Improving
Performance of Healthcare Providers |
Introduction
JHPIEGO is working with healthcare professionals in reproductive health (RH) in East and Southern Africa to implement a structured on-the-job training (OJT) program for clinical family planning (FP) training. The goal of this program is to increase access for women wanting to use a FP method by training more service providers in clinical FP skills. In collaboration with the Zimbabwe National Family Planning Council (ZNFPC) and later with the Kenya Ministry of Health (MOH)/Division of Primary Health Care (DPHC), JHPIEGO staff converted an existing group-based (also referred to as instructor-led) clinical training course to a structured OJT for IUD skills course and helped build support for this new training approach. The design and consensus-building activities led to the implementation of an effective, structured OJT program for improving the performance of IUD service providers, which in turn resulted in the provision of quality services. The model for implementing this innovative training intervention identifies key steps from conception through pilot testing to full-scale implementation—steps relevant to a variety of training situations. This technical report reviews the development and implementation of the structured OJT approach, through pilot tests in Zimbabwe and Kenya, including the adaptation of training materials from a group-based IUD skills course.
Background
On-the-Job Training
OJT (also referred to as site-based or clinic-based training) is a form of individualized training. OJT allows an individual who needs training to receive the necessary knowledge, develop the required skills and improve performance—all on the job. A review of the literature indicates that OJT can be designed and delivered using two basic approaches: unstructured and structured. OJT programs that are implemented with little or no prior planning and that pair a worker to be trained with an experienced worker are referred to as unstructured, informal or unplanned OJT experiences. Programs that are built on an organized process are known as structured, formal or planned OJT experiences. This report will focus on structured OJT.
The ultimate success of structured OJT depends on the organization’s commitment to improving training quality (Mullaney and Trask 1992). These authors stress that a successful OJT program is one that is used in appropriate situations and ensures that OJT trainers have the appropriate technical competence and extensive work experience. They also feel that OJT trainers should have organizational support and receive training to be an OJT trainer. The successful structured OJT program is one that is based on an effective training model. The elements that should be built into a formal or structured OJT program are: performance objectives, a schedule, assignment to a qualified employee for training and a performance checklist that must be signed off as each objective is met (Reynolds 1995). Table 1 lists the advantages and limitations of structured OJT. In healthcare systems that need to keep pace with changing performance needs, structured OJT expands learning options beyond the traditional group-based course.
Table 1. Advantages and Limitations of Structured On-the-Job Training
Advantages
Trainees2 can be trained immediately without waiting for a scheduled course.
Clinic personnel control the quality of training.
Training can be designed to meet local needs.
Obtaining a sufficient client caseload to ensure adequate clinical experience is easier.
The problem of inappropriate participant selection (e.g., political decisions, lack of interest in training) is minimized.
Once established, OJT may be more sustainable than traditional group-based training.
OJT can be more cost-effective than traditional group-based training.
OJT is most effective at sites that have staff turnover or where large numbers of clinicians require training.
Limitations
Participants may tend to revert to "see one, do one, teach one" instead of following the steps in the structured OJT program.
Maintaining quality of training in a national-level program can be difficult.
Limited reading abilities of the participants may create problems because the OJT participant is expected to meet reading requirements on her own, independent of the trainer.
In the early phases of training when participant skills are weak, participants may have a tendency to practice skills with clients in the clinic instead of with anatomic models.
Training needs of the OJT trainers must be met.
OJT may not be cost-effective at sites where staff turnover is limited.
The Situation in Zimbabwe and Kenya
In both countries, the training officials at the national level realized the need for alternatives to the traditional group-based courses for training FP service providers. Ultimately, alternative training was expected to increase the number of providers who could deliver quality services and give women access to a full range of FP options. (Appendix A gives details of the country situations in Zimbabwe and Kenya that stimulated development of the IUD/GTI structured OJT program.) Expanding training options would also allow a more rapid increase in the numbers of service providers competent in IUD insertion. The IUD/genital tract infection (GTI) structured OJT pilot test was initially programmed for and developed in Zimbabwe. Then, because training officials in Kenya had similar limitations on training IUD service providers3, the pilot test was expanded to include Kenya.
2During the initial design of the OJT model for Zimbabwe and Kenya, the word "trainee" was used to describe those who participated in the OJT courses. For the remainder of this report, "participant" will be used unless "trainee" is part of a title.
3Providing inservice group-based training to the large numbers of nurses who were needed to increase access to FP was costly, and assuring adequate caseload for clinical training was difficult.
