Background characteristics of L4HEWs
A total of 51 L4HEWs (i.e., 10 from Amhara, 10 from Oromia, 14 from Tigray, 17 from SNNPR) were included in the study. The remaining (4 from Amhara, 3 from Oromia, 6 from Tigray and 2 from SNNPR) were not interviewed for various reasons (migration to another area, maternity leave, study leave, and termination of their job).
Number of clients served by L4HEWs
After receiving the training, 85.2% of L4HEWs inserted at least 10 implanon and 25.6% inserted at least 10 IUCD. More than one-fourth (27.7%) removed implanon and 4.3% removed IUCD. While regarding to jadelle 15.2% inserted and 6.6% removed.
Knowledge Level of L4HEWs
More than three-fifth (58.8%) of L4HEWs have good level of knowledge about LARC. Nearly two-third (62.7%) of L4HEWs has good knowledge of counseling for LARC. While above half (52.9%) of L4HEWs have good level of knowledge of selecting appropriate method for the client. Moreover, slightly above half (51.0%) of L4HEWs have good knowledge on LARC side effects and complications.
Attitude of L4HEWs towards LARC through L4HEWs
Most (84.4%) of the L4HEWs (84.4%) disagree with the idea that, contraceptive information should only be available to married women in Ethiopia. Almost two-third (35.3%) agree that “a woman needs to have her husband’s or partner’s approval for contraception services”. Nearly one-fourth (23.5%) of them prefer to give short acting (OCP or injectable) to women more than giving LARC. Only one-tenth (9.8%) disagree that L4HEW can improve the overall LARC service provision. Similarly, 9.8% of them agree that LARC should be given only by reproductive nurses and mid-wives. While only 5.9% of them agree that LARC should not be given in a HP [Table 1].
Self-perceived competency towards LARC service provision
Fifteen percent of the L4HEWs believe that they are not competent in counseling of clients about family planning. Regarding insertion, 19.1%, 19.1%, and 6.4%, are not competent in inserting implanon, jadelle and IUCD, respectively. Similarly, 25.5%, and 12.8% believe that they are not competent in removing implants and IUCD, respectively [Table 2].
Competency on counseling
Based on the trained supervisor evaluation using structured observation checklist, (96.0% of L4HEWs had completely performed greeting and client respect as per minimum required standard. Similarly, majority (82.0%) of them completely assured confidentiality and privacy of the client although 18.0% need improvement. Regarding, confidentiality and privacy assurance 14% of them either not did or did incorrectly while the other one-fifth (22.0%) needs improvement in doing it. Majority (70.0%) of them asked their clients reasons for visit and explore for previous knowledge or use of family planning method completely. While 22.0% needs improvement and the remaining 8.0% not did at all. On the other hand, nearly half (46.0%) never explore the social context and relationship or did it incorrectly. Two-fifth (42.0%), and 32.0% did not explore about sexuality, and STI and HIV history respectively.
Competency score of L4HEWs
Of the 41 L4HEWs observed for implanon insertion, 26.8% are 100% competent in implant insertion, 8.3% are 100% competent in insertion of jadelle and 2.0% are 100% competent in insertion of IUCD. On the other hand 4.2% and 12.5% were 100% competent in removing implants and IUCD, respectively [Table 3].