A Comprehensive Reproductive Health Curriculum

Family Planning Training Curriculum

for Health Care Professionals
Trainers Guide

RMNCAH UN JOINT PROGRAMME

 Acknowledgements

The development of this Comprehensive Family Planning Trainer’s

Guide is based on the Vanuatu Reproductive, Maternal Newborn
Child and Adolescent Health Policy and Implementation Strategy for
2017-2020, Vanuatu National Family Planning Guideline 2016,
Vanuatu National RH policy 2015 and the National Population Policy 2011-2020. The
Guide is designed to help Health Care Professionals understand it and be able to teach
and educate other health workers in Family Planning. It is to be used together with the
Family Planning Participant’s Guide.

I would like to extend the Ministry of Health special appreciation and gratitude to Dr.
Sophaganine Ty, the Consultant who developed the Trainer’s Guide without whom it
would not have been in its present form. The Trainer’s Guide has also benefitted from
the contributions of many people working as a team from the Ministry of Health, UNFPA,
UNJP RMNCAH and different organization. The members of the team are:

# Name Organization
01 Dr Errolyn Tungu O&G Consultant – Vila Central Hospital
02 Ms Siula Bulu Wan Smol Bag Theatre
03 Ms Marie Jean Baptist Willy Ante-Natal Clinic – Vila Central Hospital
04 Ms Apisai Tokon National RH Coordinator – MOH Public Health
05 Ms Emily Bovu Vanuatu Family Health Association
06 Ms Leiwaku Noah Save the Children Australia
07 Dr Shafag Rahimova UNICEF / RMNCAH National Coordinator
08 Mr Pioni Willie UNDP
09 Mr Gideons Mael UNFPA

A word of appreciation to RMNCAH UN Joint Program for coordination in the development

and printing of the guide. The cooperation by the UN Joint Partners for health is gratefully
acknowledged.

I take this opportunity to invite the Ministry of Health to use the Trainer’s Guide and train
as many health workers in the country upskilling them to a level where they are able to
provide Family Planning services to the people of the country. Let us all work together
and give positive values to the health of our people for brighter future.

George Taleo
Director-General
Ministry of Health
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 Forward by Minister of Health
Family Planning is a component of the reproductive health services of
the Vanuatu Ministry of Health (MOH). Over the years the MOH trained
its health workers to administer different types of Family Planning methods available to
female and male users in the reproductive age groups in all health facilities across the
country covering hospitals, health centers, dispensaries and even at aid posts where
condoms are accessed.
The MOH workforce shows that it does not have adequate trained FP health personnel.
The health workers who have had training FP have and are nearing retirement age and
will soon exit the workforce. The lack of sufficient health personnel trained in FP meant
that all nurses especially in the province and community managing health facilities have
to be trained in FP methods. A trained FP health personnel managing a rural facility would
be able to provide FP services to the people within the facility catchment. This will help
to increase coverage as well as reach out more into areas that are difficult to access.
This Family Planning Trainer’s Guide is yet another milestone for the MOH. It is designed
to help professional health workers train young nurses to understand and improve their
services on Family Planning issues in the country. The lessons that the Guide has covers
health professionals from hospital setting right down to dispensary level. The Guide is
designed in such a way that it is interactive and enables a positive learning environment.
Family Planning service has its own challenges and although Vanuatu communities view
the service differently based on the different cultures and beliefs they have, it cannot be
overemphasized the fact that the future wellbeing of individual families depend on the
decisions on Family Planning choices they make now. The Ministry of Health must be
seen to take the lead in Family Planning services for the people of Vanuatu and I would
like to commend the work of UNFPA / UNJP on RMNCAH in continuing to make it possible
for families to have a choice of making a decision about their family.
I would like to thank all those who have contributed in the realization of the Guide. I
therefore ask the MOH to fully utilize the Guide and educate young health workers in the
country contributing to bringing Vanuatu’s unmet needs of Family Planning to zero.

Hon. Jerome LUDVAUNE (MP)

Minister of Health
Vanuatu

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Acronyms

ARI Acute Respiratory Infections

ARV Antiretroviral

BBT Basal Body Temperature

CPR Contraceptive Prevalence Rate

CYP Couple Years of Protection

COC Combined Oral Contraceptive Pills

DMPA Depot Medroxprogesterone Acetate

ECPs Emergency Contraceptive Pills

FSH Follicle Stimulating Hormone

FP Family Planning

FAB Fertility Awareness Based Methods

GnRH Gonadotropin-releasing Hormone

HIV/AIDS Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome

ICPD International Conference on Population and Development

IMR Infant Mortality Rate

IUD Intra-Uterine (Contraceptive) Devises

KPA Key Policy Areas

LAM Lactational Amenorrhoea Method

LNG Levonorgestrel / Leutinizing Hormone

MOH Ministry of Health

MDG Millennium Development Goal

MMR Maternal Mortality Rate

STI Sexually Transmitted Infections

SRH / SRHR Sexual Reproductive Health / Sexual Reproductive Health Rights

POPs / POI Progestogen Only Pills / Progestogen Only Injectable

PMTCT Prevention of Mother To Child Transmission of HIV

PID Pelvic Inflammatory Disease

UNFPA United Nations Population Fund

WHO World Health Organization.

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Contents
Acknowledgements…………………………………………………………………………………..…………01
Forward…………………………………………………………………………………………………..…………02
Acronyms ............................................................................................................... 03
How to use this manual ........................................................................................... 05
Introduction of the workshop ................................................................................... 09
PART 1: Guidelines for the MoH Program Management of Family Planning including
Policy environment .................................................................................................. 12
Part 2: The FP guidelines for client services and facility/clinic management. ............... 13
LESSON 1: Reproductive Health and over view of Family Planning………………………..13
LESSON 2 : Male's reproductive anatomy and physiology…………………………………….15
LESSON 3: Female's reproductive anatomy and physiology………………………………….16
LESSON 4: Client counselling and sexual health promotion…………………………………..17
LESSON 5: Fertility and fertility awareness………………………………………………………….24
LESSON 6: Contraception………………………………………………..……………………………..26
LESSON 7: Sexual transmitted diseases (including HIV) and their consequences on
reproductive and sexual health ............................................................................. 39
LESSON 8: Legal and ethical issues....................................................................... 41
Part 3: The evaluation criteria and monitoring components……………………………………..43
Annexes……………………………………………………………………………………………………………..44
Annex 1: Pre-Test Answers Key - FOR TRAINERS…………………………………………………44
Annex 2: Pre-Test questionnaires for PARTICIPANTS ................................................ 47
Annex 3: Instructions for Role Plays ......................................................................... 49

Health Workers with certificates in Jadelle Implant training Norsup, Melsisi, Lolowai & Vaemali 2016

4
How to use this manual
This manual is designed for training health professionals (family doctors and nurses)
working in all levels in the provision of Family Planning services.

The concept of the manual is designed for an interactive working style, with active
involvement of the trainees in the learning process.

This manual offer to trainers the model to be followed during the training workshop, in
order to facilitate the training activities, so that the trainees will acquire the necessary
knowledge, abilities and skills –through own experience- for providing quality, client-
focused family planning services.

At the end of the workshop, trainees will be able to provide general and specific
counseling for contraception; to initiate, monitor and evaluate the use of contraceptives
by their clients.

The manual contains three parts:

Part 1: Guidelines for the MoH Program Management of Family Planning including Policy
environment.
Part 2: The FP guidelines for client services and facility/clinic management.
- Reproductive Health and over view of Family Planning
- Male’s reproductive anatomy and physiology
- Female’s reproductive anatomy and physiology
- Client counselling and sexual health promotion
- Fertility and fertility awareness
- Conception
- Sexual transmitted diseases (including HIV) and their consequences on
reproductive and sexual health
- Legal and ethical issues

Part 3: The evaluation criteria and monitoring components.

Each session contains:

- Description of the session – contains necessary technical information for

conducting the activities of each session.
- Trainer’s Documents/Materials – contain standard information necessary to
trainer for conducting the activities.

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Each session contains: specific objectives of the session, time, training techniques, and
necessary materials. The trainers will need to check, prior to the beginning of the
workshop and before each session that all necessary materials are in place.

This manual need to be used with;

- The comprehensive Family Planning Trainer’s manual- participant’s handout 2016,
- Vanuatu National Family Planning Guideline 2016,
- The Vanuatu National RH policy
-
a. Why should training be conducted?
Training in the provision of high-quality Family Panning (FP) is an essential component
of improving Reproductive Health services. The curriculum has been developed to provide
the latest information on FP, and aim to upgrade the knowledge and skills of healthcare
providers already providing care in the country.

b. Who is the training programme for?

The programme is for health-care providers whose normal duties include first-level of
health service deliveries and for those who work as outreach providers. The training may
also be of value to more experienced staff who will be involved in the management or
administration of clinics and health services.

c. The learning support roles

The trainer “teacher” play a major role in organizing and passing the message to
participants “ learners “ during the training.

You have more time to ensure positive practical outcomes of the learning. Your main
functions are:

- to identify suitable candidates and select who will take part in the training
programme;
- to select and plan the training approach and necessary resources;
- to introduce the programme to supervisors and establish a positive learning
- environment for learners;
- to ensure that learners identify their training needs and make an effective study
plan;
- to enable learners to practise the necessary skills and give and receive effective
feedback so that each one becomes competent;

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 - to ensure that learners have regular contact so that they do not feel isolated;
- to ensure that learners receive useful feedback on exercises and skills; and to
monitor and assess learning outcomes.

Notes to the Trainer

The trainer during any workshop must always consider the following aspects:

DO-s: DON’T-s:
- Do prepare in advance, prior to the beginning of the - Don’t talk to the flipchart
workshop/ session/ activity - Don’t block visibility
- Do maintain eye contact - Don’t stand in one place, move around in the
- Do involve participants in the activities room
- Do use audio-visual aids - Don’t ignore the participants’ comments and
- Do speak loud and clear feedbacks (verbal and non-verbal)
- Do encourage questions - Don’t read from the curricula/ manual
- Do recap at the end of each session - Don’t raise your voice
- Do encourage participation
- Do write clearly and visibly
- Do summarize
- Do watch the time
- Do keep it simple
- Do give feed-back
- Do position visuals so everyone can see them
- Do avoid distracting and distraction in the workshop
room
- Do be aware of the participants’ non-verbal language
- Do keep the group focused on the task they have to
complete
- Do check to see if instructions are understood by the
participants
- Do permanently evaluate as you go
- Do be patient

d. Before the training

Careful planning and preparation are essential for any training programme. This section
provides you with the essential steps in preparation:

- Becoming familiar with the programme and modules

- Identifying the participating facilities and learners
- Deciding upon the training approach or mix
- Planning the course
- Planning the records you will need to keep
- Preparing training materials

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 e. Family planning training workshop agenda

TIME DAY I DAY II DAY III

8.00 – 09.45 Opening Re-cap day 1 Re-cap day 2

Introduction and Pre test
1hr 45mn Lesson 4: Client Lesson 6: cont
Part 1: Guidelines for the counselling and sexual
MoH Program Management of health promotion 7. Barrier methods
FP including Policy 8. Emergency
environment. contraception

09.45 – 10.00 Coffee break Coffee break Coffee break

10.00 –12.00 Continue Part 1 Lesson 5: Fertility and Lesson 7: STI

2 hr fertility awareness
12.00 - 13.00 Lunch break Lunch break Lunch break
13.00 - 14.45 Part 2: Lesson 6: Conception
Lesson 1: RH and over view Lesson 8: Legal and
1hr 45mn of FP 1. Combined oral ethical issues
contraceptives
2. Progestin only pills

14.45 - 15.00 Coffee break Coffee break Coffee break

15.00 - 16.00 Lesson 2: Male’s reproductive Lesson 6: cont Part 3: The evaluation
anatomy and physiology criteria and monitoring
1hr 3. Injectable components.
contraceptives
4. Hormonal implants

16.00. - 16.30 Lesson 3: Female’s Lesson 6: cont Post test

reproductive anatomy and
30mn physiology 5. Tubal ligation and Evaluation of training
vasectomy Close-workshop
6. IUCD

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Introduction of the workshop

Objectives

By the end of the session participants will:

- Refer to the trainers and to the other participants by their names
- Reconsider their expectancies in relationship with the objectives of the workshop
- Describe the schedule of the workshop
- Evaluate their knowledge in Family Planning

Time: 1h
Techniques: Presentations, listing, individual work
Trainer’s Documents:
- Training program
- Presentation exercises

Other materials
- Folders containing A4 paper sheets
- Name tags
- Flipchart paper sheets
- Markers
- A4 paper sheets
- Pens

Activities:

1. Introduction

- Greet participants as they arrive and welcome them. Hand each one of them a
folder and a pen. Thank them for participating in the program
- Introduce yourself. State your name, surname, position, professional
experience, steady job position.
- Ask the co-trainer to introduce him/ herself.
- Ask participants to introduce themselves
- Mention the organizers of the workshop and the donors that financially support
the costs

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 2. Participants’ expectations

Ask the trainees about their expectations regarding this workshop and write down on the
flipchart all their answers (what they expect/ want to find out during this workshop).

3. Workshop Objectives
- Post on the flipchart: “General Objectives of the Workshop”
- Ask participants to read the objectives and clarify what it’s mean

General objectives of the workshop

We propose participants to:

- Achieve information about the contraceptive methods available in Vanuatu
- Achieve abilities to initiate, monitor and evaluate use of contraceptive
methods by clients
- Achieve the necessary skills for family planning counseling

4. Group norms
- Explain that, in order to attain the workshop’s objectives, another important
factor is the way in which the participants will work together as a group.
- Ask participants to propose rules, norms and write them down on the flipchart.
Discuss each of the proposed rules, asking for arguments to sustain them.
- If difficulties occur in formulating the norms/ rules, suggest them through direct
questions, or refer to the consequences of disrespecting these rules (“what
happens when everybody is talking and no one is listening?”).
- In the end, review the list and make sure that there is a consensus for assuming
the norms.

Examples Group Norms

- Participate in all sessions!

- One person at a time is speaking!
- Do not interrupt those that are speaking!
- Be concise!
- Respect the points of view and ideas that are different from yours!
- Punctuality is respected by everybody!
- Smoke in spaces destined for this!
- Turn off the cell phones or put “on silent”!

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 5. Workshop agenda presentation
- The co-trainer distributes to participants the Workshop Agenda
- Make a brief presentation of the subjects which will be discuss during the workshop

6. Pre-test (10 minutes)-

(see pre-test’s questionnaire in annex 1)

- Give each participant a copy of the pre-test
- Mention the time allowed for this activity (10 minutes)
- While the participants are completing the test, the trainers are walking through
them.
- Collect the pre-tests
- Give participants the handout: FP training participants the handout, FP National
guideline and RH National policy

Participants introduction guide

- what is your name?

- what do you like to be called?
- where do you work?
- what other courses/ workshops
- have you participated in?
- what kind of music do you like?
- what are your favorite flowers?

Jadelle insertion by health worker trainees Family Planning Awareness

11
PART 1: Guidelines for the MoH Program Management of
Family Planning including Policy environment

Objectives of the session:

- Understand the link between Sexual Reproductive Health and Family Planning
- Understand Key Policy Areas (KPAs) for Reproductive Health in Vanuatu
- Understand the policy environment related to FP in Vanuatu

Time: 2h and 45 minutes

Techniques: Presentations, listing, individual work

Materials:
 Material for the trainer
1. National RH policy
2. Participant’s handout
3. Power point presentation

Subjects should be included in power point presentation:

- Objectives of the session

- Definition of Policy and strategy
- Link between Policy and strategy
- Vanuatu RH policy
- The SRH Framework
- Brief information on International Conference on Population and Development
(ICPD)
- The Millennium Development Goals (MDGs) and how the FP fit within the MDG
- Guidance principles SRHR in Vanuatu
- The Key Policy Areas for Reproductive health service in Vanuatu

 Material for the trainees

1. Participant’s handout
2. National RH policy
3. Paper and pens

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  Other materials
1. Flipchart paper sheets
2. Markers

Activities:
- Ask participants if they have any questions/issues/sharing information related to
the RH National Policy
- List all the issues mentioned by the group on the flipchart. Post the obtained list
in a visible place
- ask participants: How do you believe you may help in solving these problems
through the light of the FP objectives? Which are the services you might provide
in your office in order to solve these issues?

Part 2: The FP guidelines for client services and

facility/clinic management.

LESSON 1: Reproductive Health and Overview of Family Planning

Objectives
By the end of the session, the participants will able to:
- define the concepts of Reproductive Health and Family Planning
- describe the objectives of Family Planning and services
- describe the benefits of Family Planning (for individuals, health professionals,
community)

Time: 1h 15 mn
Techniques: Presentations, discussions, listing, brainstorming
Materials:
 Material for the trainer
1. Vanuatu national family planning guideline 2016
2. Participant’s handout
3. Power point presentation

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 Subjects should be included in power point presentation:

- Objectives of the section

- Definition: SRHR, SH, FP
- The key importance of reproductive health
- Why is Family Planning (FP) Important?
- Family Planning Services Objectives
- The benefits of Family Planning

 Material for the trainees

1. Participant’s handout
2. Vanuatu National family planning guideline- 2016
3. Paper and pens

 Other materials
1. Flipchart paper sheets
2. Markers

Activities
- Ask participants to state difficult situations, problems they are confronting with in
their professional activity, related with reproductive health (including mother and
child’s health status). Ask: What kind of issues are you confronting with?

- List all the issues mentioned by the group on the flipchart. Post the obtained list
in a visible place (you will return to this list at the end of the session).

- Post on the flipchart (or show in the slide presentation) RH/ FP Definition

- Ask one of the participants to read the FP definition.

- Ask then one of the participants to read the RH definition.

- Ask then one of the participants to read the Sexual Health definition

- Ask the group if they have any question related to the definition

- Ask participant to read the Objective of Family Planning Services

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 - Ask participants: How could FP objectives be attained? Do you believe that such
objectives can be attained within the health care providers (doctors and nurses)
within the current practice?

- Mention the fact that the list of FP services also includes services other than those
stated.

LESSON 2: Male’s Reproductive Anatomy and Physiology

Objectives
By the end of the session, the participants will able to:
- Define and use correctly all of the key words
- Identify and describe the basic anatomical features of the male reproductive
organs
- Describe the functions of the main anatomical structures in the male reproductive
system

Time: 30 mn
Techniques: Presentations, discussions, listing, brainstorming
Materials:
 Material for the trainer
1. Vanuatu national family planning guideline 2016
2. Participant’s handout
3. Power point presentation

Subjects should be included in power point presentation:

- Objectives of the session

- Anatomy of male reproductive system
- Hormone and mechanism of action
- Sperm production

 Material for the trainees

1. Participant’s handout
2. Vanuatu National family planning guideline- 2016
3. Paper and pens

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  Other materials
1. Flipchart paper sheets
2. Markers

Activities

- Post on the flipchart (or show in the slide presentation) male reproductive
organ- (no name show in the pictures)
- Ask the participants to identify the name of each parts of the organ and explain
on it’s function
- Ask participants to name some of the diseases/problems that could occurred on
each parts of the organ

LESSON 3: Female’s Reproductive Anatomy and Physiology

Objectives
By the end of the session, the participants will able to:
- Define and use correctly all of the key words
- Identify and describe the basic anatomical features of the external female
genitalia and the internal reproductive organs
- Describe the functions of the main anatomical structures in the female
reproductive system

Time: 1 h
Techniques: Presentations, discussions, listing, brainstorming
Materials:
 Material for the trainer
1. Vanuatu national family planning guideline 2016
2. Participant’s handout
3. Power point presentation
Subjects should be included in power point presentation:

- Objectives of the session

- Some common directional terms used in anatomy
- Anatomy and physiology of female reproductive organ
- Hormones and menstrual cycle

16
  Material for the trainees
1. Participant’s handout
2. Vanuatu National family planning guideline- 2016
3. Paper and pens

 Other materials
1. Flipchart paper sheets
2. Markers

Activities

- Post on the flipchart (or show in the slide presentation) female reproductive
organ- (no name show in the pictures)
- Ask the participants to identify the name of each parts of the organ and explain
on it’s function
- Ask participants to name some of the diseases/problems that could occurred on
each parts of the organ

LESSON 4: Client Counselling and Sexual Health Promotion

Objectives
By the end of the training in FP counselling, participants will be able to:
- Describe affective of interpersonal communication skills
- Identify effective communication
- Describe the counseling process
- Acknowledge the process of decision making and solving problems
- Describe the Six Elements of Effective Counselling
- List the rights of the FP client
- Family Planning Counseling Needs of Diverse Groups

Time: 1h 30 mn
Techniques: Presentation, Simulation, Small groups, Brainstorming, Discussions, Case
studies, Demonstration

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Materials:
 Material for the trainer
1. Vanuatu national family planning guideline 2016
2. Participant’s handout
3. Power point presentation

Subjects should be included in power point presentation:

- Objectives of the session

- Principles of the “Decision-Making Tool
- What is Family Planning Counselling?
- Why is Family Planning Counselling is important
- Family Planning Counsellors
- Interpersonal Communication Skills
- Six elements of effective FP Counselling
- Process of decision making and solving problems
- Types of Family Planning Counseling
- FP and client’s right

 Material for the trainees

1. Participant’s handout
2. Vanuatu National family planning guideline- 2016
3. Paper and pens

 Other materials
1. Flipchart paper sheets
2. Markers

Activities
1. The communication process
- Discuss the way in which each component influence on the effectiveness of the
communication process
- Ask the group: Why is it important for a service provider to understand these
components of communication? How can it help you in counseling?

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Note:

The communication process: is a process in which a message is transmitted from

a source to a recipient through a verbal or non-verbal channel.

Components of communication:
- Sender: person who speaks (or makes jests)
- Message (of the sender)
- Channel (for the message)
- Receiver (person who listens/receive/s the message)
- Feedback (from receiver to sender)
- Code (language or non-verbal jests used)

Sender (source). Qualities that make a person trusted:

- competence (in message content & communication of information, though not
necessarily by virtue of educational status)
- ability to establish positive & constructive rapport with the individual
- coherence between verbal & non-verbal messages
- influence on the client (resulting from communication of respect & trust, not
power)
- natural position in the community
- personal qualities or actions (readiness/ willingness to help)
- similar characteristics (e.g. age, culture, experiences etc)

Message: clarity, simplicity, relevance to needs of the receiver

2 components of a message:
- content
- emotions/feelings (often communicated non-verbally: facial expressions, jests,
tone of voice etc)

Channel (for the message): relevance to the characteristics of the individual

(participative/active versus passive)

Receiver: interest in the subject, other preoccupations, attitude toward the sender
- Anxiety in the receiver may provoke defensiveness & a tendency to misinterpret
what is said (perceive threats which are not there). (Ex: adolescent clients;
clients during STI risk assessment)

Feedback: degree to which it is sought, respected & constructive

Code: language (words, expressions) must be common to the sender and receiver
(counselor and client/group). (ex: technical language, adolescent jargon)

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 2. Obstacles to Communication

- Make the following exercise: together with the co-trainer simulate a real situation
that should illustrate the regular doctor/nurse-patient relationship.

- Ask participants to follow the simulation and to identify the obstacles to

communication between the doctor and client, generated by the doctor (service
provider).

- Discuss in the large group about identified obstacles and how they might be
remove if the exercise should be repeated.

- Or Group participants in pairs of two and ask them to tell, by turn, to their
partner something about their body (not about sexuality!); each one has 5 minutes
to speak, then they switch the roles (speaker and listener)

- Ask participants to answer the question: What obstacles have you identified?

- Ask at the end of the exercise: Who wants to speak about how he/she felt when
speaking about him/her selves?

- Ask “the patients” how did they felt? Probably, you will get some answers that
reflect negative feelings.

- Emphasize that our patients/clients have similar feelings too.

Note: Some examples on sources of obstacles in communication-

- differences in values, education, class, vocabulary

- extreme appearance (of client or worker)
- client’s problem is shocking
- service provider is unable to respond
- information/message communicated by the client is not what the service
provider wanted to hear
- service provider is distracted by other pre-occupations
- service provider’s response is not what the client needed, wanted to hear
- environment and/or atmosphere is not conducive to communication (noisy,
distracting, no privacy)

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 - client feels uncomfortable and distracted, is self-conscious to discuss problems
because of people overhearing or does not really trust the health worker
- health worker does not understand the client’s problem, uses complicated
language with unfamiliar terms, gives advice that is irrelevant or impossible to
implement
- too much information is given: the person only remembers part of what was
said, especially if she was worried or anxious
- people who do not know each other or otherwise lack confidence in each other
have difficulties hearing each other

3. Counselling
- Post the definition of counselling
- Ask a volunteer to read the definition
- Ask the group: How would you describe the difference between counseling and
giving advice? Which do we tend to do most of in our consultations?
- Ask participants- What does the concept 'informed choice' mean?

Informed choice: a voluntary choice/decision based on knowledge of all information

relevant to the choice/decision.

- Decision making process: Ask participants:

o How do we usually make a decision?
o Do we usually respect the decision-making process?

Steps reflection decision making:

- People weigh the pros and cons of the situation
- People anticipate the consequences of their decision
- People ask themselves questions
- People consider the alternatives

The importance of the step Information on the step Reflection:

Information provided must:
- Be relevant to the clients’ interests and needs
- Be complete, precise, and clear; and be understood by the clients

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 4. Counseling in the context of FP consultations

Role of FP counseling in ensuring an informed choice: assist the client to consider

all aspects of her problem/choice in order to choose what suits her best.

- Review with the group key elements of each step of GATHER & the goal of each
step. (see document: GATHER)

G = Greet the client

A = Ask about client needs, medical history, etc
T = Tell client about methods
H = Help client to choose a method
E = Explain the method
R = Return visit

- Ask volunteer- Benefits of Counseling; Consequences of the Lack of Counseling

- Ask the group: What must a doctor and/or nurse know about contraceptive
methods in order to be able to counsel FP clients?

For all the methods available in the country, service providers must know:
- description of the method
- availability of the method (where one can obtain it)
- how the method works (contraceptive action)
- effectiveness of the method
- advantages of the method
- disadvantages of the method
- reversibility of the method
- cost of the method
- contraindications (relative and absolute)/precautions in the provision of the
method
- secondary/side effects of the method and what to do in case of a secondary
effect
- warning signs of the method and what to do in case of warning signs
- rumors about the method and how to respond to them
- follow-up schedule for the method
- instructions for the user of the method
- the method’s effectiveness against STIs

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 5. Client Rights Regarding the Delivery of FP Services
- Ask participants- why “client rights “ is very important in regarding the Delivery of
FP Services

Role play (see instruction in annex 3)

Case study 1: Amina

Client Description
You are a 30-year-old married woman with four children. You want to avoid pregnancy
and want a reliable method, but you are not sure which method you can use.

Case study 2: Rose

Client Description
You are a 19-year-old unmarried woman with a steady boyfriend and no children. You
have come to talk with the health worker because you had unprotected sex three days
ago and want help preventing pregnancy.

Case study 3:
Client Description
The client is a 15-year-old female. She attends high school in a neighboring town
where she stays with her aunt and uncle. She has a sexual relationship with her
teacher, who is in his mid-20’s. She insists that she wants this relationship. She does
not know if he has sex with other women. She does not want to get pregnant.

Case study 4:
Client Description
The client is a 35-year-old man. His wife is pregnant. He occasionally sleeps with other
women, but does not say whether they are sex workers or not. He wants to use
condoms with his other partners so that he does not pass an infection to his wife. You
know his wife.

Case study 5:
Client Description
The client is a 28-year-old married woman who is breastfeeding a three-month-old
baby, her third child. She does not want another child and wants to know how to
prevent another pregnancy. She sometimes gives the baby formula.

23
LESSON 5: Fertility and Fertility Awareness

Objectives
By the end of the session, the participants will able to:
- Define fertility.
- Identify and describe the difference types of Fertility based Awareness
Methods
- Understanding the Side Effects, Health Benefits and Health Risks

Time: 1h 45mn
Techniques: Presentations, discussions, listing
Materials:
 Material for the trainer
1. Vanuatu national family planning guideline 2016
2. Participant’s handout
3. Power point presentation

Subjects should be included in power point presentation:

- What Are Fertility based Awareness Methods

- Side Effects, Health Benefits and Health Risks of FAB
- How does FAB method work?
- Types of Fertility awareness based (FAB) methods
o Basal body temperature (BBT)
o Calendar Method (Rhythm Method)
o Cycle Beads Methods
o Mucus or Billing's Method
o Sympto-thermal Method
o Withdrawal method
o Post-partum family planning
o Lactational Amenorrhoe Method (LAM)
o Post miscarriage family planning

24
NATURAL FAMILY PLANNING: ADVANTAGES

- It does not influence the health status, it does not constitute a risk for health
- It can be used by anyone, its use does not imply boundaries
- There are no side-effects
- It is cost-free
- It is immediately reversible
- It facilitates acknowledgement of own body
- After it has been learned, the method no longer needs help from the medical staff
or from other trained personnel
- Once it is correctly understood, the method can be used for avoiding, as well as for
obtaining a pregnancy, depending on the couple’s interest
- It involves both partners in assuming pregnancy related responsibilities
- The method is accepted by some religious groups which refuse other contraceptive
methods

NATURAL FAMILY PLANNING: DIS-ADVANTAGES

- Within the common use, these methods are more or less efficient: up to 20
pregnancies in 100 women in the first year of use

- The method based on calendar implies keeping track of data about the menstrual
cycle over a period of many months

- The methods based on recognizing the fertile period need a time period for
learning the signs which indicate the fertile period

- Touching the genitals is unacceptable to some women, thus self-exploration of the

genital sphere possibly being a difficult process to some persons

- Temporary abstinence might be unacceptable or difficult for some couple/ the

male partner

- Natural methods could become unsure and hard to use when the woman’s health
status goes through changes (fever, vaginal infections, breastfeeding or others
conditions that can affect the body temperature, the aspect of cervical mucus or
the length of the menstrual cycle)

- In situations in which the menstrual cycles are irregular, the efficiency of

temporary abstinence is unclear

- It does not protect against sexually transmitted infections.

25
  Material for the trainees
1. Participant’s handout
2. Vanuatu National family planning guideline- 2016
3. Paper and pens

 Other materials
1. Flipchart paper sheets
2. Markers

Activities
- Between each presentation, ask participants is they have any question
- Invite participants to address questions; ask the group if any one of them knows
the answer; if the answer is wrong, request other opinions. If there are more
answers, precise the correct answer.
- Ask participants what is the efficiency of each method.

- Divide participants into 4 groups; two groups will list the advantages of using
fertility awareness methods; the other two groups will list the disadvantages.

- Explain participants the task they are assigned and mention that they have 10
minutes in order to complete it.

- During the exercise, the two trainers pass in order to make sure that they have
correctly understood the task they have been assigned.

LESSON 6: Contraception

Objectives
By the end of the session, the participants will able to:
- Steps in decision making at a Family Planning visit
- Characterize the following contraceptive methods based on mechanism of action,
effectiveness, side effects, benefits, eligibility criteria and interventions for certain
problems during use;

Time: 3h 75mn
Techniques: Presentations, discussions, listing, brainstorming
26
Materials:
 Material for the trainer
1. Vanuatu national family planning guideline 2016
2. Participant’s handout
3. Power point presentation (refer to power point presentation)

Subjects should be included in power point presentation:

- Steps in decision making at a Family Planning visit

- Combined oral contraceptives
- Progestin only pills
- Injectable contraceptives
- Hormonal implants
- Tubal ligation and vasectomy
- IUCD
- Barrier methods
- Emergency contraception

Note:
Each method should present on: type/available in Vanuatu, effectives, return to fertility,
Side effects, management of side effects and Instruction on how to Use.

 Material for the trainees

1. Participant’s handout
2. Vanuatu National family planning guideline- 2016
3. Paper and pens

 Other materials
1. Flipchart paper sheets
2. Markers

Activities
1. Combined Oral Hormonal Contraceptives
- Divide participants in pairs of two
- Hand each pair a sample of COC and ask them to demonstrate the way in which
clients are given the information they need
- Tell them that they have 5 minutes in order to complete this.

27
 - The co-trainer hands each pair of participants a checklist and the trainer asks
participants, still divided in pairs, to check –using the list (see in participant
manual, annex 1) - if all necessary information has been offered to the clients
- Ask if there have been many oversights compared to the list

Role play
(Use the client roleplay description in participant manual)

COCs Scenario 1:

Client Description
You are a 17-year-old female who has been counseled about the benefits of using family
planning by a nurse at the antenatal clinic. You were pregnant but miscarried one month
ago. You read the pamphlet on family planning method options that was given to you by
the provider at the clinic and have made a decision about which method you believe best
suits your needs.

COCs Scenario 2

Client Description
You are a 23-year-old woman and have come to the clinic because your seven-month-
old baby has a mild fever. You use this visit to ask about pregnancy spacing. You do not
want another child for at least two years.

COCs Scenario 3

Client Description
You are a 20-year-old woman who has never been pregnant. A month ago you purchased
COCs from a nearby pharmacy. You have been taking the pills every day for one month
but have been experiencing nausea and spotting. When you told your friend about this,
she suggested that you stop taking the pills because you might be pregnant. You stopped
taking the pills two days ago and have come to the clinic to see if you are pregnant.

28
2. Progestin only pills

- Divide participants in pairs of two

- Hand each pair a sample of POP and ask them to demonstrate the way in which
clients are given the information they need
- Tell them that they have 5 minutes in order to complete this.
- The co-trainer hands each pair of participants a checklist and the trainer asks
participants, still divided in pairs, to check –using the list (see in participant
manual, annex 1) - if all necessary information has been offered to the clients
- Ask if there have been many oversights compared to the list

Role play
(Use the client roleplay description in participant manual)

POPs Scenario 1:

Client Description
You are a 25 years old female who have been counseled about the benefits of using
family planning by a nurse at the antenatal clinic. You were pregnant but miscarried
one month ago. You read the pamphlet on family planning method options that was
given to you by the provider at the clinic and have made a decision about which method
you believe best suits your needs.

3. Injectable contraceptives

- Divide participants in to three groups

- Hand each group a sample of progesterone infection and ask them to demonstrate
the way in which clients are given the information they need
- Tell them that they have 5 minutes in order to complete this.
- One participant will act as a client and one will act as an health care provider. The
rest of participants will act as an observer.
- Tell them that they have 5 minutes in order to complete this.
- At the end, check with everyone if they have any information to share with the big
group

29
Role play

Injectable FP Scenario 1:
Kaneisha is a 20-year-old mother of a two-month-old infant. Kaneisha has heard that
spacing children about three years apart is good for her health and for her family’s
well-being. Many of her friends are using Depo and say it is a simple, good, affordable
method. She has come to the clinic with her husband to learn more about it.

4. Hormonal implants

CASE STUDES:
- Divide participants in to three groups
- Give each group a task to discuss on one case scenario and present their
discussion/decision to big group.

Scenario 1:
Your client is a healthy 24-year-old woman who gave birth to her first child five months
ago. She has been fully breastfeeding and has not had a menstrual period since giving
birth She is returning to work in two weeks and will begin supplementing with formula.

Scenario 2:
Your client is a 30-year-old woman who is married, monogamous, and has three
children. She has HIV but has no symptoms and has no other health problems. She has
been using condoms consistently and correctly but is still concerned that she might
become pregnant.

Scenario 3:
Your client is a 42-year-old woman with five children. Six months ago, she was
admitted to the hospital with severe chest pain and shortness of breath. She was
diagnosed with a blood clot in her lung. She is now on anticoagulant therapy (blood
thinners). She has no other health problems. She has not had sex since her last menses.

30
ROLE PLAY

Role Play Scenario 1—Client with HIV is interested in and is eligible for
implants
Scenario 1

Client Description
You are a 29-year-old married woman with HIV. You are monogamous and have three
children. You have met previously with a provider at the PMTCT clinic, have learned
about different methods of contraception, and are very interested in implants.

Role Play Scenario 2—Client without children is interested in but is not eligible
for implants

Scenario 2

Client Description
You are a 28-year-old married woman with a busy professional career. You do not want
to have children. You have been married and monogamous for over eight years. You
have recently seen a promotion for progestin-only implants and have come to the family
planning site to learn more about them.

Role Play Scenario 3—Postpartum, breastfeeding client is interested in but is

not currently eligible for implants
Scenario 3

Client Description
You are a 20-year-old woman who gave birth to your first child four weeks ago. You
are unmarried and are not in a serious relationship. You read about progestin-only
implants in a family planning brochure, and you have come to the family planning site
to learn more.

31
5. Tubal ligation and Vasectomy

Tubal ligation

CASE STUDIES:

- Divide participants in to two groups

- Give each group a task to discuss on one case scenario and present their
discussion/decision back to the big group.

Case study 1:

A woman, 35 years old, married with 3 children arrives at the clinic. She relies on her
husband’s income from factory work to support the family. During the consultation, she
said she would like to have tubulisation.

- Explain the counselling steps you would follow to deal with this situation.

Case study 2:

A man, 35 years old, married with 3 children arrives at the clinic. He is very keen for his
wife to have tubaligation because he doesn’t want to have any more children.

- Explain the counselling steps you would follow to deal with this situation.

Vasectomy
- Divide participants in to two groups
- Give each group a task to discuss on one case scenario and present their
discussion/decision back to the big group.

CASE STUDIES:

Case study 1:
A man, 30 years old, married with 3 children arrives at the clinic. He is the only person
have regular income to support his family. During the consultation, he said she would like
to have vasectomy.
- Explain the counselling steps you would follow to deal with this situation.

32
Case study 2:

A man, 45 years old, married with 3 children arrives at the clinic. He is very keen for his
vasectomy done today because he doesn’t want to have any more children.
- Explain the counselling steps you would follow to deal with this situation.

6. IUCD

- In the beginning, pass the IUD to the first participant on your left in order for him/
her to examine it and to express his/ her opinions about it. Exercise will continue
until all participants will express their opinions on it.
- Ask the group what are the IUD advantages and disadvantages.
- Write down the statements on the flipchart. Make clarifications if needed
- Compare this method with the ideal contraceptive.

IUD Eligibility Criteria

- Ask: “Who can use this method?” and invite participants to give the answers.

IUD insertion
- Ask participants to list all necessary equipment use for IUD insertion
- Ask to describe the step for insertion and removal

ROLE PLAY

Scenario 1: Client is interested in and is eligible for an IUD

Client Description:
You are a 23-year-old woman who gave birth to your first child six weeks ago, and
you have abstained from sexual intercourse since the birth. You and your husband are
mutually monogamous. You are interested in IUDs.

Scenario 2— Client is interested in and is not yet eligible for an IUD

Client Description
You are a 32-year-old married woman. You do not want to have children. You have
been married and monogamous for over eight years. You have recently seen a
promotion for IUDs and have come to the family planning site to learn more about
them.

33
Scenario 3— Client is interested in but is not eligible for an IUD

Client Description
You are a 20-year-old woman who gave birth to your first child three weeks ago. You
are unmarried and are not in a serious relationship. You read about IUDs in a family
planning brochure, and you have come to the family planning site to learn more.

7. Barrier methods

MALE CONDOMS
- Divide participants in to two groups
- Give each group a task to discuss on one case scenario and present their
discussion/decision to big group.

ROLE PLAY

Scenario 1—Client is interested in and eligible for male condoms

Client Description
You are a 41-year-old man. You have two teenage daughters with your wife and a two-
year-old son by your current girlfriend, who was using oral contraceptive pills, but forgot
to take them for several days and became pregnant. Your wife now has an IUD. You
are interested in using condoms with your girlfriend until she decides on a reliable
contraceptive method that suits her better.

Scenario 2—Allergy to latex condoms

Client Description
You are a 23-year-old married man with one child. You have come to the clinic because
after having sex with your wife your genitals became very red and itchy, there were red
spots in several other places on your body, and you felt dizzy.

FEMALE CONDOMS
- Divide participants in to three groups
34
 - Give each group a task to discuss on one case scenario and present their
discussion/decision to big group.

ROLE PLAY

Scenario 1—Client is interested in and eligible for female condoms

Scenario 1

Client Description
You are a 17-year-old female who has been referred for contraception from an HIV care
and treatment provider. You were pregnant but miscarried two months ago. You read
the pamphlet on family planning method options given to you by the provider and have
made a decision about which method you believe best suits your needs.

Scenario 2—Client is pregnant and wants protection from STIs

Scenario 2

Client Description
You are a 22-year-old woman and you are pregnant. You have come to talk with the
provider about condoms, because you want protection from sexually transmitted
infections (STIs). Your boyfriend previously gave you an STI, for which you received
treatment, and you don’t want to risk getting another STI while you are pregnant.

Scenario 3—Managing problems with female condoms; negotiating condom

use

Scenario 3

Client Description
You are a 20-year-old woman who has never been pregnant. You and your boyfriend
have been using male condoms, but he often doesn’t have any with him, so you use
withdrawal. A few days ago you bought female condoms from a pharmacy. You have
had trouble inserting the condoms and something feels wrong when your boyfriend
inserts his penis inside your vagina.

35
8. Emergency contraception

- Check whether the participants have understood how they can use the brand of
contraceptives that they will receive for distribution to provide emergency
contraception.
- State the fact that when they will provide this method to a woman, she has the
right to know what kind of pills the method supposes.
- Ask participants to define the situations of unprotected sex. List the answers on
the flipchart.

Expected Answers:

o The woman has had sexual intercourse without contraception

o The woman has had sex against her will
o The woman has used a contraceptive method, but it has failed: e.g. the
condom broke, the diaphragm has slide out of the vagina before 6 hours,
the IUD has been expulsed, pills were trough out after less than 1 hour
after administration.
o The woman has incorrectly used the contraceptive method: e.g. she has
run out of pills or she has forgotten to take them

- State the fact that in any of these situations emergency contraception can be used.
- Emphasize that this type of contraception should not be used as routine. if a
woman repeatedly requests emergency contraception, she needs in fact a family
planning method and she should be counseled for choosing one.

Frequently Asked Questions and Their Answers

Go through question below with participants. This exercise should be done with the big
group.
1. What if the ECPs don’t work and I don’t get my period?

Answer: If you have not menstruated for a week after your expected menstruation, you
may be pregnant. Your provider will give you a pregnancy test to see if you are pregnant.
If you are pregnant, your provider will discuss options with you.

36
 2. If a woman is breastfeeding can she use ECPs?

Answer: YES. A woman who is exclusively breastfeeding and who has not had a
menstrual period since delivery is unlikely to be at risk of pregnancy and therefore may
not need ECPs. However, a woman who is providing supplemental feeding to her infant
or who has had menses since delivery may be at risk for pregnancy. A single treatment
with ECPs is unlikely to have an important effect on milk quantity or quality. Some
hormones may pass into the breast milk, but they are unlikely to affect the infant
adversely.
3. Are ECPs safe?

Answer: YES, emergency contraceptive pills can be given even to women who cannot
use oral contraceptive pills regularly, such as those with a history of hypertension or
severe migraine.

This is because emergency contraceptive pills are taken for a short span of time and,
consequently, will have fewer side-effects than oral contraceptive pills. It will not have
side effects that may have developed due to use of oral contraceptive for long periods.

4. How will emergency contraceptive pills affect a woman's menses?

Answer: Emergency contraceptive pills have no significant impact on a woman's menses.

Only 10-15 percent of the women who use emergency contraceptive pills will have
menstrual problems. A woman's menses will be at about the expected time, or at most a
week early or late (usually 2-3 days). In a few cases, menstrual flow might be heavier,
lighter or more spotty than usual.

5. Will emergency contraceptive pills protect a woman from future

unprotected intercourse?

Answer: NO. Emergency contraceptive pills do not protect a woman from any future
unprotected intercourse.

6. Will emergency contraceptive pills harm an existing pregnancy or a

pregnancy caused by the failure of emergency contraceptive pills?

Answer: ECPs cannot terminate or interrupt an established pregnancy and will not stop
a fertilized egg from implanting in the uterus, nor can they harm a developing embryo.
ECPs are ineffective once implantation has begun.

37
 7. What should a woman do if vomiting is severe after the first dose of ECPs
and she cannot take her second dose?

Answer: Non-prescription, anti-nausea medication generally is not effective once

nausea is present. If vomiting is severe, one option is for her to place the second dose
of pills high into the vagina. Although studies are not complete about how effective this
is, LNG is absorbed through the vaginal wall and she will get some benefit. If the woman
has no other options, (vomiting being severe) vaginal placement seems more reasonable
than not taking the second dose. Inform the woman that the treatment may be less
effective if the second dose is not taken.

8. Can emergency contraceptive pills be taken if there is problem in the leg

(such as varicose veins)?

Answer: YES. As the dose of hormones in emergency contraceptive pills is relatively low,
the short exposure to estrogen and/or progestin does not appear to alter blood-clotting
mechanisms, as in the case of combined oral contraceptives, which are used over a longer
period.

9. Should we provide ECPs if the woman had unprotected sex on a day

when her risk of pregnancy was not very high?

Answer: Yes, often a woman cannot be sure she is infertile at any one time during her
cycle. Therefore, ECPs should be provided any time unprotected sex occurs and the
woman is concerned that she is at risk of pregnancy.

10. How many times can one take emergency contraceptive pills in a
month?

Answer: Emergency contraceptive pills are not intended for repeated use. These pills
should be used only as an emergency method for back-up support. However, given that
there is little likelihood that limited repeated use will cause harm, emergency
contraceptive pills should not be denied only because a woman has used them before,
even within the same menstrual period. All women who use ECPs, particularly those who
use them repeatedly, should be informed that
ECPs are less effective and have more side-effects than regular contraceptives.

11. How soon after taking ECPs should a regular contraceptive be

started?

Answer: Regular contraceptive methods (such as condoms. DMPA and pills) can be
resumed immediately after taking ECPs. Alternatively, clients could switch over to

38
condoms till the start of the next menstrual cycle. Other regular contraceptives such as
IUCD or implants, can be started within 7 days of the next menstrual period.

12. Can ECPs be taken before intercourse?

Answer: Yes. No data is available about how long the contraceptive effect of ECPs
persists after the pills have been taken. Presumably ECPs taken immediately before
intercourse are as effective as ECPs taken immediately afterwards. However, if a woman
has the opportunity to plan to use a contraceptive method before intercourse, a method
other than ECPs, such as condoms or another barrier method, it is recommended.

13. Is emergency contraception the same as abortion?

Answer: NO. Emergency contraception and abortion are entirely different. Emergency
contraceptives only prevent pregnancy from unprotected sex by preventing or delaying
ovulation. In an abortion, a fertilized fetus is removed.

14. Do ECPs interact with other drugs?

Answer: No specific data is available about the interaction of ECPs with other drugs that
the client may be taking. However, it seems reasonable that drug interactions would be
similar to those with regular oral contraceptive pills. Women taking drugs that may
reduce the effectiveness of oral contraceptives (including, but not limited to, Rifampin,
and certain anticonvulsant drugs) should be advised that the effectiveness of ECPs may
be reduced.

LESSON 7: Sexual Transmitted Diseases (including HIV) and their

Consequences on Reproductive and Sexual Health

Objectives
By the end of the session, the participants will able to:
- Identify and describe the difference types of STIs
- Define conduct risk assessment for STIs
- Conduct history taking and physical examination
- Making diagnostic of STIs

Time: 1h 45mn
Techniques: Presentations, discussions, listing, brainstorming

39
Materials:
 Material for the trainer
1. Vanuatu national family planning guideline 2016
2. Participant’s handout
3. Power point presentation

Subjects should be included in power point presentation:

 Objectives of the session
 The transmission of STIs
 The Common sexually transmitted pathogens and their clinical presentation
 Risk assessment for STIs
 History taking and physical examination
 Making diagnostic of STIs
 Management FP planning clients with STIs

 Material for the trainees

1. Participant’s handout
2. Vanuatu National family planning guideline- 2016
3. Paper and pens

Activities
- Divide participants in to three or four groups
- Give each group a task to discuss the subjects listed below.
- After discussion, participants need to present their discussion/decision back to the
big group.

Subjects for discussion:

Set 1 Questions:
1. The burden and transmission of STIs in the country
2. Examples of the social and economic effects of STI
3. What makes the control of STIs so difficult, factors affecting the control of STIs
and what can we do to control STIs in Vanuatu?
4. How STI services may be linked to other services at the primary-care level
5. Where are STI services available in difference locations

40
 Set 2 Questions:
1. Modes of transmission of STIs
2. Comprehensive STI case management
3. Etiological and syndromic diagnosis: local problems and advantages
4. To what extent are privacy and confidentiality possible at health centres?
5. Culturally acceptable ways of asking questions; history-taking

Set 3 Questions:

1. Discuss on the local risk assessment criteria for vaginal discharge syndrome
2. Discussion on most-at-risk population groups
3. Discuss about syndromic management for STIs in the country
4. Dugs treatments for STIs in Vanuatu
5. Laboratory services available locally

Set 4 Questions:

1. Partner management
2. Local investigation into the possibility of partner referral
3. Outreach activities
4. Role-play on how to arrange for partners to be treated

LESSON 8: Legal and Ethical Issues

Objectives:
By the end of the session, the participants will able to:
- understand the legal right of individual in access to RH including family planning
services

Time: 1h 45mn
Techniques: Presentations, discussions, listing, brainstorming

41
Materials:
 Material for the trainer
1. Vanuatu national family planning guideline 2016
2. Participant’s handout
3. Power point presentation

Subjects should be included in power point presentation:

- Reproductive rights
- Who should access to FP services
- Family planning for young people

 Material for the trainees

1. Participant’s handout
2. Vanuatu National family planning guideline- 2016
3. Paper and pens

 Other materials
1. Flipchart paper sheets
2. Markers

Activities: - brainstorming activity

Discuss the following topics in the big group:
1. FP planning services for young people
2. Barrier accessing for FP for young people
3. Why should be done to improve FP services for young people

Family Planning training in Torba Family Planning course participants doing presentation

42
Part 3: The evaluation criteria and monitoring
components.

Objectives
By the end of the session, the participants will able to:
- Understand difference level of indicators for monitor the RH program
- Calculate the minimum indicated recommended in the pacific

Time: 1h 15mn
Techniques: Presentations, discussions, listing, brainstorming
Materials:
 Material for the trainer
1. Vanuatu national family planning guideline 2016
2. Participant’s handout
3. Power point presentation

Subjects should be included in power point presentation:

- Indicator measured RH in difference level of health system
- FP and Millennium Development Goal indicators

 Material for the trainees

1. Participant’s handout
2. Vanuatu National family planning guideline- 2016
3. Paper and pens

 Other materials

1. Flipchart paper sheets

2. Markers
Activities:
Discuss the following topics in the big group:
- Indicator measured RH in difference level of health system

43
Annexes

Annex 1: Pre-Test Answers Key- FOR TRAINERS

(Note to the trainer: The correct answers are bolded. Total score is 50)

1. The benefits of the family planning services mean:

a. reduced number of abortions
b. women with a better health state
c. desired pregnancies and well care of children
d. decrease in number of persons infected with sexually transmitted
infections
e. more time granted for curative medical assistance
f. less social problems

2. Ovulation takes place:

a. at mid-time of menstrual cycle
b. 14 days before the next period
c. days 12-14 after the first day of the period

3. Switching one contraceptive method to a combined oral contraceptive can

be done:
a. immediately, without waiting the next period
b. after the interruption of the previously used method, the woman will wait for her next
period and she will start taking the pills from the first day
c. after a 3 months break necessary for full recovery of the organism
d. anytime, if the woman is certain that she is not pregnant

4. FP counselling means:
a. helping a person/ couple choose whether they want children or not
b. helping a person/ couple choose a contraceptive method
c. facilitating the safe use of the contraceptives
d. helping a person identify his/ her problems within the reproductive health
sphere
e. helping a person/ couple assume their responsibility about maintaining
their health

44
5. List 5 advantages of the contraceptive pills
a. Increased efficiency if used correctly
b. Do not interfere with sexual intercourse
c. Are immediately reversible
d. Can be used by many categories of women, at any age
e. Prevent the iron deficiency anemia
f. Prevent some genital disorders: ectopic pregnancy, endometrial cancer, ovarian
cancer, ovarian cysts, pelvic inflammatory disease
g. Prevent benign breast affections
h. Can be used as emergency contraception

Any statement will be awarded 1 point.

6. Which are the methods which protect against unwanted pregnancy, as well
as against STIs?

Condom

7. If a client request changing the family planning method, you must:

a. Change her method, because she knows best what she wants;
b. Ask her why she wants to change the method and try to discover the
reason, in order to make sure that she has taken a well-informed decision;
c. Try to find a medical reason in order to change the method and if this is not found,
try to convince her to continue with the method she is already using.

8. The most important aspect of counseling is:

a. Offering brochures about FP methods, so that the client will be able to discuss them
with his/ her partner
b. Identifying the client’s needs and concerns regarding the use of
contraception and the answer to these;
c. Obtaining the written consent of the client regarding the use of contraception;
d. Describing all side-effects of the FP methods.

9. The following statements, except for one, are important elements of the
information necessary for a client in order for her to take an “informed
decision”. Which of the following is not important?

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a. Major advantages and disadvantages of the contraceptive methods that present
interest to the client
b. Short description of all the available contraceptive methods
c. Personal experience of the provider regarding the available methods
d. Possible side-effects
e. Relative efficiency of the methods.

10. It is recommended to give family planning to married women only

Tue
False

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Annex 2: Pre-Test questionnaires for PARTICIPANTS
(To be printed for participants)

Name, Surname: …………………………………………………….. Date: ………………………..

Please circle the letters that correspond to the answers which you consider
correct (there can be more than one correct answer):

1. The benefits of the family planning services mean:

a. reduced number of abortions
b. women with a better health state
c. desired pregnancies and well care of children
d. decrease in number of persons infected with sexually transmitted infections
e. more time granted for curative medical assistance
f. less social problems

2. Ovulation takes place:

a. at mid-time of menstrual cycle
b. 14 days before the next period
c. days 12-14 after the first day of the period

3. Switching one contraceptive method to a combined oral contraceptive can be

done:
a. immediately, without waiting the next period
b. after the interruption of the previously used method, the woman will wait for her next period
and she will start taking the pills from the first day
c. after a 3 months break necessary for full recovery of the organism
d. anytime, if the woman is certain that she is not pregnant

4. FP counseling means:
a. helping a person/ couple choose whether they want children or not
b. helping a person/ couple choose a contraceptive method
c. facilitating the safe use of the contraceptives
d. helping a person identify his/ her problems within the reproductive health sphere
e. helping a person/ couple assume their responsibility about maintaining their health

5. List 5 advantages of the contraceptive pills

a. Increased efficiency if used correctly
b. Do not interfere with sexual intercourse
c. Are immediately reversible
d. Can be used by many categories of women, at any age
e. Prevent the iron deficiency anemia

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f. Prevent some genital disorders: ectopic pregnancy, endometrial cancer, ovarian cancer,
ovarian cysts, pelvic inflammatory disease
g. Prevent benign breast affections
h. Can be used as emergency contraception

6. Which are the methods which protect against unwanted pregnancy, as well as
against STIs? : ………………………………………….. …………………………………………..

7. If a client request changing the family planning method, you must:

a. Change her method, because she knows best what she wants;
b. Ask her why she wants to change the method and try to discover the reason, in order to
make sure that she has taken a well-informed decision;
c. Try to find a medical reason in order to change the method and if this is not found, try to
convince her to continue with the method she is already using.

8. The most important aspect of counseling is:

a. Offering brochures about FP methods, so that the client will be able to discuss them with his/
her partner
b. Identifying the client’s needs and concerns regarding the use of contraception and the answer
to these;
c. Obtaining the written consent of the client regarding the use of contraception;
d. Describing all side-effects of the FP methods.

9. The following statements, except for one, are important elements of the
information necessary for a client in order for her to take an “informed decision”.
Which of the following is not important?

a. Major advantages and disadvantages of the contraceptive methods that present interest to
the client
b. Short description of all the available contraceptive methods
c. Personal experience of the provider regarding the available methods
d. Possible side-effects
e. Relative efficiency of the methods.

10. To maximise the benefit, it is recommended that Family planning should be given
to married women only
a. Tue
b. False

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 Annex 3: Instructions for Role Plays

Provider Instructions for Role Plays

Pretend that you are meeting the client for the first time. Ask the client for his or her name, gender (male or female)
and age. Pretend that there is a health center nearby to which you can refer the client, if needed. Remember to:
 Assess the client’s reproductive health (RH) goals, concerns, and fertility intentions.
 Address the primary and secondary reasons for the client’s visit.
 Facilitate the client’s decision-making process.
 Integrate information and services related to other RH issues as appropriate.
 Help the client act on her or his decision(s).

Apply your prior experience along with what you have learned from the training and use job aids and tools as
appropriate to address the client’s concerns.

Observer Instructions for Role Plays

Prior to the start of the interaction:

 Review the Role Play Observation Checklist so that you are familiar with the behaviors that you are observing and
where they appear on the checklist.
 Review the case-specific issues on the observer information sheet for the role play.
While observing the interaction between the provider and client, remember to:
 Use the observation checklist to take notes on what happens during the interaction.
 Record how well the provider addresses the case-specific issues in the space provided.
 Be prepared to give feedback to the provider regarding how well he or she addressed the client’s needs.
Pay particular attention to whether the provider:
 Helped the client deal with anxiety
 Facilitated communication with a partner
 Allowed the client to make an informed decision
 Ensured that the client met the medical eligibility criteria for the method she chose
 Helped the client carry out her decision

Client Instructions for Role Plays

Prior to the start of the interaction:
 Read the client information sheet and make sure you understand your character’s situation.
 Pick a name for your character. Tell the provider your name, age, and whether you are male or female.
During the interaction, offer information only when the provider asks relevant questions. Use the information given in
your client information sheet to respond to the provider’s questions. Feel free to ask questions of the provider.

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