study report on training needs assessment of public …
TRANSCRIPT
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Eduard KAKARRIQI Alban YLLI Ervin TOÇI
(INSTITUTE OF PUBLIC HEALTH)
Tirana, September 2008
CONTENT 1. INTRODUCTION 2. STUDY OBJECTIVES 3. STUDY METHODOLOGY 4. STUDY OUTPUTS 4.1. OVERVIEW OF THE ORGANIZATIONAL FRAMEWORK OF PUBLIC HEALTH IN ALBANIA 4.2. OVERVIEW OF THE DISTRIBUTION OF DISTRICT PUBLIC HEALTH PROFESSIONALS 4.3. GENERAL DESCRIPTION OF THE WORKING CONDITIONS FOR DISTRICT PUBLIC HEALTH PROFESSIONALS 4.4. SURVEY FINDINGS ON BASIC PROFESSIONAL EDUCATION AND OTHER QUALIFICATIONS AND TRAINING OF DISTRICT PUBLIC HEALTH PROFESSIONALS 4.5. DESCRIPTION OF JOBS AND TASKS THAT MUST BE CARRIED OUT BY DISTRICT EPIDEMIOLOGISTS AND HYGIENISTS/SANITARY INSPECTORS 4.6. ANALYSIS OF TRAINING NEEDS FOR DISTRICT EPIDEMIOLOGISTS AND HYGIENISTS/SANITARY INSPECTORS ON THE BASIS OF THEIR SELF-PERCEPTION CONCERNING PROFESSIONAL INDIVIDUAL SKILLS AND KNOWLEDGE EVALUATION USING EXERCISES 4.7. ONCE MORE ON ANALYSIS OF TRAINING NEEDS FOR DISTRICT EPIDEMIOLOGISTS AND HYGIENISTS/SANITARY INSPECTORS, INCLUDING THEIR ASSISTANTS AND TWO OTHER PUBLIC HEALTH CATEGORIES (REPRODUCTIVE HEALTH AND HEALTH EDUCATION AND PROMOTION), ON THE BASIS OF THEIR SELF-PERCEPTION CONCERNING THE PROFESSIONAL CORE COMPETENCIES THE DISTRICT PUBLIC HEALTH PERSONNEL MUST HAVE 4.8. RECOMMENDATIONS ON TRAINING PACKAGE FOR BOTH DISTRICT EPIDEMIOLOGISTS AND HYGIENISTS/SANITARY INSPECTORS INTO THE FRAME OF THE CONTINUING TRAINING FOR ALL DISTRICT PUBLIC HEALTH PROFESSIONALS ANNEXES ANNEX 1 CHECK-LIST ANNEX 2 QUESTIONNAIRE ANNEX 3 EXERCISES 3.1. EXERCISE FOR DISTRICT EPIDEMIOLOGISTS 3.2. EXERCISE FOR DISTRICTS HYGIENISTS/SANITARY INSPECTORS
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1. INTRODUCTION As a clearly defined area within the health system, the public health structures, in coordination and close collaboration with all the other governmental and non-governmental structures involved, have made a significant contribution toward the improvement of health status of the general population in Albania. Despite the major achievements of Albanian public health sector, its further development is not with the pace of time. One of the main contributing factors to this situation is the level of training of the personnel who actually works in the field of public health in Albania. There are several factors, which combined together could explain why the public health personnel, at least for the time being, does not posses the appropriate training level. The frequent turnover over time of the leading public health persons, due to political reasons, represents one important factor on the matter. Frequently, the newly assigned leaders do not have the required theoretical capacity and practical experience in the field of public health to properly run their position and/or they lack the needed vision for realizing substantial changes within their organization in order to better fulfill its tasks and objectives. Though a large number of short-term training sessions involving public health personnel have been time-by-time taking place, they were of a sporadic feature and focused at special topics, thus not at all being able to cover the training needs of public health personnel. Therefore, the lack of a duly organized training to the public health personnel of the country is another important factor on the matter. Another reason why the public health personnel do not posses the appropriate level of knowledge and skills is the low prevalence of consulting/using the literature and/or the internet (via electronic media), due to both objective (low availability and accessibility rate) and subjective (low level of foreign language knowledge and computer using skills) factors. There would be of value to mention that a detailed inventory of all training courses/sessions despite of the time-length, carried out over the period 2005-2007, is already developed and might be of use for interested professionals and policy makers. The aforementioned picture would dictate the necessity, even indispensability, of the continuing training of public health professionals. Into such a context, it was necessary to performing a proper survey in the field, aiming at assessing the training needs of public health professionals in Albania. The obtained results and conclusions of such a study, carried out by the Institute of Public Health –
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IPH (May-June 2008) in close collaboration with the University of Montreal, constitute the essence of the following report [1]. [1] The approach proposed by the Consortium IUED/UdeM (Université de Montreal) aims at designing and building a three-pillar “Professional Development System” (PDS). The main functions of such a system are: a) provision of continuing education through the Centre for Continuing Education (CCE); b) accreditation of training programs; c) certification of health professionals.
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2. STUDY OBJECTIVES Assessing the training needs of Albanian professionals working in the area of public health represents the general objective of this work. Meanwhile, the specific objectives were: 1. To provide an overview of the organizational framework where Albanian professionals of public health work (organization, structures, lines of authority, recruitment, etc.); 2. To provide an overview of the distribution of personnel working in the area of public health (numbers, geographical and professional distributions); 3. To provide a general description of the working conditions for public health professionals and a more detailed one for epidemiologists and sanitary inspectors that include physical conditions of infrastructure, offices, equipment, laboratories, information technologies, etc.; 4. To provide a preliminary list of topics that should be included in a general training package for all public health professionals and the training objectives; 5. To provide a description of jobs and tasks that must be carried out by epidemiologists and hygienists/sanitary inspectors; 6. To complete the analysis of training needs for epidemiologists and hygienists/sanitary inspectors based on jobs and tasks to be performed; 7. To formulate recommendations on priority training needs for epidemiologists and hygienists/sanitary inspectors, beyond those included in the general training package.
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3. STUDY METHODOLOGY The survey was carried out in 6 (out of 36 in total) country districts of different sizes (as population): three big districts (Shkoder, Vlore, Korçe), two medium ones (Mat, Kavaje), and one small district (Peqin). The survey data were collected through a combination of methods, namely: 1. A QUESTIONNAIRE AND A CHECK-LIST in order to collect the necessary information on the following: 1) data related to personnel (age, basic training, etc.); 2) participation in continuing education activities; 3) perceptions on working conditions; 4) perceptions on personal continuing training needs; etc. This method was used mostly for achievement of specific objectives 6 and 7. 2. FOCUS GROUP with selected representatives of public health professionals (district public health director, service of hygiene and epidemiology, service of health education and promotion, statistics unit, public health labs), in order to get information related to specific objectives 3 to 5. 3. 3. Engagement of epidemiologists and hygienists/sanitary inspectors in resolving EXERCISES related to their knowledge regarding their duties and situation solving. The IPH team interviewed all the public health personnel included in the district public health structure, ranging from the director of public health to the epidemiological service personnel, hygiene and sanitary inspectorate service personnel, reproductive health (or mother and child health) inspector(s), statisticians, public health microbiological and physico-chemical laboratories, and health education and promotion service personnel as well. Though the data collection process targeted all aforementioned district public health professionals, a special attention among the variety of public health functions and specialties was dedicated to EPIDEMIOLOGISTS AND HYGIENISTS/SANITARY INSPECTORS AND THEIR ASSISTANTS, since they cover essential public health roles. The persons performing the above functions were thoroughly investigated regarding their existing capacities and training needs using the data collection tools available (the following questionnaire, check-list, and exercise). The IPH team made use a total of 85 individual questionnaires, 6 check-lists (one check-list for each of 6 districts under survey), 8 hard copies of the exercise intended for epidemiologists and 9 hard copies of the exercise intended for hygienists/sanitary inspectors (that is, for respectively 8 epidemiologists and 9 hygienists/sanitary inspectors of those 6 districts). Additionally, the check-list contained rubrics regarding all other categories of public health personnel not mentioned above, a total of 102 persons, where the required information was collected by either personal interview or proxy one (that is, asking his/her colleagues in the case the person was not present at the time of interview). Thus, 8
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epidemiologists, 29 assistant epidemiologists, 9 hygienists/sanitary inspectors and 39 assistant hygienists/sanitary inspectors were interviewed. A focus group, which literally was a free discussion between the interested personnel concerning the study objectives, was gathered in each of 6 (six) target districts. Each of 6 focus groups comprised of 3 to 7 people, most often including the epidemiologist(s), hygienists/sanitary inspector(s), some of their assistants, and occasionally other categories of public health personnel. Along with above survey data, other set of data were collected in order to fully enrich the required information regarding the achievement of the general objective of this work. Such data were obtained by: 1. DATABASES AND EXISTING DOCUMENTS AND REPORTS produced by Ministry of Health – MoH and IPH [2] as well as other MoH agencies or individual experts. These data sources and documents would provide information mostly on specific objectives 1 and 2 and also partially on other ones as well. 2. Semi-structured interviews with key informants working in the area of public health such as: 1) Public Health Directorate at the MoH (3 people); and 2) IPH directory and important experts of the institute (12 people). Such interviews were used mostly for achievement of the objectives 3 to 7. QUESTIONNAIRES OF THE SURVEY In order to extract all the desired data two different types of questionnaires were used, as well as two kinds of exercises for epidemiologists and hygienists/sanitary inspectors of six selected districts under survey. The two questionnaires used for data collection were:
- a detailed check-list, - and a questionnaire [3] to asses the capacities of personnel working in the field of
public health. The CHECK-LIST was intended to be filled in by the key public health persons in the selected districts. It contained several blocks, namely: 1) Block 1, which tried to shed light upon the mutual dependencies of public health professionals, way of reporting and to who they are obliged to report, the way of mutual inter-collaboration, etc. 2) Block 2, which tried to give a general overview of the duties and responsibilities that the public health personnel should fulfill theoretically. This block aimed at discovering
[2] The IPH team made use of official correspondence between (a) the MoH and IPH and (b) the IPH and each District Public Health Directorate regarding the existing (year 2008) organigramma of public health personnel according to categories (specialties) at district level for all 36 country districts, as well as recent documents regarding the organization of public health in Albania. [3] The data collection tools, namely the questionnaire, the check-list, and the exercises are presented (in Albanian, that is, their original form) in the Annex of this Report.
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the level of knowledge of public health professionals about what is technically required by them, as reported by them. 3) Block 3, which tried to asses the concrete skills of public health professionals and their abilities to successfully fulfill a number of important duties related to their profession. This block had detailed questions about the epidemiologists and hygienists/sanitary inspectors, and another sub-section on common skills required by all public health professionals: they were asked to provide an explicit answer (yes/no) if they were confident regarding the fulfillment of their duties and responsibilities. Therefore, while the Block 2 dealt with the “knowledge on what is required to do”, the Block 3 dealt with the “existing theoretical ability in achieving in practice what is required to do”, that is, “how” (Block 3) versus “what” (Block 2). 4) Block 4, which was intended to elicit information regarding basic education, qualifications and continuous training of public health personnel. 5) Block 5, which asked questions about the general working conditions of public health personnel, such as the infrastructure of the office, etc. The QUESTIONNAIRE was intended to asses the public health capacities of public health personnel. It contained several sections, namely: - general information about the respondent; - his/her socio economic status and income, professional position, basic education and trainings; - ability level to professionally conduct certain public health activities (ranked from 1 to 4, where the core 4 stands for the maximum ability); - and finally, questions about foreign languages and computer knowledge. EXERCISES IN THE SURVEY Two types of exercises were compiled: - an exercise for the epidemiologists, - and an exercise for the hygienists/sanitary inspectors of the 6 (six) district under the survey. The exercises [4] comprised logical and theoretical questions which aimed at evaluating the theoretical knowledge of the respondents. The exercises contained also real scenarios and the respondents were told to describe the way they would act in order to have the situation under control. The respective exercises (quiz form) were distributed to the respondents (8 epidemiologists and 9 hygienists/sanitary inspectors of 6 aforementioned districts under survey); the obtained results (answers) were examined by the IPH team. [4] See the Annex of this Report.
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4. STUDY OUTPUTS “Study outputs” represents the main chapter of this report. Its subchapters 1, 2, 3, 4, and 5, respectively:
- Overview of the organizational framework of public health in Albania; - Overview of the distribution of district public health professionals; - General description of the working conditions for district public health
professionals; - Survey findings on basic professional education and other qualifications and
training of district public health professionals; - Description of jobs and tasks that must be carried out by district epidemiologists
and hygienists/sanitary inspectors, pave the way for the data analysis:
- Analysis of training needs for district epidemiologists and hygienists/sanitary inspectors (subchapter 6), and
- Once more on analysis of training needs for District Epidemiologists and Hygienists/Sanitary Inspectors, including Their Assistants and two other public health categories (Reproductive Health and Health Education and Promotion), on the basis of their self-perception concerning the professional core competencies the district public health personnel must have (subchapter 7);
thus concluding on the last chapter (chapter 8) of this report: - Recommendations on Training Package for Both District Epidemiologists and
Hygienists/Sanitary Inspectors into the frame of the continuing training for all district public health professionals.
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4.1. OVERVIEW OF THE ORGANIZATIONAL FRAMEWORK PF PUBLIC HEALTH IN ALBANIA The organizational public health framework (organization, structure, lines of authority, recruitment, etc.) within the health system structure at central and especially district level in Albania is important with regards to assessing training needs in the area of public health. Public health in Albania is the responsibility of the government. The Ministry of Health – MoH represents the national policy-making body in the field of public health. Meanwhile, the Institute of Public Health – IPH represents the national research-training-reference-expertise-operational center in the public health field, thus acting as the technical branch of the MoH. Each district has its own Public Health, Directory (PHD) which is accountable administratively to the MoH and technically to the IPH. The general directives flow from the MoH to IPH and district PHDs and/or from the IPH to district PHDs, while the information flows in both directions. The following chart visualizes these lines of authority.
Moving to the lower level of authority, the structure of information flow and mutual dependencies of public health personnel (to whom they are obliged to report and who reports to them) working in district PHD is displayed in the following chart, concretely showing the place of district epidemiological service (with its microbiological laboratory) and its relationships with other public health – PH structures.
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The same considerations have place for the district hygiene service and sanitary inspectorate, with the physical-chemical laboratory (instead of the microbiological one) dependent on it. The microbiologists and chemists, that is, the specialists of the district PH microbiological and physical-chemical labs respectively, report to the respective service of epidemiology, hygiene and sanitary inspectorate; the district statistics unit reports to the district PH director and exchanges data and information with all the interested parties. The reproductive health (=mother and child health) inspector and the health education and promotion professionals report to the district PH director and exchange information with the service of epidemiology, hygiene and sanitary inspectorate. Regarding the mutual communication of PH personnel there is not any “isolated island” in the meaning that everybody is somehow connected with other persons playing different roles in the district public health system. The following flow chart demonstrates in a specific way the current place and mutual dependencies and relationships of the epidemiological service and hygiene service and sanitary inspectorate at district level in Albania.
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FLOW CHART OF HEALTH SERVICE STRUCTURE AT DISTRICT LEVEL IN ALBANIA:
POSITION OF SERVICE OF HYGIENE AND EPIDEMIOLOGY (AND RESPECTIVE PUBLIC HEALTH PHYSICAL-CHEMICAL AND
MICROBIOLOGICAL LABORATORIES)
Directory of Primary Health Care (*)
Service of Primary Health Care (**)
Directory of Hospital Care (*)
Hospital Service (**)
Director of Primary Health Care
Chief of Primary Health Care
Director of Hospital
Chief of Hospital Service
13 big districts (districts of primary category); Tirana with a special status (*) 15 medium districts (districts of secondary category) (**)
& 8 small districts (districts of tertiary category) (***)
SERVICE OF EPIDEMIOLOGY
PUBLIC HEALTH MICROBIOLOGICAL LABORATORY
SERVICE OF HYGIENE AND SANITARY INSPECTORATE
PUBLIC HEALTH PHYSICAL-CHEMICAL LABORATORY
PUBLIC HEALTH DIRECTORY
DIRECTOR OF PUBLIC HEALTH
(*) 13 districts of primary category (big districts), namely Tirana (= with a special status, referring the establishment of the Regional Health Authority since 1999), Berat, Diber, Durres, Elbasan, Fier, Gjirokaster, Korçe,, Kukes, Lezhe, Shkoder, Vlore, Lushnje. They represent both the respective country districts and the respective country prefectures (or regions or qarks) (except Lushnja district), the prefecture name deriving from that of the respective district. The organigramme of each big district (except Tirana) has the Directory of Primary Health Care and the Directory of Hospital Care, what does mean a direct dependency on the MoH concerning funds. Therefore, the respective District Public Health Directory, the top level of health structure hierarchy, has only an administrative function. In the special case of Tirana, the Directory of Public Health is administratively and financially dependent on Tirana Regional Health Authority, which actually covers Tirana district only, instead of Tirana Prefecture (composed by Tirana and Kavaja districts), thus not justifying at all the attribute “regional”. (**) 15 districts of secondary category (medium districts), namely Gramsh, Kavaje, Librazhd, Mirdite, Puke, Permet, Sarande, Skrapar, Tepelene, Tropoje, Kolonje, Kruje, Mat, Pogradec, Kurbin. Differently from the big districts, they have Service (instead of Directory) of Primary Health Care and Service (instead of Directory) of Hospital Care, what does mean a direct dependency from the respective District Directory of Public Health concerning both administrative and financial point of view. (***) 8 districts of tertiary category (small districts), namely Bulqize, Devoll, Delvine, Kuçove, Malesi e Madhe, Mallakaster, Peqin, Has. Differently from the medium districts, the director of district public health is meanwhile the head of primary health care service and the hospital care one.
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4.2. OVERVIEW OF THE DISTRIBUTION OF DISTRICT PUBLIC HEALTH PROFESSIONALS All country districts were asked by the IPH (March-April 2008) to officially mail back the respective existing number of public health professionals, namely - epidemiologists and their assistants, - hygienists/sanitary inspectors and their assistants, - microbiologists and technicians of public health microbiological laboratory, - chemists and technicians of public health physical-chemical laboratory, - statisticians, - reproductive health (or mother and child health) service personnel, - and health education and promotion professionals. The obtained data gave thus a detailed picture on the current (year 2008) distribution of the public health professionals according to country districts. It’s important to emphasize in our survey we were mainly focused on district epidemiologists and hygienists/sanitary inspectors (including their assistants as well). We selected just these main categories among all public health professionals at district level because they cover core public health functions, and therefore their optimal training is essential for a good functioning of public health. The current (year 2008) figures for district epidemiologists and their assistants and hygienists/sanitary inspectors and their assistants as total number in Albania results to be: - epidemiologists: 38 persons, - assistant epidemiologists: 149 persons, - hygienists/sanitary inspectors: 70 persons, - assistant hygienists/sanitary inspectors: 179 persons. To figure out their distribution at district level we used the rates (number of respective PH professionals per 100,000 population) rather than the absolute numbers. MAPS 1, 2, 3, and 4 visualize the distribution (rate as public health professionals per 100,000 population) of epidemiologist, hygienists/sanitary inspectors and respective assistants according to the country districts. It can be noticed that regarding the epidemiologists and their assistants the rates are considerably lower for bigger or more populated districts than smaller or less populated ones. Thus the capital Tirana and other important Albanian districts are underserved and the respective epidemiologists and their assistants are overloaded with daily duties and tasks. The picture differs regarding the hygienists/sanitary inspectors and their assistants: the rates (public health professionals per 100.000 population) are higher among
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bigger or more populated districts and/or bordering ones than in smaller or less populated districts. MAP 1 MAP 2
MAP 3 MAP 4
Based on the MoH data regarding the number of public health personnel in 2007 (more specifically to the human resources plans of MOH for 2007) we have calculated its current excess and/or lack; the results are shown in the following graph (GRAPH 2).
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GRAPH 1
Excess or lack of public health personnel by district
-3
1 2
-4
1
9
-4
-7
20
-3
1 1
8
0
14
-1
3
-2 -2
1
-3-1
2 1 1
-1-3
1
5
-10
-5
0
5
10
15
Bera
t
Bulq
ize
Del
vine
Dev
oll
Dib
er
Dur
res
Elba
san
Fier
Gra
msh
Gjir
okas
ter
Has
Kava
je
Kolo
nje
Korc
e
Kruj
a
Kuco
va
Kuke
s
Lac
Lezh
e
Libr
azhd
Lush
nje
Mal
esi e
Mad
he
Mal
laka
ster
Mat
Mird
ite
Peqi
n
Perm
et
Pogr
adec
Puke
Sara
nde
Skra
par
Shko
der
Tepe
lene
Trop
oje
Vlor
e
Num
ber
It can be seen that there is an excess of public health personnel in 16 out of the 36 country districts, while in 12 other ones more personnel is needed. There is no information regarding 8 remaining districts.
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4.3. GENERAL DESCRIPTION OF THE WORKING ENVIRONMENT FOR DISTRICT PUBLIC HEALTH PROFESSIONALS The working environment (infrastructure, offices, equipment, laboratories, information technologies, etc.) are an important part of the human daily work productivity. Into such a context, the epidemiologists and hygienists/sanitary inspectors, and all other public health professionals, need acceptable working conditions in order to fulfill their daily duties. The working conditions of public health personnel were investigated and physically inspected in situ in the 6 (six) selected districts during the survey by the IPH team. Information was retrieved regarding availability of computers, electricity, internet, telephony, running water, heating, transportation opportunities, and the general conditions of hosting buildings as well. The obtained results are summarized and displayed in the following graph (GRAPH 2). . GRAPH 2
The working conditions of PH personnel
0%10%20%30%40%50%60%70%80%90%
100%
Epidemiologist
s
Ass/Epi
Sanita
ry Insp
ectors
Ass/S.In
s
Statist
ician
RH Insp
ector
Hlth Pro
m.Educators
Computer Water Heating Electricity Telephone Internet Transportation
It can be noted that working conditions of PH professionals, in general, are acceptable. Almost all of them have computers, heating, electricity, telephones and transportation means. The main lacking element is the internet; even in the cases when it is available, it is very slow because it still relies upon dial-up connection. Best equipped are the epidemiologists, hygienists/sanitary inspectors, and statisticians, while the least equipped are the assistant sanitary inspectors and reproductive health inspectors. In general, the physical conditions of the hosting buildings are acceptable; a good proportion of them are newly renovated offering optimal working environment. Among the public health professionals, the microbiologists and chemists and their respective assistants (or lab technicians) seem to have the biggest problems.
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Basically, sometimes they lack the basic equipments necessary for the normal working procedures, and generally they lack a variety of equipments needed for specific laboratory diagnostic tests and procedures. Anyway, it is beyond the scope of this survey to have a complete list of what the PH microbiological and physical-chemical laboratories are lacking. The above conclusions are representative for all country districts.
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4.4. SURVEY FINDINGS ON BASIC PROFESSIONAL EDUCATION AND OTHER QUALIFICATIONS AND TRAININGS OF DISTRICT PUBLIC HEALTH PROFESSIONALS The detailed data on basic professional education and other qualifications and training of district public health professionals were obtained by the questionnaire and check-list of the survey carried out in the above-mentioned 6 (six) country districts (see the chapter 3 “Survey Methodology” for the details), (TABLE 1). TABLE 1
Basic education, other qualifications
and trainings of PH professional
Epidemiologists
All of them have completed the Faculty of Medicine and have a post-graduate training in Epidemiology. The majority of them (more than 90%) has attended different training courses during different periods of time, in general short term ones, organized by the IPH.
Assistant Epidemiologists
Around 30% of them have completed general high school whereas 70% some forms of professional medical high school in different cities of Albania. Approximately 80% of them have received trainings organized by the IPH.
Hygienists/ Sanitary Inspectors
Approximately 90% of them have completed the Faculty of Medicine, whereas 10% have veterinary background. The majority have received trainings offered by the IPH and/or the Directory of Public Health in Tirana.
Assistant Sanitary Inspector
Approximately 60% of them have completed the professional high school while the remaining has nursing background. Most of the received trainings were offered by the IPH and/or the Directory of Public Health in Tirana.
Microbiologists All of them have completed the Faculty of Medicine and received a number of trainings offered by the IPH.
Assistant Microbiologists
Approximately one tenth of them have completed the Faculty of Medicine while the remaining 90% the high school followed mostly by a one year specialization in Microbiology in Tirana.
Chemists All of them have completed the University: some the Faculty of Natural Sciences and the others the Faculty of Industrial Chemistry. Some of them have received trainings organized by the IPH and MoH, in all cases short-term ones.
Assistant Chemists Around 90% of them have completed the technical high school while the remaining ones the high schools followed by less than one year specialization in the IPH.
Statisticians Around 90% of them have completed the Faculty of Economy while the remaining one tenth have nursing background.
Health Promotion Educators
Around 80% of them have completed the Faculty of Medicine while the remaining ones have nursing background. They have received short sporadic trainings on different topics.
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The respondents (the epidemiologists and hygienists/sanitary inspectors, 17 in total) were asked to give feed-back regarding the most important trainings they have had. The findings displayed in the following GRAPH 3 show that the most important training lasted up to 12 months for the majority of the respondents, while the other ones have shorter trainings (*). GRAPH 3
Distribution of respondents by duration of most important training
10%
60%
10% 10% 10%
0%
10%
20%
30%
40%
50%
60%
70%
6 months 12 months 18 months 24 months 36 months
Duration of trainings
(*) 3 missing; percentages rounded up The IPH team was interested to investigate the respondents’ opinion about potential improvements regarding future trainings. Therefore the respondents were asked if the future training efforts should be directed toward an array of listed topics. A summary of their answers is displayed in the following GRAPH 4. GRAPH 4
Do you think that training efforts should be directed toward the following areas?
92%
78%
66%
95%
90%
86%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Tools for assuring trainings' quality
Improvement of teaching methods
Enhancement of distant learning
More theory-practice interactions
Better institutional PH training regulation
Intl standardization of PH trainings
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It can be noticed that most of the respondents are very interested in more theory-practice interactions during the training sessions, followed by concerns about the ensuring of trainings’ quality and the institutional regulation of these trainings in order to avoid the actual chaos regarding this issue. This conclusion is in concordance with the goals of the Center for Continuing Education (CCE). The distribution of public health personnel opinions about the existence of appropriate human resources (by both quantitative and qualitative point of view) at regional level is as follows (GRAPH 5): GRAPH 5
Distribution of respondents opinions about the existence of appropriate human resources in regional level
50%65%
48%57%
46%53% 58%
44% 38%49% 44%
52%
0%10%20%30%40%50%60%70%
Health
man
ag an
d plan
Inf Dis
Control
Chronic
Dis Contro
l
Epidemiology/S
tatist
ics
Environmen
tal H
ealth
Health
promotio
n/Ed...
Repro
ductive
Hea
lth
Hospita
l Man
agem
ent
Health
Economics
Chemic
Laborat
ories
Biochem
ic Lab
oratorie
s
Bacter
iologic Lab
s
Enough
As it can be noticed, in general only about 50% of the respondents think that there are appropriate human resources at regional level in order to meet the challenges of the respective sectors. Meanwhile, the obtained data (expressed in percentages) can be very useful at providing some hints regarding the direction of future training efforts as well as the priority intervention fields. For example, only 44% of the respondents think that there are appropriate human resources regarding the management of hospitals, fact which, stated by health professionals, should be carefully taken into consideration.
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4.5. DESCRIPTION OF JOBS AND TASKS THAT MUST BE CARRIED OUT BY DISTRICT EPIDEMIOLOGISTS AND HYGIENISTS/SANITARY INSPECTORS Another important issue of the survey concerned the tasks and duties expected to be performed by the district public health professionals. Though theoretically they should know the respective job description, formally issued by the MoH, in order to reveal the existing level of awareness, each public health professional in each of six (6) districts under survey was asked to list all the tasks and duties he/she knows that he/she should performed in his/her daily work. Otherwise, at what rate the district health professional is aware of tasks and duties to be performed in his/her daily technical activity versus what it is theoretically expected from him/her to perform in his/her daily technical activity? The obtained results on such an issue are presented as follows. 1) The district epidemiologist is theoretically expected to:
1. Know the demographic situation of the country; 2. Perform and continuously enhance (as the respective district technically
responsible public health specialist) the surveillance of infectious diseases and periodically report to the IPH the obtained data according to the Albanian Statutory Integrated Surveillance System of Infectious Diseases;
3. Perform and continuously enhance (as the respective district technically responsible public health specialist) the vaccination activities according to the National Statutory Calendar of Immunization and periodically report to the IPH the obtained data on vaccination coverage;
4. Control the infectious morbidity including epidemiological investigation of any outbreak, measures to control the disease spreading, source screening, prevention through vaccination, etc.;
5. Continuously monitor the morbidity and mortality rates; 6. Commit himself/herself to achieve the planned vaccination coverage (including
monitoring of cold chain, vaccine quality, vaccination coverage, adverse events following vaccination, waste disposals, etc.);
7. Investigate and understand the causes of mortality; 8. Periodically report to the IPH the collected data of the Statutory Integrated
Surveillance System of Infectious Diseases; 9. Prevent or weaken risk factors; 10. Establish and compile risk reduction policies and projects; 11. Be able to check if the legislation is properly implemented; 12. Be able to properly operate according to the International Health Regulations
2005.
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The job of the assistant epidemiologist is basically to help the epidemiologist in the operative daily activities, technically knowing the proper duties and responsibilities. From 8 interviewed epidemiologists in 6 country districts of the survey, only 13% were aware of the theoretical issues above-listed, 50% were aware of more than half of them, while 37% were aware of less than half of these theoretical issues, (see the following GRAPH 6). GRAPH 6
The distribution of epidemiologist according to the theoretical issues
they are aware of
37%
13%
50%
Al l
M or e t ha n ha l f
Le ss t ha n ha l f
2) The district hygienist/sanitary inspector is theoretically expected to:
1. Monitor the quality of potable water and the integrity of potable water and sewage infrastructure; periodically report to the IPH (as the respective district public health specialist) the obtained data on water monitoring;
2. Control and guarantee the quality of the food (including storing, handling, way of producing, etc.); periodically report to the IPH (as the respective district public health specialist) the obtained data on food safety monitoring;
3. Ensure that the accepted working standards are applied in the working environment;
4. Ensure that hygienic standards are applied and maintained in the educational infrastructure (kindergarten, schools, etc.);
5. Know the hygienic and sanitary situation of the respective district; 6. Continuously screen the veterinary issues that may come up; 7. Know in detail the laws on hygienic inspectorate, smoking, alcohol, etc.; 8. Establish and compile environmental and occupational risk reduction policies and
projects; 9. Be able to check if the legislation is properly implemented; 10. Be able to properly operate according to the International Health Regulations
2005.
23
The job of the assistant hygienists/sanitary inspector is basically to help the hygienist/sanitary inspector in the operative daily activities, technically knowing the proper duties and responsibilities. From 9 interviewed hygienists/sanitary inspectors in 6 country districts of the survey, only 11% knew perfectly all their theoretical responsibilities and duties, while the remaining part (around 90%) was aware of more than half of their duties and responsibilities, (see the following GRAPH 7). GRAPH 7
The distribution of the sanitary inspectors by the number of theoretical issues they
are aware of
0%
11%
89%
AllMore than halfLess than half
3) The district microbiologist is theoretically expected to:
1. Perform properly all diagnostic laboratory tests/analyses/methods which the district PH microbiological lab would carried out;
2. Plan the needed amount of chemicals, reagents, laboratory diagnostic kits, as well as facilities and disposals for the respective district PH microbiological lab;
3. Continuously monitor the asepsis conditions of the respective district hospital wards (especially surgical ones) and/or other and health clinics;
4. Timely report the result of lab diagnostic tests to the district services of epidemiology, hygiene and sanitary inspectorate;
5. Continuously monitor the microbiological pollution of the potable water and food specimens (food safety) through microbiological tests/analyses.
The job of microbiological laboratory technician (or assistant microbiologist) is to prepare the media, get the specimens to be analyzed, assist the microbiologist in his/her daily activity. From 6 interviewed microbiologists in 6 country districts of the survey, none of them (=0%) knew all the above issues concerning the technical duties and responsibilities of their daily activity.
24
4) The district chemist is theoretically expected to:
1. Continuously monitor the chemical pollution of the potable water and food specimens (food safety) through chemical tests/analyses;
2. Be able to monitor the air pollution through the respective chemical methods; 3. Timely report the result of lab diagnostic tests to the district services of
epidemiology, hygiene and sanitary inspectorate; 4. Evaluate and immediately report the emergency situations.
The job of chemical laboratory technician (or assistant chemist) is to prepare the media, get the specimens to be analyzed, assist the chemist in his/her daily activity. From 6 interviewed chemists in 6 country districts of the survey, none of them (=0%) mentioned all the above issues concerning the technical duties and responsibilities of their daily activity. 5) The district statistician is theoretically expected to:
1. Periodically collect the required hospital-based morbidity data and report them to the MoH (and IPH);
2. Periodically collect the required data on hospital activity and functioning and report them to the MoH (and IPH);
3. Periodically collect the required data on the activity of primary health care services;
4. Prepare for the MoH (and IPH) the monthly statistical analysis on health situation in the respective district based on the evidences collected from district hospital and primary health care services.
From 6 interviewed statisticians in 6 country districts of the survey, all of them were aware on their technical task and responsibility. 6) The district reproductive (=mother and child) health inspector is theoretically expected to:
1. Know the number of women of reproductive age; 2. Timely plan the contraceptive supply; 3. Distribute the contraceptive to the health centers according to their needs; 4. Engage in promotion campaigns; 5. Periodically collect and report to the MoH (and IPH) the data on infant morbidity
and mortality, under-5 morbidity and mortality, and mother morbidity and mortality;
6. Periodically collect and report to the IPH the required data on family planning; 7. Periodically collect and report to the IPH the requiored data on abortion;
25
8. Offer counseling about HIV/AIDS/STIs to interested population groups. From 6 interviewed reproductive health inspectors in 6 country districts of the survey, none of them (=0%) mentioned all the above issues concerning the technical duties and responsibilities of their daily activity. 7) The district health education and promotion professional is theoretically expected to:
1. Compile and implement promotion policies and strategies; 2. Realize the health promotion campaigns according to planned promotion days; 3. Distribute health promotion posters, leaflets, etc.; 4. Educate and promote health among health workers, youth, population risk groups,
etc. The interviewed health promotion educators (9) mentioned all above issues concerning the technical duties and responsibilities of their daily activity. It would be not superfluous to stress something concerning the above presentation of theoretical job description of each category of district public health professionals. The job description might give the impression to be not of the same detailed manner for all of them. But, actually there is not any bias related to it. Simply because a less detailed job description in appearance contains all the required information in its items.
26
4.6. ANALYSIS OF TRAINING NEEDS FOR DISTRICT EPIDEMIOLOGISTS AND HYGIENISTS/SANITARY INSPECTORS ON THE BASIS OF THEIR SELF- PERCEPTION CONCERNING PROFESSIONAL INDIVIDUAL SKILLS AND KNOWLEDGE EVALUATION USING EXERCISES Training needs of district epidemiologists and hygienists/sanitary inspectors were investigated separately. District epidemiologists and hygienists/sanitary inspectors were asked to self evaluate their abilities to perform selected activities concerning their everyday work. For this purpose it was used a system requiring a “yes”/”no” answer, where “yes” means a good ability to perform the selected task, thus standing not for little ability. It should be emphasized the activities ranked in the following TABLES 4 and 5, formulated by the IPH team, essentially represent the respective job description presented in the previous subchapter 4.5. 1) Regarding the District Epidemiologists, the conclusions can be explored using the following TABLE 4: TABLE 4
Evaluation chart of self-perceived actual concrete professional skills of District Epidemiologistssuccessfully fulfill the following important issues related to their daily technical activity
Final ranking
↓
Final ranking
↓
Final ranking
↓
Final ranking
↓
F
1. Ability to describe and
categorize the
community health
7755%%
2. Ability to duly manage a surveillance
system 6633%%
3. Ability to transform
epidemiological findings in
recommendations
6633%%
4. Ability to duly perform
an epidemiologi
cal investigation
8888%%
5. Knowledge on
International Health
Regulation (2005)
pp
Assessment of existing
data 100%
Practical resources to manage a
surveillance system
25% Critical literature
review over a specific PH problem
0% Applying of Epi. Principles 75% Very good
Analysis of data 75% Case definition 100%
Identification of data on which are based
the conclusions 100%
Identifying of unusual
occurrence of disease
75% Good
Selecting of appropriate
method 25%
Use of surveillance
tools 75%
Applying epidemiological
principles 100%
Properly management
of acute situations
100% Only partially
Literature reviewing 50% Analysis and
use of data 100% Identification of
limitations of practical
implementation
25%
Recommending of
appropriate control
measures
100% Not at all
Further investigation 100%
Determining sensitivity /specificity
25% Creating of prevention activities 50% Communicatio
n of results 50%
Reporting and recommendat-
ions 100%
Data and conclusions presenting
100%
27
Legend
100% 75% 50% 25% 0%
The above TABLE 4 can be read as follows: For example, in column 1 are described the epidemiologist ability to successfully describing and categorizing the community health. The ability to assess the existing data was possessed by all the interviewed epidemiologists; therefore the score color of this skill is black (meaning 100% of epidemiologists possess this skill). And we continue like that for all other cells of the table. Following such logic the final score of the respective ability is found averaging the scores of each skill under that ability. According to obtained data, only 75% of the interviewed epidemiologists think that they have good or very good skills to successfully describe and categorize the community health and to create and implement an epidemiological investigation. According to the respondents there is no need for further training for only 3 (out of 8 in total) skills under that ability, while there is obvious training need for 3 remaining skills, namely on
- data analysis, - appropriate methods selection, - and literature review,
where the level of the proper knowledge oscillates from 25% to 75%. Only 63% of the interviewed epidemiologists think that they are fully able to duly manage a surveillance system. According to the respondents there is need for training on 3 out of 5 skills under that ability, and specifically on
- practical resources to manage a surveillance system, - use of surveillance tools, - and determining sensitivity and specificity of screening tests,
where the level of the proper knowledge oscillates from 25% to 75%. Only 63% of the interviewed epidemiologists think that they have the required ability to transform epidemiologic findings into recommendations. According to the respondents there is need for training on 3 out of 6 skills under that ability, specifically on
- critical literature review about a specific public health problem (current level of ability results to be …zero),
- identification of limitations of practical implementation (current ability level of 50%),
- and developing prevention activities (ability level of 50%). 88% of the interviewed epidemiologists think that they are fully able to perform an epidemiological investigation. There is need for training on 3 out of 5 skills under that ability, specifically on
- applying epidemiological principles, - identifying unusual occurrence of disease,
28
- and communication of results, where the level of the proper knowledge oscillates from 50% to 75%. Finally, all the interviewed epidemiologists appear to have little knowledge on the International Health Regulations (2005); therefore training is needed on this topic. 2) The following TABLE 5 displays the same kind of information regarding the concrete abilities of District Hygienists/Sanitary Inspectors to successfully fulfill a number of important issues related to their professional activity. TABLE 5
Evaluation chart of actual concrete professional skills of District Hygienists/Sanitary Inspectors to successfully fulfill the following important issues related to their profession
Final ranking
↓
Final ranking
↓
Final ranking
↓
Final ranking
↓
1. Ability to assess
individual risk 6677%%
2. Ability to identify risks, and other environmental
diseases in populations
5566%%
3. Ability to appropriately
intervene in order to minimize
environmental/ occupational
risks and exposure
4455%%
4. Knowledge on Intl Health
Regulation (2005)
OOnnllyy ppaarrttiiaallllyy
Exposure history taking 100%
Describing of actual environmental/ occupational
risks
75% Recommending of
appropriate methods for risk reduction
100% Very good 0%
Knowledge about exposure-
symptoms relationship
100% Knowledge about effects
of chemicals or other exposures on health
0% Advocacy to protect
health of employees/ers etc
25% Good 0%
Identification /diagnosis of
environmental /occupational
diseases
25% Identifying of sources
and transmitting modes of environmental
exposures
100%
Organizing of intervention to minimize
environmental/ occupational risks,
through health promotion
25% Only partially 100%
Presenting/reporting of results 50%
Evaluation of efficacy of methods which aim to
reduce risk 50% Not at all 0%
Literature review 25%
Legend
100% 75% 50% 25% 0%
The obtained results suggest that only 67% of the interviewed hygienists/sanitary inspectors think they have the appropriate ability and knowledge to successfully asses the individual risk. According to the respondents there is need for training on 2 out of 4 skills under that ability, specifically on identification and/or diagnosis of environmental and occupational diseases, and presenting/reporting the results, where the self-perceived level of the proper knowledge oscillates from 25% to 50%.
29
Only 56% of the interviewed hygienists/sanitary inspectors think they are fully able to identify and monitor environmental/occupational risk determinants/hazards. According to the respondents there is need for training on 2 out of 3 skills under that ability, especially on
- the knowledge about effects of chemicals exposure and other environmental/occupational exposures on health (where the current level of knowledge is self assessed as ….zero),
- as well as on describing actual environmental/occupational risk determinants/hazards (with a current level of knowledge of 75%).
Only 45% of the interviewed hygienists/sanitary inspectors think they have the ability to appropriately intervene in order to minimize the exposure to the environmental and occupational risk determinants/hazards. According to the respondents there is need for training on 4 out of 5 skills under that ability, specifically on
- advocacy to protect health of employees/employers, - organizing the intervention through health education/promotion in order to
minimize environmental/occupational risk determinants/hazards threat, - evaluation of efficacy and effectiveness of methods aiming at risk
reduction/minimization, - and literature review,
where the level of the proper knowledge oscillates from 25% to 50%. Finally, all interviewed hygienists/sanitary inspectors appear to have very little knowledge on the International Health Regulations (2005); therefore training is needed on this topic. 3) Additionally, epidemiologists and hygienists/sanitary inspectors were asked to self-rank their knowledge to professionally conduct specified activities enlisted below (TABLE 6). For this purpose a scoring system ranging from 1 to 4 was used, where the score 1 stands for little or no knowledge and the score 4 stands for very good knowledge. The results of such scoring are displayed in the following TABLE 6, where the final score expresses the average of all the answers regarding each of the topics.
30
TABLE 6 Knowledge to successfully perform the listed activities
Final score (max=4.0)
Situation analysis 2.9 Priority setting 2.8 Monitoring/Evaluation 2.6 Supervision/Audition 2.4 Analysis of health policies 2.5 Statistical analysis 2.3 Epidemiological studies 2.3 Environmental risks analysis 2.4 Epidemiological outbreak investigation 2.7 Project writing 2.3 Human Resources Management 2.8 Financial analysis/budget/financial report 2.1 Evidence based decision making 2.5 Scientific report writing 2.1 Health promotion/public communication 3.1 Training of other professionals 2.7 Analysis and legislation use 2.8
Obviously the desired score on each of the topics would have been 4, but the results show that the highest score is 3.1 only for one (out of total 17 topics), whereas for the remaining 16 topics the score oscillates in the range 2.1-2.9. Such results do dictate the indispensability of the training on all those topics. 4) As it has been mentioned, BESIDES THE QUESTIONNAIRES, two different types of EXERCISES were compiled; one intended to be solved by the EPIDEMIOLOGISTS and the other by HYGIENISTS/SANITARY INSPECTORS. The aim of the exercises was to reveal the theoretical knowledge of the respondents regarding different aspects of epidemiology and to assess their managing capacities of outbreak situations. In general, the results of the exercise given to the epidemiologists were not satisfactory. The respondents had difficulties in solving a good part of theoretical questions offered to them. In most cases there was total confusion about the basic concepts of epidemiology, for example regarding prevention issues, sensitivity and specificity issues, the argumentation of certain answers related to active/passive surveillance, types of epidemiological studies and what kind of information do they offer, when it is most appropriate to use incidence and/or prevalence, etc.
31
The situation was totally different regarding the exercise which the hygienists/sanitary inspectors had to solve. In general, the results were satisfactory, with almost all of the respondents giving the correct answers. The main reason of such a big difference between the outcomes of the two exercises is the way the exercises were conceived. The exercise meant for the hygienists/sanitary inspectors was very practical, in the meaning that the given situation was pretty straight forward and had to deal with their everyday work. This exercise did not require too much theoretical skills and knowledge and therefore the completion of it was easier. In contrast, the epidemiological exercise was much heavier regarding theoretical knowledge it required, and even though what was required can be considered as the basics of epidemiology, a significant number of epidemiologists got confused and didn’t give correct answers. Furthermore, a crucial moment should be emphasized, namely the current need of training curricula for the hygienists/sanitary inspectors with the basic theoretical concepts of epidemiology, and vice versa, for the epidemiologists with the practical issues of sanitary-hygienic investigation, since the both groups should basically have the same post-graduated training in public health.
32
4.7. ONCE MORE ON ANALYSIS OF TRAINING NEEDS FOR DISTRICT EPIDEMIOLOGISTS AND HYGIENISTS/SANITARY INSPECTORS, INCLUDING THEIR ASSISTANTS AND TWO OTHER PUBLIC HEALTH CATEGORIES (REPRODUCTIVE HEALTH AND HEALTH EDUCATION AND PROMOTION), ON THE BASIS OF THEIR SELF-PERCEPTION CONCERNING THE PROFESSIONAL CORE COMPETENCIES THE DISTRICT PUBLIC HEALTH PERSONNEL MUST HAVE The previous subchapter 4.6 dealt with the analysis of training needs for District Epidemiologists and Hygienists/Sanitary Inspectors on the basis of their self-perception concerning professionals individual skills and knowledge evaluation using exercises. The IPH team extended such an analysis based on the same individual self-perception approach by including in a second step Assistant Epidemiologists and Assistant Hygienist/Sanitary Inspectors as well as two other public health categories, namely Reproductive Health and Health Education/Promotion professionals, in order to come up with a more comprehensive training package concerning the professional core competencies the district public health personnel must have. The aforementioned district public health professionals along with epidemiologists and hygienists/sanitary inspectors were asked to give feedback about their self-perceived ability to perform a list of activities related to their professional daily work. They were asked to provide a “yes/no” answer to the questions related to specific skills, which are listed in the following TABLE 7. It should be again emphasized the activities ranked in this table, were formulated by the IPH team, essentially always representing the respective job descriptions presented in the subchapter 4.5. The final ranking in the table refers to the average proportion of public health professionals who feel confident in performing correctly the listed activities. (For example, only 75% of the surveyed persons feel comfortable with their communication abilities, what does mean that a quarter of them need to be trained regarding this topic.)
33
TABLE 7
Epidem Ass/ Epidem Hyg-San.Insp Ass/
Hyg-San.Insp Reproduc. Hlth. Insp
Hlth PrEduc
Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ran
↓1. Communication abilities 7755%% <<7755%% 7755%% 5500%% 7755%% 7755%%Clearly transmit the information 100% 100% 100% 75% 100% 100%Clearly answer the audience 100% 75% 100% 75% 100% 100%Advocacy on PH programmes 75% 50% 75% 50% 75% 75%Scientific report writing 0% 0% 0% 0% 0% 0%Manage confidentiality 100% 100% 100% 50% 100% 100%
Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ran
↓2. Research/analytical abilities 5500%% <<5500%% 5500%% <<5500%% <<2255%% <<7755%%Applying of appropriate knowledge to define a problem 75% 50% 75% 50% 25% 75%
Use of most appropriate methodology to collect data 75% 50% 75% 50% 25% 75%
Identification of most appropriate sources of information 75% 50% 50% 50% 25% 100%
Creation of appropriate variables 25% 0% 0% 0% 0% 25%Interpretation of information regarding environmental risks 25% 25% 50% 25% 25% 25%
Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ran
↓3. Law knowledge <<2255%% 0% <<2255%% 0% 2255%% 2255%%Legislation review 0% 0% 0% 0% 25% 25%Recommendation and application of appropriate standards regarding health safety
25% 0% 25% 0% 25% 25%
Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ran
↓4. Planning/Prioritizing abilities <<5500%% 2255%% <<7755%% <<5500%% 2255%% 5500%%Correctly describe all dimensions of the problem 75% 25% 100% 50% 25% 50%
Building and using the most appropriate prioritizing model 50% 25% 25% 25% 25% 50%
Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ran
↓5. Managing abilities 7755%% <<5500%% <<5500%% <<5500%% 2255%% 2255%%Identification of organizational structures 75% 50% 50% 25% 25% 25%Identification of key persons and their interests 75% 50% 50% 25% 25% 25%
Applying of correct human relationships 75% 75% 75% 75% 25% 25%
Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ran
↓6. Ability to apply ethical principles 7755%% <<5500%% 5500%% <<5500%% <<110000%% <<110000Recognition of ethical issues regarding intervention 50% 25% 25% 25% 75% 100%
Responsible use of information 75% 25% 50% 25% 100% 100%Recognition of cultural diversity and its impact on community health 100% 75% 75% 50% 75% 75%
Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ranking
↓ Final ran
↓7. Information technology abilities 5500%% <<2255%% <<5500%% 2255%% <<5500%% <<5500%%Computer use 75% 50% 75% 50% 75% 75%Report writing 75% 50% 75% 50% 75% 75%Internet use 75% 25% 25% 50% 75% 75%Literature review 0% 0% 0% 0% 0% 0%Graphics/tables 25% 25% 25% 25% 50% 75%Statistical analysis 50% 0% 50% 0% 0% 0%Managing of databases 25% 0% 25% 0% 0% 0%
34
The above TABLE 7 makes it clear that there is no public health category which does not need training, since none of the final rank cells is 100%.
35
8. RECOMMENDATIONS ON TRAINING PACKAGE FOR BOTH DISTRICT EPIDEMIOLOGISTS AND HYGIENISTS/SANITARY INSPECTORS INTO THE FRAME OF THE CONTINUING TRAINING FOR ALL DISTRICT PUBLIC HEALTH PROFESSIONALS Important to re-emphasize: Though the above analysis on the respective training needs for District Epidemiologists and Hygienists/Sanitary Inspectors has been done separately there is only one recommended training curricula package for both these two public health categories due to a very close relationship of their professional activity. Furthermore, there is (from the year 1996 onwards) the same theoretical post-university specialization course in public health at our Faculty Medicine of Tirana University (in collaboration with the IPH) regardless a future subdivision in practical activity. Based on the obtained results of this study, namely: a) The opinion of district epidemiologists and hygienists/sanitary inspectors on the main directions of the future training efforts (Graph 4 in the Subchapter 4.4.); b) The awareness rates of district epidemiologists and hygienists/sanitary inspectors on tasks and duties to be performed in their daily technical activity versus what it is theoretically expected from them to perform in their daily technical activity (SUBCHAPTER 4.5.); c) The analysis of training needs for district epidemiologists and hygienists/sanitary inspectors on the basis of their self-perception concerning professional individual skills and knowledge evaluation using exercises (TABLES 4 and 5 in the SUBCHAPTER 4.6.) as well as the score-ranking of their abilities to professionally conduct specified technical tasks and duties (TABLE 6 in the same SUBCHAPTER 4.6.); and d) A more comprehensive analysis of training needs for district epidemiologists and hygienists/sanitary inspectors, including their assistants, as well as the professionals of reproductive health and health education and promotion, on the basis of their self-perception concerning the professional core competencies the district public health personnel must have (TABLE 7 in the SUBCHAPTER 4.7.); the following PACKAGE OF TRAINING CURRICULA FOR DISTRICT EPIDEMIOLOGISTS AND HYGIENISTS/SANITARY INSPECTORS would be proposed.
36
APPLIED EPIDEMIOLOGY
Surveillance issues
Screening issues
Epidemiological outbreak investigation, control and prevention
Environmental and occupational risk determinants/hazards analysis, control
and prevention
Identification of unusual occurrence of disease
Health demographics issues
Data collection and analysis
INFORMATION TECHNOLOGY ABILITIES
Appropriate computer and internet use
Graphics/tables
& Statistical analysis (statistical packages)
Data base management
Critical literature review about specific health problems
Report writing
RESEARCH/ANALYTICAL AND PLANNING/PRIORITIZING ABILITIES
Evidence based decision making
Financial analysis and reporting
Analysis of health policies and overall health situation for planning and
prioritization
Risk reduction policies and projects
Scientific report project writing
HEALTH LEGISLATION
Albanian health legislation knowledge, review, analysis and appropriate use
International Health Regulation (2005)
MANAGING ABILITIES
Identification of organizational structures and its importance for decision-
making process
Human resources management in organization management
37
COMMUNICATION ABILITIES
Clearly transmitting the information
Clearly answer the audience
Advocacy on public health programmes
QUALITY ENSURING ABILITIES
Monitoring and evaluation (supervision and audition)
ETHICAL ISSUES
Ethical issues regarding intervention
Responsible use of information and managing of confidentiality issues
Recognition of cultural diversity and its impact on community health
The above training package for district epidemiologists and hygienists/sanitary inspectors contains topics, each of them being composed by items. Our GENERAL SUGGESTIONS FOR THE TRAINING COURSE would be as follows:
• The most appropriate methodology of the training course seems to be the distance learning one. Curricula topics will combine a two/three-days seminar being conducted at the Institute of Public Health.
• The training team will provide assigned reading materials and related worksheets for each curricula item to all training course participants. Each participant will read the assigned material and complete the worksheet to be presented to the training team according to the planned time-frame of the course structure.
• The seminar at the end of each training course session will contain the respective exam. Each participant should accomplish the required credits for each training item separately in order to complete the whole training course.
The training course should not be viewed as a unique one but as a course of time-by-time updated and viewed in the context of the continuing training programme.
_________________________ _______________________________________
_____________________________________________________
38
ANNEXES
39
ANNEX 1
CHECK-LIST (PER T’U PERDORUR ME PUNONJESIT E SHENDETIT PUBLIK NE RRETH)
BLLOKU 1 – STRUKTURA E PUNES NE DREJTORINE E SHENDETIT PUBLIK (DSHP) TE RRETHIT Ky bllok synon te hedhe drite mbi varesine e ndersjelle midis punonjesve te shendetit publik, menyren e raportimit dhe kujt i raportojne, lidhjet strukturore me profesionet e tjera, etj. 1.1. Epidemiologu – Emer Mbiemer ___________________________________ 1.1.1 Epidemiologu II – Emer Mbiemer ____________________________________ 1.1.2 Ndihmes-Epidemiologet – Emer Mbiemer _________________________________
_________________________________ _________________________________ 1.2. Higjienisti/Inspektori Sanitar – Emer Mbiemer ______________________________ 1.2.1 Higjienisti/Inspektori Sanitar II – Emer Mbiemer _______________________________ 1.2.1 Higjienisti/Inspektori Sanitar III – Emer Mbiemer ______________________________ 1.2.1 Higjienisti/Inspektori Sanitar IV – Emer Mbiemer _______________________________ 1.2.1 Higjienisti/Inspektori Sanitar V – Emer Mbiemer ____________________________ 1.2.2 Ndihmes-Higjienistet/Inspekt. Sanitare – Emer Mbiemer ___________________________
___________________________ ___________________________ ___________________________ 1.3. Mikrobiologu (laboratori mikrobiologjik) – Emer Mbiemer _______________________ 1.3.1 Mikrobiologu II – Emer Mbiemer ___________________________ 1.3.1 Mikrobiologu III – Emer Mbiemer ___________________________ 1.3.2 Laborantet Mikrobiologe – Emer Mbiemer ______________________________
______________________________ ______________________________ ______________________________ 1.4. Kimisti (laboratori fiziko-kimik) Emer Mbiemer __________________________ 1.4.1 Kimisti II – Emer Mbiemer __________________________ 1.4.1 Kimisti III – Emer Mbiemer __________________________ 1.4.2 Laborantet Kimiste - Emer Mbiemer ____________________________
____________________________ ____________________________ ____________________________
40
1.5. Statisticieni i DSHP-se – Emer Mbiemer __________________________ 1.5.1 Statisticieni II – Emer Mbiemer __________________________ 1.5.2 Statisticieni III – Emer Mbiemer __________________________ 1.6. Inspektori i Shendetit Riprodhues – Emer Mbiemer _____________________________ 1.7. Edukatori (punonjesi i promocionit) – Emer Mbiemer ___________________________ 1.7.1 Punonjesi i promocionit II – Emer Mbiemer _______________________________ 1.7.1 Punonjesi i promocionit III – Emer Mbiemer _______________________________ 1.7.1 Punonjesi i promocionit IV – Emer Mbiemer _______________________________ 1.7.1 Punonjesi i promocionit V – Emer Mbiemer _______________________________ 1.7.1 Punonjesi i promocionit VI– Emer Mbiemer _______________________________
41
BLLOKU 2 – PERSHKRIMI I PERGJEGJESIVE/DETYRAVE QE DUHET TE PERMBUSHIN PUNONJESIT E SHENDETIT PUBLIK Ky bllok synon te jape nje panorame te pergjegjesive dhe detyrave qe duhet te permbushin ne teori punonjesit e shendetit publik. 2.1. Epidemiologu / Nd Epidemiologu _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 2.2. Higjienisti/Inspektori Sanitar / Nd.Higjienisti/Inspekt.Sanitar _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 2.3. Mikrobiologu / Laborantet e laboratorit mikrobiologjik _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 2.4. Kimisti / Laborantet e laboratorit fiziko-kimik _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 2.5. Statisticieni i DSHP _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 2.6. Inspektori i shendetit riprodhues _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
42
_______________________________________________________________________ _______________________________________________________________________ 2.7. Edukatoret (punonjesit e promocionit) _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
43
BLLOKU 3 – AFTESITE PROFESIONALE KONKRETE TE PUNONJESVE TE SHENDETIT PUBLIK Ky bllok synon te hedhe drite mbi aftesite konkrete te punonjesve te shendetit publik dhe mundesite e tyre per te permbushur me sukses nje sere detyrash te rendesishme te lidhura me profesionin e tyre. 3.1. Epidemiologu
Aftesite per te pershkruar dhe kategorizuar shendetin e nje komuniteti – konkretisht aftesite mbi:
Epidemiologu
I Epidemiologu
II Po Jo Po Jo
1) Vleresimin dhe grumbullimin e te dhenave ekzistuese, perfshire statistika demografike, statistika te perdorimit te sherbimeve, statistika nga organet e zbatimit te ligjit si policia, drejtesia, etj 2) Analizen dhe interpretimin e infomacionit te perftuar nga te dhenat e mesiperme 3) Validimin dhe perzgjedhjen e metodave te pershtatshme, duke pasur parasysh kufizimet e seciles prej tyre 4) Shfrytezimin sistematik te literatures perkatese 5) Kryerjen e hetimeve apo studimeve te tjera nese paraqitet e nevojshme 6) Raportimin ne komunitet, perfshire edhe dhenien e rekomandimeve perkatese
Aftesite per te menaxhuar dhe operuar nje sistem survejance – konkretisht aftesite mbi:
Epidemiologu
I Epidemiologu
II Po Jo Po Jo 1) Percaktimin dhe dokumentimin e aftesive dhe mundesive te menaxhimit/operimit ne praktike lidhur me nje sistem survejance 2) Perkufizimin e rastit dhe identifikimin e burimeve te pershtatshme te te dhenave 3) Perdorimin e instrumentave perkates te survejances, perfshire depistimin, raportet e laboratorit, regjistrat e sherbimeve shendetesore, etj 4) Analizimin dhe perdorimin e te dhenave te prodhuara 5) Vleresimin e sensitivitetit dhe specificitetit te nje sistemi survejance
44
Aftesite per te transformuar gjetjet epidemiologjike ne rekomandime per nderhyrje specifike lidhur me nje problem te caktuar te shendetit publik
– konkretisht aftesite mbi:
Epidemiologu
I Epidemiologu
II Po Jo Po Jo 1) Kryerjen dhe demonstrimin e nje shikimi kritik te literatures mbi nje çeshtje specifike te shendetit publik/mjekesise parandaluese (preventive) 2) Identifikimin dhe demonstrimin e te dhenave mbi te cilat jane bazuar konkluzionet/rekomandimet 3) Aplikimin e principeve epidemiologjike 4) Identifikimin e kufizimeve lidhur me mundesite e zbatimit ne praktike apo realitetin konkret ku kerkohet te aplikohen gjetjet epidemiologjike 5) Ndertimin e strategjive praktike te nderhyrjes parandaluese 6) Paraqitjen tek vendim-marresit e te dhenave, gjetjeve dhe konkluzioneve
Aftesite per te skicuar dhe kryer ne praktike nje hetim epidemiologjik lidhur me nje shperthim te nje semundje apo grumbullim jo-normal te nje problemi shendetesor ne hapesire apo kohe
– konkretisht aftesite mbi:
Epidemiologu
I Epidemiologu
II Po Jo Po Jo 1) Aplikimin e principeve te epidemiologjise 2) Identifikimin, percaktimin e hasjes se pazakonte te semundjeve apo problemeve te tjera me natyre shendetesore 3) Menaxhimin e duhur dhe korrekt te situatave akute/emergjente 4) Rekomandimin e masave perkatese te kontrollit 5) Komunikimin e informacionit te zbuluar ne audiencat perkatese
Njohurite mbi Rregulloren Nderkombetare Nderkombetare te Shendetit (2005) (Rregullorja e Re Sanitare Nderkombetare, perkthyer dhe botuar ne shqip) [*]
E njoh shume mire (dmth ne tere detajet e
saj)
E njoh mire E njoh vetem perciptazi
Nuk e njoh fare
Epidemiologu I Epidemiologu II
[*] Vendosni kryq ne kutizen perkatese lidhur me shkallen e njohjes suaj si individ
45
3.2. Higjienisti/Inspektori Sanitar
Aftesite per te vleresuar riskun individual per probleme shendetesore lidhur me mjedisin/punen duke perdorur anamnezen mjedisore apo okupacionale
– konkretisht aftesite mbi
Higjienisti
I Higjienisti
II Higjienisti
III Higjienisti
IV Po Jo Po Jo Po Jo Po Jo 1) Marrjen e historive/anamnezave te plota dhe te sakta te pacienteve duke pasur ne fokus ekspozimin mjedisor dhe okupacional 2) Njohjen e marredhenieve potenciale ndermjet simptomave te pacientit dhe ekspozimeve te mundshme mjedisore dhe okupacionale 3) Identifikimin/diagnostikimin e semundjeve te caktuara mjedisore dhe okupacionale duke komunikuar ne menyren e duhur me konsulentet eksperte ne fushat perkatese 4) Paraqitjen/raportimin e rezultateve tek individet, grupet apo organizatat e interesuara
Aftesite per te identifikuar rreziqet (risqet), semundjet dhe problemet e tjera mjedisore e okupacionale ne popullata te caktuara si dhe per te vleresuar permasat e risqeve
– konkretisht aftesite mbi:
Higjienisti
I Higjienisti
II Higjienisti
III Higjienisti
IV Po Jo Po Jo Po Jo Po Jo 1) Karakterizimin/pershkrimin e rreziqeve
ekzistuese apo potenciale mjedisore dhe okupacionale ne popullata te caktuara
2) Njohjen e efekteve ne shendet te kimikateve toksike apo te ekspozimeve te tjera mjedisore dhe okupacionale
3) Identifikimin e burimeve dhe rrugeve te transmetimit te ekspozimeve mjedisore
46
Aftesite per te nderhyre ne menyren e duhur ndaj rreziqeve mjedisore dhe okupacionale me qellim minimizimin e tyre dhe uljen e ekspozimit
– konkretisht aftesite mbi:
Higjienisti
I Higjienisti
II Higjienisti
III Higjienisti
IV Po Jo Po Jo Po Jo Po Jo 1) Rekomandimin e metodave te pershtshme per reduktimin e rreziqeve mjedisore 2) Organizimin e avokatise per shendetin dhe sigurine e te punesuarve, punedhenesve, e me gjere
3) Organizimin dhe zbatimin e nderhyrjeve per te minimizuar nje risk mjedisor apo okupacional te dhene, duke promovuar shendetin dhe sigurine e individeve, vendeve te punes dhe te komunitetit 4) Vleresimin e efektivitetit te metodave qe synojne ne uljen e riskut 5) Perdorimin e burimeve te informacionit profesional duke kryer nje kerkim literature ne pergjigje te nje situate te caktuar ne terren
Njohurite mbi Rregulloren Nderkombetare Nderkombetare te Shendetit (2005) (Rregullorja e Re Sanitare Nderkombetare, perkthyer dhe botuar ne shqip) [*]
E njoh shume mire (dmth ne tere detajet e
saj)
E njoh mire E njoh vetem perciptazi
Nuk e njoh fare
Higjienisti I Higjienisti II Higjienisti III Higjienisti IV
[*] Vendosni kryq ne kutizen perkatese lidhur me shkallen e njohjes suaj si individ
47
3.3. Statisticieni prane DSHP
Aftesite per
Statisticieni
I Statisticieni
II Po Jo Po Jo 1) Perzgjedhjen dhe aplikimin e metodologjive me te pershtatshme per mbledhjen, administrimin dhe analizimin statistikor te te dhenave shendetesore 2) Interpretimin e rezultateve 3) Identifikimin dhe dokumentimin e karakteristikave te nje seti (=takemi) apo grupi te dhenash 4) Perdorimin korrekt te teknikave statistikore
48
3.4. Aftesi te pergjithshme te perbashketa per punonjesit e shendetit publik
Epid Nd/Ep Higj Nd/Hgj
Inspekt.Shend.
Riprodh.
EdProSh
Po Jo Po Jo Po Jo Po Jo Po Jo PoAftesi komunikuese per: 1) Te trasmetuar infomacionin ne menyre te sakte dhe te qarte si me goje, me shkrim, apo me menyra te tjera
2) T’ju pergjigjur ne menyre te pershtatshme pyetjeve dhe komenteve te audiences
3) Te bere avokati per programet e shendetit publik dhe burimet e shendetesise
4) Te pergatitur materiale per publikime te natyres shkencore
5) Te njohur dhe menaxhuar ne menyre korrekte çeshtjet e konfidencialitetit
Aftesi kerkuese/hetuese dhe analitike per: 1) Aplikimin e njohurive perkatese dhe metodologjive te pershtatshme ne perkufizimin e nje problemi te shendetit publik
2) Identifikimin e metodologjise me te pershtatshme per sigurimin e informacionit. Ketu perfshihen metoda me natyre sasiore (kuantitative) dhe cilesore (kualitative)
3) Identifikimin e burimeve me te pershtatshme te te dhenave ne sistemet e informacionit rutine
5) Zgjedhjen dhe ndertimin e variablave apo indikatoreve te pershtatshem per te matur nje problem shendetesor
5) Interpretime te informacionit lidhur me riskun dhe perfitimet
Njohuri te ligjeve, rregulloreve dhe standardeve mbi: 1) Legjislacionin dhe te gjitha aktet juridike me vlere mbi nje çeshtje te caktuar, duke identifikuar se cili institucion apo profesion ka pergjegjesite apo autoritetin per nderhyrje apo zbatim
2) Rekomandimin dhe aplikimin korrekt ne praktike te standardeve me te pershtatshme lidhur me sigurine shendetesore dhe nivelet e ekspozimit ndaj rreziqeve mjedisore
Aftesi prioritizimi/planifikimi per: 1) Te pershkruar sakte gjendjen e problemit ne te gjithe dimensionet e tij dhe te te gjithe faktoreve qe kane lidhje apo ndikojne ne te; aftesi per te kryer analize te mire te situates
2) Te ndertuar dhe perdorur modelin me te pershtatshem te prioritizimit
Aftesi menaxhuese dhe drejtimi mbi: 1) Identifikimin e struktures organizative dhe te rendesise se saj ne proçesin e vendim-marrjes
2) Identifikimin e personave apo agjensive kyç dhe interesave te tyre
49
3) Aplikimin e marredhenieve te pershtatshme njerezore ne menaxhimin e organizates, motivimin e personelit dhe zgjidhjen e konflikteve
Aplikimi i principeve etike dhe pranimi i diversitetit social-kulturor lidhur me: 1) Njohjen dhe pranimin e çeshtjeve etike ne kuader te nderhyrjeve (perfshire çeshtjet lidhur me gjinine)
2) Perdorimin e pergjegjshem te informacionit nga individet, perfshire ndjeshmerine mbi te drejtat e njeriut
3) Njohjen dhe pranimin e diversitetit kulturor dhe impaktin qe ai ka ne shendetin e komunitetit
Aftesi lidhur me teknologjine e informacionit: Perdorim i kompjuterit Shkrim raportesh Komunimim ne internet Kerkim literature apo referencash Ndertim grafiqesh dhe tabelash Kalkulime dhe analize statistikore Menaxhim i nje baze te te dhenave
50
BLLOKU 4 – ARSIMIMI/KUALIFIKIMI I PUNONJESVE TE SHENDETIT PUBLIK Ky bllok synon te siguroje informacion lidhur me arsimimin baze, kualifikimet dhe trajnimet e vazhdueshme te kryera nga punonjesit e shendetit publik. 4.1. Epidemiologu Arsimi baze __________________________ Kualifikimi formal pas-universitar dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.1. Epidemiologu II Arsimi baze __________________________ Kualifikimi formal pas-universitar dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.2. Ndihmes-Epidemiologu I Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.2. Ndihmes-Epidemiologu II Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.3. Higjienisti/Inspektori Sanitar I Arsimi baze __________________________ Kualifikimi formal pas-universitar dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.3. Higjienisti/Inspektori Sanitar II Arsimi baze __________________________ Kualifikimi formal pas-universitar dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.3. Higjienisti/Inspektori Sanitar III Arsimi baze __________________________ Kualifikimi formal pas-universitar dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.3. Higjienisti/Inspektori Sanitar IV Arsimi baze __________________________ Kualifikimi formal pas-universitar dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.4. Ndihmes/Higjienisti I Arsimi baze __________________________
51
Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.4. Ndihmes/Higjienisti II Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.4. Ndihmes/Higjienisti III Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.4. Ndihmes/Higjienisti IV Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.5. Mikrobiologu I Arsimi baze __________________________ Kualifikimi formal pas-universitar dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.5. Mikrobiologu II Arsimi baze __________________________ Kualifikimi formal pas-universitar dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.5. Mikrobiologu III Arsimi baze __________________________ Kualifikimi formal pas-universitar dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.6. Laboranti mikrobiolog I Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.6. Laboranti mikrobiolog II Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.6. Laboranti mikrobiolog III Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.6. Laboranti mikrobiolog IV
52
Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.7. Kimisti I Arsimi baze __________________________ Kualifikimi formal pas-universitar dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.7. Kimisti II Arsimi baze __________________________ Kualifikimi formal pas-universitar dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.7. Kimisti III Arsimi baze __________________________ Kualifikimi formal pas-universitar dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.8. Laboranti kimist I Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.8. Laboranti kimist II Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.8. Laboranti kimist III Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.8. Laboranti kimist IV Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.9. Statisticieni I Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.9. Statisticieni II Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________
53
4.9. Statisticieni III Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.10. Inspektori i Shendetit Riprodhues Arsimi baze __________________________ Kualifikimi formal pas-universitar (profesional ???) dhe ku eshte kryer __________________________________ Trajnimet e vazhdueshme __________________________________________________ 4.11. Edukatori shendetesor (punonjesi i promocionit shendetesor) I Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.11. Edukatori shendetesor (punonjesi i promocionit shendetesor) II Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.11. Edukatori shendetesor (punonjesi i promocionit shendetesor) III Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.11. Edukatori shendetesor (punonjesi i promocionit shendetesor) IV Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________ 4.11. Edukatori shendetesor (punonjesi i promocionit shendetesor) V Arsimi baze __________________________ Kualifikimi formal profesional dhe ku eshte kryer ____________________________ Trajnimet e vazhdueshme __________________________________________________
54
BLLOKU 5 – INFRASTRUKTURA/TEKNOLOGJIA Ky bllok synon te siguroje nje panorame te pergjithshme te kushteve te mjedisit te punes ku punojne dhe veprojne punonjesit e shendetit publik. Kushtet e punes ne pergjithesi (zyrat/laboratoret) per secilin nga funksionet e meposhtme: 5.1. Epidemiologu Zyra_________________________________________________________________________ Kompjuter Po Jo Uje Po Jo Ngrohje Po Jo Drita Po Jo Telefon Po Jo Internet Po Jo Mundesi transporti Po Jo 5.2. Ndihmes-Epidemiologu Zyra_________________________________________________________________________ Kompjuter Po Jo Uje Po Jo Ngrohje Po Jo Drita Po Jo Telefon Po Jo Internet Po Jo Mundesi transporti Po Jo 5.3. Higjienisti/Inspektori Sanitar Zyra_________________________________________________________________________ Kompjuter Po Jo Uje Po Jo Ngrohje Po Jo Drita Po Jo Telefon Po Jo Internet Po Jo Mundesi transporti Po Jo 5.4. Ndihmes-Higjienisti/Inspektori Sanitar Zyra_________________________________________________________________________ Kompjuter Po Jo
55
Uje Po Jo Ngrohje Po Jo Drita Po Jo Telefon Po Jo Internet Po Jo Mundesi transporti Po Jo 5.5. Mikrobiologu Laboratori (pershkrim i sendeve qe mungojne dhe qe duhen per mire funksionimin e laboratorit) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 5.6. Kimisti Laboratori (pershkrim i sendeve qe mungojne dhe qe duhen per mire funksionimin e laboratorit) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 5.7. Statisticieni i DSHP Zyra_________________________________________________________________________ Kompjuter Po Jo Uje Po Jo Ngrohje Po Jo Drita Po Jo Telefon Po Jo Internet Po Jo Mundesi transporti Po Jo 5.8. Inspektori i Shendetit Riprodhues Zyra_________________________________________________________________________ Kompjuter Po Jo Uje Po Jo
56
Ngrohje Po Jo Drita Po Jo Telefon Po Jo Internet Po Jo Mundesi transporti Po Jo 5.9. Edukatoret (punonjesit e promocionit) Zyra_________________________________________________________________________ Kompjuter Po Jo Uje Po Jo Ngrohje Po Jo Drita Po Jo Telefon Po Jo Internet Po Jo Mundesi transporti Po Jo
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ANNEX 2
PYETESOR (QUESTIONNAIRE)
MBI VLERESIMIN E KAPACITETEVE INDIVIDUALE PROFESIONALE TE PUNONJESVE TE SHENDETIT PUBLIK TE RRETHIT
Ky pyetesor synon te vleresoje kapacitetet dhe nevojat lidhur me burimet njerezore qe operojne ne fushen e shendetit publik ne shkalle rrethi me qellim permiresimin e strukturave te trajnimit/ edukimit te vazhdueshem ne kete fushe. Statusi social ekonomik 1. Emri Mbiemri ___________________________________
2. Mosha ___ vjeç
3. Gjinia: M__ F__
4. Vendbanimi ______________________________________________
5. Vendlindja __________________________________________
6. Statusi familjar ______________________
7. Te ardhurat mesatare mujore familjare _______ leke
Pozicioni profesional
9. Institucioni ______________________________________
10. Pozicioni ______________________________
11. Koha (ne vite) ne detyren aktuale __ vjet
12. Pozicionet e tjera ne te kaluaren 1______________________
2______________________
3______________________
4______________________
Arsimimi/trajnimi
13. Shkollim universitar Po__ Jo__
14. Nese po, Fakulteti: __________________________________
58
15. Specializim pas universitar (mbi tre muaj) Po __ Jo __
16. Nese po kohe-zgjatja e specializimit me te rendesishem __ muaj
17. Nese po kohe-zgjatja totale e specializimeve __vjet
18. Specializim i rregullt prane
Fakultetit te Mjekesise me certifikate: Po__ Jo __
19. Emertimi i/e kursit/eve te specializimit 1__________________________
2__________________________
3__________________________
20. Trajnime te shkurtera (ne tre muaj) Po__ Jo __
21. Emertimi i/e trajnimit/eve 1__________________________
2__________________________
3__________________________
4__________________________
22. Cili/et ka/ne qene organizatori/et i/e trajnimeve:
1. Instituti i Shendetit Publik Po__ Jo__
2. Ministria e Shendetsise Po__ Jo__
3. Fakulteti i Mjekesise Po__ Jo__
4. Instituti i Sigurimeve te Kujdesit Shendetesor Po__ Jo__
5. Tjeter shteteror Po__ Jo__
5.1 Cili _____________________
6. Organizate jo shteterore Po__ Jo__
6.1 Cila_____________________
Njohurite/aftesite
23. A mendoni se keni njohuri per te kryer me profesionalizem aktivitetet e meposhteme
(vendosni nje kryq ne kutine perkatese
Niveli i Njohurise dhe Profesionalizmit
Nivel i ulet Nivel Maksimal
1 2 3 4
59
Analize situate 1 2 3
Identifikimi i sakte i problemit; identifikimi i burimeve te mundshme dhe pengesave per zgjidhjen e problemit; identifikimi i avantazheve dhe disavantazheve te menyrave te ndryshme te zgjidhjes se problemit
Vendosje prioritetesh 1 2 3
Aftesia per te identifikuar ne menyre te sakte problemin/et qe kerkon/jne nderhyrje emergjente bazuar ne gravitetin, shtrirjen ne kohe dhe hapesire, kostot dhe ekzistencen e mundesive per zgjidhjen e tij/tyre
Monitorim/vleresim 1 2 3
Aftesia per te ndjekur ne menyre rigoroze dhe ne perputhje me protokollin implementimin e programeve te caktuar, respektimin e afateve kohore dhe cilesise, perdorimin e indikatoreve per te vleresuar rezultatet e programit
Mbikqyrje/audit/vleresim te cilesise se sherbimeve te qendrave shendetsore (QSH)
1 2 3
Aftesia per te kontrolluar personalisht cilesine e sherbimeve ne QSH nepermjet verifikimit te ndjekjes se protokollit dhe vezhgimit fizik te mardhenies mjek-pacient; kryerja e auditit te brendshem apo te jashtem bazuar mbi indikatore te caktuar te cilesise
Analize e politikave/organizimit te sistemit shendetesor
1 2 3
Aftesia per te zberthyer parimet kryesore te organizimit te sistemit shendetesor ne drejtim te hierarkise, rruges se rrjedhjes se pergjegjesise, funskionalitetin e strukturave eksituese, bashkepunimin e aktoreve te ndryshem ne sistem etj. Aftesi per te analizuar me saktesi politikat e ndryshme shendetesore qe serviren dhe te qenit ne gjendje te parashikosh efektet e ketyre politikave mbi popullaten dhe sistemin.
Analize statistikore e te dhenave ekzistuese
1 2 3
Aftesia per te analizuar statistikisht te dhenat e mbledhura, per te perdorur testet e duhura statistikore ne rrethanat e duhura, te dije dallimet dhe perdorimet e testeve statistikore, te jete ne gjendje te kuptoje kufizimet e te dhenave statistikore, te interpretoje ne menyre te sakte rezultatet e analizave dhe t'i shpjegoje keto rezultate ne menyre te qarte dhe te kuptueshme
Studime epidemiologjike
1 2 3
Aftesia per te dizenjuar dhe drejtuar nje studim epidemiologjik, per te zgjedhur tipin e pershtatshem te studimit bazuar ne rrethanat e vendit, kohes dhe problemit; per te shpjeguar diferencat midis llojeve te ndryshme te studimeve; per te shpjeguar avantazhet dhe disavantazhet e secilit studim
Analize e risqeve mjedisore
1 2 3
Aftesi per te identifikuar saktesisht risqet, llojet e tyre; aftesia per te gjykuar ne lidhje me shtrirjen e tyre; aftesia per t'a kuantifikuar riskun dhe shkallen e ekspozimit te popullates ndaj nje risku specifik; aftesia per te identifikuar burimin e riskut; aftesia per te gjykuar mbi masat e pershtatshme qe duhen marre per minimizimin/eleminimin e riskut
Hetim i nje shperthimi epidemik apo nje situate te pazakonte shendetesore 1 2 3
Aftesia per te hulumtuar origjinen e shperthimit epidemik nepermjet pyetjeve ne lidhje me vendin, personin dhe kohen; shkaktarin e tij, numrin e njerezve te ekspozuar, aftesia per analizen e periudhes se inkubacionit te shkaktarit; aftesi per te vepruar shpejt per kufizimin e perhapjes dhe per mbrojtjen dhe orientimin e te prekurve drejt qendrave te ndihmes
Ndertim i nje projekti
1 2 3
Aftesia per te perpiluar qellimin e projektit, objektivat e pergjithshem, objektivat specifike; listimi i aktiviteteve te ndryshme te projektit, analizimi i kostot se projektit, hartimi i skemes se monitorimit dhe vleresimit te projektit.
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Menaxhim i burimeve njerezore
1 2 3
Aftesia per te identifikuar nevojat qe kane institucionet per burime njerezore dhe per cfare kualifikimesh kane nevoje; identifikimi i rolit te personelit ne jeten e organizates; zgjidhja e konflikteve te ndryshme; aftesi per te motivuar punonjesit apo personelin, per t'u siguruar kushte pune te pershtashme, aftesia per te marre parasysh kerkesat e personelit, aftesia per te siguruar zbatimin e rregullores se punes dhe plotesimin e detyrave nga ana e punonjesve te organizates
Analize financiare/pergatitje buxheti/raportim financiar 1 2 3
Aftesia per te analizuar nje problem te caktuar ne lidhje me kostot, shpenzimet dhe perfitimet e mundshme; aftesia per te marre parasysh te gjithe faktoret qe ndikojne cmimin e nje produkti apo sherbimi; aftesia per te identifikuar pengesat financiare dhe dhenia e alternativave per zgjidhjen e tyre; aftesia per te parashikuar shpenzimet bazuar ne shumellojshmerine e aktiviteteve dhe pagesave pergjate nje periudhe te caktuar kohore; aftesi per te perpiluar nje raport financiar profesional dhe te kuptueshem
Perdorim i literatures per te marre vendime te bazuara ne fakte
1 2 3
Aftesia per te qene ne kontakt me te dhenat me te fundit te shkences ne lidhje me problemin ne fjale, nepermjet shfletimit te librave/revistave/artikujve, internetit, tv, radios etj; aftesia per te sintetizuar informacion perkates dhe krahasimin e gjendjes aktuale me ate qe ofron literatura; aftesi per te marre vendime te arsyeshme bazuar ne keto fakte
Shkrim i nje raporti shkencor 1 2 3 Aftesi per perpilimin e nje raporti ku perfshihen te gjitha etapat e raportit
shkencor, perdorimi i referencave, hartim profesional Edukim shendetesor/komunikim me publikun apo pacientet
1 2 3
Njohur te shkelqyra ne drejtim te promocionit, parandalimit te nje gjendjeje te caktuar; aftesi te mira komunkuese; aftesi per te folur qarte, thjeshte dhe ne menyre te kuptueshme; aftesi per t'e bere permbledhje te fakteve dhe pershkrime te sakta te problemit ne fjale; aftesi bindese; jo arrogant
Trajnim i profesionisteve te nje fushe te caktuar 1 2 3
Njohuri shume te mira te fushes apo lendes perkatese; paraqitje e kuptueshme e objektivave te trajinimit dhe metodologjise se tij; aftesi te mira komunikuese me te tjeret; vetebesim
Analize dhe perdorim i legjislacionit 1 2 3 Aftesi per te shqyrtuar ne menyre kritike legjislacionin ne fuqi; njohuri
shume te mira te ligjeve qe kane te bejne direkt me profesionin
24. A keni njohuri te gjuheve te huaja? Po__ Jo__
25. Nese po cilat jane njohurite (vendosni nje kryq ne kutine/te perkatese):
Anglisht Frengjisht Italisht Gjermanisht
Mund te lexoj por nuk flas
Mund te flas dhe te kuptoj pak
Komunikoj mire
Komunikoj dhe shkruaj shume mire
26. E perdorni kompjuterin? Po__ Jo__
27. Nese po:
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1. Per te shkruajtur dokumente/raporte ne Word Rralle__ Shpesh__
2. Per te ndertuar grafike/figura Rralle__ Shpesh__
3. Per te analizuar te dhena ne database Rralle__ Shpesh__
Opinione mbi kapacietetet dhe nevojat ne shkalle rrethi
28. A mendoni se ekzistojne kapacitete njerezore (ne sasi dhe cilesi) te mjaftueshme ne rrethin
tuaj ne drejtim te:
Aspak Pak Mire Nuk e di
Menaxhimit/planifikimit shendetesor
Kontrollit te semundjeve infektive
Kontrollit te semundjeve kronike
Epidemiologjise/biostatistikes
Shendetit mjedisor
Edukimit shendetesor/promovimit te jete se
shendetshme
Shendetit riprodhues
Shendeti oral
Menaxhimit spitalor
Ekonomise se shendetit
Laboratoreve kimike
Laboratoreve biokimike
Laboratoreve bakteriologjike
29. A keni dijeni mbi ekzistencen e ndonje plani per forcimin e kapaciteteve njerezore ne sistemin
shendetsor te rrethit tuaj? Po__ Jo__
30. Mendoni se perpjekjet per trajnim duhen drejtuar ne aktivitetet e meposhteme:
1. Futje e instrumentave per sigurimin e
cilesise se trajnimit Po__ Jo__
2. Permiresim i stilit te mesimdhenies Po__ Jo__
3. Nxitje e trajnimit ne distance Po__ Jo__
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4. Lidhje me e forte e trajnimit me praktiken Po__ Jo__
5. Rregullimi me i mire institucional i
trajnimit ne shendet publik Po__ Jo__
6. Trajnimi pa shkeputje nga puna Po__ Jo__
7. Modernizim/standartizim nderkombetar i
kurseve pasuniversitare ne shendet publik Po__ Jo__
8. Futje e sistemit te akreditimit per te nxitur
edukimin e vazhdueshem profesional Po__ Jo__
31. Cilat mendoni se kane qene difektet kryesore te kurseve te trajnimit ku keni qene pjesemarres:
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32. Ndonje mendim tjeter lidhur me permiresimin e sistemit te trajnimit ne shendet publik ne
Shqiperi ne menyre qe nevojat te permbushen ne menyren e duhur:
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ANNEX 3.1
USHTRIM PER EPIDEMIOLOGUN E RRETHIT (EXERCISE FOR DISTRICT EPIDEMIOLOGIST):
EPIDEMIOLOGJIA E SEMUNDJEVE INFEKTIVE □ Sistemi Madhor i Bazuar-ne-Semundje (SMBS) i survejances te semundjeve infektive eshte sensitiv ne zublimin e shperthimeve epidemike. V (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… F (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… □ Sistemi Alert i survejances te semundjeve infektive eshte me specifik se SMBS sepse edhe perkufizimi i rastit ne Sistemin Alert eshte me specifik se perkufizimi i rastit ne SMBS.
V (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… F (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… □ Permendni te pakten 4 (kater) elemente te hulumtimit (hetimit) te shperthimit epidemik. 1) ...................................................................................................................................... 2) ...................................................................................................................................... 3) ...................................................................................................................................... 4) ...................................................................................................................................... □ Cila eshte popullata “ne risk” (kujdes lidhur me strukturen moshore te popullates per sa i perket receptivitetit ndaj infeksionit/semundjes konkrete). (plotesoni mbi pikezimet) 1) ne nje shperthim semundjeje diarreike me origjine hidrike ne nje qytet .......................................................................................................................................... 2) ne nje shperthim toksikoalimentar ne nje njesi ushtarake .......................................................................................................................................... 3) ne nje shperthim gripi ne disa rrethe te vendit .......................................................................................................................................... 4) ne epidemine e poliomielitit ne Shqiperi me 1996 (epidemi e shtrire ne te gjitha rrethet e vendit) .......................................................................................................................................... 5) ne nje shperthim fruthi ne nje fshat .......................................................................................................................................... 6) ne Semundjet Seksualisht te Transmetueshme «gonorre» dhe «sifiliz» ne popullaten e vendit .......................................................................................................................................... 7) lidhur me infeksionin HIV ne popullaten e vendit ..........................................................................................................................................
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□ Ne cilen hallke te zinxhirit epidemik do te ishte me e efektshme nderhyrja (intervenimi) per kontroll/prevenim dhe ne çfare do te konsistonte kjo nderhyrje: 1) ne nje shperthim semundjeje diarreike me origjine hidrike ne nje qytet .......................................................................................................................................... 2) ne nje shperthim toksikoalimentar ne nje njesi ushtarake .......................................................................................................................................... 3) ne nje shperthim gripi ne disa rrethe te vendit .......................................................................................................................................... 4) ne epidemine e poliomielitit ne Shqiperi me 1996 (epidemi e shtrire ne te gjitha rrethet e vendit) .......................................................................................................................................... 5) ne nje shperthim fruthi ne nje fshat .......................................................................................................................................... 6) ne Semundjet Seksualisht te Transmetueshme « gonorre » dhe « sifiliz » ne popullaten e vendit .......................................................................................................................................... 7) lidhur me infeksionin HIV ne popullaten e vendit .......................................................................................................................................... □ Permendni te pakten 3 (tre) kritere te perfshirjes te nje semundjeje infektive ne sistemin e survejances epidemiologjike 1) ...................................................................................................................................... 2) ...................................................................................................................................... 3) ...................................................................................................................................... □ Cfare nenkupton 1) Parandalimi paresor? .......................................................................................................................................... 2) Parandalimi dytesor? .......................................................................................................................................... 3) Parandalimi tretesor? .......................................................................................................................................... 4) Parandalimi ketersor? .......................................................................................................................................... □ Cili eshte me i rendesishmi dhe me perfaqesuesi nga te kater llojet e parandalimeve (paresor, dytesor, tretesor, katersor) dhe perse .......................................................................................................................................... .......................................................................................................................................... .......................................................................................................................................... □ Cila eshte popullata nden survejance ne survejancen epidemiologjike te semundjeve infektive ne Shqiperi? ..........................................................................................................................................
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□ Sensitiviteti ne perkufizimin e rastit ne survejancen epidemiologjike te semundjeve infektive lidhet me fallco-negativitetin. V (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… F (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… □ Specificiteti ne perkufizimin e rastit ne surv3ejancen epidemiologjike te semundjeve infektive lidhet me fallco-pozitivitetin. V (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… F (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… □ Cili e kryen konfirmimin e rastit ne semundshmerine infektive? E kryen …………………………………………………………………………………………… □ Synimi yne ne SMBS te survejances te semundjeve infektive eshte te maksimalizojme (te rritim sa me teper te jete e mundur peshen specifike numerike) te raportimit te rasteve si raste “te konfirmuara”. Çfare nenkupton kjo? Pra, si mund t’a realizojme? ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… □ Cili eshte dallimi ndermjet survejances pasive dhe asaj aktive dhe cila prej syresh ka perparesi ne survejancen e semundjeve infektive? ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… □ Niveli i sulmit eshte nje madhesi e veçante e incidences qe perdoret ne forcat e armatosura V F □ Cili eshte dallimi ndermjet termave “epidemi” dhe “shperthim epidemik? (Dmth me çfare lidhet ky dallim?) ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… □ Permendni te pakten 4 (kater) karakteristika te agjentit mikrobik 1) ...................................................................................................................................... 2) ...................................................................................................................................... 3) ...................................................................................................................................... 4) ......................................................................................................................................
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□ Rezervuari i infeksionit ne natyre eshte gjithmone i njejte me burimin e infeksionit V (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… F (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… □ Studimi epidemiologjik deskriptiv i jep pergjigje pyetjeve: 1) Kush semuret ne popullate V F 2) Ku haset semundja V F 3) Kur haset semundja V F 4) Si haset semundja V F 5) Pse haset semundja V F 6) Si kontrollohet/parandalohet semundja V F □ Studimi epidemiologjik analitik i jep pergjigje pyetjeve: 1) Kush semuret ne popullate V F 2) Ku haset semundja V F 3) Kur haset semundja V F 4) Si haset semundja V F 5) Pse haset semundja V F 6) Si kontrollohet/parandalohet semundja V F □ Cili eshte dallimi ndermjet infeksionit dhe semundjes? ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… □ Bartesi eshte burim infeksioni V (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… F (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… □ Ne fushen e semundjeve infektive, per matjen e frekuences te hasjes te semundjes 1) Perdoret vetem prevalenca V (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… F (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… 2) Perdoret vetem incidenca V (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… F (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… 3) Perdoret me teper prevalenca V (nese po, perse)……………………………………………………………………….. ………………………………………………………………………………………………………
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F (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… 4) Perdoret me teper incidenca V (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… F (nese po, perse)……………………………………………………………………….. ……………………………………………………………………………………………………… □ Ne cilen hallke te zinxhirit epidemik fokusohen me teper nderhyrja per kontroll/parandalim ne rastin e semundjeve diarrike me perhapje hidrike ose/dhe ushqimore, dhe cfare permban konkretisht kjo nderhyrje? ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… □ Ne cilen hallke te zinxhirit epidemik fokusohen me teper nderhyrja per kontroll/parandalim ne rastin e semundjeve me transmetim vektorial (insekte, brejtes) dhe çfare permban konkretisht kjo nderhyrje? ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… □ Ne cilen hallke te zinxhirit epidemik fokusohen me teper nderhyrja per kontroll/parandalim ne rastin e semundjeve zoonotike me prejardhje nga kafshet bujqesore/shtepiake dhe çfare permban konkretisht kjo nderhyrje? ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… □ Ne cilen hallke te zinxhirit epidemik fokusohen me teper nderhyrja per kontroll/parandalim ne rastin e semundjeve te prevenueshme me vaksinim dhe çfare permban konkretisht kjo nderhyrje? ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… □ Ne cilen hallke te zinxhirit epidemik fokusohen me teper nderhyrja per kontroll/parandalim ne rastin e infeksioneve respiratore (psh shperthim i gripit) dhe çfare permban konkretisht kjo nderhyrje? ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… □ Kemi nje shperthim epidemik te semundjeve diarreike (psh rotavirus, apo salmoneloze jo-tifoide). Kemi nje shperthim te nje infeksioni respirator (psh adenovirus, apo virus respirator
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sincicial, etj). Ne cilin prej tyre do te ishte me e efektshme nderhyrja ne hallken e transmetimit te infeksionit dhe perse? ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… □ “Xhepat receptive” lidhur me semundjet e prevenueshme me vaksinim. Pse hasen? ……………………………………………………………………………………………………… Konkretisht ne stadin aktual ne vendin tone, cilet jane potencialisht te tille? ……………………………………………………………………………………………………… A evidentohen, dhe neso po, si? ……………………………………………………………………………………………………… Si eliminohen (minimizohen)? ………………………………………………………………………………………………………
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ANNEX 3.2
USHTRIM PER HIGJIENISTIN/INSPEKTORIN SANITAR TE RRETHIT (EXERCISE FOR DISTRICT HYGIENIST/SANITARY INSPECTOR):
INSPEKTORIATI SANITAR SHTETEROR NE KRYERJEN E NJE HETIMI HIGJIENIK
Drejtori e institucionit (=çerdhes apo administrates perkatese) njofton me telefon Drejtorine e Shendetit Publik, ne ora 12 (paradite) qe nje numer frekuentuesish te nje çerdheje ne qytet, rreth 25 femije te grup-moshave 1-3 vjeç, kane çrregullime shendetesore, me temperature te rritur ≥38◦C, heqje barku, djerse dhe femijet grinden. Ne kete institucion, frekuentimi i perditshem eshte 60 femije. Si duhet te veprohet ne kete rast? Konkretisht: 1) A duhet te vleresohet njoftimi i marre? Jo □ Po □ 2) Kush duhet te njoftohet? …………………………………………………….......................................................... 3) A duhet ngritur ekip vleresimi te gjendjes? Jo □ Po □ 4) Perberja e ekipit duhet te jete: vetem me higjieniste Jo □ Po □ vetem me epidemiologe Jo □ Po □ vetem me mikrobiologe Jo □ Po □ 5) Si duhet te jete ekipi i vleresimit te gjendjes? (pershkruaj) ……………………………………………………………………………………………………………………………………………………………………………………………………………………................................................................................................................................................... 6) A duhet te merret takim me mjekun e institucionit? Jo □ Po □ 7) Kur shkohet ne institucion, cfare dhe si fillohet puna: a) Duke marre kontaktin e pare me pergjegjesin e institucionit? Jo □ Po □ b) Si ndahen detyrat e ekipit? Kush e drejton ate? (higjienisti? epidemiologu? mikrobiologu?) …………………………………………………………………………………….. c) Kush percakton detyrat? ……………………………………………………………………… d) Kush mban shenimet gjate vleresimit? ……………………………………………………… 8) Cfare evidenton ne fillim? - shqetesimet e femijeve? simptomat? Jo □ Po □ - numrin e femijeve me çrregullime? Jo □ Po □ - a rekomandoni ndarjen e femijeve me çrregullime nga ata te qete? Jo □ Po □ 9) A merr informacion mbi ushqimet qe jane perdorur? Jo □ Po □ 10) A kerkon burimet e furnizimit nga vijne ushqimet? Jo □ Po □
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11) A merr mostra ushqimesh per vleresim laboratorik? Jo □ Po □ 12) A merr moster te ujit qe perdoret ne institucion? Jo □ Po □ 13) Per çfare analizash? - fiziko-kimike? Jo □ Po □ - bakteriologjike? Jo □ Po □ 14) A ben ekzaminim te shpejte per klorin mbetes? Jo □ Po □ 15) Mikrobiologu, çfare mostrash (kampionesh) merr? - te vjella? Jo □ Po □ - moster diarreje? Jo □ Po □ 16) Epidemiolgou me çfare merret? a) Ndjek higjienistin? Jo □ Po □ b) Çfare kerkon dhe vlereson? (pershkruaj) ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… 17) A kontrollohet personeli per librezat shendetesore? Jo □ Po □ 18) A merren ekzaminime per shkallen e pastertise se mjediseve, etj.? Jo □ Po □ 19) Kush i drejton: Higjienisti apo Epidemiologu? H □ E □ 20) Kush informohet pas kryerjes se vleresim/hetimit? ………………………………………......... 21) A pergatitet informacion paraprak? Jo □ Po □ 22) A ndiqet gjendja ne ecurine e vet? Jo □ Po □ 23) Kur pergatitet informacioni perfundimtar? - te nesermen? Jo □ Po □ - nese jo te nesermen, pas sa ditesh minimalisht? … dite 24) Kush e pergatit informacionin? - kryetari? Jo □ Po □ - grupi? Jo □ Po □ 25) A mund te gjendet shkaktari i kesaj ngjarjeje? Jo □ Po □ 26) A duhen informuar institucionet vendore? Jo □ Po □ Nese po, kur? ……………........................................... 27) A duhet informuar ISHP? Jo □ Po □ Nese po, kur? ...............................................................
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28) A duhet informuar MSH? Jo □ Po □ Nese po, kur? ........................................................................
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