This case shows the successes of the cascading model approach for training of Laboratory and other Health care personnel, designed and utilized bythe EAPHLN-Project in participating countries. The project supports training of health personnel through organizing Regional training, where the participants from the countries have an opportunity to share experiences and expertise. The regionally trained personnel are expected to cascade the training by facilitating knowledge transfer to the lower level facility staff (district and regional/provincial level). The case study presented in covers successes of cascading model for Biorisk Management training designed and implemented by the regional project.
BACKGROUND
East Africa Public Health Laboratory Network Project (EAPHLNP)” is a regional World Bank funded Project, which is being implemented in five countries, namely Kenya, Rwanda, Tanzania, Uganda and Burundi in collaboration between the East, Central and Southern Africa Health Community Secretariat (ECSA-HC) and East African Community. The EAPHLN Project has provided the necessary support to promote increased number of highly qualified and trained laboratory workforce. The project is supporting both long term (Bachelors, Masters and PhD) training as well as short-term training in various disciplines that are organized in the Region.
Developing a competent health workforce is a key component of capacity building for the future improvement in health programs and is critical to delivering on the vision, values and commitments of global health promotion. Current and future health challenges demand new and changing competencies to form the basis for education, training development and workforce planning. International developments in disease prevention & management and evidence-based practice provide the context for developing health workforce competencies, standards, quality assurance and accountability in professional preparation and practice.
Having many health professionals travel for training outside their working stations has been a challenge in terms cost and human resource deprivation as it takes people out of their daily working context therefore compromising the quality of the services at the facilities.To address the challenges of getting many staff out of their working station for either a short term or long term training, the EAPHLNP came up with cascading model of training and capacity building to health personel, The Project provided training to a core team of experts in each country who can then be used to cascade and provide training to other health personnel at the national and at the health facility level (satellite sites).The cascade model helps to provide training of large number of health work force without incurring too much cost and creating a human resource crisis due to training related travels.
OVERVIEW OF THE PROJECT DESIGN AND THE CASCADE MODEL
The EAPHLNP has five technical working groups, the Disease Surveillance and Operations Research Technical Working Groups led by Kenya, Laboratory Accreditation and Networking led by Uganda, The Information and Communication Technology and the Mult Drug Resistance Tuberculosis led by Rwanda the Performance Based Financing which is co-led by Rwanda and Burundi and the Training and Capacity Building which is led by Tanzania.ECSA-HC Plays a facilitating and coordinating role under the project supporting the five participating countries
The EAPHLN-Project through the Regional Training and Capacity Building Technical working group in Tanzania has supported a number of short term and long term training across the Region. In these Regional training participants from the supported countries were trained as TOTs in identified areas of laboratory sciences that are priority to the Region. Therefore at the end of the training each participant developed implementation plan for rolling out the training when they go back to the facilities in their home countries. The trainingis being facilitated by Regional or Local facilitators as well as international facilitators where necessary. The Muhimbili University of Health and Allied Sciences located in Tanzania has been providing a Regional oversight to the quality of the training provided by the project to make sure that the training conducted by the project meets the internationally agreed standards.
The participating countries had shared responsibilities and developed training modules for different courses i.e. Laboratory Management (Tanzania), Biorisk management (Uganda), Laboratory Based Surveillance (Kenya), ICT (Rwanda) and Operations research (Kenya-KEMRI). These training modules have been successfully piloted for training laboratory staff in the region. These moduleswill be converted into e learning format for easier accessibility by staff from satellite and non-satellite sites in the East African Region and beyond, who would wish to take the online courses.
RESULTS
The EAPHLN-Project has conducted 22 Regional training with 299 health personel trained from all the five East African countries. The training were in the following disciplines; Laboratory management, Disease Surveillance and outbreak investigations, Biorisk Management, Basic & Advanced ICT, procurement training and Laboratory Assessors (auditors) training, Operational research, ICT-TYPO3, Typo3 refresher course, Procurement, Biosecurity Assessors training, Procurement Training, Quality Management Systems; and Monitoring and Evaluation. The trained personel from the Regional training had trained their fellow staff at the National level and those at the satellite sites, in this case increasing the numbers of trained personel and improve the knowledge sharing in the Region. Through this model of training and knowledge sharing, the countries under EAPHLN-Projecthave been able to train a total of 3,478 for the year 2012-2013.Each country has trained varied number of participants under this model of approach.Kenya trained 649 out of a target of 1045 (62%), Uganda 163 out of a target of 150, Burundi trained 40 out of a target of 54 (74%) Rwanda trained 1765 and Tanzania has trained 861 health personnel out of a target of 1160 (74.2%)
Both Tanzania and Rwanda have utilized the cascading model of training effectively for the year 2012-2013 and have succeeded in training large numbers of Health Personel compared to other countries within the Project.Tanzania trained a core team of professionals on Biorisk management, IDSR guidelines, Outbreak Management, Infectious Disease Control and Specimen Managementat country level. The participants from these training were trained as TOTs and therefore dispatched to the satellite sites and cascaded the training to 698 staff at the satellite sites in Kibongoto, Sumbawanga, Ndanda, Kigoma, Musoma, Mnazi Mmoja as shown in the Table 1.below.
Table 1:Training Conducted & Number of Health Personel Trained at Tanzanian Satellite Sites
SATELLITE LABS / TRAINING CONDUCTED & NUMBER OF HEALTH PERSONEL TRAINED / TOTAL/SITEBiorisk M / TOT on IDSR / OM / IDC / SM
KIBONG’OTO / 35 / 30 / 65
SUMBAWANGA / 83 / 24 / 40 / 147
NDANDA / 142 / 73 / 55 / 270
KIGOMA / 28 / 28
MUSOMA / 55 / 32 / 51 / 138
MNAZI MMOJA / 50 / 50
TOTAL / 698
BM: Biorisk Management, TOT: Trainer of Trainees, IDSR; Integrated Disease Surveillance and Response, OM: Outbreak Management, IDC: Infectious Disease Control, SM: Specimen Management
Biorisk Management is one of the courses that were successfully cascaded to the satellites in Tanzania, where 3 staff were trained regionally, when the 3 went back they managed to train 4 other staff at National level who then formed a team of National facilitators and trained 365 at the 5 satellite sites as shown in figure 1 bellow;
Figure1. Example of cascading Model for Biorisk Training in Tanzania
Participants for Biorisk management training in Ndanda Satellite Site
Rwandahastrained a core team of professionals on Biorisk management, Integrated Disease Surveillance and Responseguidelines, Outbreak Management, Laboratory information System, SLMTA, Good Laboratory Practice, ICT and Specimen Management at country level. The participants from these training were trained as TOTs and therefore dispatched to the satellite sites and cascaded the training 976 staff at the satellite sites in Kibungo, Nyagatare, Gihundwe, Byumba, Gisenyi, NRL and EID as shown in the Table 2 below.
Table 2: Training Conducted & Number of Health Personel Trained at the Rwandan National & Satellite Sites.
SATELLITE LABS / TRAINING CONDUCTED & NUMBER OF HEALTH PERSONEL TRAINED / TOTAL/SITEBiorisk / TOT on IDSR / OM / LIS / SLMTA / GLP / ICT / SM
KIBUNGO / 68 / 31 / 20 / 17 / 53 / 189
NYAGATARE / 28 / 14 / 2 / 12 / 56
GIHUNDWE / 6 / 16 / 22
BYUMBA / 68 / 23 / 27 / 118
GISENYI / 77 / 15 / 22 / 78 / 192
NRL / 50 / 26 / 26 / 60 / 162
EID / 8 / 229 / 237
TOTAL / 976
TOT: Trainer of Trainees, IDSR; Integrated Disease Surveillance and Response, OM: Outbreak Management, LIS: Laboratory Information System, SLMTA: Strengthening Laboratory Management Towards Accreditation, GLP: Good Laboratory Practice, SM: Specimen Management
Biorisk Management is one of the courses that were successfully cascaded to the satellites in Tanzania, where 3 staff were trained regionally, when the 3 went back they managed to train 50 other staff at National Reference Laboratory who then formed a team of National facilitators and trained 241 at the 4 satellite sites as shown in figure 2 bellow;
Figure2. Example of cascading Model for Biorisk Training in Rwanda
LESSONS LEARNT AND WAY FORWARD
Cascading model of training may be provide
- An effective way of reaching health personel s especially those in remote areas like the satellite sites, where many staff can be trained locally without leaving their working stations, in this case continue offering the services to clients.
- A cost effective way of training compared to sending staff out of their working, therefore many staff can be trained using minimum resources
In order the increase access of the training to large number of persons from remote areas, the project is converting the regionally developed training materials to multi-media to be used by team at the satellite sites and other remote areas
The regional training and capacity building TWG is working to upgrade one of the locally developed courses in laboratory management to be offered as certificate course in the universities in the region. This will provide training in management of laboratory services, a skill that has been found missing in many laboratory supervisors in facilities in the region