From Training to Competency: An Operations Research Evaluation of Family Planning and Post-Abortion Care Capacity Building in Sierra Leone
Abstract:
Sierra Leone faces persistent reproductive health challenges, including unmet need for family planning, unsafe abortion-related morbidity, and limited public-sector capacity to provide quality family planning and post-abortion care services. This retrospective mixed-methods operations research evaluation assessed whether a competency-based training, mentorship, and supportive supervision model implemented under the Saving Lives Phase 2 project was associated with improvements in provider knowledge, clinical competency, quality-of-care indicators, and post-abortion care service delivery in selected public-sector facilities in Sierra Leone. Kirkpatrick’s four-level model and a programme theory linking training inputs to learning, workplace competency, service readiness, and service outputs guided the evaluation. The evaluation reviewed routine programme data from 2019 to 2020, including trainee reaction forms, pre- and post-test scores, competency assessment records, supervision and mentorship records, quality-of-care assessments, service statistics, programme reports, and exploratory financial and modelled impact estimates. Descriptive analysis summarised changes over time. Trainee reaction was highly positive. Mean knowledge scores increased from 28% at pre-test to 81% at post-test. The share of providers attaining Level 1 competency increased from 59% in Q3 2019 to 97% in Q4 2020. Model-site quality-of-care status increased from 3% in 2019 to 33% in 2020, while model-area status increased from 8% to 22%. Post-abortion care service volume increased from 442 in 2019 to 1,950 in 2020. The findings suggest programme-associated improvements across the training-to-practice pathway, but causal inference is limited by the retrospective descriptive design and absence of a comparison group.References:
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