Training Methodologies

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]

Today’s health professionals are inappropriately trained to address the health of the public, particularly the large proportion who are disadvantaged; they are also maldistributed by specialty and geography. Health disparities exist worldwide, but are of crisis proportions in developing countries where the magnitude of health problems far outstrips the available meager resources. Community-based education has the potential to train service providers, educators and researchers who can assist communities to identify their priority health needs and to implement feasible, affordable and sustainable interventions.

Community-based education (CBE) was developed thirty years ago in response to the maldistribution of physicians and subsequent inequity of health care services across geographical areas in developed and developing countries. Several medical schools in Nigeria report adopting CBE. This study seeks to identify and describe the CBE programs in accredited Nigerian medical schools and to report students’ assessments of the knowledge and skills gained during their community-based educational experience. [from abstract]

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]

A participatory assessment process is a valuable starting point for involving all community members, including young people, in YRH and HIV/AIDS program development. YRH and HIV/AIDS program workers need skills in facilitating participatory assessments, especially when youth involvement is a key component. Supporting facilitators to learn by doing is an effective strategy to build skills in using participatory learning and action (PLA) approaches and tools during participatory assessment and throughout the project cycle. This guide aims to provide easy-to-follow guidelines for carrying out a participatory assessment with young and adult community members, and to outline how these tools and methods can be applied throughout the project cycle.

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]

This presentation was part of the International Conference on Global Health session, “Innovations in Human Resources: Strategies to Address the Health-Care Workers Shortage.” It outlines the reproductive medical education project in Vietnam that aims to improve the quality of RH care through pre-service teaching in medical schools.

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]

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]

This guidance was developed to help staff of the ACQUIRE Project understand and explain to counterparts and field partners the improvement approaches and tools used by ACQUIRE. ACQUIRE brings together partners with proven, effective approaches to improving provider performance and the quality of services and to mobilizing communities to drive improvements in health care: performance improvement (PI), quality improvement (QI), and participatory learning and action (PLA). These approaches and tools can be used alone or in a complementary manner, depending on the situation and on the program level being addressed.

The problem of training human resources in health is a real concern in public health in Central Africa. What can be changed in order to train more competent health professionals? This is of utmost importance in primary health care. Taking into account the level of training of secondary-level nurses in the Democratic Republic of the Congo, a systemic approach, based on the PRECEDE PROCEED model of analysis, led to a better understanding of the educational determinants and of the factors favourable to a better match between training in health sciences and the expected competences of the health professionals.

In 1993, USAID and the Ministry of Health (MOH) in Nepal approved a twofold family planning (FP) training strategy that called for the immediate strengthening of inservice training of health professionals to meet existing service delivery needs. As a secondary objective, the strategy recognized the need to develop a sustainable integrated (inservice and preservice) education and training network to meet future human resource needs. This technical report updates the 1993 strategy, reviews the rationale for both the inservice and preservice components of the training strategy, documents progress to date in achieving strategy objectives, describes modifications that have been made to the original 1993 strategy, and outlines future plans. [publisher’s description]

This paper reviews recent innovations in education for human resources for health (HRH). The paper outlines the rationale for HRH education, identifies shortcomings in HRH education, and addresses the global contents of educational programs and trends. Recent changes in didactic approaches used in HRH educational programs are analyzed. The paper concludes with an evaluation of innovations and a set of recommendations. [adapted from author]

This book considers the topic of scaling up with a focus on ways to increase the impact of health service innovations that have been tested in pilot or experimental projects so as to benefit more people and to foster policy and program development on a lasting, sustainable basis.

Chapter 8 of this book describes an innovative educational approach to capacity building and scaling up reproductive health services in Latin America. It explains how the capacity to provide innovative training was scaled up in public sector reproductive health services in Brazil, Bolivia and Chile. [from introd

This presentation describes the benefits and challenges of structured on-the-job training with evidence from a case study of Nepal.

Various tools and approaches can help accelerate the process of providing health care workers with the skill sets needed to tackle current health care needs. To this end, the Capacity Project has identified and categorized existing tools and approaches that support health cadres in learning new skills, especially in the area of HIV/AIDS. In this paper, we briefly describe and give examples of these potential resources, providing web links (where available) in the appendices. [from introduction]

Here, we review challenges and approaches to clinical HIV training, and suggest an agenda for implementation research—defined here as research into how proven interventions can be implemented to accelerate high-quality HIV-treatment scale-up—to address the question: what is the optimal approach to training the health workforce for an expanding HIV-treatment program in a resource-limited setting? [author’s description]

Human resources for health are non-existent in many parts of the world and the outer islands of Marshall Islands in Micronesia are prime examples. While the more populated islands with hospital facilities are often successful in recruiting qualified health professionals from overseas, the outer islands generally have very limited health resources, and are thus less successful. In an attempt to provide reasonable health services to these islands, indigenous people were trained as Health Assistants (HA) to service their local communities. In an effort to remedy the effectiveness of health care delivery to these islands, a program to train mid-level health care workers (Hospital Assistants) was developed and implemented by the Ministry of Health in conjunction with the hospital in Majuro, the capital city of the Marshall Islands. This paper discusses the details of the training, the modalities used to groom the candidates, and an assessment of the ultimate effectiveness of the program. [author’s description]

This course in Training Methods and Continuing Education for Health Workers identifies the role of training and continuing education as an important component of health service and personnel management. Participants will be guided through the steps of planning training and continuing education activities for a range of health workers from managers to village volunteers. The course draws on real life examples from community-directed onchocerciasis control, village health worker programs, and patent medicine vendor training programs, to name a few. [publisher’s description]

This paper reviews the main trends that have taken place in training persons for CBR (Community Based Rehabilitation) work in the past twenty years. It stresses the relevance of the Canadian manpower model to CBR and the logical approach to training generated. New trends for the near future are outlined and a need for more research is seen as crucial to future developments. [abstract]

What makes one training experience better than another? Effective training can help providers of family planning/reproductive health (FP/RH) services to improve their performance. This handbook summarizes the tasks that should be completed at each stage of training to ensure an effective training course.

When health care workers participating in training are able to transfer their newly acquired knowledge and skills to their jobs, higher levels of performance and sustained improvements in service delivery are likely to result. A joint publication of PRIME II and JHPIEGO, Transfer of Learning uses a dynamic matrix to outline specific steps for supervisors, trainers, learners and co-workers to follow before, during and after a learning intervention to promote the transfer of learning. PRIME II has also created an interactive website based on Transfer of Learning.

This manual was developed to assist district health management teams in countries where malaria is endemic to improve the quality of malaria treatment given by private clinics, pharmacies, shops and kiosks. It gives step-by-step instructions for how to implement a public health activity that will involve wholesalers in communicating malaria guidelines to retailers and private clinics. [author’s description]

Training managers within hospitals and health services do not just rely on transmitting packets of knowledge in a formal setting. This article argues that successful training should contain an emotional element to ensure engagement with the message. Immersion in real life circumstances is also important and leaders must develop training around shared objectives and team building. [abstract]

Whole-site training (WST) is an approach for meeting the learning needs of all staff at a health care service-delivery site. This paper describes WST, the advantages it offers, the challenges it faces, and examples of where it is being used. The approach has been developed in response to the training needs of health care providers working in reproductive health in developing countries. It emanates from AVSC International’s practical experience working with service providers, site managers, supervisors, health care agencies, and ministries of health to improve the quality of services. [author’s description]