Improving access to long-term contraceptives in rural Guatemala through the Ministry of Health

The purpose of this study was to test a model to train nurse auxiliaries at health centers and posts in Guatemala and to determine whether these providers could deliver adequate cost-effective services. The training model consisted of: a) selection of nurse auxiliaries; b) two-day group training; c) on-the-job training including work with actual clients at the trainees’ work centers; and d) certification of trainees that had conducted at least five quality insertions under supervision. Clinical job-aids and promotional materials were developed to assist training. The project consisted of two 12-month phases. In the first phase 45 of 52 enrolled health providers completed training and delivered 301 IUD services whereas in the second phase 45 of 114 enrolled providers completed training and delivered 424 IUD services. As a result there was an increase in the overall number of IUD services provided by participating health centers and posts as well as in the couple-years of protection provided by IUDs. Other results showed that a large proportion of IUD acceptors had never used a method or had just given birth. The quality of services provided by trainees improved over time. The total cost of the strategy was about US$402 per certified service provider $50 per IUD service delivered or $14.28 per couple-year of protection. The main recommendation derived from the project is to scale up the strategy nationally. (excerpt)