Distance Learning for Health: Tana Wuliji

Human resources for health training: An overview of training priorities and approaches

Tana WulijiSenior Associate,nstituto de Cooperaciόn Social - Integrare (ISCI)[email protected]

1

DL4H International WorkshopLondon, UK26 October 2010

Overview

• Background• Post-qualification training priorities• Training design for performance• Conceptual framework for approaches to

health worker training

2

Background Human resources for health crisis

3

Health systems strengthening

What is a health system?

4

“All organisations, people and actions whose primary intent is to promote, restore

or maintain health”

WHO, 2000

Health systems building blocks

5

Service delivery

Health workforce

Information

Medical products, vaccines and technologies

Financing

Leadership/ governance

Improved health

Responsiveness

Social and financial risk protection

Improved efficiency

4 million health worker shortage in 57 countries

In 60 countries, less than ¼ deaths recorded

Medicines availability 20% in public sector in 39 LMIC

100 million people impoverished due to

health spending per year

Public health spending

6

Private health spending

7

8

Child 1-5 mortality

www.worldmapper.org Data: UNDP, WHO, 2002

Health workforce crisis: 57 countries

9

10

Nurses

www.worldmapper.org Data: WHO Global Health Workforce Atlas

Midwives

11


Pharmacists

12


Physicians

13


Dentists

14


Post-qualification training priorities

Training and performance

15

Health systems strengthening perspective

Training priorities

16

Service delivery:Diabetes UK Twinning to train health workers and trainers

Health workforce:PEPFAR funded MEPI, NEPI; PROFAE nursing workforce

Brazil, AMREF nursing workforce

Information: Field Epidemiology Training programs (FETP): Americas,

Africa

Medical products, vaccines and technologies:

Supply chain management training (MSH, JSI)

Financing

Leadership/ governance:

6 month health management skills program Yale/Liberia

- HR Managers- Educators- Primary

healthcare workers

- Specialists

Supply chain management

- Researchers

Health systems building blocks

17

Service delivery

Health workforce

Information

Medical products, vaccines and technologies

Financing

Leadership/ governance

Improved health

Responsiveness

Social and financial risk protection

Improved efficiency

Training!

But is training always the answer?

18

Myth: Training will result in

improvements in health worker performance

Performance

Competence

Training

Work environment

Job satisfaction

Autonomy

Supervision support and feedback

Monitoring of outcomes

Performance is influenced by a broad set of factors

Training design for performance Interactive and

integrated learning

19

Work-place based learning

Distance education and e-learning

Workplace based learning• Health facility management 6 month training program in

Liberia– Reduced disruption to work, enabled field based learning

for application of learnt skills• Field Epidemiology Training Program

– Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Dominican republic, Burkina Faso, Ethiopia, Ghana, Kenya, Nigeria, Rwanda, South Africa, Tanzania

– 80% learning in field, 20% in classroom• 3 year work-place based post-graduate diploma to build

general level competencies of hospital pharmacists (UK)

20

Distance education and e-learning• University of Western Cape Masters of Public Health

– Health workforce management. 75% distance education. Face to face learning: 4 visits.

• E-learning: online video programs, online modules, live videoconferencing and broadcasting, online case conferencing, web based portfolio systems, online learning platforms

• 2008 meta-analysis of 201 studies (Cook et al, 2008)– large and positive effects from e-learning vs non-

intervention– Mixed/limited positive effects compared to classroom

based training

21

Distance education produces comparable but not necessarily superior

effects to classroom education

Interactive and integrated learning

22

Level 1: Interactive and clinically integrated

Level 2: Interactive classroom activities and didactic, clinically integrated

activities

Level 3: Didactic /classroom

Khan & Coomarasamy, 2006

Improvements in evidence based medicine practice

7/8 evaluations: Associated with improvements in practice

6/7 RCTs: No significant differences between groups

Conceptual framework for approaches to health worker training

Broadening the Distance Education approach

23

From competence to performance

24

BEHAVIOUR CHANGE

Performance

As Performance institutionalisation

Level 4: ResultsEg –Improvements in health outcomes, improved health service efficiency (mortality, morbidity, healthcare utilisation)

Level 3: BehaviourEg – Improvements in health worker performance (peer review, observation, patient exit surveys)

·Supervision, support & feedback·Monitoring of outcomes (audit)·Work environment

·Structured preceptorship ·Work-place based & integrated learning·Peer learning and review

CompetenceCOMPETENCE

Level 2: LearningEg – Improvements in competence (pre-test vs post-test, self-assessment)

·Feedback ·Self-directed learning·Problem based learning ·Simulations and case based learning·Distributed learning

EngagementENGAGEMENT

Level 1: ReactionEg – Positive response to training

·Interactive·Competency based·Clear learning objectives·Relevant assessments

Kirkpatrick’s levels of training effectiveness

HEALTH WORKER CAPACITY BUILDING PROCESS GOALS

Enabling factors

Broadening the distance education approach

25

Performance

Competence

Training

Work environment

Job satisfaction

Autonomy

Supervision support and feedback

Monitoring of outcomes/audit

= small/moderate effect on practice

= small/moderate effect on practice

Distance education supported by strategies to enable

behaviour change to improve and institutionalise

performance

Distance Learning for Health: Tana Wuliji

Education

org data

training

work

post

interactive

improvements

learning

vaccines