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Table 3 Selected pre-service and in-service training in LMICs

From: Pre- and in-service training of health care workers on immunization data management in LMICs: a scoping review

Training moduleAuthor and yearStudy settingPopulationIntervention(s)/instrument/tools usedComments/(relevant findings)
Pre-service trainingMutabaruka et al. (2010) [21]26 training institutions in five selected countries: Ethiopia, Ghana, Lesotho, Senegal and Zambia.• 642 Mid-Level Management (MLM) Inter-country and Regional offices• Review of curricula at regional and country levels; Review of WHO/AFRO MLM modules, related reference documents and handouts; country visits for qualitative data collection and analysis
• Interviews with past MLM course participants, facilitators, supervisors, Ministry of Health officials, country-based partners and other stakeholders
• Focus group discussions with past course participants and facilitators; questionnaires sent to past MLM course participants and facilitator
• Immunization data management not directly referenced
• The MLM training increased the performance of trained staff and therefore contributed to the improvement of EPI data management.
Pre-service trainingHossain et al. (2017) [22]Nursing education institutions: 14 pre-service education institutions (seven public, three faith-based, four private), 23 field placement sites and 29 health facilities• 14 nursing tutors at pre-service education institutions, 28 nursing graduates in health facilities, 21 health facility managers and 16 sub-county EPI supervisors• Updated Expanded Programme on Immunization Manuals in the pre-service education institutions• Limited EPI demonstrations in the classrooms and skills laboratories
• Inadequate practical training in documentation and calculation of estimates. Students lacked required knowledge and skills to prepare summary reports and calculate dropout rates.
• Graduates of public institutions (KMTCs) appeared to be more competent than those from the private or faith-based universities
• Only nine practicum sites (39%), showed students how to calculate coverage rates and plot them on the monitoring chart.
• More than half (52%) of the managers thought that nurses were capable of performing EPI activities without in-service training.
In-service training
(Capacity building of tutors of pre-service and in-service training institutions)
Mutabaruka et al. (2005) [23]African Region (12 of the 13 countries covered by the United Nations Foundation (UNF), USAID and the Network for Education and
Support in Immunization (NESI)-funded projects)
• Tutors and lecturers at health worker training institutions in Cameroon, Madagascar, Malawi, Mali, Niger, Nigeria, Democratic Republic of Congo, Senegal, Tanzania, Uganda, Zambia and Zimbabwe• Semi-structured questionnaires (based on a tool developed by WHO/AFRO) were used for interviews with selected key personnel at regional, district and hospital levels, supervisors and health workers, trainers and trainees at pre- and in-service training institutions
• Refresher and orientation workshop
• Generally, EPI content was either not outlined in the curricula or was incomplete or outdated
• Reference materials and demonstration equipment were also lacking
• Time allocated to EPI theory was inadequate and not standardized
• Inadequate practical and supervision. Lecturers and tutors lacked modern EPI training.
In-service training (Pre-service and in-service training tutors of health worker)Umar et al. (2011) [24]Sokoto and Kebbi States, Nigeria• Tutors in all the five pre-service health training institutions in Sokoto and Kebbi states of Nigeria. (Training nurses, midwives, community health officers (CHO), community health extension workers (CHEW), senior community health worker (SCHEW) and junior community health worker).• Questionnaire on bio-data of health workers’ tutors, their highest educational qualification, years of service, in-service training received on EPI,
• The five components of Reaching Every Ward (REW) namely planning and management of resources, establishing or reactivating fixed post and outreach services, supportive supervision and community linkage and monitoring for action.
• Although in-service training demonstrated significant statistical association on overall knowledge of respondents’ (df = 1; F = 8.62; P < 0.0001), less than half of the respondents had received an in-service training on EPI after graduation.
• There is a need for retraining of tutors on the current trends in immunization and management.
Pre-service curriculumMumbo et al. (2015) [25]Kenya• 14 institutions from 18 institutions identified for initial collaboration with the project towards strengthening health workforce training• The assessment collected data from 533 respondents.
• The assessment questions relating to quality of curriculum sought responses on the following: availability of curriculum guidelines, curriculum responsiveness to institutional mission and regularity of curriculum review as well as involvement of stakeholders in the review process
• The findings revealed major gaps in quality and adequacy of curricula in the training institutions.
• A national standard framework to guide curricula review process is lacking
• Curricula did not adequately prepare students for clinical placement, as most failed to directly respond to national health needs.
In-service trainingWeeks et al. (2000) [26]Kyrgyzstan, Central Asia• Medical workers (41 health facility staff).
• Supervisors of health information records.
• Duration of training: two days
• Simplify DPT records and reports, collect only relevant reports and decentralized decision making.
• Modify the existing data collection forms and records, developed graphs that could be constructed manually.
• Analytic supervision checklist developed for the 3 levels of supervision.
• HCW training and data management
• 95% improved data collection and data reporting and quality.
In-service training (Evaluation of dashboard)Poy et al. (2017) [27]6 African countries: Angola, Chad, DR Congo, Ethiopia, Nigeria, South Sudan• Immunization programme managers• Creation and implementation of multidimensional monitoring tool (i.e. dashboard) designed
• to provide information on immunization system performance
• The capacity building workshop and job aids development facilitated the dashboard reporting process clarifying both indicator definitions and reporting timelines
• Data availability and quality improved between the first quarter of 2014 and fourth quarter of 2015, especially for the process indicators.
In-service trainingWard et al. (2017) [28]Kampala, Uganda• Data improvement team (DIT) between November 2014 and September 2016, all 112 districts and five divisions of Kampala (total 116 DIT operational districts) in Uganda sent staff to DIT regional training and deployed district-level DITs.
• Seventeen regional trainings, covering 2–14 districts per training,
• Attended by 451 district and health sub-district staff and 35 MakSPH students (some attended multiple trainings)
• Pre-intervention 5-day orientation to the strategy and Uganda’s immunization information systems was provided to national staff.
• 3-day regional training aimed to build selected DIT members’ knowledge and skills in data management and quality.
• Training was evaluated through a self-administered survey focused on quality of the training experience; a pre-test and post-test measured participants’ acquisition of knowledge and level of preparedness to implement DIT activities.
• Organizational assessments contained a mix of closed and open questions covering dimensions of, and factors affecting vaccination data quality.
• DITs also used a data quality improvement (DQI) questionnaire to review practices for data management, collection, accuracy, analysis and use
• After training, 83% (355/429) of district staff demonstrated improved knowledge on post-test compared with pre-test scores, and more participants felt ’fully prepared’ to conduct DIT activities (14% pre-test, 82% post-test).
In-service trainingPappaioanou et al. (2003) [29]Bolivia, Cameroon, Mexico and the Philippines• Interdisciplinary, in-service training programmes, tailored to the needs of mid-level policymakers, programme managers, technical experts and information specialists,• National trainers, with support from CDC technical advisors, conducted local training and information needs assessments. Based on needs assessments and post-training job responsibilities of participants, learning objectives were developed for specific target audiences (e.g. decision makers and technical advisors), and training curricula and materials, using information from the country’s HIS.
• Workshops include training exercises aimed at teaching priority setting, health problem analysis, programme planning, monitoring and evaluation. Staff were trained, and technical assistance was provided in the use of the HIS and software as part of the interdisciplinary training programmes.
• Post-intervention: Existing sources of information and the effectiveness of routine data collection procedures were evaluated for their potential to provide the needed information.
• Results showed that the DDM strategy improved evidence-based public health.
• Subsequently, DDM concepts and practices have been institutionalized in participating countries and at CDC.
In-service interventionVasan et al. (2017) [30]LMICs• Frontline non-physician HCWs in LMICs• Of the 40 papers, 13 papers used cross-sectional survey study designs based on pre-/post-intervention plausibility design. Eight involved qualitative research using a variety of methods (realist evaluation, focus group discussion, key informant interviews). Seven described randomized controlled trials (RCTs) or studies nested within RCTs, and another seven were reviews, three of which were systematic reviews. Other study designs included were four programme evaluations (using routinely collected data not under research conditions) and one time-use study.
• The reviewed studies were categorized under ‘Supervision or Supportive Supervision (23),’ ‘Tools, and Aids, (10)’ ‘Mentoring or Clinical Mentoring’ (3) and three under ‘Quality Improvement (3),’ and ‘Coaching and Peer Review Strategies’ (1)
• The variety of study designs and quality/ performance indicators precluded a formal quantitative data synthesis.
• The most extensive literature was on supervision, but there was little clarity on what defines the most effective approach to the supervision activities themselves, let alone the design and implementation of supervision programmes.
In-service intervention (Health Care Provider Performance Review)Rowe (2018) [31]LMICs• The Health Care Provider Performance Review (HCPPR)• Systematic review of strategies to improve health-care provider performance in LMICs• Training combined with supervision or group problem solving strategies tended to be more effective in improving HCW’s performance.
• Monitoring HCWs’ performance by implementing evidence-based strategy alongside including local context knowledge likely to be more effective.
• Identify and address gaps modifying or remove strategies or adding new strategies.
• The effects of any strategy should be monitored so that managers can know how well it is working.
• Strategies that include community support plus training for HCWs prove to be more effective in improving healthcare providers.
• Use more standardized methods.
Pre-service and in-service trainingTsega et al. (2014) [32]Health training institutions in Malawi• Health care professionals (National EPI managers, immunization officers, district health officers, immunization coordinators and supervisors)• Tailored questionnaires were used to elicit information from central, zonal and district healthcare facilities and training institutions.
• At the central, zonal and district levels, interviewees included heads of health offices; at the healthcare facility level, interviewees included immunization coordinators and supervisors
• Graduates not well equipped to provide quality service
• Insufficient time allocated for immunization training (50% of school principals)
• Half of training institutions had copies of the national immunization guidelines, but had outdated curricula
• 50% of the principals said students will benefit from in-service training to be able to perform immunization activities, and reported suboptimal relationship between service providers and training institutions
• Insufficient training materials for in-service mid-level management (MLM) training, Electronic copies are only accessible to a few people.