se30 improving hw ist - harvesting good practices and lessons learnt
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Session overview and objectives Diana Frymus Health Systems Strengthening Advisor Office of HIV/AIDS USAID
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Workshop objectives:
1. To launch the first global improvement framework for health worker IST
2. Harvest and share experiences, strategies, and lessons learnt on
addressing key IST challenges for health workers
3. Facilitate networking, shared understanding and learning between
health workers, Ministry of Health representatives, training institutions,
donors and partners to improve IST
Expected outcomes:
1. Participants will learn about the IST improvement framework and how
to use it to improve in-service training systems for health workers
2. Participants will enhance their understanding of how to evaluate in-
service training program outcomes and impacts
3. Participants will gain new knowledge and multi-stakeholder
connections to improve in-service training that will enable health
workers to provide better care
4. Participant experiences, lessons learnt and evidence will seed a new
global wiki on in-service training improvement
Launch of the in-service training improvement framework: What, why and how to apply Tana Wuliji Senior Quality Improvement Advisor USAID ASSIST Project, University Research Co., LLC (URC) @TanaWuliji
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The in-service training improvement framework Towards more effective, efficient and sustainable training
Developed and launched by
International Center for AIDS Care and Treatment Programs (ICAP); International
Pharmaceutical Federation (FIP); IntraHealth; International Training and Education
Center for Health (I-TECH); Jhpiego; Sciences for Health (MSH); Pan-American Health
Organization (PAHO); Pathfinder; World Medical Association (WMA); USAID; University
Research Co. (URC)
What is the in-service training (IST) improvement framework?
A set of practice recommendations to improve
in-service training effectiveness, efficiency and
sustainability that were developed and agreed
through international expert consensus
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Significant proportion of country HRH investments
Needed for scale-up of health services (HIV, TB, MCH)
Growing attention of countries in reviewing IST portfolios
Global landscape: Need for evidence-
based guidance for improving IST
How was the IST improvement framework developed? Delphi process
1. Develop and revise recommendations
2. Consolidate recommendations
3. Targeted literature review on
recommendations
4. Rate agreement on recommendations
25 member
consensus group
June – December
2011
Delphi process Development and review of recommendations through 5 rounds of peer review and ratings (Delphi process) and literature review
External open consultation: 4th round
• November 3-29 2011, online
• 26 countries
• 86/119 complete responses
Final consensus: 40 recommendations across 6 themes by 25 member expert panel
Improvement framework +
guidance Expected January 2014
How was the IST improvement framework developed?
IST improvement framework themes
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1. Strengthening
training institutions
and systems
2. Coordination of
training
3. Continuum of
learning from pre-
service to in-service
4. Design and delivery
of training
5. Support for
learning
6. Evaluation and
improvement of
training
Using the IST improvement framework: Examples
• Nigeria- IST Assessment of PEPFAR Nigeria Portfolio
(CapacityPlus/IntraHealth)
• Afghanistan- Informed organization of National Training
Standards for the Afghanistan General Directorate of Human
Resources In-Service Department (HSSP/Jhpiego)
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National IST strategy development workshop,
Oromia, Ethiopia, August 2012. Photo: USAID
HCI.
• Ethiopia- IST Rapid
Assessment to inform
Ethiopia Federal
Ministry of Health
efforts and strategies
to improve,
institutionalize, and
standardize IST
(HCI/URC)
In-service training journal series: Human Resources for Health Journal
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Launched October 1st 2013 by
USAID, USAID ASSIST, Jhpiego,
I-TECH and IntraHealth
Open access: www.human-
resources-health.com/series/IST
Design and delivery of training: Recommendation: 4.3 IST should be based on sound, evidence-based learning principles and methodologies that offer the best opportunity to produce sustainable performance improvement within the workplace.
Explanatory note:
In order for IST programs to most effectively improve health worker competencies,
they should apply state of the art learning principles and methodologies appropriate
to the context that are based on the latest evidence……
Examples:
• For the development of clinical decision
making skills, a RCT comparing an
interactive workshop-based training to
simulation training found that simulation
training resulted in better skill performance.
This is reinforced by systematic reviews
that identify clinical simulations as an
effective technique for developing
psychomotor and critical thinking skills.
Daniels et al, 2010; Nestel et al, 2011;
Issenberg et al, 2005
Resources:
• The Johns Hopkins Evidence-
Based Practice Center
recommends multiple techniques,
multiple media, interaction and
repetition. Marinopoulos SS et al,
2007.
• The Learning for Performance
tools provide guidance on
designing training for desired
performance
http://www.intrahealth.org/page/le
arning-for-performance
Expert Consensus Group Marita Murrman, International Center for AIDS Care and Treatment
Programs (ICAP); Mike Rouse, International Pharmaceutical
Federation (FIP); Rebecca Bailey, Shaun Noronha, Kate Tulenko,
IntraHealth; Gabrielle O’Malley, Tom Perdue, Frances Petracca,
International Training and Education Center for Health (I-TECH);
Julia Bluestone, Peter Johnson, Edgar Necochea, Jhpiego; Karen
Chio, Gail Naimoli, Management Sciences for Health (MSH); Rosa
Maria Borrell, Pan-American Health Organization (PAHO); Cathy
Solter, Graciela Salvador-Davila, Pathfinder; Julia Seyer, World
Medical Association (WMA); Diana Frymus and Lois Schaefer,
USAID; Tana Wuliji, Akuba Dolphyne, Tisna Veldhuizen Van Zanten
University Research Co. (URC); Habib Benzinan, Alan Lyles, Linda
Ippolito, Hugo Mercer, Independent experts.
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Lightning talks
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1. Strengthening
training institutions
and systems
2. Coordination of
training
3. Continuum of
learning from pre-
service to in-service
4. Design and delivery
of training
5. Support for
learning
6. Evaluation and
improvement of
training
1. Strengthening
training institutions
and systems
2. Coordination of
training
3. Continuum of
learning from pre-
service to in-service
4. Design and delivery
of training
5. Support for
learning
6. Evaluation and
improvement of
training
• Engage national authorities, regulatory and professional bodies
• Build capacity and strengthen local infrastructure and trainers
• Support CPD systems
Theme 1: Strengthening training institutions and systems
Ethiopia’s experience with in-service training institutionalization and standardization Dr Samuel Hailemariam, Health Systems Strengthening Advisor, USAID Ethiopia
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1. Strengthening
training institutions
and systems
2. Coordination of
training
3. Continuum of
learning from pre-
service to in-service
4. Design and delivery
of training
5. Support for
learning
6. Evaluation and
improvement of
training
• Coordinate IST
• Minimize duplications: Coordination mechanism
• Reduce disruption to health services
• IST tracking mechanism
Theme 2: Coordination of training
iHRIS system for tracking training Rebecca Bailey Team Lead, Health Workforce Development, CapacityPlus, IntraHealth
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Coordination of Training
iHRIS system for tracking training
Sam Ngobua, Director, CapacityPlus, Nigeria
Rebecca Bailey, Team Lead, Health Workforce Development, CapacityPlus
Nigeria - Context
• Substantial US Government investment in in-service training (IST) of health workers in HIV/AIDS-related topics.
• A 2012 assessment – based on the IST Framework – found limited coordination of IST among PEPFAR-funded implementing partners.
• Recommended introducing an information system to track IST across implementing partners in order to decrease duplication, improve coordination, and ensure that the right health workers receive the right kinds of training.
Objectives of the Training Information System
• Track trainees to avoid double training of the same health worker
• Coordinate training between PEPFAR-funded implementing agencies
• Track availability of Master Trainers
• Ultimately reduce cost and improve efficiency
iHRIS Train Prototype for Nigeria
• Web-based application developed on the open-source application platform of iHRIS
• Open-source, user friendly and user operating system independent, affordable and customizable
• Sustainable through local capacity building
• Backed by IntraHealth informatics experience in over 23 countries
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Welcome Page – Implementing Agency
iHRIS Train Nigeria 24
View and Edit Training Courses
iHRIS Train Nigeria 25
View Calendar of Scheduled Training Courses
iHRIS Train Nigeria 26
View Summary page of Participants
iHRIS Train Nigeria 27
Search for other Implementing Agencies
iHRIS Train Nigeria 28
List of Participants Report
iHRIS Train Nigeria 29
CONCLUSION
iHRIS Train Nigeria 30
• iHRIS Train Nigeria is a work-in-progress.
• It is scalable to meet the needs of the PEPFAR-funded implementing agencies and the Federal Government of Nigeria for an In-Service Training Information System.
• Affordable and sustainable
• Backed by the multi-national experience of CapacityPlus/IntraHealth Informatics.
Questions for Knowledge Café Discussion
• Is there a need for an electronic IST
tracking system in your country or for your
training programs?
• What characteristics or functions are most
desirable in a training information/tracking
system?
1. Strengthening
training institutions
and systems
2. Coordination of
training
3. Continuum of
learning from pre-
service to in-service
4. Design and delivery
of training
5. Support for
learning
6. Evaluation and
improvement of
training
• Synergies between pre-service education and IST systems
• Consistency in approaches and content
Theme 3: Continuum of learning from pre-service to in-service
Lessons learnt by professional associations, regulatory bodies, nursing schools and Ministries of Health from strengthening CPD systems Carey McCarthy Health Systems Scientist, CDC supported African Regulatory Collaborative
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1. Strengthening
training institutions
and systems
2. Coordination of
training
3. Continuum of
learning from pre-
service to in-service
4. Design and delivery
of training
5. Support for
learning
6. Evaluation and
improvement of
training
• Needs based: aligned with plans, understand performance barriers
• Compliance with policies, strategies and laws
• Evidence based methodologies
Theme 4: Design and delivery
Findings from an integrative review of literature on training design and delivery Julia Bluestone Senior Technical Advisor, Jhipego @juliabluestone
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Effective In-Service Training Techniques,
Frequency, Setting and Media:
Synthesis of an Integrative
Review of the Literature
What evidence is there to
support educational
techniques, Frequency (single
vs. repetitive), setting, and
media used to deliver
instruction?
What evidence exists about
the outcomes (knowledge,
skills, attitudes, provider
behaviors, patient outcomes)
of continued health
professional education?
In the context of continuing health
professional education
Julia Bluestone, MS
Peter Johnson, PhD
Judith Fullerton, PhD
Catherine Carr, DrPH
Jessica Alderman, MPH
James BonTempo, MS
What surprised us? (Or didn’t!)
Didactic-”low to no” outcomes
Simulation effective
Practice and feedback ‘dosage’
matters
Shorter, but more often
Workplace-setting better
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Question:
Given the current system is
designed for group-based training,
what changes do we need to make
to implement, shorter, repeated,
simulation-heavy, workplace-based
training?
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1. Strengthening
training institutions
and systems
2. Coordination of
training
3. Continuum of
learning from pre-
service to in-service
4. Design and delivery
of training
5. Support for
learning
6. Evaluation and
improvement of
training
• Share resources and materials
• Support trainees post-training
• Life long learning skills
Theme 5: Support for learning
Point of care performance support tools linking standards to resources needed to support them Julia Bluestone Senior Technical Advisor, Jhipego
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SSDI Services
Mentoring in Malawi
Support for Learning
SSDI Services
Question:
How do we prepare, support and incentivize busy health care workers to provide workplace-based mentoring or support to others?
1. Strengthening
training institutions
and systems
2. Coordination of
training
3. Continuum of
learning from pre-
service to in-service
4. Design and delivery
of training
5. Support for
learning
6. Evaluation and
improvement of
training
• Build in evaluation to inform continuous improvement
• Evaluate against defined criteria
• Engage key stakeholders and trainees
Theme 6: Evaluation and improvement of training
Training Evaluation Framework and Tools (TEFT) Gabrielle O’Malley Director for Implementation Science, I-TECH
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Is training making a difference?
International Education and Training Center for Health
INDIVIDUAL
SITUATIONAL FACTORS
ENVIRONMENT
HEALTH SYSTEM / POPULATION
ORGANIZATION
TRAINING EVALUATION FRAMEWORK
Training
Population level systems improvements
Population level performance outcomes
Population patient health Outcomes (impacts)
Organization systems improvements
Organization performance outcomes
Organization patient health outcomes (impacts)
Individual knowledge, attitude, skill outcomes
Individual performance outcomes
Individual patient health outcomes
INDIVIDUAL • Trainee background,
knowledge, experience, education
• Intrinsic motivation • Family demands
HEALTH SYSTEM/POPULATION • National, regional, community
systems – labs, supply chain • National, regional policies • Partner programs • Available health workforce,
including informal private, attrition issues
• Pre-service program • Retention factors, e.g. pay scales
ENVIRONMENT • Political instability • Prevalent disease • Natural disasters • Food availability • Seasonal changes • Patient access to food,
transportation • Available community support
resources
ORGANIZATION • Management support • HR – staffing levels, salaries,
burnout • Available drugs, supplies,
equipment and infrastructure • Facility systems –
appointments, records, flow, referrals
• Patient needs
Training Evaluation Framework (TEFT)
6 planning steps with tools and guidance
Planning steps Tools 1. Identify anticipated
outcomes Framework and template
2. Address situational factors Worksheet
3. Refine the scope of the evaluation
5 Considerations tool
4. Define evaluation questions, objectives, and indicators
Worksheet
5. Choose evaluation design and methods
Resource tables
6. Plan the evaluation Planning template
Training Evaluation Framework and Tools 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?
http://www.go2itech.org/resources/TEFT
Knowledge cafe
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1. Strengthening training institutions and systems: Dr Amir Aman, Samuel Hailemariam
2. Coordination of training Sam Ngobua, Rebecca
Bailey 3. Continuum of learning
from pre-service to in-service
Carey McCarthy
3 x 10 min discussions on
theme of your choice
4. Design and delivery Julia Bluestone 5. Support for learning Lois Schaefer 6. Evaluation and
improvement of training Gabrielle O’Malley,
Francie Petracca
Summary of discussions Lois Schaefer Senior Technical Advisor for HRH, USAID
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