An essential component of access to safe and quality comprehensive abortion care (CAC) is a trained and supported health workforce providing stigma-free services that meet clinical and service delivery standards. Yet in Nigeria, despite Ipas training support to states, frequent attrition of health workers disrupts availability of quality CAC services across public health facilities.
Ipas Nigeria worked in Jigawa with the Gombe State Ministry of Health to address this issue in 2021. Together, they developed and piloted the first On-the-Job Training (OJT) Guideline for Comprehensive Abortion Care (CAC) in seven facilities, with 22 health workers in each state. State health officials, clinical trainers, and health workers co-developed the draft guideline used to facilitate CAC skill transfer across pilot sites.
The benefits of this approach have proved to not only increase the availability of skilled health workers, but to provide a more cost-effective training approach that improves clinical competency of trained providers when compared to historic classroom-based models. This is in part due to the standardized structure that the tool provides, which ensures that critical components of comprehensive abortion care, like counseling, are not overlooked.
In addition, this on-the-job training model enables a more decentralized provision of quality abortion services across lower-level facilities—bringing services closer to women and girls who need them. “It’s a game changer for sustainability,” says Yinka Abiola Adojutelegan, Ipas Nigeria senior advisor for programs. “It’s a standard process of transferring skills. So if I go to any facility in the state, whether it’s a [classroom-trained] trained provider or somebody who learned on the job in that facility or in another facility, the standard of service and quality of care is the same and there is equity of access.”
Following the pilot, Ipas Nigeria supported rollout of the CAC OJT model to an additional 61 sites and 163 health workers, and trained state and local government health officials on the model to support further scale-up and promote this more sustainable, systems-focused approach. The positive results may soon influence other public sector service delivery approaches, with the Jigawa State Primary Healthcare Development Agency and Jigawa State Ministry of Health considering expanding the OJT model beyond CAC to include other health service delivery areas, like immunization.
In 2022, Ipas Nigeria will work with the Federal Ministry of Health to scale-up the CAC OJT model at the national level and develop a national manual to guide the transfer of CAC skills and competence at the facility level. They will work on increasing availability of relevant anatomical models for training, as well as bringing in virtual approaches to support peer-to-peer skill sharing. By adopting a stakeholder-led approach, Ipas Nigeria built capacity of the state supervisory and technical monitoring structures, paving the way for Jigawa State’s release of funds to its Ministry of Health to support another round of scale-up.