distance learning for health: tana wuliji
Post on 01-Nov-2014
1.836 Views
Preview:
DESCRIPTION
TRANSCRIPT
Human resources for health training: An overview of training priorities and approaches
Tana WulijiSenior Associate,nstituto de Cooperaciόn Social - Integrare (ISCI)Tana.wuliji@integrare.es
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
www.worldmapper.org Data: WHO Global Health Workforce Atlas
Pharmacists
12
www.worldmapper.org Data: WHO Global Health Workforce Atlas
Physicians
13
www.worldmapper.org Data: WHO Global Health Workforce Atlas
Dentists
14
www.worldmapper.org Data: WHO Global Health Workforce Atlas
Post-qualification training priorities
Training and performance
15
Health systems strengthening perspective
Training priorities
16
Service delivery:Diabetes UK Twinning to train health workers and trainers
Health workforce:PEPFAR funded MEPI, NEPI; PROFAE nursing workforce
Brazil, AMREF nursing workforce
Information: Field Epidemiology Training programs (FETP): Americas,
Africa
Medical products, vaccines and technologies:
Supply chain management training (MSH, JSI)
Financing
Leadership/ governance:
6 month health management skills program Yale/Liberia
- HR Managers- Educators- Primary
healthcare workers
- Specialists
Supply chain management
- Researchers
Health systems building blocks
17
Service delivery
Health workforce
Information
Medical products, vaccines and technologies
Financing
Leadership/ governance
Improved health
Responsiveness
Social and financial risk protection
Improved efficiency
Training!
But is training always the answer?
18
Myth: Training will result in
improvements in health worker performance
Performance
Competence
Training
Work environment
Job satisfaction
Autonomy
Supervision support and feedback
Monitoring of outcomes
Performance is influenced by a broad set of factors
Training design for performance Interactive and
integrated learning
19
Work-place based learning
Distance education and e-learning
Workplace based learning• Health facility management 6 month training program in
Liberia– Reduced disruption to work, enabled field based learning
for application of learnt skills• Field Epidemiology Training Program
– Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Dominican republic, Burkina Faso, Ethiopia, Ghana, Kenya, Nigeria, Rwanda, South Africa, Tanzania
– 80% learning in field, 20% in classroom• 3 year work-place based post-graduate diploma to build
general level competencies of hospital pharmacists (UK)
20
Distance education and e-learning• University of Western Cape Masters of Public Health
– Health workforce management. 75% distance education. Face to face learning: 4 visits.
• E-learning: online video programs, online modules, live videoconferencing and broadcasting, online case conferencing, web based portfolio systems, online learning platforms
• 2008 meta-analysis of 201 studies (Cook et al, 2008)– large and positive effects from e-learning vs non-
intervention– Mixed/limited positive effects compared to classroom
based training
21
Distance education produces comparable but not necessarily superior
effects to classroom education
Interactive and integrated learning
22
Level 1: Interactive and clinically integrated
Level 2: Interactive classroom activities and didactic, clinically integrated
activities
Level 3: Didactic /classroom
Khan & Coomarasamy, 2006
Improvements in evidence based medicine practice
7/8 evaluations: Associated with improvements in practice
6/7 RCTs: No significant differences between groups
Conceptual framework for approaches to health worker training
Broadening the Distance Education approach
23
From competence to performance
24
BEHAVIOUR CHANGE
Performance
As Performance institutionalisation
Level 4: 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
top related