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Distance Learning for Health: Tana Wuliji

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Distance Learning for Health: Tana Wuliji

  1. 1. Human resources for health training: An overview of training priorities and approaches Tana Wuliji Senior Associate,nstituto de Cooperaciόn Social - Integrare (ISCI) Tana.wuliji@integrare.es 1 DL4H International Workshop London, UK 26 October 2010
  2. 2. Overview • Background • Post-qualification training priorities • Training design for performance • Conceptual framework for approaches to health worker training 2
  3. 3. Background Human resources for health crisis 3 Health systems strengthening
  4. 4. What is a health system? 4 “All organisations, people and actions whose primary intent is to promote, restore or maintain health” WHO, 2000
  5. 5. Health systems building blocks 5 Service delivery Health workforce Information Medical products, vaccines and technologies Financing Leadership/ governance Improved health Responsiveness Social and financial risk protection Improved efficiency 4 million health worker shortage in 57 countries In 60 countries, less than ¼ deaths recorded Medicines availability 20% in public sector in 39 LMIC 100 million people impoverished due to health spending per year
  6. 6. Public health spending 6
  7. 7. Private health spending 7
  8. 8. 8 Child 1-5 mortality www.worldmapper.org Data: UNDP, WHO, 2002
  9. 9. Health workforce crisis: 57 countries 9
  10. 10. Nurses 10 www.worldmapper.org Data: WHO Global Health Workforce Atlas
  11. 11. Midwives 11 www.worldmapper.org Data: WHO Global Health Workforce Atlas
  12. 12. Pharmacists 12 www.worldmapper.org Data: WHO Global Health Workforce Atlas
  13. 13. Physicians 13 www.worldmapper.org Data: WHO Global Health Workforce Atlas
  14. 14. Dentists 14 www.worldmapper.org Data: WHO Global Health Workforce Atlas
  15. 15. Post- qualification training priorities Training and performance 15 Health systems strengthening perspective
  16. 16. Training priorities 16 Service delivery: Diabetes UK Twinning to train health workers and trainers Health workforce: PEPFAR funded MEPI, NEPI; PROFAE nursing workforce Brazil, AMREF nursing workforce Information: Field Epidemiology Training programs (FETP): Americas, Africa Medical products, vaccines and technologies: Supply chain management training (MSH, JSI) Financing Leadership/ governance: 6 month health management skills program Yale/Liberia - HR Managers -Educators -Primary healthcare workers -Specialists Supply chain management - Researchers
  17. 17. Health systems building blocks 17 Service delivery Health workforce Information Medical products, vaccines and technologies Financing Leadership/ governance Improved health Responsiveness Social and financial risk protection Improved efficiency Training! But is training always the answer?
  18. 18. 18 Myth: Training will result in improvements in health worker performance Performance Competence Training Work environment Job satisfaction Autonomy Supervision support and feedback Monitoring of outcomes Performance is influenced by a broad set of factors
  19. 19. Training design for performance Interactive and integrated learning 19 Work-place based learning Distance education and e-learning
  20. 20. Workplace based learning • Health facility management 6 month training program in Liberia – Reduced disruption to work, enabled field based learning for application of learnt skills • Field Epidemiology Training Program – Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Dominican republic, Burkina Faso, Ethiopia, Ghana, Kenya, Nigeria, Rwanda, South Africa, Tanzania – 80% learning in field, 20% in classroom • 3 year work-place based post-graduate diploma to build general level competencies of hospital pharmacists (UK) 20
  21. 21. Distance education and e-learning • University of Western Cape Masters of Public Health – Health workforce management. 75% distance education. Face to face learning: 4 visits. • E-learning: online video programs, online modules, live videoconferencing and broadcasting, online case conferencing, web based portfolio systems, online learning platforms • 2008 meta-analysis of 201 studies (Cook et al, 2008) – large and positive effects from e-learning vs non- intervention – Mixed/limited positive effects compared to classroom based training 21 Distance education produces comparable but not necessarily superior effects to classroom education
  22. 22. Interactive and integrated learning 22 Level 1: Interactive and clinically integrated Level 2: Interactive classroom activities and didactic, clinically integrated activities Level 3: Didactic /classroom Khan & Coomarasamy, 2006 Improvements in evidence based medicine practice 7/8 evaluations: Associated with improvements in practice 6/7 RCTs: No significant differences between groups
  23. 23. Conceptual framework for approaches to health worker training Broadening the Distance Education approach 23 From competence to performance
  24. 24. 24 BEHAVIOUR CHANGE Performance As Performance institutionalisation Level 4: Results Eg –Improvements in health outcomes, improved health service efficiency (mortality, morbidity, healthcare utilisation) Level 3: Behaviour Eg – Improvements in health worker performance (peer review, observation, patient exit surveys) Supervision, support & feedback Monitoring of outcomes (audit) Work environment Structured preceptorship Work-place based & integrated learning Peer learning and review Competence COMPETENCE Level 2: Learning Eg – Improvements in competence (pre-test vs post-test, self-assessment) Feedback Self-directed learning Problem based learning Simulations and case based learning Distributed learning Engagement ENGAGEMENT Level 1: Reaction Eg – Positive response to training Interactive Competency based Clear learning objectives Relevant assessments Kirkpatrick’s levels of training effectiveness HEALTH WORKER CAPACITY BUILDING PROCESS GOALS Enabling factors
  25. 25. Broadening the distance education approach 25 Performance Competence Training Work environment Job satisfaction Autonomy Supervision support and feedback Monitoring of outcomes/audit = small/moderate effect on practice = small/moderate effect on practice Distance education supported by strategies to enable behaviour change to improve and institutionalise performance

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