Post Training Asessment Report

Post Training Follow-up Assessment of
Kenya Health Workforce Trainings 2012
Post Training Follow-up Assessment of
Kenya Health Workforce Trainings 2012
Ministry of Health
March 2014

Post Training Follow-up Assessment
of Kenya Health Workforce
Trainings 2012
March 2014
The views expressed in this document do not necessarily reflect the views of the United States
Agency for International Development or the United States Government

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ACKNOWLEDGEMENTS
The Post Training Assessment (PTA) exercise was a collaborative effort of various
stakeholders. The Ministry of Health wishes to acknowledge USAID and IntraHealth
International lead FUNZOKenya project for funding and overall leadership specifically by;
Peter Milo, Dr. Joyce Kinaro and Dr. Norbert Rakiro. We also recognize the regional hub
managers; Isaac Munene, Benjamin Cheboi, Judith Karia, Rebecca Songoi, Mary Kamau,
Mohammed Hussein, Ian Wanyoike and Allan Oginga for their input and coordinating role at
the counties and Catherine Murphy from IntraHealth International Headquarters in Chapel
Hill, USA for designing the draft assessment tool and reviewing the draft document and
seeing it to its total completion.
We appreciate Moi University College of Health Sciences and the AMPATH Project for
providing technical leadership and support. The secretariat from Moi University comprising
Dr. Simiyu Tabu, Dr. Anne Mwangi, Edwin Sang, Joseph Koech, Andrew Busienei, Jepchirchir
Kiplagat and Eunice Walumbe and all the research assistants.
The Ministry of Health looks forward to more collaborative research between the public and
private sectors as best demonstrated in this assessment exercise.
Grace E. Odwako,
Head-Human Resource Development Unit (HRD)
Ministry of Health

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FOREWORD
The government of Kenya’s (GOK) overall goal in health is to provide accessible, affordable
and quality health care to all Kenyans. To achieve this target the ministry of health needs to
have adequate human resources that are well trained to offer health services. According to
the Constitution of Kenya (2010) training remains the mandate of the central government
and in-service training for health workers need to be guided by clear training needs and
above all should lead to improvement in service delivery at national and county levels as
outlined in Vision 2030 and the Kenya Essential Package for Health (2005-2010).
According to the Report of the Training Needs Assessment of the Health Workforce in Kenya
(MOH, 2012) it was observed that over 80% of in-service training is donor funded and each
year the ministry of health spends colossal amounts of money on training. In addition,
several days in a year are spent on training as health workers attended skill based trainings
either at their facilities and or outside their duty stations.
With this background therefore this report has evaluated to what extend the trainings have
contributed to improvements in service delivery in the country and identified barriers that
hinder application of knowledge and skills post training. The evaluation result will be used to
guide future trainings and advice donor support to the ministry. The report has made key
recommendations on how in-service training is to be tailored to be more effective and
explored opportunities for innovative learning methodologies that include e-learning among
others that allow health workers to remain updated while offering critical health services.
This document will go a long in improving training of health workforce and in turn improve
service delivery in the health sector.
Prof. Fred H.K Segor,
Principal Secretary,
Ministry of Health

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TABLE OF CONTENTS
ACKNOWLEDGEMENTS.....................................................................................................................i
TABLE OF CONTENTS...................................................................................................................... iii
LIST OF TABLES..................................................................................................................................v
LIST OF FIGURES........................................................................................................................................v
LIST OF ABBREVIATIONS & ACRONYMS ....................................................................................vi
FORWARD............................................................................................................................................ ii
EXECUTIVE SUMMARY ................................................................................................................ viii
CHAPTER ONE: INTRODUCTION.....................................................................................................1
Goal of the Post-Training Assessment...........................................................................................2
Objectives ..........................................................................................................................................2
CHAPTER TWO: DESIGNS AND METHODS ...................................................................................4
Population .........................................................................................................................................4
Sample ...............................................................................................................................................4
Sampling Technique.........................................................................................................................4
Data Collection..................................................................................................................................4
Pilot Testing.......................................................................................................................................5
Mapping of the Region....................................................................................................................5
Data Quality and Confidentiality ....................................................................................................5
Data Entry ..........................................................................................................................................5
Data Analysis.....................................................................................................................................6
Focus Group Discussion...................................................................................................................6
Limitations of the Study...................................................................................................................6
CHAPTER THREE: FINDINGS............................................................................................................7
Response Rate...................................................................................................................................7
Quantitative Results .........................................................................................................................8
Service Delivery...........................................................................................................................10
Enabling Factors and Barriers to Service Delivery..................................................................12
Challenges ...................................................................................................................................13
Professional development.........................................................................................................13
Proposed Improvements in the Trainings...............................................................................13
Recommendation for Other Trainings.....................................................................................14
Findings from the Focus Group Discussions (FGDs) ..................................................................14
Infrastructure...............................................................................................................................14
Consumable resources...............................................................................................................14
Skills inventory/ human resource .............................................................................................15
Selection criteria .........................................................................................................................15
Mentorship/Follow up................................................................................................................16
Mentorship guidelines ...............................................................................................................17
Communication and coordination ...........................................................................................17
Interagency collaboration..........................................................................................................17
Training curriculum.....................................................................................................................18
Coordination of training............................................................................................................18

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Training logistics.........................................................................................................................18
Trainers.........................................................................................................................................18
Focal person/ coordination .......................................................................................................18
Certification and accreditation to offer service ......................................................................19
Placement and posting..............................................................................................................19
On-the-job training....................................................................................................................19
Benefits of trainings support ........................................................................................................19
Areas of Improvement ...................................................................................................................19
Barriers & Challenges to Service Provision by the Trainees .....................................................20
Summary Findings from Supervisor Interviews..........................................................................21
Duties and Services offered by the supervisor .......................................................................21
Reason for change in provision of services by trainee..........................................................21
Changes in quality of service delivery......................................................................................21
Changes in quantity of service delivery...................................................................................21
Forms of supportive supervision ..............................................................................................21
Available opportunities for continuing professional development .....................................21
Comments on training that would improve service delivery in your facility......................22
Recommendations for improvement of the trainings...........................................................22
CHAPTER FOUR: DISCUSSION.......................................................................................................23
CHAPTER FIVE: CONCLUSIONS AND RECOMMENDATIONS .................................................27
RECOMMENDATIONS......................................................................................................................28
REFERENCES .....................................................................................................................................29
APPENDICES ......................................................................................................................................31
APPENDIX 1- CONSENT FORM RA Code: ___________..................................................31
APPENDIX 2- TRAINING FOLLOW-UP PARTICIPANT’S QUESTIONNAIRE...........................33
APPENDIX 3- POST TRAINING FOLLOW-UP SUPERVISOR’S QUESTIONNAIRE .................41
APPENDIX 4: POST TRAINING FOLLOW-UP CHECKLIST.........................................................46
APPENDIX 5- POST TRAINING FOLLOW-UP GUIDE FOR FOCUSED GROUP DISCUSSION
(FGD)....................................................................................................................................................47
APPENDIX 6: RESEARCH ASSISTANTS........................................................................................50
APPENDIX 7: ADVISORY GROUP...................................................................................................50
APPENDIX 8: SECRETARIAT...........................................................................................................50
APPENDIX 9: Transfer Matrix and Trainee Support Framework .......................................................51
Modified from Broad (2005).................................................................................................................51
APPENDIX 10: Muchs-FUNZOKenya Post-training Assessment Schedule.......................................52
APPENDIX 11: Letter from the Human Resources Department, MOH ..............................................53

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LIST OF TABLES
Table 1: Socio-demographic characteristics of trainees............................................................................8
Table 2: Training assessed and facility type...................................................................................................9
Table 3: Change in Service offered before and after training.............................................................. 10
Table 4: Enabling factors and barriers to training................................................................................... 12
Table 5: Challenges to service delivery......................................................................................................... 13
LIST OF FIGURES
Figure 1: Communication Channel during the Assessment Exercise.............................................3
Figure 2: Distribution of Respondents by region .............................................................................7
Figure 3: Type of in-service training (n=282)....................................................................................9
Figure 4: Services Offered Daily........................................................................................................11
Figure 5: Supporting and Inhibiting Factors for Intention to Transfer, adapted from Foxon,
2002......................................................................................................................................................25
Figure 6: Three-factor model of transfer.........................................................................................25

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LIST OF ABBREVIATIONS & ACRONYMS
AMSTL - Active Management of Third Stage of Labor
APHIA - Aids Population Health Integrated Assistance
ART - Anti-Retroviral Therapy
CHS - College of Health Sciences
CHS - College of Health Sciences
CO - Clinical Officer
DASCO - District AIDS and STI Control Officer
DCAH - Division of Child and Adolescent Health
DFH - Department of Family Health
DHMT - District Health Management Team
DMOH - District Medical Officer of Health
DPHN - District Public Health Nurse
DRH - Division of Reproductive Health
EMNC - Essential Maternal Newborn Care
EMOC - Emergency Obstetric Care),
ENC - New Born Care
EOC - Essential Obstetric Care
FANC - Focused Antenatal Care
FBOs - Faith-Based Organizations
FGD - Focus Group Discussion
GBV - Gender Based Violence
GOK - Government of Kenya
HIV - Human Immunodeficiency Virus
HMIS - Health Management Information System
HRD - Human Resource Development
HRH - Human Resource for Health
HRM - Human Resources Management
IMAI - Integrated Management of Adulthood Illnesses
IMCI - Integrated Management of Childhood illness
LAPM - Long Acting and Permanent Methods
LAPM-FP - Long Acting and Permanent Methods of Family Planning
LIMS - Laboratory Information Management Systems
M&E - Monitoring and Evaluation
MCH - Maternal and Child Health
MCM - Malaria Case Management
MDR-TB - Multi-Drug Resistant Tuberculosis
MO - Medical Officer
MOH - Ministry of Health
MOMS - Ministry of Medical Services
MUCHS - Moi University College of Health Sciences
NACC - National AIDS Control Council
NASCOP - Kenya National AIDS and STI Control Programme
NEP - North Eastern Province
PHO - Public Health Officer

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PMO - Provincial Medical Officer
PMTCT - Prevention of Mother-to-Child Transmission
TB - Tuberculosis
TNA - Training Needs Assessment
USG - United States Government
VCT - Voluntary Counseling and Testing

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EXECUTIVE SUMMARY
Background and Objectives
The post-training follow-up assessment conducted between October and November, 2013,
was commissioned by the Ministry of Health (MOH) through the Human Resource
Development (HRD) department to establish the extent to which health workers in
Government of Kenya (GOK), faith-based organizations (FBO) and private health facilities
integrated training knowledge and skills into their job performance, analyze whether
application of learning resulted in a change in the quality or quantity of services offered, and
identify barriers if any, towards performance of their work.
Methodology
The study was a cross-sectional survey, with respondents proportionately selected across the
country utilizing both qualitative and quantitative methods. The survey targeted 300
respondents out of the 1662 health workers that underwent in-service training from August
through December 2012. Interviews were conducted from September 30 to October 11,
2013. Trainee, supervisor and focus group discussion (FGD) tools were developed and 21
research assistants recruited, trained, and distributed across the country to administer the
tools. Prior to the data collection, a pilot study was conducted on 23rd
September 2013, and
minor revisions made on the tools. The draft report was shared with the stakeholders in a
meeting held on January 22nd
, 2014 in Nairobi. Stakeholders in the meeting comprised of
MOH- HRD, MOH technical departments and divisions, regulatory authorities, training
institutions and partners that included representatives from the USAID APHIAPlus projects
and their feedback used to improve the final report.
Summary Findings
Out of the initial target of 300 respondents, 282 were interviewed. The female to male ratio
was 71:19 with a median age of 36 years (IQR: 30, 44). Of the total interviewees, 232 (82%)
were nurses, with 201 (71%) having been in service for more than 5 years. 25% of the
trainees reported to have been transferred from their duty stations after training. More
health workers from the public facilities had received training compared to those from FBOs
and private. Of the 282 health workers interviewed 256 (92%) worked in public facilities. Most
of the respondents had previously attended other trainings besides those supported by
FUNZOKenya.
Of all the trainings assessed, prevention of mother-to-child transmission (PMTCT), 86 (31%)
and cervical cancer screening, 61(22%) had the highest number of trainees. Amongst regions,
the Rift Valley province had the highest number of trainees at 65 (23%), while Nyanza had
the least at 9 (3%).
One hundred and seventy eight (63%) respondents reported to have provided the services
prior to the training; after the training, the number increased to 247 (88%). Also, the number
of patients seen at the facility 6 months pre/post-training was found to have significantly
increased (p-value=0.0332). The supervisors confirmed there had been a change in service
provision with over 60% reporting positive change. The proportion of participants who
offered the service on a daily basis drastically increased post-training for all the services

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except for Essential Maternal and New born Care (EMNC). The change in quality cited was
due to increased accuracy in diagnosis, increased client satisfaction, reduced waiting time,
improved record keeping, positive change of attitude among health workers, increased
uptake of services, improved treatment outcomes, improved procurement of equipment and
supplies, fewer referrals and increased patient confidentiality.
Acquisition of knowledge and skills (85%) and increase in level of confidence (65%) were
reported through increased services provided post-training. The trainees however reported
factors that hindered service delivery, including stock out of supplies/equipment/instruments
(37%), inadequate physical environment (31%), staff rotation (27%), and lack of motivation
and culture/religion (23%). The trained health workers who reported not offering the service
explained that their current positions was not relevant to the training received (46%) or staff
movement/posted to another location in the facility (26%) were their limitations.
After the training, 149 (53%) of the participants reported having received mentorship, while
239 (85%) reported to have offered mentorship to colleagues within the facilities. The 47%
who did not receive mentorship attributed it to lack of financial incentives to motivate
mentors, unavailability of mentors and understaffing, poor accessibility to facility and high
staff turn-over. Supportive supervision was reported available by 225 (85%) of the
participants interviewed.
Conclusions
The report concluded that there was an improvement in quality and quantity of services
provided in the 12 training areas after the trainings. There was significant knowledge transfer
demonstrated through improved level of confidence during service delivery.
Key Recommendations
The majority of trainees had more than five years’ experience. This group could be utilized in
the development and delivery of on-the-job trainings, mentorship and supervision and
responsive, innovative teaching methodologies.
There is need to appoint focal persons on the ground to participate in trainee selection.
Efforts should be made to increase commodity supplies at facilities, provide performance-
based rewards for trainees that implement training at their posting. Recommendations were
made to conduct trainings in additional specialties, such as non-communicable disease
(NCDs), malaria, monitoring and evaluation (M&E) among others.

CHAPTER ONE: INTRODUCTION
The Government of Kenya (GOK) is committed to improving access to and quality of
essential health services in the country. In order to reach the goals outlined in the Kenya
Health Sector Strategic and Investment Plan 2013-2017, provision of a well-managed,
equitably distributed, and appropriately skilled health workforce is critical.
Chen L, et al. (2004) identified challenges to building an effective health workforce, such as
low absolute numbers of trained workforce, difficulties in recruiting and managing health
workers, impact of HIV on the health workforce, and poor performance. According to the
World Health Organization (WHO), Kenya is one of the 57 countries with acute manpower
shortages in the health sector (2006). Workforce shortage is a relative term, influenced by
other variables such as imbalances, misdistribution, and worker performance (Joint Learning
Initiative, 2004). The Kenya National HRH Strategic Plan 2009-2012, identified the following
HRH challenges: inadequate distribution of health workers, high attrition, outmigration, weak
human resource management systems, weak leadership and management capacity,
weaknesses in in-service and pre-service training, poor sectoral coordination of the HRH
agenda.
The Ministry of Health (MOH) Human Resource Development (HRD) is receiving support
from FUNZOKenya, a USAID-funded, IntraHealth International-led project, whose goal is to
transform health training throughout the country by improving training delivery, increasing
the admissions’ capacity of pre-service training institutions, link training to health worker re-
licensure, and increase the capacity of regulatory bodies to accredit and monitor training.
FUNZOKenya provides technical support to the GOK, national, county and district
stakeholders, private providers, FBOs and United States Government (USG) implementing
partners and other stakeholders working in Kenya to transform health workforce training.
In order to understand the context of in-service health workers training, the MOH-HRD
conducted a Training Needs Assessment (TNA) and a Baseline Survey between June and
August 2012. The TNA established the following as key priority areas of service delivery that
required attention:
• Cervical cancer screening, prevention of mother to child transmission of HIV (PMTCT),
pediatric HIV,
• Focused antenatal care (FANC),
• Integrated management of childhood illness (IMCI),
• New born care (ENC),
• Active management of third stage of labor (AMSTL)/essential obstetric care (EOC)
and
• Commodity management.
The FUNZOKenya supported MOH to train 1,662 heath workers between August and
December 2012, on cervical cancer screening, PMTCT, pediatric HIV, long acting and
permanent methods (LAPM) of family planning, IMCI, essential maternal newborn care
(EMNC), commodity management, FANC, multi-drug resistant TB (MDR-TB) and clinical
management of sexual violence/gender based violence (GBV).

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The training curricula was developed and prescribed by MOH technical departments and
divisions such as the National AIDS and STDs Control Programme (NASCOP), Division of
Reproductive Health (DRH) and Division of Child and Adolescent Health (DCAH) among
others. The course trainers were MOH staff certified by the relevant technical departments
and divisions as mentioned above. The course trainees where identified by MOH, in
consultation with the APHIAPlus partners, for relevant regions and MOH technical focal
persons at the provincial levels. The trainees were notified of their attendance to the training
one week prior to the start date. Each class had a maximum of 30 trainees, with the
exception of IMCI, which had a class of 24 participants. The participants represented many
cadres and facilities, comprised of GOK, FBOs and private sectors. The training targeted
those who had not attended previous in-service trainings for the same skills and served
relevant department of the health facility/hospital. The training venues were hotels and
training institutions in respective counties.
Against this background, the post-training follow-up was to evaluate service providers at
least six months post-training with an adequate sample size drawn from those trained in
2012. This aspect addresses one of FUNZOKenya’s overarching goals: Intermediate Result
2—to address existing health workforce gaps in skills and knowledge for professional
development by supporting current health workers training needs. Moi University College of
Health Sciences (MUCHS) was identified by FUNZOKenya, in consultation with the MOH-
HRD to lead the Post Training Assessment (PTA). The assessment targeted a representative
sample of 300 of the 1662 health workers who were trained during the period August-
December 2012, from across 47 counties with corresponding number of immediate (line)
supervisors.
Goal of the Post-Training Assessment
The goal of this training follow-up activity was to evaluate how the knowledge and
skills acquired by health workers (trainees) supported for training were integrated into
their job performance.
Objectives
1. Determine extent to which trainees were able to apply the acquired skills
2. Analyze whether application of learning in the context of work resulted in a change
in the quality or quantity of services offered
3. Describe barriers if any, experienced by the trainees towards performance of their
work.

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The exercise would not have been conducted successfully without the communication
channel shown below (Fig. 1):
Figure 1: Communication Channel during the Assessment Exercise

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CHAPTER TWO: DESIGNS AND METHODS
A trainee-based cross-sectional survey, employing quantitative and qualitative research
methods, was used to collect data for the PTA. The quantitative data was collected between
30 September and 11 October 2013, using researcher-administered semi-structured
questionnaires. The qualitative data was collected on the 3rd
, 7th
and 11th
October 2013, at
Nakuru, Mombasa, and Garissa targeting South Rift, Coast, and North Eastern regions
respectively. The three FGDs had 6-8 members each based on predetermined criteria.
Population
The participants involved in the study were healthworkers trained with support from
FUNZOKenya between August and December 2012. A total of 1,662 service providers from
the 8 regions (former administrative provinces in Kenya) of mixed cadre and from different
types of facilities were trained during that period.
Sample
A subset was selected from the population, representing the former eight provinces and the
different trainings.
Sampling Technique
The sampling frame for the exercise, 1,662 health workers recently-trained, was provided by
FUNZOKenya. Stratified random sampling was used to select the 300 participants from the
population; the variables were region (province) and type of training. The sampling was
conducted using STATA version 10, proportionate to the size of the trained personnel per
region. The immediate/line supervisors for the sampled trainees were eligible for the
supervisors’ interview.
For the FGDs, three regions were selected based on the geographical distribution, culture
and beliefs, healthcare capacities, and distance to health facilities. The members of the FGD
comprised of District Public Health Nurse (DPHN), Medical Officer (MO), Public Health Officer
(PHO), representative of the women support group, HIV support group, head of health
facilities, APHIAPlus representative and other interested parties. The membership
represented leadership within the Health sector and level of activity in terms of morbid
conditions. The FGDs were carried out using a standard guide and proceedings were
recorded using digital voice recorders.
Data Collection
Two semi-structured interview questionnaires were used to collect data: the participants and
the supervisor’s questionnaires. The contents of the questionnaires were based on model
questionnaires provided by FUNZOKenya that underwent revision. The revisions were done
through a consultative process between relevant stakeholders including MOH-HRD, technical

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departments and divisions, regulatory authorities, APHIAPlus, MUCHS, and other key
partners.
Pilot Testing
Research assistants (RAs) were recruited by MUCHS in mid-September based on a set of
qualifications, which included a minimum of bachelor’s degree in a health related field,
previous research experience, and availability. A total of 21 RAs were recruited and trained
on the data collection tools prior to the pilot study. The pilot carried out on 23rd
September
2013, included: testing the procedures, questionnaires, and data capture systems in a limited
subset of the facilities near MUCHS. The participants included in the pilot were not part of
those recruited for the assessment.
Authority to visit the various health facilities was obtained from the MOH-HRD office (see
Appendix 11) and respective county and facility heads. Thereafter, data entry, analysis, and
cleaning took another ten days (see annex of work plan).
The results of the pilot were used to modify the evaluation implementation tools. Through
the pilot testing, the team assessed comprehension, acceptance, feasibility, and other factors
that influence how the processes would fit into the schedules of the health care provider.
Further refinement was completed following the pilot.
Mapping of the Region
The study mapped the sampled trainees in the eight ‘former’ provinces in order to ensure
seamless implementation of the main exercise in terms of time and cost. The mapping was
based on the training facilities with the assistance of FUNZOKenya regional hub managers.
The trained RAs were divided into 11 teams of 2. The teams were then distributed according
to their knowledge of the eight regions with some regions having more than one team due
to high number of participants.
Data Quality and Confidentiality
To ensure confidentiality of the trainees and supervisors, each participant was assigned a
unique identification number instead of using their names. The questionnaires were reviewed
every day by the team leaders to check for inconsistencies and missing data.
Data Entry
Microsoft Access database was developed for the management of the data. RAs were trained
on how to enter data using user friendly interface forms. As a result of the "noise" in the
unstructured questions (e.g. illegible writing) and the lack of precision in natural language,
the data extracted by different RAs from the same documents may differ. These are potential
sources of error. To reduce the potential for these sources of error, RAs entered the data that
they collected.

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The data was then analyzed through a series of data checking operations to verify that data
values were correct.
Data Analysis
Quantitative data were exported into SAS version 9.3 for analysis. Descriptive statistics, such
as frequency listings and percentages, were used for categorical variables. Significance tests
were carried out using Kruskal Wallis and chi-square tests where appropriate. Cross
tabulation of responses by type of training were conducted to illustrate comparisons.
Focus Group Discussion
The FGD interview guide was developed alongside the other quantitative tools. It went
through a review process similar to the other tools. The identified participants were invited
for discussion on the 3rd
, 7th
and 11th
of October, 2013, to South Rift, Coast and North-
Eastern FGDs respectively. Each group had six to eight participants in attendance.
For the actual FGD, a moderator, an observer and a recorder were identified. After
introduction of those in attendance, verbal consent was received from attendees and roles
explained to participants before beginning the interview.
Each interview was recorded using two digital audio recorders. The observer and recorder
took detailed notes during the interview. After the interview, the data from the FGD was
transcribed and subsequently coded. Analysis was achieved through use of scissor–and-sort
technique and themes were developed. Some of the themes were merged with the interview
guide and the quantitative tool.
Limitations of the Study
Some factors were beyond the study’s control and may have biased the findings. These
include: inaccuracies of participants’ data (e.g. incorrect phone numbers or names of
participants), hard to reach facilities which limited contact time and access, 54 replacements
of respondents for various reasons, a high staff turnover that involved both trainees and their
supervisors and change of workstation by health workers within a short time, and poor recall
as that the survey was conducted one year after the training. Some aspects of quality of
service were difficult to objectively measure in the absence of the user of services (the client).

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CHAPTER THREE: FINDINGS
This chapter summarizes the socio-demographic summary, the extent by which knowledge
and skill was applied, the outcome of the trainings and obstacles for successful transfer of
the knowledge and skill, and some of the findings which may be classified as Aberrant.
Response Rate
A total of 300 participants were sampled, of which 228 were successfully interviewed. The
distribution of participants was as per the figure 2 below;
Figure 2: Distribution of Respondents by region
The remaining participants in the original sample were not available for the interview,
because they were on leave, attending training, were trainers themselves, or could not be
reached via phone. These participants were replaced by 54 other matched trainees (same
region, similar training, same training period) bringing the total interviewed to 282. The
response rate was thus 94% (282/300). We interviewed 245 supervisors out of the target 236.
The interesting finding was that in Western Kenya, each trainee had a supervisor.
24 (9%)
65 (23%)
17 (6%)
38 (13%)
54 (19%)
50 (18%)
9 (3%)
25 (9%)

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Quantitative Results
Table 1 below shows the socio-demographic characteristics of the participants. The median
age in years was 36 (IQR: 30, 44). Out of the 282 participants, 199 (71%) were females, 232
(82%) were nurses, and 201 (71%) had been in service for more than 5 years.
Table 1: Socio-demographic Characteristics of Trainees
Age in years
Mean (std)
Median (IQR)
n=189
37.64 (9.48)
36 (30,44)
Age in years
Mean (std)
Median (IQR)Gender
Female
Male
n=189∗
37.64 (9.48)
36
(30,44)n=282
199
83
70.6
29.4
Cadre
CO
HR
Lab Tech
MO
Nurse
PHO
n=282
199
38
1
5
2
232
4
70.6
29.413.48
0.35
1.77
0.71
82.27
1.42
Cadre
CO
HR
Lab Tech
MO
Nurse
PHO
n=282
38
1
5
2
232
4
13.48
0.35
1.77
0.71
82.27
1.42
Highest Education
Basic Degree
Certificate
Diploma
Higher Diploma
Other
Post Graduate
n=282
12
54
202
5
4
5
4.26
19.15
71.63
1.77
1.42
1.77
Years of Service
< 1
1 - 3
> 3 - 5
> 5
n=282
1
40
40
201
0.35
14.18
14.18
71.28
∗ 93 respondents declined to give their age

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A total of 282 trainees participated in the exercise, with a majority of 256 (92%) working in
public facilities. Of the trainings assessed, PMTCT had the highest number of participants at
86 (31%), followed closely by cervical cancer screening at 61 (22%), adult ART 15.3%, and
MDR-TB 10%.
Two hundred and forty five supervisors were interviewed. In some cases, more than one
trainee reported to one supervisor.
Rift Valley province had the highest number of trainees at 65 (23%), while Nyanza had the
least at 9 (3%). Most of the respondents had previously attended other trainings apart from
the one supported by FUNZOKenya, some trainings were similar but others were different,
such as basic life support, management of malaria, M&E, diabetes, and health management
information.
Figure 3: Type of in-service training (n=282)
From the bar chart above, PMTCT and cervical cancer screening formed the majority of
trainings supported country-wide (Fig. 3). Nine out of every ten facilities were public as per
the Table 2 below.
Table 2: Training Assessed and Facility Type
Variable Freq %(100)
Type of Facility
FBO
NGO
Private
Public
n=282
15
2
9
256
5.32
0.71
3.19
90.78

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Service Delivery
All the participants had more than one responsibility at their station, multitasking between
clinical clerkships, administering drugs and/or general administrative duties. 68 (24%) of the
trainees reported changing their duty station after training.
To assess the impact of the training on service delivery, the participants were asked whether
they were offering service related to the training both pre- and post- training. Prior to the
training, 178 (63%) of the respondents reported to have offered the respective services they
were trained in. After the training, the number increased to 247 (88%). This increase was
found to be statistically significant (χ2
p-value < 0.0001). The number of patients seen at the
facility six months pre and post training was also found to have increased significantly
(Kruskal Wallis p-value=0.0332). The participants cited lack of knowledge and skills, job
placement, lack of equipment, supplies, and a lack of accreditation as main reasons for not
offering the services prior to the training.
Most of the services recorded an improvement in type of training and frequency of services
provided as per the Table 3 below.
Table 3: Change in Service Offered Before and After Training
Variable Freq %
Change in section/ service area/department before and after
training
C=Change
NC=No Change
n=281*
68
213
24.20
75.80
Service offered before Training
No
Yes
n=282
104
178
36.88
63.12
Service offered after Training
No
Yes
n=282
35
247
12.41
87.59
Patients seen per month before training (Jan- June 2012)
Mean (std)
Median (IQR)
n=173
128.05 (224.29)
40 (10,156)
Patients seen per month after training
Mean (std)
Median (IQR)
n=224
165.46 (446.16)
43 (14,200)
Services offered after training
Adult ART Management
Cervical Cancer Screening
Commodity Management
EMNC
EMOC
FANC
GBV
IMCI
LAPM_FP
n=245
71
74
28
28
14
41
22
48
38
28.98
30.20
11.43
11.43
5.71
16.73
8.98
19.59
15.51

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Multidrug Resistant TB
Others(specify)
PMTCT
Pediatric ART Management
37
15
111
35
15.10
6.12
45.31
14.29
* One was non-respondent
There was a drastic increase in the proportion of participants offering service on a daily basis
except for EMNC as shown in the figure below (Fig. 4).
Figure 4: Services Offered Daily
The main reasons for low frequency of the service prior to training were: low demand for the
service, shortage of staff, lack of adequate knowledge and skills, lack of resources and space
- hence most of the patients were referred to other facilities.
On the other hand, the main reasons for the increased frequency of the service after the
training were: increased uptake of the service, availability of drugs and supplies, acquisition
of skills and having more staff trained in the facility, mentorship and support from higher
authority, and sensitization of patients on the availability of the service hence increasing the
demand. The same reasons were reported by the supervisors for the increased frequency in
the provision of service delivery by the training participants.

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Supervisors reported improved quality of services, including: improved patient safety,
accuracy of diagnosis, client satisfaction, better record keeping, faster decision making,
better treatment outcomes, procurement of equipment and supplies, reduction in waiting
time, fewer referrals, and change of attitude amongst health providers.
The supervisors also reported a positive change in numbers of health workers trained, which
included: ability to attend to more patients in a short time, availability of commodities,
increase service uptake, and increased frequency in service delivery.
Enabling Factors and Barriers to Service Delivery
Improvements in service delivery as reported by the participants who were offering the
services was due to acquisition of knowledge and skills (85%), and increase in level of
confidence (65%). Very few reported appraisal and incentives to perform as expected (4%) as
the enabling factor for improved service delivery after the training.
For those who reported not offering the service despite receiving training, they cited current
position not being relevant to the training they received (46%), followed by staff
movement/posted to another location in the facility (26%). Other findings point to
participant selection for the course and need for policy direction at facility and HRD level on
training and its application at the workplace.
Lack of resources, such as fuel and allowances for staff conducting follow-up, was cited as a
hindrance to implementation of mentorship programs. It was also noted that in some
instances, training needs assessment (TNA) was conducted with little support from partners.
Table 4: Enabling Factors and Barriers to Training
Variable Freq %
Factors enabling improved service provision post training
Acquisition of skills and knowledge required to do the job
Appraisal and incentives to perform as expected
Availability of supplies equipment instruments
Current position relevant to the service procedure
Feedback from supervisors
High demand for the services
Increase in the level of confidence in skills
Others(Please specify)
Service procedure trained in now provided in the facility
n=247
211
11
60
65
43
72
160
59
35
85.43
4.45
24.29
26.32
17.41
29.15
64.78
23.89
14.17
Barriers to service provision post training
Current position not relevant to the service procedure
Inadequate physical environment including proper tools supplies
Lack of clear and immediate feedback from supervisors
Lack of clear job description
Lack of motivation
Low demand low client caseload
Others(Please specify)
Service procedure trained in is not provided in the facility
n=35
16
7
1
1
4
14
2
9
45.71
20.00
2.86
2.86
11.43
40.00
5.71
25.71

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Variable Freq %
Staff rotation movement to different section facility 3 8.57
Challenges
The participants reported the following challenges in service delivery, including: stock out of
supplies/equipment/instruments (37%), inadequate physical environment (31%), staff
rotation (27%), lack of motivation and incentives (23%), and religion (23%). Other factors
mentioned as hindrances, included: shortage of staff, limited finances, lack of regular
updates/CME/handouts, and loss to follow-up of clients (Table 5 below).
Table 5: Challenges to Service Delivery
Challenges in service delivery
Culture religion
Current position not relevant to the service procedure
Inadequate physical environment including proper tools supplies
Lack of clear and immediate feedback from supervisors
Lack of clear job description
Lack of confidence in skills
Lack of motivation and incentives to perform as expected
Lack of skills and knowledge required to do the job
Low demand low client caseload
Others (Please specify)
Service procedure trained in is not provided in the facility
Staff rotation movement to different section facility
Stock out of supplies equipment instruments
n=248
57
13
78
20
15
3
58
14
30
153
1
67
91
22.98
5.24
31.45
8.06
6.05
1.21
23.39
5.65
12.10
61.69
0.40
27.02
36.69
Professional development
One hundred and forty nine (53%) of the participants reported receiving mentorship post-
training, while 239 (85%) reported to have offered mentorship to other service providers in
their facilities.
For the 47% who did not receive mentorship, the reasons provided were lack of financial
support to mentors, lack of mentors, understaffing, poor accessibility to facility, and high
staff turn-over.
Two hundred and twenty five (80%) of the participants interviewed reported that supportive
supervision was available post-training. The type of supportive supervision included: updates
from APHIAPlus, quarterly reports, CMEs and seminars, support from
DASCO/DCO/DPHN/DHMT/DMOH/DPHN and MOH, on the job training, refresher courses,
appraisals and regular meetings with supervisor.
Proposed Improvements in the Trainings
The main areas that require improvement are:

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• The need for flexibility of paying allowances
• Need for Frequent updates on trainings
• Provision of refresher courses
• Certificates provided on time
• Training period should be increased
• Elimination of bias in selection of trainees
• Mentorship
• Provision of supplies and equipment
• Follow-up after training
• Provision of handouts
• More time should be spent on practical and demonstrations
• More staff should be trained in one facility to ensure that facility coverage
Recommendation for Other Trainings
Apart from trainings already currently supported by FUNZOKenya, the following trainings
were recommended by participants: IMAI, LIMS, M&E, EMOC, malaria case management
(MCM), psychology and counseling, attitude and work ethics, and laboratory courses. The
supervisors generally acknowledged the quality work performed by the trainees following
the training. They endorsed similar trainings as the participants, in addition to malaria
management and comprehensive care center. They also recommended increased training of
in the facilities due to staff rotation, in addition to provision of supplies and equipment to
the trainees.
Findings from the Focus Group Discussions (FGDs)
Infrastructure
Lack of adequate infrastructure and upgrading of the different areas came out clearly during
discussion. In North Eastern Province (NEP), resource challenges are experienced during
services, such as cervical cancer screening. The case was similar for essential maternal and
newborn care. Further, the participants indicated that the Provincial General Hospital (PGH)
had no functional laboratory to comprehensively deal with cancer cases. “PGH Garissa has no
cytology laboratory despite having trained staffs including consultant pathologist. The good
news is that one NGO called SIMAHO has a chemotherapy machine sponsored by a partner.”
(FGD Participant, NEP). South Rift too had a similar problem of lack of adequate
infrastructure especially in the rural and far to reach facilities.
Consumable resources
The supply of materials was not adequate. It was reported that. ‘’there are stock-outs
because fewer materials are supplied or they are supplied late and there is delay in
communication for stock outs in the facility’’, (FGD participants said). They also stated that
there is discrepancy between what is ordered and what is supplied. The reagents are not
supplied centrally and it depends on the type of the facility and some facilities are not in a
position to order for themselves.
The South Rift group further noted that the PUSH system of drugs in the past led to most
drugs expiring, and the PULL system had reduced the problem. ART coordinator (MOH
employees) and pharmacists consulted with neighboring districts to make sure they do not

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misuse drugs. They also suggested that there should be mentorship for accounting for
commodities; for consumables, partners should work to supply reagents.
Skills inventory/ human resource
From the discussions, it emerged that there is no skill inventory for any cadre of staff whom
have been trained in various fields. If only a few officers are trained from each facility and
then transferred or leave, the health service capacity of the facility will decrease. More
officers should be trained to fill this gap and reduce the stress associated with movements
and rotations of staff. “The maintenance of skill inventory is also important to in-charges and
county directors in selecting participants for training. Poor skills inventory on the health
facilities meant that the use of data was minimal in determining participants for training and
that some participants would undergo training on ten different courses while others are left
out” (FGD participant). The feeling was that the facility managers need to maintain quality
data on the staff members and in future, it is necessary to train facility managers on data
management.
MOH Human resources could be linked with data from the institution or health facility to
ensure that they are aware of who has attended which training and who needs a specific
training. This will help avoid one person being trained in many courses and service delivery
areas.
Most staffs are employed on contract basis and are temporary status, especially those
employed by partners. Furthermore, staff that is poorly remunerated can result in turnover
and gaps in health service delivery. This is common in North Eastern Region, where staff tend
to seek transfers to places near their homes due to hardships in the region while others are
advancing their studies in universities and colleges in Nairobi, limiting their availability to
offer services trained.
Due to staff rotation, the trainee might not be able to apply the skills acquired from the
training adequately, “a vicious cycle of re-training because of staff transfers” (FGD
participant).
Selection criteria
There is need for clear criteria for selecting training participants. There is also need for
proper skills inventory to ensure that participants are considered before the training is
offered. This was reported clearly from the discussions.
It was reported that some staff attend duplicative trainings, further supporting the need to
streamline the selection criteria. It came out clearly that some staffs were continually
attending trainings at the expense of their duties, resulting in limited time available to apply
knowledge and skills gained from the training.
“I can say without fear that there are officers who are in perpetual trainings and I do
not want that. I don’t want to hear county public officer, county nutritionist and
CASCO. I don’t want this...” (FGD Participant).

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Another issue raised was the shortage of staff, which has resulted in challenges during
trainee selection since some facilities have only one health worker who is the only option to
be trained. As a result, the same staff may be trained over and over again, but in the event
that he or she is transferred, he moves on with the skills acquired, leaving a gap in services
provided in the facilities.
During the NEP region discussion, medical officers were not sponsored for training, but
nurses and clinical officers were. This was also reported as a setback to the success of the
health service delivery trainings offered since it is doctors who do ward rounds and interact
with patients more in higher level facilities (e.g. district hospitals and the PGH Garissa).
However, it was also noted that the doctors had no time to be trained for as long as a whole
week due to the large volumes of work they have. Further, doctors did not find the trainings
supported particularly useful as they were not conducted by senior doctors or professors,
The participants suggested that the selection criteria used by MOH to choose trainees needs
to capture doctors as well and that trainers should be doctors for the clinical trainings.
Further issues raised reported that training health workers who were in a different
department restricts the trainee from applying knowledge gained. It was also noted that the
trainees did not inform the facility in-charges on the training that they received. ‘The Facility
does not have information on who has been trained and on what.’’
Mentorship/Follow up
There is a high need for follow up after the trainings. Currently, there are no follow up
mechanisms on the trainings sponsored by FUNZOKenya. A suggestion was made on the
need to develop clear guidelines that indicate how a participant can apply the training skills
acquired at the workplace. An action plan and team should be set up to guide the follow up
process.
In the NEP region, there was no mentorship programs due to limited resources, such as fuel
and per diem for staff conducting follow up. However, they stated that a baseline survey for
TNA was conducted with support from partners.
Lack of mentorship program was mainly due to absence of clear guidelines; this negatively
affected the ability to provide effective health care services. In addition, there was need for
further placements and supervision.
One of the participants stressed, “It is impossible to be an expert in a certain health field after
the short course training. You cannot claim that one who has been trained in MDR-TB can
become an MDR-TB expert after short course training. In medical school, you go for internship
after completing five years medical training. This applies to this short course trainings.”
CMEs should participate in the mentorship program in all health facilities, although this is
hindered by extreme shortage of staff. For example, some staff had no colleagues to mentor
in health centers and dispensaries. In terms of services, there are trained mentors and
consultants, but the main challenge affecting mentorship in the NEP region is the very high
staff turnover rates. Supportive mentorship and supervision as part of the trainings of
FUNZOKenya is paramount.

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Mentorship guidelines
Mentorship guidelines exist for the following services trained by FUNZOKenya: EMOC,
EMNC, ART, and PMTCT. The different types of mentorship guidelines include booklets for
reference and posters for display and most of them needed review. Some of the guidelines
are stored in the different resource centers.
In South Rift, NASCOP has a mentorship training that runs for six days. The trainees are
assigned to mentors in the different departments after which they carry out a pre and post
assessment and are certified. Mentorship at the facility level is still a challenge due to lack of
a clear mentorship structure.
Communication and coordination
From the discussions, it emerged that organizing various participants for training from
various facilities needs ample time to allow in-charges to allocate duties while staff are
participating in trainings. It was further stated that early communication regarding training
should be enhanced. “At least one week is required for relaying information about the
availability of training for purposes of proper preparation for the training” (FGD participant).
There is need for proper networking in terms of referral of patients. It was reported by the
participants that communications and consultations exist and that aided with information
sharing between health caregivers. In NEP region, the district health management team
meetings are also part of interfacility communication alongside the provincial and county
training committees and quarterly sharing meetings for sub county facilities. It was noted
that some years before, radio calls helped in communication within the NEP region although
it is no longer functional.
Further, they stated information sharing should be done through regular CMEs within the
health facilities.
Interagency collaboration
The teams proposed a need for synergy among various agencies to avoid duplication. The
agencies implementing the trainings should have access to county strategic plans and
integrated development plans. The partners should carry out a baseline survey of the needs
of the county in collaboration with health management teams and address actual needs.
Quarterly stakeholders meetings were proposed in order to discuss the development plans
and address gaps in the service delivery to strengthen collaboration as well as provide a
forum for report dissemination.
‘’There is need for partners to harmonize and understand what each is doing to avoid
duplication, waste of resources and over emphasizing in some areas. This will create more
impact in the community and effective service delivery’’ (FGD participant). It was also noted
from the South Rift discussion that “Due to lack of support, the following sectors; public, private
and NGO’s do not have interagency communication” (FGD Participant, South Rift).
After the health organizations identify the needs and gaps, these should be further
disseminated to the health facilities.

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Training curriculum
‘’Aspects of induction, attitude, decision making and leadership should be part of the
curriculum that FUNZOKenya supports. This will make the trainings more effective and achieve
the desired objectives,’’ (FGD Participant).
Focus group discussions revealed a need for updating training curriculum. It was also
reported that some trainers are providing varied protocols on the same service and thus
confusing the participants.
In North Eastern region for example, participants suggested that FUNZOKenya supports the
incorporation of the harmonized HIV/AIDS curriculum in colleges and universities, which
would allow for pre- service CMEs to acquire new skills before their facility placement, as
opposed to after they are working.
As part of the curriculum, the training should focus on more practical application and less on
theories. There should be less power point presentations and more case study-based
learning to improve skills. The curriculum and guidelines need to be reviewed and updated
on a regular basis.
It would be an added advantage to have preservice training with areas of specialization for
the participants (e.g., specializing in midwifery according to one’s interest that was identified
at the onset of the training).
Coordination of training
The study identified a gap in coordination of training. In Mombasa for instance, the FGD
participants proposed that the trainings should be administered from within the service
providers of the Health facilities as opposed to being led by general trainers from the county.
Facility staff would offer trainings specifically tailored to patient population.
Training logistics
From the discussions, some of the staff would prefer half-board and dinner, rather than full-
board accommodation, as was the case during the trainings. The participants observed the
need to improve training packages as they were lower than what other training partners
were offering. They also suggested that the choice of location of trainings need to be
convenient for the trainees to minimize disruption of health service delivery in the regions.
Trainers
The team felt that there was need to train more trainers. In some instances, when key trainers
are transferred, it leads to a critical scarcity of trainers in the respective regions.
Focal person/ coordination
It was proposed that a focal person be selected to play a key role in trainee identification,
maintain the link between the facilities and training facilitators, and assist in setting up a
follow-up mechanism.

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Certification and accreditation to offer service
There are some health centers that do not have government regulatory agency’s approval to
provide certain services. Despite having a trained staff member in the specific field, they
cannot offer critical services without governmental certification.
Placement and posting
Health managers should be empowered to ensure that time is balanced between service
provision and training attendance. Some staff members are trained on a specific course, but
they cannot practice because their placement does not require the use of the skills or
minimal relevance to the course.
One example described was when, “A staff is trained in PMTCT and is deployed to mental
health department” (FGD Participant).
As a result, the trainees should be posted or placed in other areas that are relevant as per the
training received.
On-the-job training
The teams suggested that on-the-job training should be enhanced in order to improve
health service delivery. The facility in-charge should lead in organizing need-based on-the-
job trainings, enabling clinicians to provide high quality service.
Students from preservice training schools require a course in practical areas in addition to
the provision of assigned mentors. Participants indicated that there was no other PTA
conducted to identify the successes and challenges of the trainings as they related to service
delivery.
Benefits of trainings support included:
The following benefits were cited as a result of the trainings; Improvement in
infection prevention measures, data reporting and diagnosis outcomes for
cervical cancer with improved referrals at critical points ,Confidentiality had
improved in relation to PMTCT, services had been brought close to patients and
are delivered on timely basis, new services offered, reduced referrals especially
for ART, improvement confidence and skills after the training, Increase in
Uptake of cervical cancer screening and family planning
Areas of Improvement
• There is a need for strict follow-up as this will increase the trainings success for
the participants.
• MOH and other service delivery partners should collaborate and coordinate the
training follow-up.
• Data should be utilized, analyzed, and disseminated to inform future decisions

20 | P a g e
• The need for a patient exit interview/survey in evaluation of health service
improvement since they are the beneficiaries.
• Need for a skills inventory, updated database for health workers trained and in
which skills to easily identify staff requiring a specific training
• Invitations for training should go through the management as the appropriate
channel in the health facility.
• Selection process should be based on facility needs and led by MOH.
• Proper and timely communication between participants involved is important to
facilitate necessary follow up
• The participants should be trained and assigned after the training for purposes of
mentoring.
• Mentors should be assigned in every facility to allow for mentoring of the
trainees.
• They should consider retraining of cervical cancer screening because the
confidence level of the trainees is low in the North Eastern region.
• They should consider integration of training in courses offered at pre service
training institutes.
• There is a need to address mechanisms of sustainability of the trainings.
• There is a need to improve accountability for the trainings received.
• The participants should provide feedback to the facility in-charges after training.
This will enable facility in-charges to allocate duties accordingly.
• There has to be a mechanism identify and reward performers.
Barriers & Challenges to Service Provision by the Trainees
The barriers addressed in the discussion included:
• Poor attitudes: It emerged during the discussions that poor attitude is a major
issue among staff and negatively affects the quality of health services. The health
services should be client-centered and tailored. There is need for attitude change,
especially given the merging of the two previously independent ministries,
Ministry of Medical Services (MMS) and Ministry of Public Health and Sanitation
(MOPHS).
• Internal wrangles
• Lack of accountability
• High staff turnover rates
• Acute staff shortages
• Poor infrastructure in terms of roads and communication networks
• inadequate equipment and supplies
• Lack of mentorship programs and facilitation
• Cultural perspectives that hinder teachings and service delivery
• Lack of feedback after the trainings
• Commodity management: While HIV related services depend on donor funding,
and require reporting, some of the staff trained have no access to computers and
internet connectivity, hence commodities for these services are managed and
issued centrally at provincial and county/sub county level. This affected the use of
skills trained in commodity management.

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• Poor documentation is also a challenge and leads to problems in quantification in
terms of ordering of consumables in the facility
Summary Findings from Supervisor Interviews
Duties and Services offered by the supervisor
The services offered by the supervisor in the facility included: administration, curative
services, preventive, MCH services, consultative, coordination of services, enforcement of
standards and ethics, preparing duty rosters, commodity management, report writing,
mentorship and training, and supervision among others.
Reason for change in provision of services by trainee
The main reasons cited by trainees as contributing to positive change in the provision of
services included: new skills and knowledge acquired, renewed commitment to work,
increased competence, increased demand for services, change in attitude, facility starting to
offer the service, availability of services and equipment and supportive supervision.
Those who reported no change, cited lack or inadequate supplies and equipments, short
time they had worked with the trainee , the trainee was not in the department where they
could apply the skills, negative attitude towards service delivery, and poor uptake of the
service by the community.
Changes in quality of service delivery
The reported change in terms of quality of service that included: improvement in patient
safety, accuracy of diagnosis, client satisfaction, reduction in waiting time, improvement in
record keeping, change of attitude of health providers, improved decision making, increased
uptake of services, improved treatment outcomes, improvement in procurement of
equipment and supplies, less referral, and improvement in patient confidentiality.
Changes in quantity of service delivery
Change in quantity of service delivery included: ability to attend to more patients in a shorter
time, availability of commodities, increase service uptake, and increased frequency in service
delivery,
Forms of supportive supervision
The forms of supportive supervision that exist include: APHIAPlus, CMEs, DASCO, DHMT,
NASCOP, KEPHI, DMOH, DPHN, departmental supervision, institutional forums for sharing
knowledge, monthly reports, staff appraisals, daily rounds, on-the- job trainings, seminars
and working closely with supervisor.
Available opportunities for continuing professional development
The available opportunities for professional development for the trainee included:
APHIAplus, FUNZOKenya, CMEs, on job training, seminars, eLearning, and distance learning
courses, management training, and short courses.

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Comments on training that would improve service delivery in their respective facility
The supervisors generally acknowledged the good work being done by the trainees after the
trainings and recommended further training in other areas. Among the training s
recommended for future consideration include malaria case management, IMAI, M&E, and
CCC. They also recommended training of more staff in the facilities due to staff rotation and
also provision of supplies and equipments to equip the trainee.
Recommendations for improvement of the trainings
Areas suggested for improvement in service delivery included: team work, mentorship, self-
motivation, supportive supervision, and need for improved attitude.

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CHAPTER FOUR: DISCUSSION
This section is an attempt to compare our findings with what is published on intent to
transfer skills and knowledge.
Transfer of Training
Training transfer means that learners are able to “transfer” their knowledge and skills learned
in a training session back to their jobs effectively and continually, with an aim of improving
performance. Goals of successful training transfer are that trainees generalize skills and that
trainees maintain skills in the work setting. Training transfer is critical to ensure that learning
is used to enhance performance (SHRH, 2013).
Frameworks of Training Transfer
Transfer is a multi-faceted process that involves activities and interventions throughout all
phases of a training experience: pre, during and post-training. The training environment
includes managers’ participation in the training, design of the training with adult-learning
principles and instructional material in mind and development of learning goals. Under the
Foxon model, organizational environment and action plans, formal coaching, uses of
enabling technologies all affect employee performance (Foxon, 2002).
In this study, it was found that eight out of every ten trainees were nurses and the trainees
had experience of more than five years. Nine out of ten trainees were from public institutions
and majority multi-tasked with 68 (24%) of trainees having reported to have changed their
duty station after training.
The facts above have a negative influence on transfer of skills from a learning environment to
the workplace. Registered nurses have the responsibility of immunizations, out-patient
service, in-patient service, under 5 examinations, school health, nutrition, and education
(MOH, 2006). Nurses are able to multitask and this great advantage can be utilized in
designing curriculum and on-the-job trainings with gender and experience in mind.
The Trainings
A percentage of trainees had previously attended other trainings apart from those supported
by FUNZOKenya. Surprisingly, some of the trainings were similar and attended within the
same period August-December, 2012. The different ones were; basic life support,
management of malaria, monitoring and evaluation (M&E), diabetes, and health
management information. This calls for proper skills audit and planning to avoid duplication.
There was an increase in frequency for all trainings, except EMNC, which recorded close to a
10% drop in attendance. The reason was not explored during the study as was how culture
affected skill transfer.
Staffing
The WHO critical threshold for health personnel is 23 doctors, nurses and midwives per
10,000 population. Kenya remains at 13 per 10,000 (WHO, 2004). The 2004 staffing ratios for
Kenya are doctors: 3 to 10,000 and nurses: 2 to 10,000 (WHO, 2006). Furthermore, Kenya is

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one of the 57 countries with an acute shortage of health workers. The health workers are
skewed to urban areas (42% of doctors, 30% of nurses in the public sector are in Nairobi and
Rift Valley Provinces while Western has 7% and 11% nurses). The objective of this study was
not to determine adequacy or distribution of the health work force; however, it is public fact
that the Health sector is short of staff. The timing, selection and criteria for selection is hence
very important.
The National HRH Strategic Plan 2009-2012 identified challenges involving the Kenyan
human resource as inadequate distribution of health workers, high attrition, weak leadership
and management capacity, weak in-service and pre-service training, and poor sectorial
coordination of the HRH agenda among others.
Development of adult training methodologies and eLearning, training and mentorship at
workplace could address the challenges of staff shortages and improve staff performance
results. A paper on relative efficiency of didactic (principle-based), learning via information
revelation, analogical training and observational learning, imitation, or modeling found that
those who learned by analogical and observational methods learnt better (Nadler, Thompson
and Van, 2003).
Missing Respondents
Fifty-four (19%) respondents were replaced. In future trainings, there is need to use a
bottom-up approach where organizations have strategic objectives and skills inventory
which then inform the selection of trainees, with clear deliverables to the workplace. Trainees
would return to their work environment and implement organizational/institutional plans.
Similarly, such employees may be bonded by the employer for some while as they apply the
skills. A minimum period should be set before an employee applies for another course.
There exists a guide on leave days and training days per cadre RCN(Registered Community
Nurse 24 working days per month, 30 off trainings days, lab technologies 26.17 and 10 for
training while pharmaceutical technologist are allowed 25.25 and 21 days respectively (MoH,
2006). This should be taken into consideration during trainee selection.
Public Health Facilities
Health facility distribution is 21% FBO, 5% NGO, 60% public sector, and 14% private for
profit. From the trainings however, 91% of trainees were from the public sector. This may be
due to improper selection criteria, initial target of the public sector, or willingness of public
sector employees/ employers to learn. A county skills inventory and human resource plan
would be ideal for all the counties in Kenya as part of harmonized human resource planning.
Accreditation of Facilities
Some of the trainees were selected from health facilities not accredited to provide the
specific health services. This meant that the trainees would not be able to practice that skill
upon their return. Amongst the results reported, 45% of staff are in locations not directly
related to the service for which they were trained, 40% had low case loads, 26% had the
services not provided by the facility.

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Inhibiting and Supporting Factors Framework
Figure 5: Supporting and Inhibiting Factors for Intention to Transfer, adapted from
Foxon, 2002
Factors that influence transfer of skills include organizational climate, training content,
learner motivation, internalization of transfer strategies, support supervision and follow-up,
and ability to apply what was learnt. Baldwin and Ford (1988) first proposed a three-factor
model of transfer. Later, Burke and Hutchins (2007) conducted an integrative review of
literature that updated and extended the transfer model.
Figure 6: Three-factor model of transfer
Adapted from Burke and Hutchins (2007)

26 | P a g e
In this model, several factors affect both learning and transfer of knowledge and skills from a
training. Transfer is also not the end result; successful transfer ultimately leads to improved
individual and organizational performance hence meeting the individual, workplace, and
overall organizational plans and sector-wide plans.
Supportive Supervision and Mentorship
Proper supervision and follow up ensures that healthcare workers can implement the lessons
learned during the initial training sessions. It focuses on improving conditions required for
proper functioning of the health delivery system. Mentorship on the other hand aims at
improving skills of trained service providers to offer quality services (MOH, 2012). The finding
in this study was that trainees should undergo refresher courses in areas of specialization,
and that each facility should have a mentor. Drawing from the seminal work of Baldwin and
Ford (1988), who first proposed a three-factor model of transfer, Burke and Hutchins (2007),
conducted an integrated review of literature that updated and extended the transfer model.
Emerging research shows that the work environment has a strong influence on learners’ use
and maintenance of learning in the work setting. Supporting transfer at the learner, design
and work environment levels requires developing interventions that occur throughout
(before, during, after) the training experience (SHRM, 2013).

27 | P a g e
CHAPTER FIVE: CONCLUSIONS AND RECOMMENDATIONS
The PTA exercise, carried out approximately one year after training 1,662 health workers, was
designed to investigate the extent to which, if any: the acquired skills and knowledge have
been applied to the workplace, whether there had been change in quality or quantity of
health service delivery, and inhibiting or supporting factors that may have contributed to the
changes.
There was a significant increase in variety and quantity of all services provided following
training (63% offered the services before compared with 88% who offered the service after
training) with the exception of EMNC.
Measurement of quality of service delivery was difficult in this design where the client was
not interviewed. The perception was that quality of service had improved as evidenced by
improvement in service uptake, improved patient safety, decreased waiting time, and
attitude change.
Several factors contributed to the improved service delivery uptake, the top five being level
of confidence acquired and the knowledge and skills gained. However, incorrect placement
following trainings and high staff turnover were cited as inhibitors to proper service delivery.
Findings that identified over 90% of trainees having been sourced from public facilities could
be due to the initial focus; health workers from public facilities but that contradicted the
National Coordinating Agency for population and development (NCAPD) which reported
that 60% of the facilities are public while 21%, 14%, and 5% are FBO, private for profit, and
NGOs respectively.
Several trainees identified lack of an organized mentorship program despite that fact that
over 85% had supportive supervision. Trainee selection and the need for a focal point are
critical to monitoring the trainings and increasing accountability. Staff shortage needs to be
addressed during participant selection and staffs’ ability to multitask especially during
trainings. A transfer matrix tool that details the role of trainers, trainees and supervisors
before, during and after the training as below may be used to increase organization,
sustainability and ensure success (Appendix 9).

28 | P a g e
RECOMMENDATIONS
Policy
There is need to develop HR training policy that covers selection criteria of trainees, training
needs, the workload of the service provider, number of trainings during that period,
monitoring and supportive supervision. The role of county governments’ health sector
should also be clearly identified.
Program
1. Identify health sector focal person, preferably at the county health directors’
office and national levels to be liaison for trainings.
2. Examine trainee needs, taking into consideration personal comfort of trainees,
timely invitation, and flexible logistic arrangements.
3. Develop trainee follow-up mechanism for accountability and support
4. Improve the workplace environment including supplies, equipment, and
infrastructure.
5. There is need to development of adult friendly training materials and curriculum
delivery especially e-Learning updates that allow one to train at work with special
focus to resource-challenged counties.
6. Develop curriculum for other courses based on needs like malaria, induction,
attitude, leadership, etc.
Work-place Community
1. Encourage formal coaching: develop individual, departmental and institutional action
plans, employee performance agreements and support.
2. Link training to organizational goals and potential application of the trainings
Further Research
1. Revise the curriculum adopting innovative adult teaching methodologies
2. Impact of FUNZOKenya supported trainings on skill transfer at workplace
3. Investigate loss to follow-up of service providers, and influence of culture on skill
transfer.

29 | P a g e
REFERENCES
Baldwin, T.T., & Ford, K.J. (1988). Transfer of training: A review and directions for
future research. Personnel Psychology, 41, 63-105
(http://www.performancexpress.org/wp-content/uploads/2011/11/Transfer-of-
Training.pdf) Accessed on 5th
November 2013.
Broad, M. L., & Newstrom, J. W. (1992). Transfer of training: Action-packed
strategies to ensure high payoff from training investments. Reading, MA: Addison-
Wesley
Broad, M.L. (2005). Beyond transfer of training: Engaging systems to improve
performance. San Francisco, CA: John. Wiley & Sons
Buchan, J., Carnwell R., (Eds) (2005). Effective practice in Health and Social Care:
A partnership approach. Sage Publications
Burke L.A., Hutchins H.M., (2007). Transfer of Training. Society for Human
Resource Management
Burke, L.A., & Hutchins, H.M. (2007). Training transfer: An integrative literature
review and implications for future research. Human Resource Development Review,
6(3), 263-296.
Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M (2004). Human
resources for health: overcoming the crisis. Lancet, 364: 1984–1990. Available:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17482-
5/fulltext (Last accessed on 1st
November, 2013).
Dielman M., Harnmeijer J. (2006). Improving health worker performance: In search
of promising practices. Royal Tropical Institute: The Netherlands.
Foxon M. (2002). A process approach to the transfer of training. Part 2: Using
action planning to facilitate the transfer of training. http://www.shrm.org
(Accessed on 9th November, 2013).
IntraHealth and Jhpiego (2002). Transfer of Learning: a guide for strengthening
the performance of health care workers. Chapel Hill NC: PRIME II Project.
Available http://www.intrahealth.org/page/transfer-of-learning-a-guide-for-
strengthening-the-performance-of-health-care-workers- Personnel Psychology, 41.
Joint Learning Initiative (2004). Human resources for health: overcoming the crisis.
Boston: Harvard University. Available:
http://www.who.int/hrh/documents/JLi_hrh_report.pdf (Accessed on 9th
November, 2013).
Ministry of Health (2006). Guidelines on mentorship for HIV services in Kenya,
NASCOP
Ministry of Health (2006). Norms and Standards for health service Delivery

30 | P a g e
Ministry of Medical Services and Ministry of Public Health and Sanitation. The
Kenya Health Sector Strategic and Investment Plan – KHSSP July 2013 – June
2017.
Nadler, Thompson and Van (2003), Knowledge creation and transfer in negotiation,
Management science Vol.49, No.4 April, pp 529-540
Olawiyola LM, Adelaye OA. (2005). Rural infrastructural development in Nigeria;
between 1960-1990-Problems and Challenges; Journal of Social Sciences, 2004; Vol
94; No 11; pages 91-96
The Kenya National HRH strategic plan 2009-12
The Kenya National Human Resource for Health Strategic Plan 2009-2012
World Health Organization (2004). Atlas of Global work Force. WHO, Geneva
World Health Organization (2006). The world health report 2006: working together
for health. Geneva: WHO. Available: http://www.who.int/whr/2006/en/ (Accessed
on 9th November, 2013)
World Health Organization (2007). Montreux Challenge: Making health systems
work. WHO, Geneva.

31 | P a g e
APPENDICES
APPENDIX 1- CONSENT FORM RA Code:
___________
Informed Consent
Hello, my name is _____________. I work for Moi University College of Health Sciences and a
member of the post training follow-up assessment team who has been identified by MOH-
Human Resource Department and Department of Standards and Regulations with support
from FUNZOKenya to carry the post training follow up on their behalf. The training in
question was sponsored by FUNZOKenya. We request your participation in this follow-up
assessment.
The purpose of this training follow-up activity is to learn how you have integrated the
training knowledge and skills in your job performance. The objectives are to determine:
1. The extent to which you have been able to apply their new skills on the job
2. Whether application of learning in the context of work has resulted in a change in the
quality or quantity of services offered
3. Any factors limiting the use of new skills on the job
I would like to ask you about how relevant and applicable you have found the training and
materials now that you have returned to your workplace. We are conducting similar
interviews with other participants from the workshop. We will use the information to
determine how successful the training was, which training elements were most relevant and
applicable, and what additional training and other support is needed to apply what you
learned. If you agree, you will be among the 300 trainees that will participate in this survey.
Your participation in this follow-up is voluntary and there is no penalty for refusing to take
part. You may refuse to answer any question in the interview or stop the interview at any
time without any adverse consequences.
The information you provide will be confidential and your name will not be identifiable by
any unauthorized persons outside the research team. Any reports of the results of the follow-
up will not contain your name. There is no financial compensation or other personal
benefits from participating in this follow-up assessment. However, the information may be
used to influence Health policy and any other beneficial attributes to humanity.
There are no known risks to you or your institution resulting from your participation in the
follow-up. If you agree to participate, the interview will take about 30 minutes to complete.
In case you have any enquiry to make or clarification, you may contact:
The Principal College of Health Sciences or
MECC Building
3rd
Floor
Nandi Road
P.O Box 4606, 30100
Eldoret. Email: muchs@ac.ke
Tel 254 726 593141(Dr Simiyu)
Head-HRD
Ministry of Health (MOH),
AFYA House, Cathedral Road
Box 30016
Nairobi
Tel : 254-020-2717077

32 | P a g e
Do you agree to participate? Yes ____ No ____ Not Available _______
Signature: _______________________________ Date: ________________________

33 | P a g e
APPENDIX 2- TRAINING FOLLOW-UP PARTICIPANT’S
QUESTIONNAIRE
(TO BE COMPLETED BY THE SERVICE PROVIDER WHO ATTENDED TRAINING)
Part A Demographic Data:
1. Participant’s Code:______________________________ Health facility Name:
_________________________________
County: ___________________________________________
2. Name of training assessed for: (RA to complete)
__________________________________________________
3. Training dates: Start date: ________/_________/________ End Date:
________/_________/_________
4. Gender(Tick/Circle): M [ ] F [ ]
5. DOB : ________/_________/______________ or Age in
years:_________________________________
6. Cadre (e.g Nurse, Medical officer, Clinical Officer, Nutritionist etc.): _________
7. Designated Role (Administrative) if ANY:
_____________________________________________________________
8. Highest Education status:
[ ] Basic Degree Year: ___________________
[ ] Post graduate Diploma Year: ___________________
[ ] Diploma Year: ___________________
[ ] Certificate Year: ___________________
[ ] Other: _______________________ Year: ___________________
9. For how many years have you been in service (as a healthcare provider):
[ ] <1
[ ] 1-3
[ ] >3-5
[ ] >5
10. Type of Facility/Institution
[ ] Public
[ ] Private
[ ] FBO
[ ] NGO
11. In which section/ service area/department were/are you working?
DD MM YYYYDD MM YYYY
DD MM YYYY

34 | P a g e
At the time of
training
Currently Note: NC=No Change,
C=Changed
Section/Department/service
area
12. What is your duty in this station? (RA to probe)
___________________________________________________________________________________
___________________________________________________________________________________
_____________________________________
13. List previous short course training/s attended in the last 3 years and their duration:
# Name of the course Duration (Weeks)
Part B Service Delivery:
14. What in-service training(s) did you undertake with support from FUNZOKenya.(Aug-
Dec 2012)
# Training Title
Tick
(√) #
Tick
(√)
1
Pediatric ART
Management 8
Commodity
Management
2 PMTCT 9 MDR-TB
3 Adult ART Management
1
0 IMCI
4 LAPM-FP
1
1 EMNC
5
Cervical Cancer
Screening
1
2
Gender Based Violence
(GBV)/Clinical
Management of Sexual
Violence
6 EMOC
1
3 Others (specify
7 FANC
15. Were you offering these services before your training?
[ ] Yes [ ] No
16. (A) If yes, what services were you offering?
___________________________________________________________________________________
_____________________
16. (B) If no, what are the reasons? (Skip to Q18)
___________________________________________________________________________________
_____________________

35 | P a g e
17. (A) On a scale of 1 – 6, to what extent were you offering this service before training?
1=Offers the service everyday of the week, 2= Offers the service 3-4 days in a week,
3= Offers the service 2 days in a week, 4= Offers the service once in a week, 5=
Offers the service only occasionally & 6= Never

36 | P a g e
# Type of service
Frequenc
y (code)
# Type of service
Freque
ncy
(code)
1
Pediatric ART
Management 8 Commodity Management
2 PMTCT 9 MDR-TB
3 Adult ART Management
1
0 IMCI
4 LAPM-FP
1
1 EMNC
5
Cervical Cancer
Screening
1
2
Gender Based Violence
(GBV)/Clinical
Management of Sexual
Violence
6 EMOC
1
3 Others (specify
7 FANC
17. (B) RA to probe on reasons for the frequency if they are health facility determined:
___________________________________________________________________________________
___________________________________________________________________________________
__________________________________________
17. (C) Before you went for training how many patients were you seeing per month (Jan-
June 2012)?
___________________________________________________________________________________
_____________________

37 | P a g e
18. After training are you offering this/these service(s) now? □ Yes □ No .If no skip to
question 22
# Type of service
Ti
ck
(√
)
# Type of service
Ti
ck
(√
)
1
Pediatric ART
2 PMTCT 9 MDR-TB
3
Adult ART
Management
1
0 IMCI
4 LAPM-FP
1
1 EMNC
5
Cervical Cancer
Screening
1
2
Gender Based Violence (GBV)/Clinical
Management of Sexual Violence
6 EMOC
1
3 Others (specify
7 FANC
19. (A) On a scale of 1 – 6, to what extent are you offering this service – post training?
1=Offers the service everyday of the week, 2= Offers the service 3-4 days in a week,
3= Offers the service 2 days in a week, 4= Offers the service once in a week, 5=
Offers the service only occasionally & 6= Never
# Type of service
Frequ
ency
(code) # Type of service
Frequ
ency
(code)
1
Pediatric ART
2 PMTCT 9 MDR-TB
3
Adult ART
Management
1
0 IMCI
4 LAPM-FP
1
1 EMNC
5
Cervical Cancer
Screening
1
2
Gender Based Violence (GBV)/Clinical
Management of Sexual Violence
6 EMOC
1
3 Others (specify
7 FANC
19. (B) RA to probe on reasons for the frequency if they are health facility determined:
___________________________________________________________________________________
___________________________________________________________________________________
_____________________________________

38 | P a g e
19. (C) After you went for training how many patients are you seeing per month (Jan-
June 2013)?
_______________________________________________________________________________________________
____________________________________
20. What challenges are you experiencing in service delivery (tick all that apply)
[ ] Lack of confidence in skills
[ ] Service procedure-trained-in is not provided in the facility
[ ] Current position not relevant to the service procedure
[ ] Stock out of supplies/equipment/instruments
[ ] Low demand/low client caseload
[ ] Lack of clear job description
[ ] Lack of clear and immediate feedback from supervisors
[ ] Inadequate physical environment including proper tools, supplies and workspace
[ ] lack of motivation and incentives to perform as expected
[ ] Lack of skills and knowledge required to do the job
[ ] Staff rotation/movement to different section/ facility
[ ] Culture/religion
[ ] Others (Please
specify):__________________________________________________________________________________
______________________________________________________
21. What factors have enabled you to improve service provision after the training?
[ ] Increase in the level of confidence in skills
[ ] Service procedure-trained-in now provided in the facility
[ ] Current position relevant to the service procedure
[ ] Availability of supplies/equipment/instruments
[ ] High demand for the services
[ ] Feedback from supervisors
[ ] Appraisal and incentives to perform as expected
[ ] Acquisition of skills and knowledge required to do the job
[ ] Others (Please specify)
__________________________________________________________________________________________
_______________________________________________
22. If no in Q18, what difficulties prevented service provision despite you being trained?
(Tick all that apply).
[ ] Lack of confidence in skills
[ ] Service procedure-trained-in is not provided in the facility
[ ] Current position not relevant to the service procedure
[ ] Stock out of supplies/equipment/instruments
[ ] Low demand/low client caseload
[ ] Lack of clear job description
[ ] Lack of clear and immediate feedback from supervisors
[ ] Inadequate physical environment including proper tools, supplies and workspace
[ ] lack of motivation and incentives to perform as expected
[ ] Lack of skills and knowledge required to do the job
[ ] Staff rotation/movement to different section/ site/ facility

39 | P a g e
________________________________________________________________________
23. What improvements have you made in service delivery, if any, as a result of this
training? (Interviewer to probe using a checklist & respondent to demonstrate
improvement)
Type of training Services improved/introduced Score
24. In the discharge of your duties do you have access to resources that facilitate
provision of service delivery that you trained for? Need a checklist of resources for all
the 5
Resources If Yes,
proceed to
scale
In a scale of 1-4, rate the availability of
the above resources (Tick)
Yes No Poor Moderate Good Excellent
1 Physical (Space,
rooms)
2 Human
3 Financial
4 Materials
(Consumables)
5 Equipments
25. What other resources apart from the ones mentioned above do you need to
execute your functions?
_______________________________________________________________________________________
_______________________________________________________________________________________
__________________________________________
Part C Mentorship and Supervision:
26. Have you ever been mentored since the training (the current training being assessed
on)?
[ ] Yes [ ] No
27. If No, what is the reason? (Tick all that apply)

40 | P a g e
[ ] No mentorship programme in place
[ ] Unavailability of mentors
[ ] Shortage of time
[ ] Lack mentorship guideline
[ ] Not aware of anything called mentorship
______________________________________________________________________________________________
_______________________________________________________
28. Since the training, are you mentoring anybody?
[ ] Yes [ ] No
29. Are there any other forms of supportive supervision, beneficial to continuing professional
development?
[ ] Yes [ ] No
If yes, please specify:
___________________________________________________________________________________
Part D Training Recommendations:
30. What aspect of training has been useful in the place of work?
_______________________________________________________________________________________
_______________________________________________________________________________________
__________________________________________
31. What aspects of training need improvement?
_______________________________________________________________________________________
_______________________________________________________________________________________
__________________________________________
________________________________________________________________________
32. What other training if any would you require in order to improve service delivery in the
facility?
__________________________________________________________________________________________
__________________
33. Would you recommend this training to other service providers?
_______________________________________________________________________________________
_______________________________________________________________________________________
__________________________________________

41 | P a g e
APPENDIX 3- POST TRAINING FOLLOW-UP SUPERVISOR’S
QUESTIONNAIRE
Part A Demographic Data:
1. Supervisor’s Code: _______________________________________
2. Gender: M [ ] F [ ]
3. DOB: ________/_________/______________ or Age in years____________________
4. Cadre (e.g. Nurse, Medical officer, Clinical Officer, Nutritionist etc):
________________________________
5. Designated Role (Administrative) if ANY:
______________________________________________
6. Highest Education status:
[ ] Basic Degree Year: ___________________
[ ] Post graduate Diploma Year: ___________________
[ ] Diploma Year: ___________________
[ ] Certificate Year: ___________________
[ ] Other: ______________________ Year: ___________________
7. For how many years have you been in service (as a healthcare provider):
[ ] <1
[ ] 1-3
[ ] >3-5
[ ] >5
8. Type of Facility/Institution
[ ] Public
[ ] Private
[ ] FBO
[ ] NGO
9. What is the level of this health facility? Name of
facility:________________________________
[ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ] 6
10. Type of services Offered by the facility (for the institutional head)
_________________________________________________________________________________________
_________________________________________________________________________________________
________________________________
11. In which section/service area/department were/are you working?
At the time of
training
Currently Note: NC=N
Change, C=Changed
Section/Department/service
area
Part B Training and Service Provision:
DD MM YYYY

Post Training Asessment Report

Post Training Asessment Report

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