Effectiveness of Onsite Implanon Insertion Training of Health Extension Workers in Ethiopia: A Mixed-method Study by USAID Transform: Primary Health Care

Abstract Background: Training health extension workers on Implanon insertion offsite, or away from the workplace, can be cost-intensive, can depend on the human and financial resources of partners, and can compromise routine health services by taking health workers off the job. To address these limitations, the USAID Transform Primary Health Care Activity in Ethiopia designed an onsite Implanon insertion training at the primary health care level. This study compared the effectiveness and documented the implementation experience of onsite versus offsite Implanon insertion training for health extension workers.Methods: In a mixed-method study conducted in March 2020, the team collected data from 468 participants—half trained onsite and half offsite—and conducted key informant interviews with 20 purposively sampled individuals. The team analyzed this data and conducted a basic costing analysis, summarizing the data in tables and figures and performing a t-test with p-value<0.05 using SPSS v.20. Qualitative data were analyzed manually in Excel and summarized in Word based on emerging themes.Results: The difference in average per-trainee cost of onsite (2,707 Birr) and offsite (6,006 Birr) training was significant (P<0.001). Health extension workers trained onsite were away from routine work an average of three days compared to eight days for those trained offsite (P<0.001). There was no significant difference in mean scores of onsite and offsite trainees on the knowledge pre-test (P<0.947) and post-test (P<0.220) or in simulated practice on an arm model (p <0.202). Onsite trainees, assigned to their own health post for clinical practice, performed Implanon insertions on an average of 10 clients; offsite trainees on an average of 5 clients. Most interview participants reported that the onsite Implanon training was better organized, conducted, followed up, and monitored by health centers to ensure community-level access to Implanon services, with quality and continuity.Conclusions: Onsite training is cost-effective and minimizes service interruption. It is a promising strategy for on-demand training of health extension workers and immediate assignment of skilled providers to ensure access to and continuity of quality community-level Implanon care. Trial registration: N/A