national training policy (draft)nihfw.org/pdf/ntp_for comments2013.pdf · district training...

National Training Policy

(DRAFT)

Ministry of Health & Family Welfare New Delhi

National Institute of Health & Family Welfare New Delhi

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Draft National Training Policy- MoHFW, NIHFW

Chapter 1

1.1 Background

India has played a pioneering role in conceptualizing and planning a holistic and integrated

primary health care approach for all its citizens. The focus of India‟s health services right

from the early 1950s has been on health care to tackle common health problems in the

country. Improvement in the health and nutritional status of the population has been one of

the major thrust areas for the social development programmes in India. Bhore Committee

Report1 which laid the foundation for planning of health services in India, also emphasized

the importance of providing integrated preventive, promotive and curative primary health

care services through skilled workforce. Hence, the availability of an adequate number of

health personnel to effectively and efficiently manage and implement health programmes,

cannot be overemphasized.

The Government has a very significant role to play in the development process and

promotion of appropriate conditions, which would lend dynamism to a national effort. In a

developing country like India, both the Central Government and the State Governments

would need to ensure that the administrative machinery is sensitive to the dynamics of

development and responsive to the socio-economic aspirations of its citizens. A conscious

policy for the development of human resource available to the Governments, would require to

be fostered for meeting the challenges of development- health, social, economic and political.

The human resource needs have been increasing with the new health programmes being

added to the package of health services over the past few decades, along with the growth of

health infrastructure and expanding scope of the health services. Several new health

programmes have been introduced and the strategies of existing programmes have been

revised from time to time. These changes in health services and strategies have led to an

increased need for developing new competencies and skills among the health personnel, in

addition to the increasing need for more human resources at various levels. However,

numbers alone will not necessarily lead to the desired changes in the health status and

outcomes. There is a need for high levels of concern, commitment and competence among

the health personnel, responsible for the management and delivery of health care, especially

health care providers at the grassroots level.

Training is one of the most effective and tested tools for performance enhancement, as well

as for upgrading the knowledge and skills of the personnel. Organizational motivation and

morale, as reflected in the attitudes, and work culture are rendered relevant and sharply

focused through effective training programmes.

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1.2 The Paradigm Shift under NRHM

National Rural Health Mission (NRHM) launched in April 2005, envisages provisions of

accessible, affordable, equitable and quality health care to the population of India, especially

the vulnerable groups with a paradigm shift in approach. A major strategy in NRHM is

horizontal integration of vertical health and family welfare programmes as well as

convergence with the activities of related ministries/departments like AYUSH, Ministry of

Women and Child Development (MWCD), Drinking Water and Sanitation, PRI, etc. This has

lead to the provision of integrated health and family welfare, nutrition and sanitation services

for the community. As the number of services have increased, a phenomenal growth in

human resources in the health sector has occurred concomitantly, especially the peripheral

health functionaries; for example- ANMs and ASHAs, who are directly responsible for

implementing the interventions. Currently, though the indicators of access and availability of

health manpower have improved, but the productivity and performance still remain poor in

many states affecting developments aimed at reducing maternal mortality, infant and child

mortality, and reducing morbidity and mortality due to nutrition, communicable and non-

communicable diseases.

1.3 Rationale for a Training Policy under NRHM

There has been a change in the role of the government from a provider to being a facilitator

for efficient service delivery. The people expect a proactive, facilitative, quick and responsive

government department for health service delivery. For a client centred approach the

decision making process has to be more consultative with various stakeholders participating.

The government employees need to orient themselves for these changes in their knowledge,

skills and attitudinal aspects.

The continuing gaps in the health status of the people though attributed to several factors-- as

poor access and availability, inequity of distribution of health care, poor financing and

management of the health systems, cannot overlook the poor human resource development,

especially the competence and skills which determine the health system's performance.

Therefore, the challenge before the health department is to take into account the increasing

need of training for all levels of officers and staff across all states and UTs by framing a

National Training Policy for capacity building under NRHM. The training policy needs to

address the gap between the existing and the required competencies and provide opportunities

to the employees to develop their competencies.

1.4 Current Status of Training/Capacity Building in the Country - Major

Challenges

In 2008 the Government of India came out with a document The National Training Strategy3

under NRHM which very elaborately delineated the role of MOHFW, NIHFW, SIHFWs, and

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District Training Officer, use of distance method of training and Quality Assurance key

processes. The document also gives the trainings required at every level. In spite of this the

situation and the problems remain the same as identified then. The main problems and

concerns relating to training in the health sector are summarized as follows:

1.4.1 Need for Training

Low priority accorded to training and the need for in-service orientation.

Inadequate pre-service education, focused mainly on knowledge building and less on

competencies.

Low level and uneven nature of provision for training infrastructure and manpower as

mentioned in Annexure 5.

No induction training for doctors and all other health cadres.

Lack of regular subsequent refresher trainings for professional development.

Lack of adequate training-linked plan for career progression of health professionals.

Inadequate follow-up and mentoring of personnel for perfection of skills learnt in the

trainings and absence of enabling environment to practice skills gained. A simple

example is the non-functioning BP instrument with ANM which takes months to get

repaired.

Governance- Lack of coordination and communication between administrative

departments and training institutes exists2

and there is no accountability.

Ineffective management of training budgets.

Norms for payment to trainers and trainees varying from state to state for the same

training.2

1.4.2 Quality of Training and Infrastructure

Inappropriate number and quality of trainers and facilities.

Inadequate infrastructure/non-availability of adequate infrastructure.

Overly prescriptive, supply-driven and out-dated nature of training.

Lack of effective systems of accreditation and quality assurance.

Poor linkages between different training centres both public and private for training.

Inconsistent availability of distance education for field staff.

Inadequate use of information technology for training and its monitoring.

1.5 Vision

Development of skilled, ethical, dependable and socially sensitive health personnel

committed to excellence in health care, who can deliver the quality of health care comparable

with global standards.

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1.6 Goal

The goal for trainings in health sector is to develop competent, committed and innovative

health professionals to make the health systems around the country more efficient and client

centred. Standards should commensurate with country‟s changing policy for health care.

1.7 Mission

To create infrastructure, manpower and a system to have international standards of trainings,

which enable continuous professional development of all categories of health personnel, to

deliver quality health care services with confidence.

1.8 Scope of The Training Policy

This Training Policy is for the in-service trainings of health personnel for National Health

Programmes.

1.9 Guiding Principles

The training policy envisages that it is necessary and desirable for employees to be trained

regularly to improve their performance and for career progression through a well-organized

system in place. Training should systematically shift from supply based to need-based

training and learning. It has to build competencies and skills at each level, at the induction

stage, as well as through in-service training at suitable time intervals.

The guiding principles include:

1. Regular job chart updation of all levels of functionaries for developing need based

training.

2. Multitasking/ task sharing by health personnel,

3. Competency-based training,

4. Harnessing of Technology,

5. Integration of Public and the Private providers,

6. Linking training to the health systems need,

7. Strengthening the Resources for training – Faculty, training institutions, equipment and

funds.

8. Clarity on the roles and responsibilities of the Training Institutions: - Decentralization in

which clear roles of Training institutions and capacities of states and districts built for

decentralization.

9. Outlining the levels of Authority and Accountability.

10. Developing IPHS like guidelines for all the Training institutions (Annexure.4)

11. Accreditation of trainings and training institutes.

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1.10 Objectives

The training policy framework envisages:

To develop an efficient and effective training system in health sector throughout the

country in partnership with central and the state Governments.

To provide opportunities for the service delivery providers to prepare themselves for

changing roles, duties and responsibilities and to increase job satisfaction and facilitating

career progression.

To enable all health professionals to develop their knowledge, skills and attitudes in ways

that would optimize performance in their current roles.

To inculcate values among service delivery providers that would strengthen their sense of

commitment and to encourage them to regularly review their own training needs and

requirements, and to provide ways of meeting them.

To provide distance education capsules to the health personnel to enable them to

continuously update their competency.

To create an environment which will support/promote the efforts of developing and

testing alternative training approaches which are more effective.

To enhance the training competence of trainers, enabling trainers to acquire high quality

training skills and develop confidence in performing the roles of trainer, researcher and

consultant most effectively and efficiently.

To provide necessary inputs and an enabling environment along with state of the art

training equipment and material which could be periodically updated/revised for high

impact training/skill development programmes at all training institutes.

To promote health services research, and utilize its findings in modifying the trainings.

1.11 The Training Outcome

Development of competent, committed, skilled and ethical health personnel.

Better capacity of the employees for improved output.

Enhancement of the image of self and organisation.

Better responsiveness.

1.12 Ethics and Values

To foster a friendly and healthy administrative and technical environment, training

programmes should adequately emphasize on ethics and value based administration and

working environment, for all emerging issues in the health sector and for society at large.

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1.13 Training Policy Dimensions

1.13.1 Institutional Framework

Training Advisory Committees should be constituted at the national and state levels. The

committees will be responsible for giving directions for all the training activities in the

state. On similar terms, with similar objectives, district training advisory committees

should be constituted.

The training division at the MOHFW should issue guidelines and oversee the fund

utilization provided by MOHFW. National Institute of Health and Family Welfare

(NIHFW) should be the executive arm of MOHFW to work in close coordination with

MOHFW for all trainings. The National Advisory Committee will be convened by the

Training division of the Government of India including NIHFW as a member.

A Training advisory committee should be formed at the State level with Secretary H&FW

as the chair and Director State Institute of Health &Family Welfare (SIHFW) as the

member secretary, who can also be designated as the State Training Coordinator. NIHFW

to nominate a faculty to be a member of the team.

All health training institutions should be effectively linked to the National Institute of

Health and Family Welfare (NIHFW). NIHFW should coordinate with MOHFW, State

Health Directorates, SIHFWs and other training institutes from the NGO and the private

sector to implement the trainings in the country.

SIHFWs should be authorized to enable them to play the role of the lead institution in the

area of training in the state. All health sector trainings under NRHM for personnel at

district and below should be coordinated by the SIHFW with support of the respective

RHFWTC.

All the training institutions in each of the districts should be linked to the District

Training Centre (DTC), and as proposed in 12th

plan document4 and develop into a

District knowledge and training centre. The DTC In-charge should be of a rank

equivalent to that of Deputy Chief Medical and Health Officer (Dy. CMHO). She/he will

be designated as District Training Coordinator. All the DTCs will report to the regional

HFWTCs and SIHFWs.

Funding- 2.5% of salary should go to training on similar lines as quoted in paragraph 9.2

DOPT training policy document 2012. (For long-term, more than 2 weeks training)

A provision of a crèche should be facilitated to encourage women candidates to undertake

trainings.

1.13.2 Accountability Measures

The trained personnel must be posted at a position where he/she can utilize the knowledge

and skills acquired during training and will make a difference in implementation.

The criteria for promotions should include relevant training undertaken.

Deployment, transfer and promotion need to be linked with training through appropriate

HR Policy.

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The immediate supervisor should submit a feedback report after 6 months of training

about the performance of the trainee.

A training roster should be available at the districts and state levels and the trainees

should be aware of the trainings to be undertaken by them at the beginning of the year.

It should be the responsibility of the nominating authority to ensure suitable candidates

for training.

In-service health personnel should be encouraged for higher studies based on their

performance since this will be an incentive for good performance.

Trainings should be undertaken by each health personnel as per the guidelines. The same

person should not be nominated again and again.

1.13.3 Training Capacity and Approaches

Based on the needs and the area-specific situation, each District Training Institution will

decide about the training strategies to be adopted in consultation with SIHFWs and the

respective Training Advisory Committees.

The District Training Centres will be responsible for developing the Annual training

calendar.

NIHFW, SIHFW, HFWTCs and the State Health Services should favourably consider the

potential plans for the district. Funding to be based on the database at district level as per

PIP.

Special skill development programmes will be offered to enable Medical Officers, Nurses

and allied health personnel to pursue their interests and career perspectives, on a regular

basis. Successful completion of such a programme will be considered an additional

qualification for the purpose of placement.

The multiplicity of training programmes and programmes specific training should be

replaced with a well-designed integrated in-service programme for all cadres. Only in

very special situations, a programme-specific training will be organized, for which prior

approval from the appropriate advisory training committee must be taken.

The implementation measures will include linking successful completion of training with

confirmation, promotion and placement.

The training curriculum will be reviewed from time-to-time to ensure that only

competency based, high impact training programmes are organized. Training Needs

Assessment (TNA) of Trainers will be conducted periodically to design high impact

training programmes. A system of concurrent and impact evaluation should be introduced

to ascertain the effectiveness of the training programmes. The trainer‟s performance

should be measured on the basis of training impact, and not on the number of training

programmes conducted.

Realizing that a large number of health functionaries need to be trained each year, which

is far more than the existing capacity of the training institution in the state, SIHFWs

should explore the possibility of offering distance learning and e-based programmes and

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use IT for training and monitoring. Identification of alternative training venues and

resource persons must be explored.

Nomination for training of personnel each year will be based on mapping of a) Functional

facilities b) Availability of skilled personnel c) Priority of the individual e.g. pre-requisite

for promotion d) Availability of venues e) Priority of the programme in the local context

and f) Improving access to services.

Exposure visits between and within districts and states for trainees should be encouraged.

Such visits should be a part of the long-term training programme*.

a) Training Need Assessment [TNA]

TNA exercise should be undertaken on a regular basis by SIHFW to identify the training

needs, which will determine the areas of training and the programmes to be developed. It will

also identify competencies required to be developed in the staff at different levels along the

career path. There is need to focus on the technical/functional skills of the trainees so as to

facilitate their day to day operational decision making. This exercise will be conducted

through the appointment of an in-house team or external consultants as deemed necessary.

Budgetary provisions for the same should be apportioned in the training budget.

The objectives of TNA should be to:

Systematically identify developmental needs of employees

Integrate employees‟ needs with the organizational needs

b) Categories of Training

Training needs of employees should be classified into the following three categories:

1.Technical Training Needs: Focus is on the technical/functional skills or the knowledge of

the employees so as to facilitate their day to day operational decision making. It is assumed

that such training needs, if not fulfilled, may adversely affect the performance of employee.

2.Non-technical Training Needs: Focus is on the development of non-technical knowledge

and skills of employees in the areas of management, leadership, supervision, communication

for IEC & BCC, computer, accounting, and procurement etc. The acquisition of soft skills

like IPC/counselling and communication are essential for the delivery of services.

c) Trainings to be based on TNA: Assuming the health personnel are given technical know-

how only in pre-service education, the core competency should include non-technical and

behavioural besides technical needs.

Mandatory training which all persons have to undergo (Core competencies).

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Perceived /special technical needs for trainings which will be organized only when the

personnel have completed the mandatory trainings.

Programme Divisions should decide as to what would be the most essential specific

competencies for each health personnel working at the peripheral health centres and also

decide as to which health personnel will be trained in what skills at these health centre, so

as to possess the required competencies for delivery of services under NRHM.

*Long-term training programme- more than 2 weeks, these training programmes should

also include exposure to practical field situation within or outside state.

d) Training Levels

Trainings at every stage from entry, promotions, refresher or mid-level and specialised

training should be made mandatory as shown in annexure 1a. The trainings will be as

follows:

Induction level courses- at the time of entry into service for all Medical Officers, Nurses,

ANMs and other health functionaries should be mandatory and completed within 2 years

before confirmation of services. The training should be for the 'core competencies' and

special programmes.

Mid-level refresher courses- between 10-15 years of the service.

Advance courses/Senior level courses- after 20 years of their service for all officers.

Specialised courses as per need of the position.

All the promotions will be extended to personnel having undergone appropriate trainings

during the recommended period.

The potential of „on the job training‟ needs to be tapped, particularly in enhancing

competencies, developing trust, developing teams, and bringing about the much desired

attitudinal change amongst the health functionaries. NIHFW/ SIHFW/ HFWTCs are to

provide all assistance to health personnel to make the best use of „on-job training‟

opportunities.

e) Minimum Training for All Health Personnel

A minimum training package should be considered to bring about the required change in

health care delivery under NRHM. This minimum training package will contain all the core

competencies required for delivery of quality health care service according to the job profile

of the personnel. An individual‟s development can be more objectively linked to the

competencies needed for the current or future jobs.

Career progression and placement need to be based on matching the individual‟s

competencies to those required for a post.

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A fundamental principle of the competency framework is that each job should be performed

by a person who has the required competencies for that job.

During skill development it has to be ensured that each worker develops the required

confidence to provide services of a high quality. For this it is necessary to identify the

essential skills required along with communication skills. Communication skills are

important to bring out behaviour change. During training, it should be ensured that every

worker performs at least the minimum suggested number of procedures for skill

development.

Some of the essential competencies pertain to leadership, financial management, personnel

management (behavioural and inter-personnel skills), and use of information technology;

including computer, logistics and supply and communication are to be considered. The other

set of competencies relate to the professional or specialized skills, as relevant.

In addition to the health management and service providers, in-service training for

administrative staff should also be considered.

Compulsory training for non-technical support staff (drivers, stretcher bearer,

housekeeping staff, security staff etc. particularly in patient handling, biomedical waste

handling, fire safety, kitchen staff in food hygiene and nutrition), etc. Should be

included in the training plan.

1.13.4 Training Infrastructure

a) Training Facilities

Over the years, most of the training centres have become non-functional, mainly because of

less importance given to training by State Governments. There is a generalized apathy

towards training and capacity building. Training is hardly recognized as an intervention to

improve performance. A survey done by NIHFW as mentioned in annexure 5 calls for action

on all of these issues for improvement. There is a need for:

Certification and Standardization: Standards for Training Institutes should be

established at various levels and for different types of trainings, similar to Indian Public

Health Standards for health facilities. However, the norms at district level should not be

uniform but based on the size of the training institute.

Training Institutes availability – The State should draw a list of training institutes

available, map the functional facilities and the trainings imparted at these institutes. The

short listing of these should be done through an evaluation criteria based on standards

developed (as per IPHS) for training institutes, including for those at Medical/Nursing

colleges, NGOs or private facilities and also from converged sectors as department of

Education, Rural Development and Women and Child Development.

Based on the mapping, additional training facilities should be established.

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Redefining the District Training Centres: The ANMTCs, MPWTCs and the District

Training centres should be the hub of all the trainings in the district including the

trainings of the MOs, LHVs, PMSUs, male MPWs and supervisors etc. and these training

centres should be fully equipped with all teaching aids including computerization and

internet and linked to a number of learning centres and to various libraries for accessing

journals and various publications. The number of teaching rooms and the hostel rooms

should be according to the training load for the district.

The practical trainings should be imparted at the Skill lab as described in Annexure1b and

2 and District hospitals. This will help in avoiding duplication.

Specialised centres based on standards will be accredited for skill development trainings

under maternal health like BEmOC, EmOC, SBA, or family planning as Minilap,

Laparoscopic sterilisation, IUCD and NSV or child health like NSSK, IMNCI, FIMNCI

etc. The list should be uploaded on the state website.

State of the Art Simulation labs should be established at NIHFW and SIHFW for hands

on training. At other training centres there should be provision of Skill Labs which will

enhance the quality of trainings and facilitate coverage. This will help in the reduction of

workload on the Medical colleges and other hospitals.

Each HFWTC/DTC will develop a Field Practice Demonstration Area (FPDA) at one of

the Primary Health Centres (PHCs) to organize field based trainings in a systematic

manner.

b) Networking

All training institutions are not being utilized and no efforts are being made for strengthening

the arrangement of training institutes along with district training plan. To strengthen linkages,

collaboration and integration between all institutions that are involved in training there should

be networking of State Government training institutions with medical colleges, private and

NGO hospitals and various field training centres in the State.

The SIHFWs should work closely with State Health Systems Resource Centres (SHSRC) and

if possible these should be located in the same premises. In Kerala, SIHFW and the SHSRC

have a common Director which has resulted in good outcomes without any duplication.

A database of all the institutions conducting trainings in the districts and at state levels should

be available with the states, equipped with GIS software for mapping and uploading on

websites. There should be integration of SIHFW with training institutions providing training

for different National Health Programmes (e.g. TB, Leprosy, Malaria, Non-Communicable

Diseases, health care of elderly etc.).

Since NRHM envisages convergence of H&FW with WCD, AYUSH, Department of

Drinking Water and Sanitation, Education and PRI, their facilities of training should be

utilized. This will ensure cost minimisation and maximum utilisation of human resources,

materials and facilities.

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Role of Medical College – Medical College should be used as a training institute and the

medical faculty should give skill based training.

c) Knowledge Community Hub for On-going Training in Health

1. A Knowledge Community Hub for on-going training in health should be established with

NIHFW and SIHFW playing a pivotal role.

2. The NIHFW website should have an online database of certified resource persons,

available courses, information on relevant conferences and seminars and training

materials together with developments and experiences of trainers and trainees obtained

from the conduct of various training courses.

3. A blog should be a part of the NIHFW and SIHFW website for sharing of information.

1.13.5 Human Resource and Training

Various problems exist in the current situation with regard to Human Resource

Development2, 5,6,7

. Though norms have been developed for manpower to be placed at each

health facility for service delivery, there are no norms for the number of trainers required in a

district /state to fulfil quality trainings in time for all as per need.

The need of inter-sectoral manpower development as perceived under NRHM, where the

convergence of Health and Family Welfare is important with WCD, AYUSH and Department

of Drinking Water and Sanitation and PRI, but it is yet to be done. The health functionaries

along with allied human resources from other converged sectors need to be trained to provide

the services at facilities with a holistic approach.

The human resource development function cannot be discharged effectively unless

comprehensive data on recruitment, movement, training status and performance appraisal of

all functionaries is readily available with all the training institutions. A Human Resource

Management wing /Database should be created at district, state and national levels to

maintain the data on computer and provide the information regularly to training institutions

and training coordinators. The information will be used for human resource planning and

nominations for training programmes and placement.

A perspective Human Resource Plan should be developed by each state to project the needs

of human resource as precisely as possible. The need of NGOs and the private sectors will

also be considered while estimating the needs of human resource for health.

The training institutions should have a work culture where trust prevails and performance is

rewarded. Steps should be taken for humanizing work through introducing office automation

and promoting the concept of self-help and self-reliance.

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a) Availability of Faculty at the Training Centres

Dearth of faculty is a major problem at all the training centres. Incentives need to be given to

faculty who are posted at the training centres. They need to be kept motivated through

continuous updates for capacity building on knowledge and teaching skills.

b) Training Cadre

There is a need to create a Training cadre. This will address the career progression for the

faculty at the training institutions. Cadre Faculty at the district level can get with promotion

to HFWTCs and subsequently to SIHFWs may be considered. This will help in the retention

of the faculty skills for training in the officers and ensure appropriate utilization of training.

c) Selection of Trainers

It is essential that the trainers have certain special qualities and there is a system in place to

monitor the standards of trainers both in qualitative and quantitative terms. Since substantial

investments are made in developing a master trainer, it is important that the right person is

selected for development and that due recognition, incentive and respect is given to the

trainer, so that others opt for becoming trainers.

The process of development of the trainers should be standardized so that there is a certain

minimum standard in performance of their roles and responsibilities. Certification of trainers

can be done.

The role of trainers should not be limited to class room training. Trainers must participate in

solving performance deficit problems faced by the providers at the cutting-edge.

The competence and self-esteem of the trainers lend credibility to the training institutions.

Thus high priority should be assigned to development of competencies of trainers. Esteem of

training institutions can be built by creating a separate training cadre in all the states. There is

a need to develop well-defined process for recruitment, placement, rotation and promotion.

The trainers should be provided the best possible opportunities for enhancing their

competencies through regular training and study tours within the country and abroad. There

should be two types of trainers: fixed and mobile/floating.

Fixed trainers will be the regular faculty at various levels of training institutes and skill lab.

Floating or mobile trainers will be those attached with the training institutes, who will

provide technical aid in various training programmes by giving supportive supervision and

hands –on training to already trained personnel at their facility level. These mobile trainers

could be taken from public or private sector that are willing to travel.

d) Eligibility Criteria for Trainers

While appointing officers and staff to these positions the following need to be kept in mind:

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(a) They should have a stable tenure of at least five years and are keen to learn new skills and

practice them and have an aptitude for teaching.

(b) The person should be selected out of his/her own interest rather than as routine.

(c) Personnel to be trained as trainers should be computer literate from training cadre.

e) Incentives for Trainers

Incentives should be built in for trainers and recognition be given for excellent trainers.

Faculty should be given an extra allowance as recommended in sixth pay commission,

wherein they can get a definite percentage (30%) of their salaries as an incentive.

f) Resource Pool

There should be a resource pool of trainers for all the trainings involved. Reserve trainers

should be introduced so that unavoidable absence of a trainer does not hinder either initiation

or on-going training. This would also ease the load of multiple trainings on a single trainer.

Officers with specialised trainings in India or abroad will form a pool of resource persons.

Faculty in-charge programmes should be initiated similar to UGC for the training institutions.

Accredited trainers for various types of training from public and private sector should be

developed by NIHFW in collaboration with SIHFW which further will be a part of the

resource pool. This increase in the resource pool will provide opportunity for good trainers to

be a part of the public health system.

Retired trainers or from the private sector and NGOs with requisite expertise should be

included in the resource pool since there is an immense shortage of trainers and faculty.

There should be a review of master trainer‟s certification based on their commitment and

performance by the monitoring cell at SIHFW in consultation with NIHFW after every five

years.

The review should be done taking into account the minimum stipulated number of trainings

conducted and the feedback from trainees indicating competence in such courses. In case any

particular master trainer has not satisfied the stipulated criteria, then his/her certification will

not be extended.

g) Trainer's Competence

(a) Only highly competent certified faculty and resource persons will be placed in the

training institutions by open selection. If required, states will modify their recruitment

rules in the context of the training institutions.

(b) The trainers will be encouraged to pursue research.

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(c) One of the responsibilities of NIHFW/SIHFW will be developing the competencies of

trainers and resource persons for each level and organizing special programmes on

competency enhancement for trainers.

(d) Faculty exchange, visits and other forms of interaction between training centres should be

undertaken to ensure continuous renewal of expertise.

(e) Every faculty and trainer should update their skills and knowledge by undergoing faculty

development programmes which should be organized as a routine activity by NIHFW

through SIHFW.

1.13.6 Selection and Nomination of Health Personnel for Training

The need for trainings should start with the training need assessment normally not done

before the preparation of training plan currently. Planning for training is not articulated from

sub-centre upwards. Total training load is not properly calculated keeping in view the

available and functional facilities. Skill training has not been categorized as core skills and

specialized skills.

It has been generally observed that trainings are not synchronized with need of health

facilities, supplies and referral linkages.

In the absence of personnel management information systems, right candidates are not

nominated to the trainings, and there is a poor follow up after training.

State Programme Officers in their enthusiasm keep on convening vertical trainings which

take up lot of time of providers from the peripheral facilities. States, hence, face a lot of

difficulty in implementing these trainings from different divisions at the same time as the

target participant for many trainings is the same. Very often many positions are vacant

leading to further difficulties in sending appropriate nominations.

A trained officer or staff is not considered as an asset and hence not utilized properly.

i. Criteria must be followed in selection and nomination of trainees for training, keeping

in view their current job responsibilities.

ii. The training cell at state and district should maintain up to date data of all officers and

staff with reference to the trainings they have undergone and further training required.

This inventory of trained persons will be computerised, wherever possible, to

facilitate quick reference and ensure up to date information. A roster for systematic

training for all should be followed.

iii. In prestigious assignments of training, special care will be bestowed in selection of

candidates, job requirements, the attitude and aptitude of an incumbent.

iv. There will be systematic procedure to make use of the training undergone by officers,

particularly special training. On return from training, officers will be posted as far as

possible to the seats where the training can be made use of at least for a period of

three years.

16


v. On return, from long-term training courses, the officers will make a presentation of

major concepts, themes, etc. to their heads of departments and other colleagues. This

is expected to kindle interest in new ideas, systems in the concerned departments.

Further, the suggestions made by participants after training should not be brushed

aside. The heads of department will give thought to such suggestions and implement

those which are practicable and do not involve exorbitant costs. This will be an on-

going and continuous exercise.

vi. All health training institutions should be given enough functional autonomy to

generate funds for trainings as well as for research activities.

a) Models of Training

i. The Cascade Model - Cascade model for trainings has been adopted as a rule in the

system so far. Though, it is a good method but just by imparting training does not make

everyone a good trainer. This has often led to dilution of the quality at peripheral level

specially for the ANM (Figure 1).

ii. The Horizontal Model - is to train master trainers and have training of trainers (TOTs) at

state level institutions including Medical Colleges for specialised clinical skill training or

regional level at HFWTCs. The number of trainers will be according to the need and size

of the district. The required number of teams per district may be calculated according to

the training load. They should be responsible to saturate the district training load within a

given time. This strategy was adopted in Karnataka due to which they completed the

Immunization training of all medical officers within one year (Fig 1).

iii. Video Conferencing - model to do a video-recording of all the sessions as conducted by

the main master trainers and use them in each training with the local level trainer acting

as a facilitator. Webinars are the other alternatives since they will involve direct

interactions and will also cater to the issue of non-availability of good faculty

iv. Skill Lab Based Model - This model is based on use of Skill Lab. Example of this is

given at Chapter II, This reduces time and builds skills better in trainees.

17


Figure 1a

Figure 1b

Cas

cad

e M

od

el o

f

Trai

nin

g MOHFW

NIHFW

STATE

SIHFW

DTC

CHC

PHC

Hu

man

Re

sou

rce

Dev

elo

pm

ent

Po

licy

PHC PHC

SC SC SC

RESOURCE PERSON MEDICAL COLLEGES+ HFWTC +NGO + PRIVATE+DEVELOPMENT PARTNERS

HFWTC+NGO+ PVT.

MO

PHC

MO

CHC

MO

DH

LHV MPW

(M)

PHA

RMA

CIST

LAB.

TECH.

MALE

SUPER

VISOR

ANM

Horizontal Model

HFWTC+NGO+ PVT.

18


1.13.7 Tools for Management of Training

Training Calendar: The State training cell should prepare its training calendar at the

start of each financial year. This calendar should be prepared in conjunction with the

State Training Institute and be uploaded on State institute‟s website. The trainees

should be communicated about the training plan through appropriate channels so that

the trainee and the management can make proper plans to relieve the trainee on time.

Comprehensive Training Plan10

(CTP) - The plan should be feasible taking into

account all the determinants which will facilitate the completion of the planned

trainings. An alternative plan should be in place which addresses the likely

constraints. This CTP should be district based and form part of the District Action

Plan. The plan should focus on all types of training requirements of personnel posted

at the district and below till periphery. An integrated training approach should be

adopted to minimise the number of visits of the trainees. However, a scrutiny of the

PIPs 2011-12 indicated that the load for different trainings were not considered as per

the requirement of the district needs, also reflected the none or low availability of

functional facilities for training. This has led to non-completion of trainings and non-

utilization of budgets.

Monthly and Annual Progress Reports - the progress reports should be reviewed by

a monitoring team at district (District training team) and then at state level (SIHFWs

and Programme managers). Monitoring can also be done by Medical colleges

wherever available.

Standardised Checklists for assessment of pre-training site readiness, quality during

training and post training submission of reports and accounts should be developed and

followed.

Feedback Checklists to be developed which will be filled and submitted by the

immediate supervisor to district and state after 6 months of training for the trainee.

Further release of budget may be done after receipt of the reports of these checklists.

For proper management a computerized and web-based reporting system (MIS for

training) from DTC through SIHFW to NIHFW should be developed.

A uniform guideline of funding should be followed for all types of trainings across the country.

a) Evaluation

New ways of Evaluation will be introduced especially for the evaluation of skills and

competencies.

Pre and post-course evaluation using scoring/grading system.

Session evaluation

Follow up evaluation

19


After a gap of about 6-12 months, feedback should be obtained from the immediate superior

officer of the participant, to assess the performance of the participant after the training.

Development of Performance Assessment Protocol and Incentive System for Trainers should

be part of evaluation.

1.13.8 Training Management (Database)

A data base should be developed for tracking and record keeping of trainers, trainees and the

types of trainings held with details each year at district and state levels. Tracking of the

Resource Pool of trainers and of the trained personnel should be done through GIS mapping.

Visualisation of spatial distribution of trainers and trainees will facilitate better planning and

resource optimization. This database should be a dynamic one and should also include details

regarding the training institutions.

The State Training Institutes should maintain databases with respect to details like

participants name, department, training attended, location (placement after training) etc. The

database should also include details of training manual, course content, name of faculty, date

of training programme attended, feedback form filled by employee, funding etc. which

should be updated periodically. These data should be maintained at Regional/ State level for

monitoring and evaluating the achievement.

The database should be uploaded on the State‟s website with linkages to the NIHFW website.

There should be good linkages and effective communication between the State Training Co-

ordinator and SIHFW for developing and maintaining an updated database.

1.13.9 Training Material Development

(a) Very little attention is paid in developing locally relevant training material. There is an

urgent need for adopting a meticulous approach in developing training modules. In

addition to using material supplied by MOHFW/ GOI /NIHFW appropriate and relevant

materials should be developed by the training institutes in the state at all levels in

consultation with programme divisions at MOHFW. All training materials should be

made available in regional languages.

(b) The training institutions must be provided with facilities and inputs to develop new

materials, or adapt the existing materials, which are need-based and trainee-specific and

duly pre-tested. NIHFW/SIHFWs will provide necessary technical support and guidance

to all other training institutions in the state for this purpose. They will also review the

training materials periodically to ensure they are as per state need.

(c) In order to develop, encourage and evaluate a wide range of training material, including

multi-media, a special cell will be created in all SIHFWs mentored by NIHFW.

20


(d) Help of donor agencies will be taken. An example of immunization training material

developed by MOHFW/NIHFW and WHO was given along with the training kit, this

ensured that the trainings were uniformly held across all states.

1.13.10 Monitoring

Appropriate monitoring mechanisms with checklists should be instituted for ensuring the

quality of trainings. These records should be used for certification of trainings.

All States should designate training coordinators and monitors at appropriate levels to

develop and coordinate and monitor training programmes.

Use of IT should be done for monitoring and feedback.

1.13.11 Quality Assurance

a) NIHFW should evolve a process for Quality Assurance/Certification in training including

development of quality indicators and accreditation for the courses based on QCI norms

of National Accreditation Board for Education and Training (NABET). NABET is the

accrediting arm of QCI for training courses and training institutions.11

b) An Accreditation cell will be set up at NIHFW with sister cells at SIHFWs for the

purpose.

c) NIHFW will evolve as an institute of excellence to perform the functions of Accreditation

and also be a model for other training institutions.

d) MOHFW/NIHFW/SIHFW will develop the norms and standards for assessing the quality

of education in the training institutions. NIHFW will also conduct audits.

e) A Quality Manual and Standard Operating Procedures (SOPs) should be developed for all

aspects including course curriculum, content, course delivery, methodology, assessment

procedures, training infrastructure etc.

f) Training Institutions should be oriented on the quality manual and SOPs.

g) NIHFW should mentor the institutions for quality assurance measures. The accredited

training centre at NIHFW will invite applications from both Public and Private sectors for

training which will increase the pool of certified accredited trainers. This should be done

for all types of training.

1.13.12 Use of Information Technology in Training

a) All training institutes must enter in the network, either by establishing their own

websites or by joining the webs of their respective departments. These sites must create

a scope for e-mail groups or blogging or Skype through which the trainers, health

activists, and the service-providers should remain in consistent touch with each other.

b) Video conferencing, webinars and video films will be used for uniform training.

c) Training systems of all states are expected to exploit the internet technology in setting

up their communication with nominating authorities, and trainees concurrently. Annual

21


training calendars along with announcement of specific training programme should be

made available on website well in advance.

d) Developing software on transmitting training information on weekly/monthly basis to

administrative authorities at district/HRD cells at State level will help in mobilizing

training. The software will also give a regular status of the training institutions –

Faculty (their educational qualifications, training, faculty development programmes

attended), equipment, teaching learning material, infrastructure, etc.

e) E-based courses should be developed.

f) Monitoring of trainings will be done using Skype and feedback through mobiles.

g) GIS mapping of trainers and trainees for planning of trainings.

1.13.13 Convergence with Other Sectors and Inter-Sectoral Training

Convergence of H&FW is important with Departments of Women and Child Development,

AYUSH, Drinking Water and Sanitation, Education and Panchayati Raj Institutions. There is

a need to sustain the positive changes brought at community level in recent years through

NRHM. In this context, it will be reviewed.

a) The trainers at various levels would consistently contribute their potential to the

orientation of members of Village Health and Sanitation Committee formed in NRHM.

Trainers from state, regional, and district training institutes should consistently participate

in the grassroots trainings for ASHA, AWW and ANM in the field. Indirectly, such a

process would keep the training institute abreast of inter-sectoral convergence.

b) SIHFW/HFWTC/DTC must be involved in orienting PRI and their representatives in

Rogi Kalyan Samitis, Swasthya Kalyan Samitis or equivalent, whatever exists in different

states.

c) Mainstreaming of AYUSH is one of the core strategies of NRHM. The faculty of state,

regional, and district training institutions should facilitate the trainings/orientation of

AYUSH personnel.

d) Health sector training institutions must set coordination with the training systems of

Women and Child Development. It would help in carrying forward the effective

implementation of ICDS, and women empowerment programmes.

e) Faculty of health training institute must also take in cognizance the activities of total

sanitation project and water supply schemes usually implemented by Public Health

Engineering Department of the respective states.

f) Similarly agenda of Adolescent Friendly Health Services, HIV/AIDS prevention, and

reproductive health can be justified through effective coordination between education

sector and training institutions of health sector including medical colleges.

Considering the importance of training to achieve improved efficiency and effectiveness in

implementation of all national health programmes and RCH the National Training Policy of

MOHFW should be implemented.

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Chapter II

2.1 Implementation of the National Training Policy (NTP)

Implementation of the National Training Policy should be done in a time bound manner to so

as to cover the training load within a period of two years for those at PHCs and have trained

personnel at every delivery point within five years at the district level and below. The

approach has to be “Bottom Up and not Top Down”. The size of population, terrain, training

infrastructure, and the type of trainings completed and currently needed vary from state to

state and should be addressed by the states themselves based on the guidelines for the

governance and according to the structure and functions of the training institutes at the

national, state and district levels as given in Table 1 below:

Table 1: Institutional Framework

Actions at various levels Details

National Level

Structure

Training Division in the Ministry

Coordination with the various divisions for trainings

Establish minimum requirements for all programmes

Approval of plans and channelling of funds

NIHFW

NIHFW will act as the Nodal Institution to support MOHFW to implement, coordinate and monitor training under NRHM throughout the country.

Establishing a quality assurance /Accreditation cell at NIHFW

Coordinates with MOHFW in pooling of experts from various specialities available in the country.

Functions

NIHFW, NHSRC

Training Needs Assessments

Developing Prototypes of curriculum and learning material

Operations research

Resource centre for prototypes of courses, resource materials and studies

Creation of National Level Trainers

NIHFW

Developing norms and standards for Training institutions and courses similar to IPHS with NABET

Developing the SOPs and Quality Manual for Training Institutions

Develop and maintain simulation labs

Preparation of institutions and trainings for accreditation

23


Actions at various levels Details

Infrastructure assessment of Training Institutions and need assessment of strengthening these institutions from time to time

State level

Structure Establishment of a State level Training Advisory cell

Develop a database of all the required manpower

Support State Institutions

Recommend for Accreditation the identified institutions fulfilling the criteria for conducting training programmes

Monitor state requirements

Channelling and release of funds

Functions

State level institutions –

SIHFW, NGO, Pvt,

Development Partners,

HFWTCs and with

converged depts. under

NRHM

Conduct training programmes and TOTs

Adapt the national curriculum to local needs and cultural

aspects

Monitor the performance of the HFWTCs and DTCs and

ANMTCs and identify private sector for PPP.

Collation of training plans received from the District to put up

in PIP to MOHFW/NRHM

Coordinate with NGO, Pvt, HFWTCs to facilitate trainings

at the district within timelines

Creation of State Level Trainers

District level

Structure

Establishment of a

District level training

advisory cell

Coordinate with state

Assess demand for trainings from each facility

Develop a database of all the Manpower ,Trainers and

trainees

Monitor district requirements and maintain Skill Lab

Release of funds

Functions DTCs and ANMTCs

Develop District level Trainers

Ensure preparation of District training Plan and submit in

time to the SIHFW.

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References:

1. Bhore committee report, 1946.

2. 5th

Common Review Mission Report 2011, MoHFW and NHSRC.

3. National Training Strategy for In-service Training, MoHFW, 2008.

4. Approach paper to 12th

Five Year Plan.

5. Human Resource for Health: The Crisis, the NRHM Response and the Policy Options-

Draft Policy brief, NHSRC.

6. Human Resources Action Plan Orissa State- March 2009

7. Nandan, D. Nair, K.S. Datta, U. Human Resource for Public Health in India – Issues and

Challenges. Health and Population: Perspectives and Issues 30 (4): 230-242,2007.

8. National Training Policy 2012, Dept. of Personnel and Training- Training division, GOI

9. Revised IPHS 2010 draft: Job responsibilities of Medical Officer, ANM, LHV, MPW

(M), LT (As per revised IPHS 2010 and National training Strategy 2008).

10. Comprehensive Training Plan,2011, NIHFW

11. NABET- National Accreditation Board for Education and Training

12. High level expert group report on Universal Health Coverage for India- Instituted by

Planning Commission of India.

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