Implementing an Alternative Training Approach

The shift from a traditional, instructor-led, group-based training approach to a self-paced, structured OJT approach is not an easy transition. Often, trainers can more easily design a group-based course where individuals leave their jobs for a period of time to be trained in a group setting and then return after being trained. Supervisors and managers may have little knowledge about what occurs during the training course, however, and may not be prepared to help the individual apply the new knowledge and skills on return to the work setting. By contrast, when training with a focus on job performance is inserted into the job site, building consensus with key stakeholders as well as designing a quality training event become critical.

The model shown in Figure 1 was used to implement a successful and sustainable structured OJT approach in Zimbabwe (and was also applied to Kenya). This implementation model recognizes the importance of both design and development of the OJT strategy and consensus-building activities around the strategy implementation. The focus of the left side of the model is on the steps in the design and development of the structured OJT strategy. The right side of the model presents the consensus-building activities critical to the success of the design and development steps. A chronology to the two tracks is shown, with the consensus-building activities coming at certain points in the design and implementation of the strategy.

Figure 1. Model for Implementing a Structured On-the-Job Training Strategy

Each step in the implementation model is described briefly below. (Zimbabwe is used as the specific example; however, implementation was similar in Kenya)⁴.

• Identify the Training Need: Conduct a needs assessment to ensure that a training intervention is needed and to define the content of the training.

• Meet with Key Stakeholders: In all sectors involved in this type of training, key stakeholders who have input into what kind of training is needed, where and for whom must be consulted to garner support first for the new approach and then for the pilot test.

• Design the OJT Strategy: Designing the strategy includes a thorough review of the literature on OJT to allow staff to consider various types of OJT, advantages and limitations, training of OJT trainers, formats of materials and evaluation strategies. (Because a more specific strategy was needed for the OJT program requested in Zimbabwe, a strategy development workshop was held. The workshop in Zimbabwe ensured that the approach for an OJT course was realistic and gained the support of those who would be conducting the course at various sites.) The output of the strategy design phase is a clear, concise description of how OJT will work in a specific situation.

• Approve Pilot-Test Strategy: Gain approval both within the ZNFPC and among the various agencies in Zimbabwe to conduct a pilot test of the structured OJT for clinical training.

• Develop OJT Materials: Conduct a materials development workshop to develop quality materials. In Zimbabwe, this workshop resulted in the development of an OJT package. (A description of this workshop can be found below along with Figure 2, which shows the materials that were developed.)

• Conduct National-Level Orientation: In Zimbabwe, the newly developed OJT package was presented at a meeting of key Zimbabwean decision- and policymakers in February 1996 to orient them to the approach and to ensure their support for implementation of the OJT pilot test.

• Identify Training Sites and Staff: In Zimbabwe, the national OJT coordinator, in collaboration with technical resource staff at the ZNFPC, worked with the Ministry of Health/Child Welfare (MOH/CW) to identify appropriate sites and personnel for the OJT pilot test. Criteria for site selection were presented in the OJT package.

• Train the OJT Trainers and Supervisors: The preparation of the trainer and, if applicable, the OJT supervisor are essential to the success of an OJT course.

• Conduct Site Orientations: In Zimbabwe, the OJT supervisors, with technical assistance from the ZNFPC, conducted site orientations. All staff at an OJT site were involved in the orientation. They were given the opportunity to examine the training materials and review the training schedule briefly. They also had the opportunity to discuss how OJT training might affect each of their roles in carrying out daily activities.

• Conduct the OJT Pilot Test: The pilot test focuses primarily on examining the feasibility of implementing structured OJT for clinical training.

• Visit OJT Sites: Monitoring activities include site visits made at the beginning of the pilot test, often concurrent with the site orientations to launch OJT. Communication (usually by telephone) is maintained regularly during the pilot test. In Zimbabwe, at least two site visits were made, one during each participant’s training period.

• Present Pilot-Test Results: Synthesis of the results of the pilot test includes examining both the feasibility of implementation and identifying potential problem areas when scaling up to full implementation. Results are presented at a national forum of key decision-makers in the field of RH training (policymakers, program implementers, trainers, service delivery managers, donors and implementing agencies).

• Revise the OJT Strategy and Materials: Based on the results of the pilot test, revisions to both the strategy and the training materials are recommended. Two primary revisions were made to the OJT strategy in Zimbabwe. First, based on the way OJT was implemented within each of the pilot sites, the OJT program descriptions were changed to include several implementation options. Second, changes were made to the way in which followup and monitoring were conducted once an OJT course was implemented. Two of the most critical elements in an OJT approach are the interactions between the trainer and participant and between the trainer and supervisor. To help improve these interactions, additional information was added to the learning package and the workshops for the trainers and supervisors.

• Implement the OJT Strategy: The next step—after a sound strategy has been developed, training materials have been revised and support of the key players has been achieved—is to move ahead with full implementation.

Correcting Existing IUD/GTI Training Materials

JHPIEGO assisted the ZNFPC, MOH/CW and other organizations in Zimbabwe to convert the group-based IUD/GTI course to a structured OJT course. The development of a training strategy to implement structured OJT for the provision of IUD services began in Zimbabwe in August 1995. At a 2-week workshop, representatives from the ZNFPC, MOH/CW and City Health worked together to accomplish the following five objectives:

• Develop a model for an on-the-job approach to training IUD service providers

• Develop draft materials for use in the IUD/GTI OJT program

• Develop strategies for implementation of the OJT program

• Develop strategies for evaluating the OJT program

• Develop recommendations regarding managerial and technical support for the OJT program

To ensure the quality of a structured OJT approach to training, the participants (ZNFPC, MOH and JHPIEGO trainers) felt that OJT, like traditional group-based training, must embody four essential components of clinical skills training:

• Knowledge transfer and assessment

• Skill transfer and assessment using anatomic models

• Skill transfer and assessment working with clients

• Attitude transfer through behavior modeling by the trainer and interaction with the clients and the trainer

The participants at the August 1995 (Zimbabwe) and the March 1996 (Kenya) workshops drafted a training model for how the structured OJT process would work. Several methods were used to create a basis for the development of the OJT approach to training. Participants discussed the situation in their country for preparing IUD service providers. Following the model development, the facilitators presented the concept of OJT (Sullivan and Smith 1996).

Participants then reviewed the types of training activities used for different target groups, described the lengths of various training courses and discussed the training methods used by trainers at the time. In Zimbabwe, participants also reviewed the learning package developed for delivering the IUD/GTI traditional (group-based) training course. In addition, they decided that the structured OJT package should include the IUD/GTI reference manual without changes. New materials, however, would need to be developed for OJT participants because the focus of training was shifting to a self-paced, individualized approach.

At the conclusion of the Zimbabwe workshop training materials had been drafted, a model for how structured OJT should be conducted in Zimbabwe had been developed and a plan for implementing the program had been formulated. The pilot test was to include two sequential training periods. During each training period, one OJT participant would be trained at each site. In March 1996 the materials developed in Zimbabwe were adapted for Kenya, and in August 1996 the pilot test began for both countries (14 sites in Zimbabwe and 6 in Kenya).

Figure 2 represents the materials associated with the structured OJT package, some of which are identical to those in a group-based course.

Figure 2. Structured On-the-Job Training Package

In the sections that follow, the structured OJT model for each of the two countries is presented. Although they are quite similar, the different situations in each country called for a slightly different approach. These approaches are explained below.

The Structured On-the-Job Training Model for Zimbabwe

The training model for Zimbabwe (Figure 3) contained the following components:

• A national OJT coordinator was responsible for working with the regional OJT supervisors to ensure the sustainability of the OJT approach to training. The national OJT coordinator was also the liaison with ZNFPC, MOH/CW and City Health services.

• OJT supervisors were responsible for working with the OJT trainers and the participants within the local clinics. The OJT supervisor assisted in site selection, training of the OJT trainers, and orienting site staff both to the FP method and the OJT program. The OJT supervisor also administered the final knowledge assessment to participants and either administered or arranged for a clinical skills assessor to administer the final skills assessment to participants.

• The OJT trainer was responsible for training, coaching and assessing the participant as she moved through the individualized OJT program.

• The OJT participant was a service provider who was interested in participating in the OJT program to learn how to provide IUD services.

Figure 3. Structured On-the-Job Training Model for Zimbabwe

Table 2 describes the roles in the OJT program taken on by the various government agencies (MOH/CW, City Health, ZNFPC) in Zimbabwe as agreed upon by the stakeholders.

Table 2. Cadres Identified for Various Roles in On-the-Job Training—Zimbabwe

OJT Role	MOH/CW	City Health	ZNFPC
OJT Supervisor	Provincial: General Hospital Matron District: District Nursing Officer	Harare: District Nursing Officer Chitungwiza: Resident Matron Bulawayo: Department Chief Nursing Officer	Harare: Matrons Bulawayo: Provincial Nursing Officer
OJT Trainer	Provincial: General Hospital Sister in Charge District: Community Health Sister	Community Health Sister Sister in Charge	Sister in Charge
OJT Participant	Registered General Nurse (RGN), State Certified Nurse
Clinical Skills Assessor	Previously trained in group-based IUD/GTI course, another OJT Trainer or a ZNFPC Clinical Trainer

The Structured On-the-Job Training Model for Kenya

In March 1996, JHPIEGO conducted a 1-week workshop to assist staff from the Division of Nursing, the Nursing Council of Kenya and the Division of Family Health to develop a training strategy to implement structured OJT for the provision of IUD services in Kenya. In addition, JHPIEGO assisted the Kenya staff to adapt the training materials developed in Zimbabwe.

The Kenya staff adopted a slightly different OJT model from the one developed in Zimbabwe. (See Figure 4.) In Kenya, Decentralized Training Center (DTC) trainers, who are responsible for conducting group-based clinical FP/RH inservice training, were designated as OJT supervisors. Clinical preceptors, responsible for training both preservice nursing students and service providers practicing in a clinical area, were selected as OJT trainers.

Figure 4. Structured On-the-Job Training Model for Kenya

Participants identified 6 provincial or district hospital FP clinics as the pilot-test sites. These sites had large IUD caseloads and were used for both preservice education and inservice training. The sites had a steady stream of graduate nurses passing through for practical training before they were deployed to smaller, low-caseload sites like health centers. Participants felt that a structured OJT program would also have a beneficial impact on both inservice (group-based) training and preservice education. As in Zimbabwe, workshop participants developed selection criteria for OJT sites and a list of essential equipment and supplies requested for OJT.

Table 3 describes the roles in the OJT process taken on by the MOH personnel in Kenya.

Table 3. Cadres Identified for Various Roles in On-the-Job Training— Kenya

OJT Role	MOH Staff Position	Usual Job Responsibilities
OJT Supervisor	Provincial Inservice FP Trainer	Conducting group-based courses in FP/RH
OJT Trainer	Clinical Preceptor	Providing both inservice and preservice clinical training for FP
OJT Participant	Service Provider	Providing FP services except IUD
Clinical Skills Assessor	Provincial Inservice FP Trainer	Providing provincial training; are clinically competent

 

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⁴A full description of the OJT implementation model can be found in Sullivan R, SJG Brechin and M Lacoste. 1998. Structured on-the-job training: Innovations in international health training, in Linking HRD Programs with Organizational Strategy.

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