1.     Introduction to the CIRHT program

In the past 50 years, family planning has been one of the most successful development interventions with a range of potential benefits, encompassing economic development, maternal and child health, educational advances, and women’s empowerment. In addition to these, it is one of the major strategies of harmonizing population growth with socio-economic development through balancing family size with individual economic capacity. It is also an important tool of ensuring women’s human, economic and political rights and their full participation in the development process.

For adolescent girls and women, reproductive health services particularly that of family planning care is critical at every stage of life. This is largely because the use of contraceptives can reduce maternal mortality and improve women’s health by preventing unwanted and/or high-risk pregnancies. In many countries, however, comprehensive reproductive health care, including family planning, is not available or accessible because there are too few trained health professionals to guide clients.

Health professionals are the foundation of healthy families and thriving communities. The Center for International Reproductive Health Training (CIRHT)   is striving to train the health work force of the future with comprehensive reproductive health education .It works with   universities with well established medical, midwifery and nursing schools to integrate hands-on clinical trainings on comprehensive reproductive health, including family planning and comprehensive abortion care in to their pre-service education. Together we are committed to training the next generation of doctors, nurses and midwives to be confident, compassionate leaders in their communities.

To increase the number of skilled reproductive health professionals, CIRHT focuses in three areas:

• Medical Education and Training: Working with faculty to implement an integrated, competency-based reproductive health curriculum, offering medical , midwifery, nursing  students and Obstetrics and Gynecology (BGYN) residents clinical instruction and supervised hands-on trainings in family planning, comprehensive abortion care and other critical reproductive health areas.
• Clinical Service: Helping partner medical schools upgrade on-site   reproductive health particularly family planning facilities, equipment and services to support student engagement and learning through provision of effective first-hand client care.
• Research: Fostering a culture of inquiry to contribute to the creation, dissemination and application of healthcare knowledge and practice, while measuring the impact of efforts.

2.     CIRHT Objectives

To increase the number of health professionals providing quality, comprehensive reproductive health care, CIRHT is working to:

1.  Build faculty capacity on clinical training in reproductive health services, medical and surgical pregnancy termination, as well as teaching and research skills.
2. Improve the capacity of partner medical schools with the physical infrastructure, equipment and instruction models needed to deliver quality training.
3. Implement and expand integrated pre-service training for medical, nursing and midwifery Students and OBGYN residents in higher teaching institutions of Ethiopia
4. Monitor and evaluate training to ensure that higher teaching institutions adhere to the Curriculum’s standards, while enabling CIRHT to share lessons learned.

3.     Why in Ethiopia?

With a population of nearly 94 million in 2015, Ethiopia is the second most populous country in Africa next to Nigeria. The vast majority of the people (84 percent) reside in rural areas. Women of reproductive age make up one-fifth of the total population of Ethiopia and about 45% of the female population.

In Ethiopia, as in most African countries, women play the principal roles in the rearing of children and the management of family affairs. On the other hand, the health status of these women remains poor. Unwanted pregnancy and unmet need for family planning are still high in the country; as a result of which women in Ethiopia are characterized by high fertility – 4.8 children per woman. The maternal mortality ratio in Ethiopia is currently estimated at 420 per 100,000 live births, which is one of the highest in the world.

Ethiopia has made progress in strengthening of the health system in terms of infrastructure and health taskforce   but a lot still remains to be done in the area of quality of trainings of health professionals. While reproductive health and family planning are part of Ethiopia’s medical curricula, students do not always have supervised hands-on training across the full range of services. As a result, many new doctors, nurses and midwives begin their professional careers without skills critical to meeting the needs of communities they serve.

The CIRHT Ethiopia program was   launched in February 2015 with support from the Federal Ministry of Health and the University of Michigan Health System. With a new approach to reproductive health training, CIRHT is preparing medical professionals to safeguard the health and future of women, girls and families. In this regard, CIRHT is currently working with faculty at medical schools of nine higher teaching institutions in Ethiopia to transform how reproductive health training and counseling are integrated into medical education.

Medical Schools working with CIRHT 

As a Center of Excellence for CIRHT Ethiopia, St. Paul’s Hospital Millennium Medical College in Addis Ababa is leading the way in this approach. Since adopting an integrated reproductive health training curriculum in 2012, undergraduate students at St. Paul’s have built their skills in simulation labs, supervised clinical rotations and ongoing mentoring from experienced faculty and residents.

Nearly 80 percent of St. Paul’s graduates trained in this integrated fashion are ably providing and advocating these services, and have requested support to expand the comprehensive reproductive health services they offer to clients in the rural areas where they serve as general practitioners.

For doctors, undergraduate medical training in Ethiopia spans six years. After two years of basic sciences training, students progress to three years of clinical rotation followed by rotating year-long internships. With a sound understanding reproductive health as part of basic sciences, CIRHT and partner schools are building capacity for students to strengthen practical skills in their clinical years; first through the use of skills labs and then by providing care to clients, under the supervision of residents and faculty. Students at medical schools partnering with CIRHT are learning to meet client needs across the reproductive health continuum of care.

The integrated curriculum is preparing graduates to provide family planning and contraceptive services, comprehensive abortion care and quality counseling. Beyond the classroom, these future doctors, nurses and midwives learn their skills in simulation labs, reproductive health clinic attachments and internships.

4.     What CIRHT has accomplished so far

Establishment of a center of Excellence for Reproductive Health:

This center has now been set up in St.Paul’s hospital millennium medical college to serve as a bench mark for provision of state-of-the-art reproductive health services and also to create conducive environment for pre-service training on reproductive health particularly Family Planning and Comprehensive abortion care. At the core is ensuring production of providers with the right skills, right knowledge and positive attitude. Besides, reproductive health clinics of CIRHT implementing institutions are being renovated to provide quality and client friendly services adapting to the contexts of the teaching and learning environment of the hospitals where these clinics are found.

Faculty development:

This initiative was started following an assessment of the needs of faculty in terms of discharging their responsibilities against the three main pillars i.e. – service delivery, teaching and research.

Selection of Champions – the institutions that we work with have been asked to identify a champion, who can serve as change agents for reproductive health. The institutions have identified those champions and targeted capacity building of the champions was initiated immediately.

For delivery of Reproductive health services – customized trainings which meet the needs of champions have been provided, by experts in the area.

Teaching and learning – a training focusing on leadership and communication skills was provided to the champions. In addition to the training, an assessment that explored the need for standard text books was done and more than 190 different standard text books were provided to each site.

Supporting curriculum Harmonization and Enhancement: following the successful initiation of the harmonization of the curriculum in St. Paul’s Hospital Millennium Medical College, CIRHT has been continually supporting the revision of the curriculum of all the other institutions and introduction of the curriculum in the institutions. Though at different levels, the harmonized curriculum is being implemented in all institutions.

Research Support

Research support was initiated after a comprehensive assessment of the current status of the practice of research in the institutions was assessed including reasons. A comprehensive approach was designed that included the following:

Stimulation of research: through inspirational speeches by clinicians who are also distinguished researchers, provoking sessions were carried out in each of CIRHT implementing institutions. The researchers shared their experience and encouraged the faculty to do research. We are also supporting conference attendance of faculty members from the CIRHT institutions to attend different academic conferences within and outside of Ethiopia

Actual research implementation support: this includes identification of a research question, team based proposal writing, team based execution, analysis and write up support with tailored mentoring and training. There are 33 teams already forged   across the nine institutions to work on pressing research questions.

Access to international journals: after identifying the journals which are not accessible to the Ethiopian faculty, we have subscribed 8 prestigious international journals so that all faculty members from the Obstetrics and gynecology department and can any time access them.

Helping institutions help themselves: at the core of our support in all the above three areas is local ownership and avoidance of dependence – we think our exit when we start and one of the most frequently asked questions we try to adress is “will they be able to do it without CIRHT’s presence”

5.     What the public should know about this program

Attaining the goals of sustainable, equitable development requires that individuals are able to exercise control over their sexual and reproductive lives. Reproductive rights are the rights of individuals to decide whether to reproduce and have reproductive health. This may include an individual’s right to plan a family, terminate pregnancy, use contraceptives, learn about sex education in public schools, and gain access to reproductive health services. Availability of trained health care provider would greatly influence women’ and girls’ access to all ranges of reproductive health services. CIRHT deeply believes that everyone deserves to be treated with respect and dignity. As a woman and girl, the way you receive your reproductive health care ought to be respectful and compassionate. Accordingly, CIRHT strives to support higher teaching institutions to produce health care providers who are competent, considerate and vigilant in the provision of reproductive health care.

6.     Conclusion

Access to high-quality, comprehensive reproductive health care depends largely on the prevalence of skilled health-care providers. In most developing countries including Ethiopia, there is significant shortage of high quality training programs. Most medical school, nursing school and midwifery schools lack the trained faculty who could offer such services and teach students. Expanding the provider base to broaden the number and types of providers trained to offer quality reproductive health services including contraception and safe pregnancy termination is one of the proven strategies to reduce maternal mortality.

The Center for International Reproductive Health Training (CIRHT) is working towards supporting training programs designed to produce health care providers in Ethiopia.  The program will include all levels of providers but will focus initially on medical students, interns and OBGYN residents and ultimately will include mid-level providers such as midwives. The program will improve the capacity of partner higher teaching institutions to produce competent health care providers that will deliver high quality reproductive health care including contraception and safe pregnancy termination services. This is achieved by 1) ensuring that faculty members have the necessary clinical competencies as well as teaching and research skills; 2) delivering a curriculum that is comprehensive and competency-based for the students; and 3) creating adequate opportunity for hands-on and simulation-based clinical training.

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