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Improving health worker competencies:Applying consensus-based
methods to develop
recommendations and strategies for in-service
training improvement
Tana WulijiSenior QI Advisor,URC
Diana FrymusHSS Advisor, USAID
4 December 2012
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How could this framework be used
to improve IST effectiveness,
efficiency, and sustainability?
Which of these areas are most
challenging to address?
Overview
How was it developed?
What is in it?
Content
How has it been
used?
ApplicationWhat affects theeffectiveness, efficiency
and sustainability of
IST?
What is it?
Introduction
Why?
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How could this framework be used
to improve IST effectiveness,
efficiency, and sustainability?
Which of these areas are most
challenging to address?
What affects the
effectiveness, efficiency
and sustainability of
IST?
Overview
What is it?
How was it developed?
What is in it?
How has it been
used?
Introduction
Content
Application
Why?
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What is the in-service training improvement
framework?
A set ofpractice recommendations to
improve in-service training effectiveness,
efficiency and sustainability that were
developed and agreed through international
expert consensus
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Significant proportion of country HRHinvestments
Needed for scale-up of healthservices (HIV, TB, MCH)
Growing attention of countries inreviewing IST portfolios
Global landscape of IST
*Need for evidence-
based guidance for
improving IST programs
and systems
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How can we ensure that we are achieving the
greatest gains in these investments?
Effectiveness-in training outcomes at all levels
Efficiency-in training processes, reducingwaste, and improving
cost effectiveness
Sustainability-to support in-country institutional and
national systems for continuing education
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How could this framework be used
to improve IST effectiveness,
efficiency, and sustainability?
Which of these areas are most
challenging to address?
What affects the
effectiveness, efficiency
and sustainability of
IST?
Overview
What is it?
How was it developed?
What is in it?
How has it been
used?
Introduction
Content
Application
Why?
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How was the IST improvement framework
developed?
1. Develop and reviserecommendations
2. Consolidaterecommendations
3. Targeted literaturereview on
recommendations
4. Rate agreement onrecommendations
25 member
consensus group
June December 2011
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Delphi processDevelopment and review of recommendations
through 5 rounds of peer review and ratings
(Delphi process) and literature review
Improvement framework
Compilation of evidence summaries,
examples and links to resources and
tools for each recommendation to
form how to guidance
Round 4: Open consultation
November 3-29 2011, online
26 countries
86/119 complete responses
Consensus on 44/48 recommendations
Round 5:
Consensus on 40
recommendations
Round 1:
75 recommendationsgenerated
Improvementframework
Expected early
2013
How was the IST improvement framework
developed?
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Which of these are most challenging to address?
1. Strengthening
training institutions
and systems
2. Coordination of
training
3. Continuum of
learning from pre-
service to in-service
4. Design and
delivery of training
5. Support for
learning
6. Evaluation and
improvement of
training
Have your say
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IST improvement framework themes
1. Strengthening
training institutions
and systems
2. Coordination of
training
3. Continuum of
learning from pre-
service to in-service
4. Design and
delivery of training
5. Support for
learning
6. Evaluation and
improvement of
training
Engage national authorities, regulatory and professional bodies
Build capacity and strengthen local infrastructure and trainers
Support CPD systems
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IST improvement framework themes
1. Strengthening
training institutions
and systems
2. Coordination of
training
3. Continuum of
learning from pre-
service to in-service
4. Design and
delivery of training
5. Support for
learning
6. Evaluation and
improvement of
training
Coordinate IST Minimize duplications: Coordination mechanism
Reduce disruption to health services
IST tracking mechanism
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IST improvement framework themes
1. Strengthening
training institutions
and systems
2. Coordination of
training
3. Continuum of
learning from pre-
service to in-service
4. Design and
delivery of training
5. Support for
learning
6. Evaluation and
improvement of
training
Synergies between pre-service education and IST systems
Consistency in approaches and content
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IST improvement framework themes
1. Strengthening
training institutions
and systems
2. Coordination of
training
3. Continuum of
learning from pre-
service to in-service
4. Design and
delivery of training
5. Support for
learning
6. Evaluation and
improvement of
training
Needs based: aligned with plans, understand performance barriers
Compliance with policies, strategies and laws
Evidence based methodologies
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IST improvement framework themes
1. Strengthening
training institutions
and systems
2. Coordination of
training
3. Continuum of
learning from pre-
service to in-service
4. Design and
delivery of training
5. Support for
learning
6. Evaluation and
improvement of
training
Share resources and materials Support trainees post-training
Life long learning skills
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IST improvement framework themes
1. Strengthening
training institutions
and systems
2. Coordination of
training
3. Continuum of
learning from pre-
service to in-service
4. Design and
delivery of training
5. Support for
learning
6. Evaluation and
improvement of
training
Build in evaluation to inform continuous improvement Evaluate
against defined criteria
Engage key stakeholders and trainees
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Design and delivery of training: Recommendation: 4.3
IST should be based on sound, evidence-based learning
principles
and methodologies that offer the best opportunity to produce
sustainable performance improvement within the workplace.
Explanatory note:In order for IST programs to most effectively
improve health worker competencies, they
should apply state of the art learning principles and
methodologies appropriate to the
context that are based on the latest evidence
Examples: For the development of clinical decision
making skills, a RCT comparing an interactive
workshop-based training to simulation training
found that simulation training resulted inbetter skill
performance. This is reinforced by
systematic reviews that identify clinical
simulations as an effective technique for
developing psychomotor and critical thinking
skills. Daniels et al, 2010; Nestel et al, 2011;
Issenberg et al, 2005
Resources: The Johns Hopkins Evidence-Based
Practice Center recommends
multiple techniques, multiple media,
interaction and repetition.Marinopoulos SS et al, 2007.
The Learning for Performance tools
provide guidance on designing
training for desired performance
http://www.intrahealth.org/page/lea
rning-for-performance
http://www.intrahealth.org/page/learning-for-performancehttp://www.intrahealth.org/page/learning-for-performancehttp://www.intrahealth.org/page/learning-for-performancehttp://www.intrahealth.org/page/learning-for-performance
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How could this framework be used
to improve IST effectiveness,
efficiency, and sustainability?
Which of these areas are most
challenging to address?
What affects the
effectiveness, efficiency
and sustainability of
IST?
Overview
What is it?
How was it developed?
What is in it?
How has it been
used?
Introduction
Content
Application
Why?
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Country Experiences:
Utilization of IST Framework
Nigeria- IST Assessment of PEPFAR Nigeria
Portfolio(CapacityPlus/Intrahealth)
Afghanistan- Informed organization of National Training
Standards for the Afghanistan General Directorate of
Human Resources In-Service Department (HSSP/Jhpiego)
Ethiopia- IST Rapid Assessment to inform Ethiopia Federal
Ministry of Health FMOH efforts and strategies to
improve, institutionalize, and standardize IST (HCI/URC)
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Country Experience: Ethiopia
Rapid IST Assessment
How was the assessment developed andconducted?
TWG
Consultation
Identify assessmentobjectives
Identify key themesof focus from ISTImprovement
framework
Tool
Development Turned framework
recommendations intosurvey questions
Developed 10 practicescenarios from
recommendations forkey informantinterviews
Conduct
Assessment Survey sent to 62
survey IST providers
20 key informantinterviews selected byFMOH
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Country Experience: EthiopiaRapid IST Assessment
National IST Situation
IST Program ProviderPractices
Key stakeholder
opinions on ISTpriorities, issues, and
strategic development
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Towards a National In-service TrainingStrategy: Consultative
Workshop
August 13-15th 2012
To develop and reach
consensus on a draft
strategic framework
to inform a nationalIST strategy
Country Experience: Ethiopia
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Strategic
Objectives
Strategies and
Inputs
Opportunities
and Barriers
Identified and Ranked Priority Issues
Stakeholders/
roles
Country Experience: Ethiopia
Development of a National IST
Strategic Framework
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How can this framework be used?
Inform the development of in-service trainingstandards or
quality criteria
Inform the development of in-service training
assessments/self-assessments (eg of training
program providers, training systems)
Guide the development of indicators for
monitoring and evaluation
Guide the development of activities to improvein-service
training
Guide advocacy for policy changes
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A multistakeholder process is an effective way
of engaging expertise to build consensus on
how IST can be improved
The IST improvement framework can be used
to bring together country level stakeholders
around a shared vision for IST
What are the take home messages?
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Acknowledgements
*Akuba Dolphyne, * Emily Lanford, USAID Health Care
Improvement Project (HCI), University Research Co. LLC (URC);
*Lois Schaefer, USAID; * Marita Murrman, International Center
for
AIDS Care and Treatment Programs (ICAP); * Mike Rouse,
International Pharmaceutical Federation (FIP); * Shaun
Noronha,
* Kate Tulenko, IntraHealth; *Rebecca Bailey, IntraHealth
and
World Health Organization (WHO); * Gabrielle OMalley, * Tom
Perdue, * Frances Petracca, International Training and
Education
Center for Health (I-TECH); *Julia Bluestone, * Peter Johnson,
*
Edgar Necochea, Jhpiego; *Karen Chio, * Gail Naimoli,
Management Sciences for Health (MSH); * Rosa Maria
Borrell,Pan-American Health Organization (PAHO); * Cathy Solter,
*
Graciela Salvador-Davila, Pathfinder; * Julia Seyer, World
Medical
Association (WMA); * Tisna Veldhuizen Van Zanten, URC; *
Habib
Benzinan, * Alan Lyles, * Linda Ippolito, * Hugo
Mercer,Independent experts.
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Where can I find more information?
Tana Wuliji
[email protected]
Diana Frymus
[email protected]
Improvement Framework Publication: early 2013
www.hciproject.org/healthworkforce
mailto:[email protected]:[email protected]://www.hciproject.org/healthworkforcehttp://www.hciproject.org/healthworkforcemailto:[email protected]:[email protected]
