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1
Session overview and
objectives
Diana Frymus
Health Systems Strengthening Advisor
Office of HIV/AIDS
USAID

2
Workshop objectives:
1. To launch the first global improvement framework for health worker IST
2. Harvest and share experi...
Launch of the in-service
training improvement
framework: What, why and
how to apply
Tana Wuliji
Senior Quality Improvement...
The in-service
training improvement
framework
Towards more effective, efficient
and sustainable training
Developed and lau...
What is the in-service training (IST)
improvement framework?
A set of practice recommendations to improve
in-service train...
Global landscape: Need for evidencebased guidance for improving IST

Significant proportion of
country HRH investments
Nee...
How was the IST improvement framework
developed? Delphi process

4. Rate agreement on
recommendations

1. Develop and revi...
How was the IST improvement framework
developed?
Delphi process
Development and review of recommendations
through 5 rounds...
IST improvement framework themes

1. Strengthening
training institutions
and systems

2. Coordination of
training

3. Cont...
Using the IST improvement framework:
Examples
• Nigeria- IST Assessment of PEPFAR Nigeria Portfolio
(CapacityPlus/IntraHea...
In-service training journal series:
Human Resources for Health Journal
Launched October 1st 2013 by
USAID, USAID ASSIST, J...
Design and delivery of training: Recommendation: 4.3
IST should be based on sound, evidence-based learning principles
and ...
Expert Consensus Group
Marita Murrman, International Center for AIDS Care and Treatment
Programs (ICAP); Mike Rouse, Inter...
Lightning talks
1. Strengthening
training institutions
and systems

2. Coordination of
training

3. Continuum of
learning ...
1. Strengthening
training institutions
and systems

2. Coordination of
training

3. Continuum of
learning from preservice ...
Theme 1: Strengthening training institutions and systems

Ethiopia’s experience with inservice training institutionalizati...
1. Strengthening
training institutions
and systems

2. Coordination of
training

3. Continuum of
learning from preservice ...
Theme 2: Coordination of training

iHRIS system for tracking training
Rebecca Bailey
Team Lead, Health Workforce Developme...
Coordination of Training
iHRIS system for tracking training
Sam Ngobua, Director, CapacityPlus, Nigeria
Rebecca Bailey, Te...
Nigeria - Context
•

•

•

Substantial US Government
investment in in-service training
(IST) of health workers in
HIV/AIDS...
Objectives of the Training Information System
• Track trainees to avoid double
training of the same health worker
• Coordi...
iHRIS Train Prototype for Nigeria
• Web-based application developed
on the open-source application
platform of iHRIS
• Ope...
Welcome Page – Implementing Agency

iHRIS Train Nigeria

24
View and Edit Training Courses

iHRIS Train Nigeria

25
View Calendar of Scheduled Training Courses

iHRIS Train Nigeria

26
View Summary page of Participants

iHRIS Train Nigeria

27
Search for other Implementing Agencies

iHRIS Train Nigeria

28
List of Participants Report

iHRIS Train Nigeria

29
CONCLUSION
• iHRIS Train Nigeria is a work-in-progress.
• It is scalable to meet the needs of the
PEPFAR-funded implementi...
Questions for Knowledge Café Discussion
• Is there a need for an electronic IST
tracking system in your country or for you...
1. Strengthening
training institutions
and systems

2. Coordination of
training

3. Continuum of
learning from preservice ...
Theme 3: Continuum of learning from pre-service to inservice

Lessons learnt by professional
associations, regulatory bodi...
1. Strengthening
training institutions
and systems

2. Coordination of
training

3. Continuum of
learning from preservice ...
Theme 4: Design and delivery

Findings from an integrative
review of literature on training
design and delivery
Julia Blue...
Effective In-Service Training Techniques,
Frequency, Setting and Media:
Synthesis of an Integrative
Review of the Literatu...
In the context of continuing health
professional education
 What evidence is there to
support educational
techniques, Fre...
What surprised us? (Or didn’t!)

 Didactic-”low to no” outcomes
 Simulation effective
 Practice and feedback ‘dosage’
m...
Question:

Given the current system is
designed for group-based training,
what changes do we need to make
to implement, sh...
1. Strengthening
training institutions
and systems

2. Coordination of
training

3. Continuum of
learning from preservice ...
Theme 5: Support for learning

Point of care performance support
tools linking standards to
resources needed to support th...
SSDI Services

Mentoring in Malawi

Support for Learning
SSDI Services

Question:
How do we prepare, support and
incentivize busy health care workers to
provide workplace-based me...
1. Strengthening
training institutions
and systems

2. Coordination of
training

3. Continuum of
learning from preservice ...
Theme 6: Evaluation and improvement of training

Training Evaluation Framework
and Tools (TEFT)
Gabrielle O’Malley
Directo...
Is training making a difference?

International Education and Training Center for Health
ENVIRONMENT
HEALTH SYSTEM / POPULATION
ORGANIZATION
Organization
systems
improvements

Training

Individual
knowledge,
att...
6 planning steps with tools and guidance
Planning steps

Tools

1. Identify anticipated
outcomes
2. Address situational fa...
Training Evaluation Framework
and Tools
How can evaluation of IST outcomes be strengthened
to inform improvement in traini...
Knowledge cafe

3 x 10 min discussions on
theme of your choice

1.

Strengthening training
institutions and systems:
Dr Am...
Summary of discussions
Lois Schaefer
Senior Technical Advisor for HRH, USAID

55
56
Se30   improving hw ist - harvesting good practices and lessons learnt
Se30   improving hw ist - harvesting good practices and lessons learnt
Se30   improving hw ist - harvesting good practices and lessons learnt
Se30   improving hw ist - harvesting good practices and lessons learnt
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Se30 improving hw ist - harvesting good practices and lessons learnt

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Se30 improving hw ist - harvesting good practices and lessons learnt

  1. 1. 1
  2. 2. Session overview and objectives Diana Frymus Health Systems Strengthening Advisor Office of HIV/AIDS USAID 2
  3. 3. Workshop objectives: 1. To launch the first global improvement framework for health worker IST 2. Harvest and share experiences, strategies, and lessons learnt on addressing key IST challenges for health workers 3. Facilitate networking, shared understanding and learning between health workers, Ministry of Health representatives, training institutions, donors and partners to improve IST Expected outcomes: 1. Participants will learn about the IST improvement framework and how to use it to improve in-service training systems for health workers 2. Participants will enhance their understanding of how to evaluate inservice training program outcomes and impacts 3. Participants will gain new knowledge and multi-stakeholder connections to improve in-service training that will enable health workers to provide better care 4. Participant experiences, lessons learnt and evidence will seed a new global wiki on in-service training improvement 3
  4. 4. Launch of the in-service training improvement framework: What, why and how to apply Tana Wuliji Senior Quality Improvement Advisor USAID ASSIST Project, University Research Co., LLC (URC) @TanaWuliji 4
  5. 5. The in-service training improvement framework Towards more effective, efficient and sustainable training Developed and launched by International Center for AIDS Care and Treatment Programs (ICAP); International Pharmaceutical Federation (FIP); IntraHealth; International Training and Education Center for Health (I-TECH); Jhpiego; Sciences for Health (MSH); Pan-American Health Organization (PAHO); Pathfinder; World Medical Association (WMA); USAID; University Research Co. (URC) 5
  6. 6. What is the in-service training (IST) improvement framework? A set of practice recommendations to improve in-service training effectiveness, efficiency and sustainability that were developed and agreed through international expert consensus 6
  7. 7. Global landscape: Need for evidencebased guidance for improving IST Significant proportion of country HRH investments Needed for scale-up of health services (HIV, TB, MCH) Growing attention of countries in reviewing IST portfolios
  8. 8. How was the IST improvement framework developed? Delphi process 4. Rate agreement on recommendations 1. Develop and revise recommendations 25 member consensus group 3. Targeted literature review on recommendations 2. Consolidate recommendations June – December 2011
  9. 9. How was the IST improvement framework developed? Delphi process Development and review of recommendations through 5 rounds of peer review and ratings (Delphi process) and literature review Final consensus: 40 recommendations across 6 themes by 25 member expert panel Improvement framework + guidance Expected January 2014 External open consultation: 4th round • November 3-29 2011, online • 26 countries • 86/119 complete responses
  10. 10. IST improvement framework themes 1. Strengthening training institutions and systems 2. Coordination of training 3. Continuum of learning from preservice to in-service 4. Design and delivery of training 5. Support for learning 6. Evaluation and improvement of training 10
  11. 11. Using the IST improvement framework: Examples • Nigeria- IST Assessment of PEPFAR Nigeria Portfolio (CapacityPlus/IntraHealth) • Afghanistan- Informed organization of National Training Standards for the Afghanistan General Directorate of Human Resources In-Service Department (HSSP/Jhpiego) • Ethiopia- IST Rapid Assessment to inform Ethiopia Federal Ministry of Health efforts and strategies to improve, institutionalize, and standardize IST National IST strategy development workshop, Oromia, Ethiopia, August 2012. Photo: USAID (HCI/URC) 11 HCI.
  12. 12. In-service training journal series: Human Resources for Health Journal Launched October 1st 2013 by USAID, USAID ASSIST, Jhpiego, I-TECH and IntraHealth Open access: www.humanresources-health.com/series/IST 12
  13. 13. Design and delivery of training: Recommendation: 4.3 IST should be based on sound, evidence-based learning principles and methodologies that offer the best opportunity to produce sustainable performance improvement within the workplace. Explanatory note: In order for IST programs to most effectively improve health worker competencies, they should apply state of the art learning principles and methodologies appropriate to the context that are based on the latest evidence…… Examples: Resources: • For the development of clinical decision • The Johns Hopkins Evidencemaking skills, a RCT comparing an Based Practice Center interactive workshop-based training to recommends multiple techniques, simulation training found that simulation multiple media, interaction and training resulted in better skill performance. repetition. Marinopoulos SS et al, This is reinforced by systematic reviews 2007. that identify clinical simulations as an • The Learning for Performance effective technique for developing tools provide guidance on psychomotor and critical thinking skills. designing training for desired Daniels et al, 2010; Nestel et al, 2011; performance Issenberg et al, 2005 http://www.intrahealth.org/page/le arning-for-performance
  14. 14. Expert Consensus Group Marita Murrman, International Center for AIDS Care and Treatment Programs (ICAP); Mike Rouse, International Pharmaceutical Federation (FIP); Rebecca Bailey, Shaun Noronha, Kate Tulenko, IntraHealth; Gabrielle O’Malley, Tom Perdue, Frances Petracca, International Training and Education Center for Health (I-TECH); Julia Bluestone, Peter Johnson, Edgar Necochea, Jhpiego; Karen Chio, Gail Naimoli, Management Sciences for Health (MSH); Rosa Maria Borrell, Pan-American Health Organization (PAHO); Cathy Solter, Graciela Salvador-Davila, Pathfinder; Julia Seyer, World Medical Association (WMA); Diana Frymus and Lois Schaefer, USAID; Tana Wuliji, Akuba Dolphyne, Tisna Veldhuizen Van Zanten University Research Co. (URC); Habib Benzinan, Alan Lyles, Linda Ippolito, Hugo Mercer, Independent experts. 14
  15. 15. Lightning talks 1. Strengthening training institutions and systems 2. Coordination of training 3. Continuum of learning from preservice to in-service 4. Design and delivery of training 5. Support for learning 6. Evaluation and improvement of training 15
  16. 16. 1. Strengthening training institutions and systems 2. Coordination of training 3. Continuum of learning from preservice to in-service 4. Design and delivery of training 5. Support for learning 6. Evaluation and improvement of training • Engage national authorities, regulatory and professional bodies • Build capacity and strengthen local infrastructure and trainers • Support CPD systems
  17. 17. Theme 1: Strengthening training institutions and systems Ethiopia’s experience with inservice training institutionalization and standardization Dr Samuel Hailemariam, Health Systems Strengthening Advisor, USAID Ethiopia 17
  18. 18. 1. Strengthening training institutions and systems 2. Coordination of training 3. Continuum of learning from preservice to in-service 4. Design and delivery of training 5. Support for learning 6. Evaluation and improvement of training • Coordinate IST • Minimize duplications: Coordination mechanism • Reduce disruption to health services • IST tracking mechanism
  19. 19. Theme 2: Coordination of training iHRIS system for tracking training Rebecca Bailey Team Lead, Health Workforce Development, CapacityPlus, IntraHealth 19
  20. 20. Coordination of Training iHRIS system for tracking training Sam Ngobua, Director, CapacityPlus, Nigeria Rebecca Bailey, Team Lead, Health Workforce Development, CapacityPlus
  21. 21. Nigeria - Context • • • Substantial US Government investment in in-service training (IST) of health workers in HIV/AIDS-related topics. A 2012 assessment – based on the IST Framework – found limited coordination of IST among PEPFAR-funded implementing partners. Recommended introducing an information system to track IST across implementing partners in order to decrease duplication, improve coordination, and ensure that the right health workers receive the right kinds of training.
  22. 22. Objectives of the Training Information System • Track trainees to avoid double training of the same health worker • Coordinate training between PEPFAR-funded implementing agencies • Track availability of Master Trainers • Ultimately reduce cost and improve efficiency
  23. 23. iHRIS Train Prototype for Nigeria • Web-based application developed on the open-source application platform of iHRIS • Open-source, user friendly and user operating system independent, affordable and customizable • Sustainable through local capacity building • Backed by IntraHealth informatics experience in over 23 countries 23
  24. 24. Welcome Page – Implementing Agency iHRIS Train Nigeria 24
  25. 25. View and Edit Training Courses iHRIS Train Nigeria 25
  26. 26. View Calendar of Scheduled Training Courses iHRIS Train Nigeria 26
  27. 27. View Summary page of Participants iHRIS Train Nigeria 27
  28. 28. Search for other Implementing Agencies iHRIS Train Nigeria 28
  29. 29. List of Participants Report iHRIS Train Nigeria 29
  30. 30. CONCLUSION • iHRIS Train Nigeria is a work-in-progress. • It is scalable to meet the needs of the PEPFAR-funded implementing agencies and the Federal Government of Nigeria for an InService Training Information System. • Affordable and sustainable • Backed by the multi-national experience of CapacityPlus/IntraHealth Informatics. iHRIS Train Nigeria 30
  31. 31. Questions for Knowledge Café Discussion • Is there a need for an electronic IST tracking system in your country or for your training programs? • What characteristics or functions are most desirable in a training information/tracking system?
  32. 32. 1. Strengthening training institutions and systems 2. Coordination of training 3. Continuum of learning from preservice to in-service 4. Design and delivery of training 5. Support for learning 6. Evaluation and improvement of training • Synergies between pre-service education and IST systems • Consistency in approaches and content
  33. 33. Theme 3: Continuum of learning from pre-service to inservice Lessons learnt by professional associations, regulatory bodies, nursing schools and Ministries of Health from strengthening CPD systems Carey McCarthy Health Systems Scientist, CDC supported African Regulatory Collaborative 34
  34. 34. 1. Strengthening training institutions and systems 2. Coordination of training 3. Continuum of learning from preservice to in-service 4. Design and delivery of training 5. Support for learning 6. Evaluation and improvement of training • Needs based: aligned with plans, understand performance barriers • Compliance with policies, strategies and laws • Evidence based methodologies
  35. 35. Theme 4: Design and delivery Findings from an integrative review of literature on training design and delivery Julia Bluestone Senior Technical Advisor, Jhipego @juliabluestone 36
  36. 36. Effective In-Service Training Techniques, Frequency, Setting and Media: Synthesis of an Integrative Review of the Literature
  37. 37. In the context of continuing health professional education  What evidence is there to support educational techniques, Frequency (single vs. repetitive), setting, and media used to deliver instruction?  What evidence exists about the outcomes (knowledge, skills, attitudes, provider behaviors, patient outcomes) of continued health professional education? Julia Bluestone, MS Peter Johnson, PhD Judith Fullerton, PhD Catherine Carr, DrPH Jessica Alderman, MPH James BonTempo, MS
  38. 38. What surprised us? (Or didn’t!)  Didactic-”low to no” outcomes  Simulation effective  Practice and feedback ‘dosage’ matters  Shorter, but more often  Workplace-setting better 39
  39. 39. Question: Given the current system is designed for group-based training, what changes do we need to make to implement, shorter, repeated, simulation-heavy, workplace-based training? 40
  40. 40. 1. Strengthening training institutions and systems 2. Coordination of training 3. Continuum of learning from preservice to in-service 4. Design and delivery of training 5. Support for learning 6. Evaluation and improvement of training • Share resources and materials • Support trainees post-training • Life long learning skills
  41. 41. Theme 5: Support for learning Point of care performance support tools linking standards to resources needed to support them Julia Bluestone Senior Technical Advisor, Jhipego 42
  42. 42. SSDI Services Mentoring in Malawi Support for Learning
  43. 43. SSDI Services Question: How do we prepare, support and incentivize busy health care workers to provide workplace-based mentoring or support to others?
  44. 44. 1. Strengthening training institutions and systems 2. Coordination of training 3. Continuum of learning from preservice to in-service 4. Design and delivery of training 5. Support for learning 6. Evaluation and improvement of training • Build in evaluation to inform continuous improvement • Evaluate against defined criteria • Engage key stakeholders and trainees
  45. 45. Theme 6: Evaluation and improvement of training Training Evaluation Framework and Tools (TEFT) Gabrielle O’Malley Director for Implementation Science, I-TECH 49
  46. 46. Is training making a difference? International Education and Training Center for Health
  47. 47. ENVIRONMENT HEALTH SYSTEM / POPULATION ORGANIZATION Organization systems improvements Training Individual knowledge, attitude, skill outcomes Individual performance outcomes Individual patient health outcomes Organization performance outcomes Population level performance outcomes Organization patient health outcomes (impacts) INDIVIDUAL Population level systems improvements Population patient health Outcomes (impacts) SITUATIONAL FACTORS INDIVIDUAL • Trainee background, knowledge, experience, education • Intrinsic motivation • Family demands ORGANIZATION • Management support • HR – staffing levels, salaries, burnout • Available drugs, supplies, equipment and infrastructure • Facility systems – appointments, records, flow, referrals • Patient needs HEALTH SYSTEM/POPULATION • National, regional, community systems – labs, supply chain • National, regional policies • Partner programs • Available health workforce, including informal private, attrition issues • Pre-service program • Retention factors, e.g. pay scales ENVIRONMENT • Political instability • Prevalent disease • Natural disasters • Food availability • Seasonal changes • Patient access to food, transportation • Available community support resources Training Evaluation Framework (TEFT) TRAINING EVALUATION FRAMEWORK
  48. 48. 6 planning steps with tools and guidance Planning steps Tools 1. Identify anticipated outcomes 2. Address situational factors 3. Refine the scope of the evaluation 4. Define evaluation questions, objectives, and indicators 5. Choose evaluation design and methods 6. Plan the evaluation Framework and template Worksheet 5 Considerations tool Worksheet Resource tables Planning template
  49. 49. Training Evaluation Framework and Tools How can evaluation of IST outcomes be strengthened to inform improvement in training? What are some of your successes and some of your needs in identifying results of your training programs? http://www.go2itech.org/resources/TEFT
  50. 50. Knowledge cafe 3 x 10 min discussions on theme of your choice 1. Strengthening training institutions and systems: Dr Amir Aman, Samuel Hailemariam 4. Design and delivery Julia Bluestone 2. Coordination of training Sam Ngobua, Rebecca Bailey 5. Support for learning Lois Schaefer 3. Continuum of learning from pre-service to inservice Carey McCarthy 6. Evaluation and improvement of training Gabrielle O’Malley, Francie Petracca 54
  51. 51. Summary of discussions Lois Schaefer Senior Technical Advisor for HRH, USAID 55
  52. 52. 56

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