Fielding the PAC Participatory Action Research Study
In Bolivia, Manual Vacuum Aspiration (MVA) has been added as one of the Postabortion Care (PAC) services offered by Ministry of Health facilities. Pathfinder and CATALYST have received USAID funding to train MVA providers in four of the country's departments plus facilities located in the capital city of La Paz. IPAS has received similar funding to do the same in the remaining five departments.
Both institutions use the same curriculum--the PAC services model--which as imparted to date, includes three components: 1) clinical services, 2) orientation and 3) referral. The orientation components include three different elements: 1) informing the patient about what PAC services will be provided and what a procedure will entail; 2) providing moral support to the patient during the execution of the procedure if the patient is awake; and 3) providing family planning (FP) counseling mainly once the procedure has been completed.
The training intervention as implemented by Pathfinder/CATALYST includes a 40-hour training workshop plus up to three supervision visits over a 12-month period subsequent to the workshop. However, Pathfinder/CATALYST wishes to have an impact on the performance of trained and untrained providers that work in a PAC services facility where MVA in particular is being offered as a PAC option. This strategy is based on the fact that not all providers in a hospital unit have been trained through the workshops, yet the untrained staff may work shifts where they are the only ones on duty in the PAC services hospital unit. Pathfinder/CATALYST wishes to have MVA offered as a PAC option the entire time that the hospital units in question are open. Consequently, the supervision unit is to observe, reinforce and/or correct the performance of untrained as well as trained staff.
Only 60% of the providers trained in the Pathfinder/CATALYST workshops, however, have been exposed to both training and expected supervision visits. The number of untrained providers exposed to MVA via "peer coaching" and supervision visits needs to be calculated. Pathfinder has collected information on provider performance through the supervision visits, which indicates deficiencies in provider performance in all three elements of the integral PAC services model. A recent USAID/Washington-funded PAC evaluation in four sites worldwide, including Bolivia, identified deficiencies particularly in two of the components of the model: counseling and FP/referral.
Pathfinder/CATALYST is aware of the deficiencies and intends to correct them. One first step in this direction is the implementation of a participatory action research study exploring the barriers and facilitators for the adoption of behaviors associated with the different components of the integrated PAC services model as currently implemented in Bolivia. This study, however, is not limited to providers. In fact, it addresses the perspectives of hospital administrators, the satisfaction of service users and the community at large.
Specific behaviors in which deficiencies occur will be identified as a first step. In-depth interviews with "doers" and "non-doers" will then be conducted to explore causes for adoption or non-adoption of promoted behaviors. The estimated cost of the study is $110,000. The funds have been used to train research coordinators within the targeted hospitals and provide technical assistance to NGOs and CBOs working in the communities where the hospitals are located to implement the focus group research with community members. The Population Council is also providing technical assistance in the creation of data files and in initial data cleaning and analysis.