In-Service Training Improvement Framework Launched at the Third Global Forum on Human Resources for Health
There are more health worker in-service training programs than ever before, with training often representing the lion’s share of investments for strengthening human resources for health (HRH). But an increasing number of reports indicate that such training is rarely evaluated, frequently duplicative, and may not be designed to meet needs. A growing multiplicity of poorly-coordinated training providers may overwhelm and weaken training systems rather than strengthen them.
Ensuring that quality of the services delivered by health workers is upheld and continually strengthened is of utmost importance to the universal health coverage agenda. 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?
While evidence is patchy, we have substantial experience and expertise on what practices are essential—such as the practice recommendations summarized in the USAID PEPFAR-supported Improvement Framework for Health Worker In-service Training, which we launched at the November 13th in-service training (IST) side session of the Third Global Forum on HRH.
We gathered participants from around the world at this side session to harvest and share experiences, strategies, and lessons learned. Sparked by info-rich lightning talks that compressed research, evidence-informed frameworks, and country experiences into three minutes, small groups of participants rotated through knowledge café stations on each theme of the Improvement Framework where they speed-networked and brainstormed on the questions raised during the lightning talks.
So what did we learn? Here are the questions we discussed along with some of the main lessons learned:
1. Strengthening training institutions and systems: How can we strengthen, standardize, and institutionalize training systems?
- In-country linkages between learning systems (preservice education, continuing professional development) are needed to strengthen and institutionalize training systems. IST should also be provided by local institutions rather than external organizations to increase ownership and sustainability of training. Standardization of training materials and programs can maximize existing resources for training and improve training effectiveness and efficiency. Resource flows require further analysis and improvement with participants recommending that advocacy is needed for training budgets within health care systems to support trainees to attend IST 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?
- We need to stop training 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 preservice to in-service: What roles can different stakeholders play to ensure continuum of learning between preservice education and in-service training?
- Preservice institutions can be at the heart of a coordinated in-service training structure by offering courses directly or supporting groups like professional associations to provide training. This model can help ensure consistency between preservice and in-service training content and allow for in-service trainings to count toward degree programs offered by preservice institutions. This approach requires coordination among key stakeholders such as academicians, associations, regulatory councils, and the Ministry of Health.
4. Design and delivery of training: A review of the literature suggests shorter, repeated, simulation-heavy, workplace-based training can be more effective. Given the current system is geared toward classroom-based, off-site training in large groups, how can we implement more effective methodologies?
- We should prioritize linking any training event to continued health professional development and individual needs, and look for opportunities to provide workplace-based training using alternative methodologies that supports a continuous quality-assurance process.
5. Support for learning: How do we prepare, support, and incentivize busy health workers to provide workplace-based mentoring or support to others?
- It’s interesting to note that during the knowledge café this question did not generate any discussion—perhaps because addressing support for learning extends well beyond training and education systems, into issues of supervision, job descriptions, working conditions, and other aspects of human resources and facility management. Nevertheless, all agreed that ensuring 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 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?
- The evaluation-focused group was well-attended, and participants engaged eagerly in identifying themes for discussion around the topic of outcome-level evaluation of trainings. One of the key issues discussed was that there are multiple factors—barriers and facilitators—influencing the outcomes of training programs, which poses a significant challenge to evaluation. It was noted that teasing out these factors methodologically, to identify the specific contribution of training towards desired program outcomes, requires significant time, thought, and resources. Participants in this group were provided CDs containing the Training Evaluation Framework and Tools (TEFT) and a web link providing resources to help address this challenge.
There’s clearly more than we were able to harvest and digest in a 90-minute session. We’d like to invite you to join us in sharing your experiences online via the open access wiki we are putting together, which is expected to launch in February 2014. This wiki will include 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 enrich this wiki with your examples, lessons learned, and technical resources and join the growing community that is leading change efforts toward more effective, efficient, and sustainable training.
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