Reconfiguration of clinical training delivery in a family planning and post-abortion care quality assurance programme in Sierra Leone, 2018–2022: a retrospective programme evaluation

BACKGROUND: Health programmes often use both centralised courses and embedded clinical training, but longitudinal descriptions of how training arrangements change - and how competency safeguards are maintained - remain limited. OBJECTIVE: To characterise training-delivery configurations and their implementation context across centre, outreach and public-sector strengthening (PSS) channels in Sierra Leone from January 2018 to June 2022. METHODS: We undertook a retrospective descriptive programme evaluation of the complete 472-event training register (380 clinical training, seven competency-assessed training-of-trainers and 85 non-competency activities), with event-level stratification by period and service-delivery channel. We interpreted register patterns alongside programme supervision reports, PSS strategy and quality-assurance documents. We did not conduct a controlled effectiveness evaluation. RESULTS: The register contained 286 events in 2018, 52 in 2019, 39 in 2020, 76 in 2021 and 19 in January-June 2022; 209 occurred in outreach, 172 in centres and 91 in PSS. Across 3,817 participant-episodes, 2,571 were recorded in 387 competency-assessed activities; 2,559 had L1-L3 outcomes and 2,013/2,559 (78.7%) attained Level 1. The 2019 workforce-expansion period featured longer residential courses (median 10 days), whereas other periods featured short, service-linked instruction and refreshers. An external 2020 PSS assessment documented quality safeguards and remaining gaps; no pre-implementation QTA baseline was available. CONCLUSIONS: Training configurations evolved with programme expansion, changing staffing needs and pandemic adaptation rather than a simple linear classroom-to-workplace shift. Competency-based restrictions, supervised practice and a developing government-linked trainer network formed the clinical governance context. Descriptive programme records and external assessment do not isolate the causal effects of training modality.