Results Of Training Needs Assessments TNA In AFRICA for 20012003

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Results Of Training Needs Assessments ( TNA) In
AFRICA for 2001-2003

• By Dr E. Mutabaruka
• Capacity Building Officer
• VPD/AFRO
• November 2003

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CONTEXT

• All country EPI reviews recommend to build
  capacity of health workers in order to improve
  the quality of EPI services
• No harmony between pre- in-service training
• UN Foundation has funded a project to strengthen
  immunization in 8 Africa Region countries since
  2000
• TNA to cover operational areas and supportive
  components of immunization services.
• Collaboration offered by NESI for TNA in 2003.

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OBJECTIVES Of TNA

• To describe the status of immunization training
  in the target countries.
• To document previous EPI training activities
• To identify new unmet EPI training needs
• To make recommendations for actions to improve
  EPI training
• NB TNA concerns both pre-service and in service
  training.

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Methodology

• Study population
• Planners at national level,
• EPI focal point persons at regional, district and
  hospital levels
• Supervisors and health workers
• Trainers/trainees in pre and in- service training
  institutions
• Data collection
• Focus Group Discussion guide/interviews
• Observations/site visits
• Record review

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COUNTRIES THAT HAVE CONDUCTED TNA IN 2002-2003
AND TNA PLANNED FOR 2004
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Sites Visited (1)

• Policy and planning level
•    Ministry of health - HQ
•   Ministry of health EPI unit
• Cooperating partners
• WHO country office
• UNICEF -country office
• Other partners
• Schools of Nursing (pre and in-service
  programmes)

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Study sites visited(2)

• Training Centre for Allied Health Professionals
• School of Medicine (under and post graduate
  programmes)
• Other levels
• Provincial Health Office
• Regional/Provincial/Central Hospital
• District Health Office
• District/General Hospital
• Health Centre

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LIMITATIONS OF THE EXERCISE

• Time constraints
• Questionnaires were applied to groups and there
  was possibility of generalizing responses
• Sample size was inadequate .

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Summary of Previous EPI Training Initiatives

• Integrated disease surveillance
• Cold chain and logistics management
• NIDs orientation workshops once a year
• Measles campaigns workshops
• Applied epidemiology
• New vaccine introduction workshops.
• Ad hoc training offered

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EPI TRAINING INITIATIVES Strengths (1)

• Induction course ensures all new staff joining
  EPI management to be equipped for delivery of
  immunisation services.
• A few schools invite EPI team as guest
  lecturers.
• Development of EPI reference materials in local
  languages facilitates communication and
  understanding by auxiliary health workers and
  community members.

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EPI TRAINING INITIATIVES Strengths (2)

• Training curricula for Enrolled midwives,
  clinical officers and Bsc. Nurses covers
  immunizations more comprehensively than Medical
  Schools.
• Involvement of students and tutors from some
  institutions during NIDs
• Some curricula(2 countries) are well structured
  and use check lists or practical procedure record
  books for monitoring and recording students
  performance.

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TRAINING ON IMMUNIZATION -WEAKNESSES

• No Harmony between pre in-service training
• Academic staff and clinical instructors not
  exposed to modern EPI theory and practice.
• Immunization not adequately covered in training
  curricula and where present the content is not
  structured.
• Training schools have not been getting literature
  on immunization from NPI and WHO.

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UNMET TRAINING NEEDSIN TRAINING INSTITUTIONS

• EPI Reference materials and teaching aids not
  available
• Inadequate transport to facilitate/supervise
  students practical experience in outreach
  immunization activities
• Lack of equipment for EPI practical lessons

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Unmet Training Needs in Service Delivery Areas at
Central, Provincial and District Levels

• Priority topics
• Logistics / cold chain management
• Increasing immunization coverage
• Communication/ IEC
• Managerial and financial management skills
• Surveillance of EPI targeted diseases and AEFI
• Quality data management skills
• Computer skills
• Skills to develop EPI training materials
• Principles of adult education and teaching
  methodologies

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Unmet Training Needs in Service Delivery
Areas Health Facility Level -1

• Calculation of target population and vaccine
  requirements
• Storage and arrangement of vaccines in fridges
• Monitoring of vaccine wastage
• Temperature monitoring
• Management skills (planning outreach activities,
  supervision, monitoring and evaluation)
• Data management skills (collection, completing
  forms, presentation and interpretation of EPI
  data)

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Unmet Training Needs in Service Delivery Areas 
at Health Facility Level - 2

• Organization of logistics for outreach services
• Immunization schedule
• Vaccination sites and routes of administration
• Monitoring EPI coverage using the monitoring
  chart
• Contra- indications and side effects of vaccines
• Increasing vaccination coverage
• Use of auto-disable syringes and disposal of
  sharps
•  Computer training skills
• Surveillance of EPI diseases, handling of
  specimens and AEFI
•  Reference books and manuals on EPI
• Community mobilization and communication skills

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ADDITIONAL INDIVIDUAL NEEDS

• Supervisors/teachers expressed need to attend
  further professional courses such as
• Advanced cold chain and logistics management
• Surveillance, Epidemiology and public health
  sciences
• Management
• Facilitation skills in adult learning
• Advocacy and communication
• Computer skills

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RECOMMENDATIONS MOH

• Refresher courses on immunizations to orient
• all teaching staff
• Review all training programme curricula in
  collaboration with professional bodies, in order
  to incorporate the updated immunization theory
  and practical component.
• Develop appropriate generic EPI materials
• for various professional cadres.
• Provide updated teaching/learning aids
• Develop harmonious national training plans

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RECOMMENDATIONS MOH

• Ministry of Health to provide a 2 weeks EPI
  training workshop to equip newly qualified staff
  with basics on immunization theory and practice
  before they are sent out to their postings.
• Ministry of Health to provide regular and
  continous EPI training courses to up date
  knowledge and skills of health workers in the
  field and training institutions.
• Provide funds to support continous routine EPI
  training for new in- service staff

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RECOMMENDATIONS SCHOOL OF MEDICINE

• The University to introduce a medical education
  course for lecturers on principles of education
  and teaching methodologies.
• Medical School to introduce the teaching of EPI
  as a block in medical school at the end of
  training programme in a similar way IMCI has been
  introduced.
• Medical School to develop a structured course on
  EPI theory content and practical procedures to be
  achieved by learners in order to standardize the
  teaching of immunizations

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RECOMMENDATIONS PARTNERS

• PARTNERS to support development and reprint of
  EPI training materials
• PARTNERS to financially support training of
  health workers AND TEACHERS on routine
  immunization services.

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FOR DISCUSSIONS

• HOW TO ASSIST COUNTRIES IN DEVELOPING HARMONIOUS
  TRAINING PLANS?
• HOW TO ADDRESS IDENTIFIED TRAINING NEEDS,
  ESPECIALLY FOR PRE-SERVICE TRAINING INSTITUTIONS?

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THANK YOU