Improving health worker in-service training to better deliver quality services

By Rebecca Bailey, IntraHealth International; Julia Bluestone, Jhpiego; Gabrielle O’Malley, International Training and Education Center for Health (I-TECH);  Carey McCarthy, CDC; Samuel Ngobua, IntraHealth; Frances Petracca, I-TECH; Lois Schaefer, USAID; Tana Wuliji, University Research Co., LLC (URC) There are more in-service training programs around the world than ever before, and training often represents the lion’s share of investments for strengthening human resources for health (HRH). Training is clearly an important contribution toward the development and maintenance of health worker competencies for delivering quality services – but how can we make training more effective, efficient and sustainable? Although evidence is patchy, we have substantial experience and expertise on what practices are essential – such as the practice recommendations summarized in the  USAID and PEPFAR-supported Improvement Framework for Health Worker In-service Training, that was launched last month at the Third Global Forum Global Forum on HRH in Recife, Brazil. Jhpiego, IntraHealth International, the International Center for AIDS Care and Treatment Programs (ICAP), the International Pharmaceutical Federation, International Training and Education Center for Health (I-TECH), Management Sciences for Health, the Pan American Health Organization, Pathfinder, the World Medical Association and URC partnered with the USAID ASSIST Project and USAID to develop this framework.

Some great lessons learnt were discussed during the session launching the framework in Recife, including: 1. Strengthening training institutions and systems: how can we strengthen, standardize and institutionalize training systems?

• In-country linkages between learning systems are needed to strengthen and institutionalize training systems. In-service training programs should be provided by local institutions to increase ownership and sustainability of training. Standardizing training materials and program can maximize existing resources for training for training and improve training effectiveness and efficiency. Session participants said that better advocacy for adequate training budgets is needed to support participation of in-service training programs.

2. Coordination of training: what mechanisms can be used to better coordinate training?  What characteristics are most desirable in a training information/tracking system?

• In-service training programs too often train the same people over and over again while others are not trained at all. A system for tracking training courses and participants would not only improve the efficiency, effectiveness and sustainability of training, it would also help to ensure equitable access to training by all health workers.

3. Continuum of learning from pre-service to in-service: What roles can different stakeholders play to ensure continuum of learning between pre-service education and in-service training?

• Pre-service institutions can be at the heart of a coordinated in-service training structure by offering courses directly or accrediting groups like professional associations to provide training. This model can help ensure consistency between pre-service and in-service training content and allow for in-service trainings to count towards degree programs offered by pre-service institutions.

4. Design and delivery of training:  A recent literature review  suggests shorter, repeated, simulation-heavy, workplace-based training can be more effective.  Given the current system is geared towards classroom-based, group-based training, how can we implement more effective methodologies?

• Training events should be linked to continued health professional development, and additional opportunities for workplace-based training using alternative methodologies that supports a continuous quality assurance process should be explored.

5. Support for learning: How do we prepare, support and incentivize busy health workers to provide workplace-based mentoring or support to others?

• An on-the-job environment the enables the learner to utilize new knowledge and skills is essential to translating learning into improved quality of services and health outcomes.

6. Evaluation and improvement of training: How can evaluation of in-service training outcomes be strengthened to inform improvement in training?  What are some of your successes and some of your needs in identifying results of your training programs?

• Methodologically teasing out the multitude of factors that influence outcomes of training programs, requires significant time, thought and resources.  The Training Evaluation Framework and Tools (TEFT) can aid in addressing this challenge

The launch of the framework in Recife is only the beginning of the conversation we are hoping to have to improve in-service training for health workers. In February 2014, we hope to launch an open access wiki that includes a one-page guidance for each recommendation in the Framework including a brief synthesis of the relevant literature, examples of good practice and links to additional resources and tools. We invite you to join us in enriching this wiki by providing examples, lessons learnt and technical resources by clicking on the questions below and answering them online or via text message. The links below not only let you have your say but also let you see others are saying:

1. How can we strengthen, standardize and institutionalize training systems?
2. What mechanisms can be used to better coordinate training? What characteristics are most desirable in a training information/tracking system?
3. What roles can different stakeholders play to ensure continuum of learning between pre-service education and in-service training?
4. Given the current system is geared towards classroom-based, group-based training, how can we implement more effective methodologies?
5. How do we prepare, support and incentivize busy healthcare workers to provide workplace-based mentoring or support to others?
6. How can evaluation of IST outcomes be strengthened to inform improvement in training?  What are some of your successes and some of your needs in identifying results of your training programs?