Fistula Training Strategy, Guidelines and Standards

The strategy recognizes the need for a uniform training approach and emphasizes the importance of proactive discussions about the quality of training, supervision, and follow-up with country missions, local ministries of health, hospitals, professional associations, and nongovernment health organizations. The context for fistula training is complex, with various challenges hindering quality in training. These include the many clinical types of fistula and the widely divergent degrees of surgical complexity encountered both in repair and in training. Lack of standardization in training, curricula, and reference materials also poses a significant challenge. To address these issues, the International Fistula Working Group, led by the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the United Nations Population Fund (UNFPA), has developed a uniform training strategy. Programming for training in reproductive health is a critical component of fistula training. This process involves planning, implementing, strengthening systems for, and evaluating training within the larger setting of reproductive health service delivery. The ACQUIRE Project, in which EngenderHealth was the managing partner, took a holistic, service-oriented, systems approach to programming for training, focusing on the fundamentals of care, including informed choice, medical safety, and continuous quality improvement. The overall approach to fistula training taken by EngenderHealth/Fistula Care is holistic, service-oriented, and systems-based. This approach focuses on the centrally important fundamentals of care, including choice, safety, and quality improvement. Training is intended to contribute to sustainable improvements in the quality of, availability of, access to, and use of fistula services. This approach reflects a comprehensive view that considers the systems and greater social/political and clinical environment in which services are provided. The training approach is characterized by five key principles: the welfare of the client guides all training; a combination of didactic and hands-on training is important; training should be tailored to the specific needs of the trainees; training should be conducted in a supportive environment; and training should be evaluated to ensure that it is effective. The strategy also emphasizes the importance of collaboration with other key players and stakeholders, including national, state, or district-level health authorities, to identify and strengthen training resources and to develop a strategy for training implementation. EngenderHealth may engage with national, state, or district-level health authorities to develop/update and approve training materials and policies, to identify and strengthen training resources, and to develop/agree upon a strategy for training implementation. Simultaneous with training, EngenderHealth works with both on- and off-site supervisors to ensure that trainees' newly acquired skills will be employed and that supervisors and trainers have the skills to provide mentoring and coaching to providers post-training. The strategy also emphasizes the importance of monitoring provider performance and ensuring that providers have chances to use new knowledge, attitudes, and skills that they acquire in training. This requires program managers, supervisors, and trainers to take an active part in assisting providers to identify their own training needs, creating a supportive environment in which to apply what is learned through training, and ensuring that providers also have chances to use new knowledge, attitudes, and skills that they acquire in training.