Thus the trainees from any of these sites, whether they are medical interns, nursing students or practicing midwives, emerge from training with the requisite clinical skills to competently provide a full range of reproductive health services. In this way, clinical training sites link the preservice and inservice elements of the reproductive health system. Service delivery points are those sites where trained clinical service providers work to provide high quality reproductive health services. These may be community or district health centers, district-level hospitals or referral hospitals. Evaluation approaches are used to provide feedback to assess how well the integrated training system is functioning and what impact it has made on service delivery.
Informal feedback is provided through built-in evaluation mechanisms.
Formal assessments, including special surveys, are conducted to determine the impact of training methodologies, change in national and institutional capacity to produce competent providers and ultimately the ability of providers to offer high quality reproductive health services. The components of this framework provide the core for strengthening national reproductive health education and training systems. There are many other factors specific to each country or situation, however, that also influence the process of improving the performance of healthcare providers and the systems in which they work.