title: Creating a whole institution approach to in-service training in sexual and reproductive health in Uganda.
abstract: BACKGROUND
  Uganda has one of the world's highest fertility rates, and high unmet need for family planning, even when clients have contact with health facilities. Misconceptions about contraceptive side effects and inadequate training for healthcare workers contribute to this.
  
  
  OBJECTIVE
  To develop and evaluate in-service training for family planning, across a whole institution.
  
  
  METHODS
  Course evaluation. Impact on services.
  
  
  METHODS
  Following a needs assessment, two courses were developed, adapting WHO's Training Resource Package for Family Planning. All staff were offered level 1 training (five 1 h sessions). The 30 h level 2 course aimed to train clinical staff to certificate level; assessed by written exam, consultation skills and presentations. Quantitative evaluation assessed changes in pre-course and post-course knowledge and confidence scores. Participant feedback was analysed thematically.
  
  
  RESULTS
  Of the hospital's 76 clinical staff, 44 attended some training. Of these, 21 attended and 19 completed level 2. Mean knowledge scores increased from 15.9 (SD 4.5) to 20.8 (SD 3.1)/26 (95% CI 4.9 (2.5-7.2)). Confidence rose from 8.1 (SD 1.5) to 9.5 (SD 0.5) (95% CI 1.4 (0.7-2.2)). Nine were accredited to fit intrauterine devices and implants, and three just implants. Screening for unmet need is being introduced and outreach work aims to overcome barriers to adoption of family planning.
  
  
  CONCLUSIONS
  Brief in-service training improves health workers' knowledge and skills, corrects misconceptions and increases the priority given to family planning. When aligned to local need and the culture of the institution, training can prompt moves to address unmet need for family planning.
authors.affiliation: Senior Clinical Research Fellow, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Cambridge, UK.
authors.forename: Jonathan
authors.identifier: http://orcid.org/0000-0003-4813-3286
authors.initials: J
authors.lastname: Graffy
authors.affiliation: General Practitioner, Greater Glasgow and Clyde, and formerly Bwindi Community Hospital, Kanungu, Uganda.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Capewell
authors.affiliation: General Practitioner, Lensfield Medical Practice, Cambridge, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Goodhart
authors.affiliation: Executive Director, Bwindi Community Hospital, Kanungu, Uganda.
authors.forename: Birungi Mutahunga
authors.initials: BM
authors.lastname: Rwamatware
mesh_terms: D003150:Community Health Workers; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D005193:Family Planning Services / Q000193:education*; D005260:Female; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D008297:Male; D010347:Patient Care Planning / Q000458:organization & administration; D060728:Reproductive Health / Q000706:statistics & numerical data*; D012736:Sex Education / Q000458:organization & administration*; D012725:Sexual Behavior; D014454:Uganda
keywords: counselling; education and training; family planning service provision