PATH's Cervical Cancer Prevention Action Planner

Lessons specific to training

It is not only community members who lack information about cervical cancer. PATH has also discovered relatively low levels of up-to-date knowledge among health professionals and especially among field-level health workers. Awareness-raising among a broad range of health workers, along with skills training in screening and treatment for clinical staff, is necessary to ensure high-quality, acceptable, and accessible cervical cancer prevention services.

Target audiences for training: Obvious target audiences for training include the clinicians who will provide screening and treatment services and the health educators who inform communities about the services. But women and their families often view any health staff as experts and ask them questions, so short orientation sessions can also be organized for clinic and hospital managers, supervisors, midwives, teachers, and others whose support is needed administratively, or who have access to and credibility with community members.

Existing training materials: Fortunately there are a number of existing course materials and outlines, including a web-based training tool, which training teams can consult or adapt as they develop their own materials. Sample agendas of clinical training and trainings of trainers used in the PATH projects are included among the resources listed at the end of this manual.

Course methods and timing: The ACCP partners and PATH have learned that trainees respond well to courses that hold trainees accountable for achieving clinical competencies and that include interactive training methodologies and the opportunity to practice new skills with actual patients—under the supervision of an experienced clinician (an obstetrician/gynecologist may be ideal).

Generally about five days of classroom and clinical practice are necessary to train nurses and physicians to perform VIA and cryotherapy. If the providers are not already skilled in pelvic examination technique, more time may be required. A significant portion of that time should be dedicated to supervised practice.

Training strategy: As a general strategy for training large numbers of health workers across the country (either for awareness-raising and/or clinical skills-building), a cascade training system—with highly experienced, national master trainers at the top who train and supervise teams of lower-level trainers—likely makes the most sense. To the extent possible, it is best to reduce the number of "layers" of trainers since the further removed on-the-ground trainers are from direct contact with the master trainers, the greater the potential for loss of quality in the training program.

Maintaining a set of master trainers helps provide a sensible structure and helps ensure that the quality of information on screening and treatment is sustained at a high level. Having a reliable core group of master trainers also allows for retraining, both for staff who need a refresher and for new staff entering the program.

If outreach materials have been carefully designed and tested with community members, they can become excellent resources to use when training outreach providers.

Quality assurance during and after the course: Because VIA is a subjective test, regular assessment of clinician skills helps ensure quality.

Supportive supervision is an important element for maintaining quality after the training course is over, guiding corrections as necessary and providing continued learning among health staff. Supportive supervision means that supervisors regularly interact with field staff and are aware of their roles and how they are fulfilling those roles, and that the emphasis of supervision is on supporting staff to do a better job, not on blaming or punishing them.

Any work plans developed as part of a supervision visit should clearly specify what actions are needed and should identify a responsible person at the health facility level to follow up on implementation of solutions.

Your program may benefit from these presentations on supportive supervision training.

In some cases it may be possible to enlist the help of experienced providers in reviewing VIA cases through digital imaging and email, as has been tried in Zambia. However, unless reviewers are available whenever women are screened, such a system could introduce delays and negate the benefit of presenting immediate results to the patient. Most likely distance reviews would be beneficial in only certain situations, for example if there is a question about treatment selection.

Photo: PATH/Mike Wang

Additional resources

Print version: Cervical cancer screening and treatment in low-resource settings (PDF, RHO Cervical Cancer website)

Watch videoScreening and Treatment of Precancerous Lesions video and transcript

Screening and treatment (RHO Cervical Cancer website)

World Health Organization: Comprehensive Cervical Cancer Control: A guide to essential practice (PDF)

Planning and Implementing Cervical Cancer Prevention and Control Programs: A Manual for Managers (PDF)

Evidence-Based, Alternative Cervical Cancer Screening Approaches in Low-Resource Settings

Strategic Plan for Cervical Cancer Prevention and Control in Uganda (PDF)

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