Pakistan: Service Delivery
Whole Site Orientation
What Is Whole Site Orientation?
“Together we win, together we fall” is a classic framework for unity and advocacy. If applied to family planning (FP), it can create massive benefits for the community. Whole-site orientation (WSO) is an approach where every staff member at the health facility, regardless of their credentials, designation, or academics, becomes a FP champion. All medical, non-medical and support staff, such as janitorial, security, admin and receptionists, are oriented with basic awareness of FP benefits, FP methods, and potential side effects.
WSO is considered gender intentional as the whole site manual includes a separate chapter on gender, health and FP. Facility in-charges as well as all the staff of their respective health facilities receive training on gender intentional models of FP service delivery. It focuses on two main aspects:
- Sensitize all the staff on gender-related FP issues and the importance of gender intentionality in service delivery
- Transform gender related behaviors
Who participates in WSO sessions?
- Doctors, midwives, nurses, clinical officers, nurses aides and any other clinical staff
- Receptionists, security guards, housekeeping staff, lab technicians, dispensers and other non-clinical staff
- Providers and staff from neighboring private clinics
- Pharmacists and pharmacy staff from surrounding areas
- Anyone else who might regularly interact with a potential FP client
WSO is broken down into brief sessions that are conducted at the health facility. The sessions are “low-dose, high frequency” – that is, they are short and spread out over many days to avoid taking staff away from their posts for long periods and avoid service disruptions. Values clarification and attitudinal transformation (VCAT) exercises are woven throughout the orientation sessions to ensure that messages about FP can be delivered with conviction and without judgement and personal biases.
What are the benefits?
- Helps to ensure that FP messages become universal and unequivocal.
- Ensures that there are no missed opportunities to promote and FP information and services.
- Enables all staff at the facility to have a basic knowledge of FP and minimizes myths and misconceptions that staff themselves may have.
- Addresses facility-related barriers to accessing FP services; for example, security guard teasing an unmarried woman for seeking FP services or client getting lost trying to find the FP clinic.
- Serves as platform to support provider-initiated FP services.
How to implement
Step 1: Identify and develop a list of topics to be covered within a specific timeframe
Since FP is a very broad subject, it is essential to break it down according to topics. Facility in-charges should plan a schedule of topics that can be completed within a specific time, preferably within a two-month period. Topics can be broad or specific, depending on what facility staff want to learn about and/or any identified knowledge gaps. A curriculum will be helpful as these training sessions are conducted during office hours.
Topics to be covered in WSO sessions include the following (based on technicality and education background):
- Family planning overview
- Family planning counseling
- Family planning benefits
- Family planning policies
- Medical eligibility criteria
- Adolescent and youth-friendly services
- Interpersonal communication especially with young people
- Gender considerations when counseling on FP
- Barrier methods
- Combined oral contraceptives
- Progestin-only pills
- Injectables
- Implants
- IUCD
- Permanent methods
- Natural methods, such as the standard day method (SDM)
- Lactational amenorrhea method (LAM)
- Record keeping and commodity management
- Infection prevention
- Correcting FP-related myths and misconceptions
- IEC materials – FP promotion in the community
- Provider-initiated FP
Step 2: Develop content for each session
Develop relevant content aligned with the technical capacity and level of all staff members. One training session should be a maximum of 2 hours. Use graphics and provide simple IEC material, preferably in local language, to staff members as ready reference.
Step 3: Determine who will conduct the training
Trainers can be facility mentors, trainers and/or facility in-charge/managers, and they can take turns facilitating orientation sessions.
Step 4: Organize weekly sessions to learn about a single topic
Set aside a room/space at the health facility and arrange the tables and chairs to suit the learning environment. All participants should be able to see and hear the trainer and any presentations easily.
By the end of the orientation process:
- All staff working in the facility should be able to describe the benefits of FP to each other and clients.
- All staff working in the facility should be able to describe FP methods accurately.
- All staff working in the facility should know what types of FP services are offered in the health facility and know how to inform, counsel, refer, direct, or provide clients with appropriate services, depending on their role.
- All staff should have completed VCAT, so myths and misconceptions around FP among staff should be addressed so they can be diminished or eliminated before sensitizing potential clients on FP.
Indicators for success
- Pre and post-test scores
Resources needed
- PowerPoint slides and IEC materials
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Tips
- Create the content in local languages and pictorials to enable better understanding by all staff.
- If required, sex-segregated orientation sessions should be held, owing to cultural sensitivity. This can also encourage open and interactive sessions.
- Keep WSO sessions to small groups, so that they can be more engaging and allow for ample time and space for questions.
- Keep the sessions interactive, which is extremely important because staff’s background knowledge on the topic can vary widely.
- Conduct a pre- and post-test to evaluate knowledge improvements.
