Training master trainers, health workers, and school personnel

Because HPV vaccines target a new population for most EPI programs (older girls and young female adolescents), developing an effective training curriculum for health workers and ensuring sufficient training time are essential to the success of the program. Further, since schools may be an important part of the strategy for delivering vaccines, teachers and school administrators also benefit from training.

Master trainers, health workers, and teachers need background information on HPV infection and cervical cancer so they can explain basic facts to families and community members. In the PATH projects, managers found that sensitizing all staff, including the heads of regional and local health systems and others not directly involved in vaccinations (such as midwives), motivated them and allowed them to serve as consistent and reliable sources of information to the community. Personnel may also need to interact with journalists and the mass media, so they should receive training on how to communicate with these groups.

Background facts on cervical cancer and HPV vaccines can be found in publications such as Outlook, Progress in Preventing Cervical Cancer: Updated Evidence on Vaccination and Screening, and Cervical Cancer, Human Papillomavirus (HPV) and HPV Vaccines: Key Points for Policy-Makers and Health Professionals. A fact book created in Uganda for health workers, Cancer of the Cervix and its Prevention, provides an example that can be adapted for other programs.

Objectives of training

As is common with other vaccination training programs, a cascade approach is recommended, with national EPI staff training master trainers who then train health workers at lower levels. For a school-based program, the master trainers and trained health workers may also train and sensitize teachers, school administrators, and mobilizers. An important skill for the latter groups is the ability to use age-appropriate approaches for discussing cervical cancer with young adolescents.

It is a good idea to complete all training approximately four weeks before the first dose of vaccine will be given. As discussed above, HPV vaccination programs have some unique requirements for training, but most issues—such as how to safely administer an injection, handle waste, and manage AEFIs—will be familiar to health workers who give routine childhood vaccinations.

Health workers should be able to do the following:

• Describe key facts about HPV infection and cervical cancer.
• Communicate effectively with parents, girls, and other community members.
• Speak appropriately to any audience, including those without formal education.
• Administer HPV vaccine effectively and safely to the target population.
• Manage HPV vaccine supplies.
• Manage vaccination waste.
• Use the forms and processes for monitoring and supervision of HPV vaccination sessions.
• Identify, manage, and report AEFIs.

Audiences, materials, and methods

In planning the training of health workers and school personnel, vaccination program managers will want to identify or develop appropriate training and support materials, assess the time required, and secure suitable venues for training.

When conducting training for school-based vaccinations, separate sessions for health workers and for teachers seemed to work best. After initial separate training, it was beneficial to hold a joint session aimed at coordinating roles for immunization days. Managers found that these sessions could also provide time for the combined group to do microplanning. Providing refresher training to health workers and teachers in a half-day session prior to the third dose of the vaccine was also helpful, since it comes six months after the first dose.

Interactive and participatory training methods encouraged learning, especially for skills-building. Practice sessions and role-playing helped to build skills on how health workers and teachers could communicate with parents and girls. In India, trainers found that activity-based sessions helped service providers experience what could happen in the field, for example, by role-playing an immunization session. This helped to build trainee confidence. (See: Role-play: administering HPV vaccine safely and correctly.)

A USAID guide, Refresher Training for Frontline Health Workers in Expanded Program for Immunization (EPI), presents useful topics such as how to facilitate adult learning, health worker responsibilities for the cold chain, preparing and administering vaccines, monitoring coverage and quality of services, and communicating with caregivers.

An HPV vaccination guide, Demonstration Project for the Introduction of HPV Vaccine in Uganda: Training of Health Managers and Service Providers: Facilitator’s Guide, developed for the PATH demonstration project in Uganda, includes general information on conducting an HPV immunization session and collecting vaccination data, as well as sections on cervical cancer epidemiology; HPV vaccine dosing and packaging; and sensitization, mobilization, and information, education, and communication (IEC) materials for HPV vaccination. Sample Training Agendas for Master Trainers from PATH project countries are also available.

Photo: PATH/Wendy Stone