Family planning training: What comes next? Comparison of cost effectiveness of three forms of refresher trainings in Guatemala

Upon completion of training in a new family planning method, most providers are judged competent to include the method in their services. However, literature shows that refresher training is needed to retain their capacity over time. The Knowledge Improvement Tool (KIT), developed to monitor and maintain knowledge over time, guides supervisors to ask questions, reinforce correct answers, and address knowledge gaps. This study compares the cost effectiveness of three reinforcement strategies for Guatemala providers newly trained in the SDM. Competence was evaluated through observed simulated counseling sessions. Providers were divided into four groups: those who received individual KIT, group KIT, a two-hour refresher training, and no refresher training. A total of 59 counseling sessions were observed for 3 nurses, 37 CBDs, and 19 midwives. The no-refresher group scored significantly lower on all areas of the counseling session. Group-KIT and traditional-refresher groups scored and cost about the same amount. The individual-KIT group scored significantly higher than all groups in the “user instructions” area and total score was significantly higher than group KIT. The individual KIT is the most costly because of time and travel of the supervisor. The significant results strongly suggest that some type of refresher is necessary for sustained capacity of SDM providers, with individual KIT being the optimum of methods. However, individual KIT takes more resources for limited added benefit. Programs that already conduct individual site visits may want to consider integrating individual KIT, and other programs could consider either group KIT or traditional refresher trainings.