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JHPIEGO Corporation, an affiliate of Johns Hopkins University, is working with medical
professionals in reproductive health in Zimbabwe to implement a structured on-the-job
training (OJT) program. The goal of this program is to improve the performance of family
planning service providers in clinical sites throughout the country. Working with the
Zimbabwe National Family Planning Council, the organization that was charged with helping
to implement the system, JHPIEGO staff converted an existing group-based clinical training
course to a structured OJT course and helped build support for this new training approach.
The design and consensus-building activities resulted in the implementation of an
effective, structured on-the-job training program. The model for implementing this
innovative training approach identifies key steps from conception through pilot testing to
full-scale implementation-steps relevant to a variety of training situations.
JHPIEGO assisted the Zimbabwe National Family Planning Council (ZNFPC) in 1993 to
develop and conduct a clinical training course for supervisors and service providers. A
1994 evaluation of this integrated program showed only limited success. Many trainees
returned from the group-based course to sites where they were not able to practice their
newly acquired skills because of other job responsibilities, low caseloads, or inadequate
supervision. Results of this evaluation suggested that traditional classroom courses may
not always be the most appropriate or effective way to ensure application of new skills on
the job. The assessment also emphasized the important link that needs to be made between
training and service delivery. To respond to the evaluation team’s recommendations
and to ZNFPC’s need for different training approaches that would maximize their
ability to train more service providers more quickly, JHPIEGO assisted the ZNFPC, the
Ministry of Health and Child Welfare (MOH/CW), and other organizations in converting the
group-based clinical course to a structured OJT course in August 1995.
JHPIEGO Corporation, a nonprofit training organization affiliated with Johns Hopkins
University, is funded primarily by the United States Agency for International Development
(USAID) and works to develop a reproductive health clinical-training capacity in
developing countries. In Zimbabwe, JHPIEGO collaborates with the ZNFPC, a parastatal
organization charged by the Zimbabwean government with coordinating all family planning
activities in the country, including providing technical assistance to the MOH/CW and
other organizations as necessary, and coordinating training, contraceptive logistics,
evaluation, communication activities, and provision of family planning services.
Currently working in approximately 30 countries, JHPIEGO assists organizations like the
ZNFPC and the MOH/CW to establish pre-service education and in-service training programs
to prepare clinical, advanced, and master trainers. These trainers then train clinicians
to provide quality clinical services to women and men. As the focus of training is on
clinical procedures, JHPIEGO trainers use a mastery-learning approach that is competency
based, meaning that participants must demonstrate mastery of knowledge and skills with
anatomic models before working with clients. To support this training approach, JHPIEGO
produces comprehensive clinical-training packages for group-based training. These packages
include a reference manual, guides and workbooks, pre- and postknowledge assessments, and
performance checklists.
The ZNFPC conducts in-service family planning clinical-training courses for both
public- and private-sector clinical providers. Almost all training is group based, which
means that participants are brought from work sites to a central location for a specific
period of time for a training course. They receive lodging in training centers or hotels,
allowances for meals and incidental expenses, and reimbursement for transportation costs.
Through in-country needs assessments, two primary issues were identified in 1994.
Although the individuals who attended the group-based training course demonstrated mastery
of clinical skills during training, they did not always use these skills in providing
services to clients at their work sites. It appeared that the clinician was trained and
ready to provide services, but that the job site was not always prepared to offer these
services. In addition, the clinician’s supervisor may or may not have been involved
in the decision for the individual to attend training and, therefore, may not have had a
strong commitment to seeing that knowledge and skills acquired during training were
applied on the job.
Another issue related to the link between training and job performance. Because
training was group based, participants would leave their jobs for two weeks to attend the
in-service training course at a central site. Participants acquired the latest medical
information, practiced skills on new anatomic models, had access to new instruments, and
used their skills in the best clinics. To provide quality training, every effort was made
to ensure that both classroom and clinical experiences were ideal. When the participants
went back to work, however, they often were returning to facilities where they worked in
less than ideal conditions. In addition, participants often were not in a position to
effect change in their work environment. This resulted in skills not being applied on the
job.
In light of the issues that the evaluation raised, it was apparent that either the
existing group-based training course would need to be modified, or the focus of training
would need to shift to the job site.
The shift from a traditional, instructor-led, group-based training approach to a
self-paced OJT approach is not easy. It is often much easier for trainers to design a
group-based course that allows individuals to leave their jobs for a period of time to be
trained in a controlled 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 trainees apply their new knowledge and skills when
they do return to work. By contrast, when training is inserted into the job site with a
focus on job performance, it becomes critical to build consensus with key stakeholders and
design a quality training event. Recognizing the importance of design, development, and
consensus-building activities, JHPIEGO staff developed the model shown in Figure 1. The focus of the left side of the
model is on the steps in the design and development of the OJT training strategy. The
right side of the model presents the consensus-building activities critical to the success
of the design and development steps. Both sides combine to create the implementation
model. JHPIEGO’s position was that to implement a successful and sustainable OJT
approach required a combination of design, development, and consensus-building activities.
The descriptions below each of the steps shown in Figure
1 summarize the approach JHPIEGO used in conjunction with the client to
implement the structured OJT in Zimbabwe.
Figure 1. Model for Implementing an OJT Strategy
Identify the Training Need
In 1993, JHPIEGO assisted the ZNFPC in developing an in-service family planning
clinical-training package and in conducting group-based courses using these materials. As
discussed above, this group-based approach experienced only limited success. Many trainees
returned to sites where they were not able to practice their newly acquired skills because
of other job responsibilities, low client caseload for the method in which they were
trained, or inappropriate and inadequate supervision. Results of this evaluation suggested
that traditional instructor-led courses may not always be the most appropriate or
effective way to ensure application of new skills on the job. Given these findings and the
ZNFPC’s need for different training approaches that would maximize its ability to
train more service providers more quickly, the evaluation team recommended that JHPIEGO
assist the ZNFPC in developing a structured OJT package for clinical training.
Meet With Key Stakeholders
After defining a broader clinical-training strategy to expand more quickly the numbers
of service providers trained, senior managers decided to pilot test a structured OJT
approach. It was imperative that all sectors involved in this type of training be
consulted to garner support for the pilot test. Although ZNFPC coordinates all family
planning training in the country, a number of key stakeholders have input into what kind
of training is needed, where, and for whom. Meetings with these decision makers were held
over a period of approximately six months, until both JHPIEGO and ZNFPC felt confident
that consensus on this approach had been reached and that the pilot test could move
forward.
Design the OJT Strategy
Because structured on-the-job clinical training was a new training approach for
JHPIEGO, a decision was made to define the approach through a strategy paper before
developing needed training materials. The first step in the development of the strategy
paper was to conduct a thorough review of the literature on OJT (see references at the end
of this case study), which would allow staff to consider various types of OJT, advantages
and limitations, training of OJT trainers, formats of materials, and evaluation
strategies. A draft of the paper was circulated to staff for comments and suggestions.
After several revisions, the strategy paper was ready for use in developing a specific OJT
program.
The strategy paper was useful in describing JHPIEGO’s general approach to
structured OJT and provided readers with a clear picture of what OJT should look like. A
more specific strategy, however, was needed for the OJT program being requested in
Zimbabwe. With the support of key stakeholders, a workshop was held with trainers from
those organizations that would be using the OJT approach. Although a centralized training
office can develop a traditional, instructor-led course, development of an OJT course must
involve the individuals who will be implementing this training approach. Therefore, a
strategy development workshop was held in Zimbabwe to ensure that the approach was
realistic and to gain the support of those who would be conducting the course at various
sites.
During the workshop, participants learned about OJT and reviewed JHPIEGO’s general
OJT strategy. Participants then identified key personnel to be involved in the OJT
approach, including the trainee, trainer, supervisor, and national OJT coordinator.
Participants, working in small groups, identified the roles and responsibilities of each
of these individuals. There were lengthy discussions to reach consensus on the
responsibilities of each person involved in the OJT course.
The most critical discussions in the workshop centered on the process for knowledge and
skill transfer and assessment. How would the trainee acquire the knowledge contained in
the reference manual? How and when would the trainee be assessed? What types of activities
would the trainee complete both individually and with the trainer in order to practice or
apply newly acquired information? How would the trainee and trainer know when specific
activities (e.g., trainee to read a specific chapter, trainer to give a demonstration)
were to occur? When would the supervisor administer the final knowledge and skill
assessment? The answers to these and similar questions, coupled with the results of the
discussion about roles and responsibilities, helped to form the basis for the Zimbabwe OJT
strategy.
The output of the strategy design phase is a clear, concise description of how OJT will
work in a specific situation. If JHPIEGO were to develop an OJT approach for another
country, it would have to go through the same strategy design process again. OJT will
necessarily differ slightly in each setting to meet the specific requirements of the
country.
 (continued)
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