO/CMO/CMO for conducting PPIUCD insertion training:

• Identify doctors and staff nurses from each facility to travel to the divisional training site for a three-day theoretical and practical training. Each trainee is provided with theoretical knowledge, has the opportunity to observe procedures and to conduct a minimum of one procedure independently prior to certification.
• Ensure that this training is followed by on-site mentoring of trainees by the divisional level trainers as per the standard PPIUCD training plan
• Providers and the facility-in-charge to review PPIUCD performance of trained providers at the facility level, sharing experiences and planning for consistent quality of care

Refresher training of on clinical methods is important for providers to have updated knowledge including the contra-indications, technical provision and the management of side-effects and complications of the methods. Government training centers having necessary infrastructure and adequate client load can be used as sites for refresher training. The trainers can include professors of government medical colleges and other trained and experienced doctors.

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Purpose: To enhance the skills of existing trained providers
Duration: Three days
Content: Follow GOI reference manual for female sterilization (Refer Standards & Quality Assurance in Sterilization Services; GOI, Nov. 2014)
Audience: Doctors (MBBS, PG diploma or degree in Obstetrics/Gynecology)
Frequency: One time training, post training support/mentoring

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Steps to be taken by CMHO/CDMO/CMO/CMO for conducting FST refresher training:

• Identify the number of doctors previously trained on FST and assess their performance, so as to identify the need for further refresher training, guidance and support
• Along with the NGO partner, help in identifying empanelled private providers requiring further refresher training, guidance and support
• Nominate such doctors/empanelled private providers for a refresher training

Refer to the TCIHC FDS tool for additional guidance