world health organization draft report who/hq geneva – dr. sasha goubarev who/searo &...
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WORLD HEALTH ORGANIZATION Draft ReportWHO/HQ Geneva – Dr. Sasha Goubarev
WHO/SEARO & WHO/Nepal
Presented by Karen GladbachContributions by Arie Rotem & Amitai Rotem
U.N. Senior Fellowship Officers Meeting 2-4 November 2010 – Paris
Impact Evaluation of WHO FellowshipsNepal Pilot Study
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The Journey begins . . .
Why Nepal? Supportive team: WHO/SEARO & WHO/Nepal, home & host
institutes• Quantity sample: 55 long-term Fellows (3 months+) • Supporting FEL documents: readily available• Core institutes: less diversity
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The pilot study aimed to:
1) Evaluate the impact of WHO fellowships in Nepal: 2004-2008
2) Derive lessons from Contribution Analysis to evaluate impact
3) Assess availability + usefulness of existing FEL information from national & international fellowship authorities
4) Develop and/or refine tools and protocols to obtain
evidence
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The Study Sample
Step 1 – AnalysisReviewed all 55 long term fellows--three cohorts (2004-
2008)
Analysis of existing information available in WHO files
Step 2 – InterviewsFace-to-Face (F2F) interviews with 26 FellowsFocus groups with fellows, peers and home institutes Kathmandu , Dharan, and districts in Chitwan and Pokhara provinces
Step 3 – Final Analysis and draft report
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Milestones: FONTS
F – Future: What is Fellow expected to do with training post-Fellowship?
O – Objectives: Are objectives SMART? Will they enable Fellow to meet post- Fellowship expectations?
N – National Priorities: Are national priorities clearly defined and known by Fellow, training & home institute? Was the Fellow the right choice?
T – Training: Is the training institute aware of and able to address the training objectives aligned with national priorities? Will they conduct their own post- training evaluation? Are they aware of post-Fellowship expectations?
S – Sharing: How will the Fellow share the new knowledge and skills? How will this sharing lead to impact?
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Levels of Impact
Sustainable Impact: Created a new unit, established new services, applied new procedures , major transfer to others, sustainable capacity building, likely to be sustained beyond the fellow’s direct involvement
Considerable Impact: Significant improvement of competence leading to better performance and better outcomes, sharing with others
Some Impact: Gained skills, some opportunity to apply or share with others
No Immediate Impact: No significant gain in capabilities
and/or inability to apply in Nepal context
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Assessment of Impact
Based on this analysis it has been concluded that:
One in five fellows interviewed (19%) made sustainable impact as a result of their fellowship training
Two in five (42%) demonstrated a considerable impact
One third (31%) had at least some impact
In two cases (8%) no impact was evident due to inappropriate placement that led to incomplete program
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Impact rating # %
Clinical specialists
Senior managers
District level officers
Clinical academics
Non clinician academics
Sustainable 5 19 3 1 - 1 -
Considerable 11 42 1 2 3 5 -
Some 8 31 1 2 1 1 3
No immediate 2 8 2 - - - -
Total 26 100 7 5 4 7 3
Overall Impact Ratings Interviewed Nepal Fellows 2004-2008
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Impact
Sustainable Impact: Established new Intensive Care unit in a major hospital Contributed to development of new medical education model
Considerable Impact: Introduced new techniques for testing and preparing antigens Improved the use of phototherapy in treatment and research Taught new methodologies to colleagues and/or students
Some Impact: Managed investigation and surveillance of local cholera
outbreak, applying new surveillance techniques
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Impact
No Impact: Senior neurologist placed at an institution that could not
provide advanced training -- Fellow returned home early with no gained capacity
Surgeon not able to complete study in urology due to budget restriction -- Fellow not recognised as urologist so could not to apply new knowledge and skills
Equally important to learn from no impact cases
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WHO Findings
1) Current information collected by WHO has the potential to address data needs to assess fellowship impact
Fellowship Application Form: Fellow’s details, study objectives, endorsements
Letter of Award: relevant information on training program & fundingTermination of Studies Report: Fellows & host institutes’ assessment of
trainingUtilization of Studies Report : Fellow & supervisor’ assessment one-year
laterFellows in-depth written reports: Required by some home institutes
BUT forms are forms – the quality and depth of responses vary
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WHO Findings
2) Face-to-Face (F2F) Interviews are crucial Better understand complexity of individual cases
Elicits potentially sensitive information Offers richer, in-depth ‘st ories’ of the journey
3) Debriefing important at various intervals Post-Fellowship (1-3 years)
4) Significant contributions were made in strengthening institutional capacity and provision of services
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Recommendations
1) Provide briefing of national needs to training institutions
2) Require progress and post-training reports from training institutions
3) Require fellows to prepare detailed and insightful termination and follow up reports
4) F2F debriefings on utilization of training with a sample of fellows 1 -3 years post- fellowship
5) Review barriers to utilization and provide further support, when feasible and appropriate
6) Develop Fellowship alumni network
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What Next?
What can we do now to improve our FEL program?
• Gain Fellows’ commitment to follow-up evaluations (1-5 years)At program onset, include post-training evaluation commitment in application
• Incorporate interviews into FEL program, not as ‘add-on’ activity but integral componentSelect cohort of 20 each year
• Share information – ‘get the message out’ to stakeholdersPackage’ according to audience: Ministry / government, Home institutes, Host
institutes
KISS Keep It Simple Sweetheart
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The Journey Continues . . .
What’s your next step?