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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
Overview
• Background
• Post-qualification training priorities
• Training design for performance
• Conceptual framework for approaches to
health worker training
2
Background Human resources
for health crisis
3
Health systems
strengthening
What is a health system?
4
“All organisations, people
and actions whose primary
intent is to promote, restore
or maintain health”
WHO, 2000
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
Public health spending
6
Private health spending
7
8
Child 1-5 mortality
www.worldmapper.org Data: UNDP, WHO, 2002
Health workforce crisis: 57 countries
9
Nurses
10
www.worldmapper.org Data: WHO Global
Health Workforce Atlas
Midwives
11
www.worldmapper.org Data: WHO Global
Health Workforce Atlas
Pharmacists
12
www.worldmapper.org Data: WHO Global
Health Workforce Atlas
Physicians
13
www.worldmapper.org Data: WHO Global
Health Workforce Atlas
Dentists
14
www.worldmapper.org Data: WHO Global
Health Workforce Atlas
Post-
qualification
training
priorities
Training and
performance
15
Health systems
strengthening
perspective
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
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
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
Training design
for performance Interactive and
integrated learning
19
Work-place based
learning
Distance education
and e-learning
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
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
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
Conceptual
framework for
approaches to
health worker
training
Broadening the
Distance Education
approach
23
From competence
to performance
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
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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Distance Learning for Health: Tana Wuliji

  • 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. Overview • Background • Post-qualification training priorities • Training design for performance • Conceptual framework for approaches to health worker training 2
  • 3. Background Human resources for health crisis 3 Health systems strengthening
  • 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. 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
  • 9. Health workforce crisis: 57 countries 9
  • 10. Nurses 10 www.worldmapper.org Data: WHO Global Health Workforce Atlas
  • 11. Midwives 11 www.worldmapper.org Data: WHO Global Health Workforce Atlas
  • 12. Pharmacists 12 www.worldmapper.org Data: WHO Global Health Workforce Atlas
  • 13. Physicians 13 www.worldmapper.org Data: WHO Global Health Workforce Atlas
  • 14. Dentists 14 www.worldmapper.org Data: WHO Global Health Workforce Atlas
  • 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. 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 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. Training design for performance Interactive and integrated learning 19 Work-place based learning Distance education and e-learning
  • 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. 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. 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. Conceptual framework for approaches to health worker training Broadening the Distance Education approach 23 From competence to performance
  • 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. 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

Editor's Notes

  1. PROFAE: 180,000 nursing aides, 72,000 nursing technicians, 12,000 nursing educators (2000 – 2007 via decentralised onsite training and distance edu) in Brazil
  2. Blended learning. Contextualise and apply learning.