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Creating a whole institution approach to in-service training in sexual and reproductive health in Uganda
  1. Jonathan Graffy1,
  2. Sarah J Capewell2,
  3. Clare Goodhart3,
  4. Birungi Mutahunga Rwamatware4
  1. 1Senior Clinical Research Fellow, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Cambridge, UK
  2. 2General Practitioner, Greater Glasgow and Clyde, and formerly Bwindi Community Hospital, Kanungu, Uganda
  3. 3General Practitioner, Lensfield Medical Practice, Cambridge, UK
  4. 4Executive Director, Bwindi Community Hospital, Kanungu, Uganda
  1. Correspondence to Dr Jonathan Graffy, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Robinson Way, Cambridge CB2 0SR, UK; jpg43{at}


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.

Aim To develop and evaluate in-service training for family planning, across a whole institution.

Design 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.

  • family planning service provision
  • education and training
  • counselling

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