Distance Learning for Health: Tana Wuliji
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Transcript of Distance Learning for Health: Tana Wuliji
Human resources for health training: An overview of training priorities and approaches
Tana WulijiSenior Associate,nstituto de Cooperaciόn Social - Integrare (ISCI)[email protected]
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DL4H International WorkshopLondon, UK26 October 2010
Overview
• Background• Post-qualification training priorities• Training design for performance• Conceptual framework for approaches to
health worker training
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Background Human resources for health crisis
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Health systems strengthening
What is a health system?
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“All organisations, people and actions whose primary intent is to promote, restore
or maintain health”
WHO, 2000
Health systems building blocks
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Service delivery
Health workforce
Information
Medical products, vaccines and technologies
Financing
Leadership/ governance
Improved health
Responsiveness
Social and financial risk protection
Improved efficiency
4 million health worker shortage in 57 countries
In 60 countries, less than ¼ deaths recorded
Medicines availability 20% in public sector in 39 LMIC
100 million people impoverished due to
health spending per year
Public health spending
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Private health spending
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Child 1-5 mortality
www.worldmapper.org Data: UNDP, WHO, 2002
Health workforce crisis: 57 countries
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Nurses
www.worldmapper.org Data: WHO Global Health Workforce Atlas
Midwives
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www.worldmapper.org Data: WHO Global Health Workforce Atlas
Pharmacists
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www.worldmapper.org Data: WHO Global Health Workforce Atlas
Physicians
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www.worldmapper.org Data: WHO Global Health Workforce Atlas
Dentists
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www.worldmapper.org Data: WHO Global Health Workforce Atlas
Post-qualification training priorities
Training and performance
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Health systems strengthening perspective
Training priorities
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Service delivery:Diabetes UK Twinning to train health workers and trainers
Health workforce:PEPFAR funded MEPI, NEPI; PROFAE nursing workforce
Brazil, AMREF nursing workforce
Information: Field Epidemiology Training programs (FETP): Americas,
Africa
Medical products, vaccines and technologies:
Supply chain management training (MSH, JSI)
Financing
Leadership/ governance:
6 month health management skills program Yale/Liberia
- HR Managers- Educators- Primary
healthcare workers
- Specialists
Supply chain management
- Researchers
Health systems building blocks
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Service delivery
Health workforce
Information
Medical products, vaccines and technologies
Financing
Leadership/ governance
Improved health
Responsiveness
Social and financial risk protection
Improved efficiency
Training!
But is training always the answer?
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Myth: Training will result in
improvements in health worker performance
Performance
Competence
Training
Work environment
Job satisfaction
Autonomy
Supervision support and feedback
Monitoring of outcomes
Performance is influenced by a broad set of factors
Training design for performance Interactive and
integrated learning
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Work-place based learning
Distance education and e-learning
Workplace based learning• Health facility management 6 month training program in
Liberia– Reduced disruption to work, enabled field based learning
for application of learnt skills• Field Epidemiology Training Program
– Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Dominican republic, Burkina Faso, Ethiopia, Ghana, Kenya, Nigeria, Rwanda, South Africa, Tanzania
– 80% learning in field, 20% in classroom• 3 year work-place based post-graduate diploma to build
general level competencies of hospital pharmacists (UK)
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Distance education and e-learning• University of Western Cape Masters of Public Health
– Health workforce management. 75% distance education. Face to face learning: 4 visits.
• E-learning: online video programs, online modules, live videoconferencing and broadcasting, online case conferencing, web based portfolio systems, online learning platforms
• 2008 meta-analysis of 201 studies (Cook et al, 2008)– large and positive effects from e-learning vs non-
intervention– Mixed/limited positive effects compared to classroom
based training
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Distance education produces comparable but not necessarily superior
effects to classroom education
Interactive and integrated learning
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Level 1: Interactive and clinically integrated
Level 2: Interactive classroom activities and didactic, clinically integrated
activities
Level 3: Didactic /classroom
Khan & Coomarasamy, 2006
Improvements in evidence based medicine practice
7/8 evaluations: Associated with improvements in practice
6/7 RCTs: No significant differences between groups
Conceptual framework for approaches to health worker training
Broadening the Distance Education approach
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From competence to performance
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BEHAVIOUR CHANGE
Performance
As Performance institutionalisation
Level 4: ResultsEg –Improvements in health outcomes, improved health service efficiency (mortality, morbidity, healthcare utilisation)
Level 3: BehaviourEg – Improvements in health worker performance (peer review, observation, patient exit surveys)
·Supervision, support & feedback·Monitoring of outcomes (audit)·Work environment
·Structured preceptorship ·Work-place based & integrated learning·Peer learning and review
CompetenceCOMPETENCE
Level 2: LearningEg – Improvements in competence (pre-test vs post-test, self-assessment)
·Feedback ·Self-directed learning·Problem based learning ·Simulations and case based learning·Distributed learning
EngagementENGAGEMENT
Level 1: ReactionEg – Positive response to training
·Interactive·Competency based·Clear learning objectives·Relevant assessments
Kirkpatrick’s levels of training effectiveness
HEALTH WORKER CAPACITY BUILDING PROCESS GOALS
Enabling factors
Broadening the distance education approach
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Performance
Competence
Training
Work environment
Job satisfaction
Autonomy
Supervision support and feedback
Monitoring of outcomes/audit
= small/moderate effect on practice
= small/moderate effect on practice
Distance education supported by strategies to enable
behaviour change to improve and institutionalise
performance