Training Effectiveness

The Quality Assurance Project investigated how job aids could increase compliance with guidelines for the Integrated Management of Childhood Illness (IMCI) in cooperation with the Zambia Central Board of Health beginning in 1999. One of the first countries to introduce IMCI, Zambia had a large number of IMCI-trained providers, and several IMCI job aids were already in use: a chartbook, recording form, poster, and mother card. The study proceeded in three stages: an initial assessment of job aid usage in 1999, the design and introduction of a new IMCI job aid (called “new outpatient department book” or “NOPD book”) that also served as the patient record, and a second assessment of job aid usage in 2000 after introduction of the NOPD book.

The study was carried out to evaluate short term effects of one to one educational intervention approach, conducted with 40 drug sellers in order to improve the private sector’s practices, compliance and performance in using the national treatment guidelines for malaria and other common childhood (diarrhoea, acute respiratory tract infection-ARI) illnesses in Kibaha district-Tanzania. [from abstract]

This issue introduces Training Impact Evaluation (TIE), a process designed to help managers identify and strengthen the links between training and staff performance. The issue describes the benefits of conducting a Training Impact Evaluation using a team approach and takes you step-by-step through the TIE process. The issue also offers practical suggestions for collecting, analyzing, and interpreting data on trainee performance in the workplace. It concludes with suggestions for ways that managers can use the information to make recommendations to decision makers, to improve training courses, or to seek management solutions to performance problems.

This retrospective study assessed the effects of pre- and post-training programme for healthcare professionals about breastfeeding. [from abstract]

This Praxis Note provides an overview of the impact of HIV/AIDS on the Malawi health care system and on the organisational capacity of Mulanje Mission Hospital. It describes the experiences and lessons learnt from a capacity building program designed to address capacity deficits and erosion caused by HIV/AIDS attrition. Less emphasis was placed on external training courses and increasing attention given to short-course inputs and distance learning. [from introduction]

A comparison showed that two models for teaching maternal care skills to providers resulted in similarly modest improvements in knowledge and performance. However, maternal care skills remained weak overall. Training should incorporate the best elements of the two approaches while seeking improvements in basic knowledge of maternal care. [author’s description]

Facilitator-led training of 20 healthcare providers in IMCI requires 11 days of lectures/practice and 6 facilitators, while the QA Project’s computer-based training requires 9 days and 4 facilitators. This study compared the cost-effectiveness of the two methods and found that both courses had equal effects on participants’ knowledge and skills, and retention after three to four months. The computer course was about 25 percent less expensive, excluding the cost of developing the software and for the computers used in the training. [publisher’s description]

The MCH clinic workers in Somalia receive formal and in-service training to perform their professional duties. Their competence in the field was never examined. This study assessed their competencies in detecting malnourished children 5 years and below in Beledweyne. [from abstract]

This cost analysis is based on QAP research on the effectiveness of two interventions (self-assessment and peer review) in sustaining or increasing the effectiveness of interpersonal communications training that midwives had taken. The research had measured the effectiveness of the interventions in terms of the number of utterances midwives made during family planning consultations, and this case study followed on, measuring the cost of each intervention in terms of the number of utterances generated. Activities/tools: Sample provider self-assessment form, sources of costs, evaluation of marginal benefit.

In both Senegal and Mali, JHPIEGO used a “jumpstart” training approach that combines both basic and intermediate training to ensure that participants are not only competent but are also confident in the skills or procedures acquired during training. High caseloads are needed so that trainers can have enough practice to achieve both competency and confidence in method provision skills—insertion and removal. The Klinik Raden Saleh (KRS), in Indonesia, was selected as the jumpstart training center for the Senegalese and Malian clinical teams because of its large Norplant implants clinical caseload, extensive clinical training, programmatic and research experience, large number of master trainers and clinical coaches, and extensive use of midwives as trainers and service providers. [publisher’s description]

A substantial number of patients with psychiatric disorders consult primary care physicians for comprehensive health care; however, the diagnosis and effective treatment of psychiatric disorders are deficient in primary health care. The aim of this intervention study is to assess the pre- and post-psychiatric training knowledge of primary care physicians. [from abstract]

The main objective of this study was to determine the perceptions of Iranian nurse educators and students regarding the evaluation of teaching effectiveness in university-based programs. [from abstract]

The Quality Assurance Project (QAP) has developed and twice tested a computer-based version of the Integrated Management of Childhood Illness (IMCI) training course. Earlier testing had shown that the computer-based training (CBT), which takes six days, was as effective as the 11-day training traditionally used to teach healthcare providers to use IMCI. This report describes more recent testing of the CBT, which is available on CD-ROM. The two training programs are equally effective in knowledge transfer, as demonstrated here through a knowledge test and observed performance with two simulated, standardized cases of childhood illness. Budgeted costs were $230 or 29% less per trainee for the computer-based training, largely because of the reduction in the number of days committed to training. [publisher’s description]

In 1993, JHPIEGO initiated two new programs with the Association of Deans of Philippine Colleges of Nursing (ADPCN) and the Association of Philippine Schools of Midwifery (APSOM). These programs responded to the need to institutionalize clinical reproductive health/family planning (RH/FP) training, to develop a sustainable, decentralized national clinical training network for RH/FP services and to develop standardized training materials. This network was intended to increase the number of skilled graduating nurses and midwives available to meet the needs of the country. This study assessed the following outcomes in the project-affiliated schools of midwifery and colleges of nursing: institutionalization of FP training, quality of training (both classroom and clinical) and quality of services in the project-affiliated clinics. The plan also included an assessment of the institutionalization of RH/FP and the use of project training materials by all schools of midwifery and colleges of nursing. [publisher’s description]

Between 23 May and 2 June 1996, an evaluation of the infection prevention (IP) component of JHPIEGO’s project Strengthening Reproductive Health Services in Mali was conducted to monitor the project’s progress and help with decisions about expanding the project and refining its components. Evaluation objectives were to: document the IP strategy used in Bamako, Mali; document any changes in IP practices at selected sites in Bamako where Norplant

Beginning in 1992, JHPIEGO worked in close collaboration with the Bolivia Ministry of Health (MOH) to develop an integrated family planning/reproductive health (FP/RH) training network throughout the country. The focus of the assistance was the establishment of nine national training centers (NTCs) for inservice training conducted by physician-nurse teams and located at departmental maternity hospitals in departmental capitals. By 2000, the government of Bolivia and other stakeholders had shifted the training emphasis to preservice education efforts. JHPIEGO preservice assistance focused on improving FP/RH education in three medical and nine nursing schools, and the role of the training teams at the NTCs moved toward supporting the preservice education efforts.

The popularity of female sterilization often falls behind other FP methods due in partly because the method is permanent, but mostly because there is a lack of trained service providers who are competent in performing this procedure. Government hospitals and clinics are the primary service delivery points for FP services and, in fact, provide services to more than two-thirds of Kenyan women who use modern methods of contraception. There is, therefore, a strong need for appropriately trained service providers at these sites who can support the service provision system. [publisher’s description]

Clinical skills and the ability to perform procedures is a vital part of general medicine. Teaching these skills to aspiring doctors is a complex task and it starts with a good theoretical preparation and some practical experience at university. On graduating from university, each doctor is faced with the task of transforming theoretical knowledge into the practical, procedural skills of a competent professional. This study aims to assess the perceptions of intern doctors working in regional hospitals in the Western Cape of their skills training both at undergraduate level and during the intern year.

Using all of the tools in the document will provide a comprehensive assessment of skills and service delivery. Each tool, however, may be used separately or combined with others to create a document appropriate for the content of a specific maternal and newborn health training course. [author’s description]

This study assessed the impact of management training in the performance of managers from agencies in Bangladesh delivering primary healthcare services. [from abstract]

Modified computer-assisted learning (ModCal) is JHPIEGO’s newest option for implementing competency-based training (CBT) in reproductive health. A pilot test of ModCal for the intrauterine device (IUD), conducted in May 1996 at the Mpilo School of Midwifery in Bulawayo, Zimbabwe, determined the acceptability of computer-assisted learning (CAL) and the feasibility for implementing it in an institutional setting. The goal was to assess how participants with no prior computer experience responded to computer-based learning about IUDs. [publisher’s description]

In family planning programs, good face-to-face interaction between the client and providers is key to meeting clients’ needs and program goals. Programs can best improve client-provider interaction (CPI) when they move beyond just training providers and strengthen CPI continuously in multiple ways. [summary]

Increased interest in parasite-based malaria diagnosis has led to increased use of rapid diagnostic tests (RDTs), particularly in rural settings. The scarcity of health facilities and trained personnel in many sub-Saharan African countries means that limiting RDT use to such facilities would exclude a significant proportion of febrile cases. Use of RDTs by volunteer community health workers (CHWs) is one alternative, but most sub-Saharan African countries prohibit CHWs from handling blood, and little is known about CHW ability to use RDTs safely and effectively. [adapted from introduction]

Through its work with the Zimbabwe National Family Planning Council and the Kenya Ministry of Health/Division of Primary Health Care, JHPIEGO facilitated the adaptation of materials to improve the performance of IUD service providers through structured on-the-job training (OJT). In Zimbabwe, providers at 14 sites learned IUD/genital tract infection skills by means of structured OJT. At the same time, in August 1996, JHPIEGO began pilot testing this structured OJT in Kenya at six provincial hospitals. Although the pilot test was intended to train about 40 service providers in both countries (two per site), it actually produced 50 providers who achieved competency during 4 to 6 weeks of self-paced learning. [publisher’s description]

This study tested two low-cost alternatives to supervision-self-assessment and peer review-that may reinforce providers’ skills after training, in this case training in interpersonal communication and counseling (IPC/C). There were three study groups: the control group received no reinforcement after training, a “self-assessment” (SA) group performed SA exercises for 16 weeks after training, and a SA and peer review group also performed SA exercises for 16 weeks and met in small groups to peer review and guide each other in their efforts to improve their IPC/C skills. These reinforcement strategies taught providers how to work more efficiently so that they could shorten consultations yet provide high quality interactions with clients. An analysis of the cost-effectiveness of each intervention is included. [publisher’s description]

From 1987 to 1998, JHPIEGO, through its Training in Reproductive Health (TRH) Project, collaborated with the Association of Deans of Philippine Colleges of Nursing (ADPCN) and the Association of Philippine Schools of Midwifery (APSOM) to strengthen preservice nursing and midwifery education in the Philippines. Between 1987 and 1994, JHPIEGO initiated activities to strengthen family planning/reproductive health (FP/RH) and enhance trainer/faculty development in five nursing schools and five midwifery schools. In February 2001, JHPIEGO conducted an evaluation in the Philippines to assess the impact of the preservice program since its closeout in 1998.

Typically, provider–client interactions are brief, and providers often behave condescendingly toward clients. As a result, clients are unable to express their concerns or describe the limitations they face in trying to implement the providers’ suggested course of action. A training intervention was developed for providers that focused on addressing the problems inherent in this dynamic. This research was undertaken to assess whether providers in the experimental area delivered services in a different manner than they had prior to the training intervention. [adapted from author]

This presentation was part of the International Conference on Global Health session, “Integration and Application: Successes and Challenges in Health-Worker Training.” Based on the initial high MMR estimates and the low number of facility deliveries, the Ministry of Health adopted an aggressive Safe Motherhood Strategy to reduce maternal mortality as well as neonatal and child morbidity and mortality. This presentation describes this training program for nurse-midwives and details the results of a study to evaluate the program. [adapted from author]

This document asks how leadership contributes to measurable changes in organizational performance and how to evaluate the outcomes of leadership development programs in developing countries.

In Indonesia responsibility for immunizations is placed on local government health centres and on the nurses who provide the immunizations at each centre. An on-the-job peer training programme for these nurses, which was designed to improve the immunization performance of poorly performing health centres in terms of coverage and practice in Maluku province, was evaluated. [from abstract]