TRAINING IS SELDOM USED AS A DEVELOPMENT TOOL and

INCENTIVES TO WORK ARE OFTEN INADEQUATE

Workshop-itis appears to be an endemic disease transmitted by many health projects and programs. The symptoms include:

frequent absences of personnel from their regular jobs;
an addictive and craving for larger doses of perdiem;
a lethargy in completing routine work that doesn't include "motivation"; a
nd an uncontrollable urge, when faced with a problem, to "organize a workshop".

These symptoms are closely linked to numerous underlying causes:

monthly salaries of health workers which are less than workshop perdiem; donor agencies who organize a workshop to promote their own development agenda; competition between projects and programs to train the best people; a lack of skilled trainers at the peripheral levels; and an attitude that every problem can be solved by training. inflexible curricula of medical and nursing schools which necessitate seek alternative training strategies; Remedies for this disease syndrome may include a combination of the following:

Link training and continuing education to regular supervision (see Box 9).

Organize an annual national or regional conference with a "theme-a-day format" that combines a number of workshops in place and time. This also provides an forum for the dissemination of lessons learned from operations research.

Creating a PHC reference library kit for each level of the health system which could encourage access to information for self-improvement.

Encourage study tours and informal visits between projects and health districts.

Promote team-building and planning at the district level as an internal and on- going development process rather than as a workshop product.

back to OBSTACLES TO SYSTEMS STRENGTHENING

Box 9

LINKING TRAINING WITH SUPERVISION IN CAMEROON

In 1990 USAID approved a grant to Save the Children Federation for the Reform of the Health Delivery System (RHDS) project to "strengthen the capacities of both community and public and private health services in the delivery of primary health care to mothers and children in the Far North Province of Cameroon."

An evaluation conducted in 1993 found that RHDS had done a good job at providing the basic training required in the principles of primary health care, co-financing and co-management. Training from three days to two weeks was provided for the health center chief nurse, the nurse-aide, the members of the health committee and health center management committee. This training effectiveness was demonstrated in that: all centers had map of the health area showing villages and outreach points; all centers had a monthly schedules for health center and outreach activities; all centers were completing and submitting monthly reports; and most centers had graphs to monitor the level of specific activities.

The evaluation team found, however, that some training occurred before materials and equipment were available, and that opportunities for in-service training were not being taken during supervision. Supervision was perceived as supervision/control rather than as a supervision/training. RHDS project personnel appeared to be placing more emphasis on training seminars and not enough on training during supervision.

The evaluation noted that it is not always necessary to organize a training seminar to initiate a new idea, e.g. graphing health indicators. Project personnel could "train" supervisors in this technique during a one-day meeting, who would devote part of their supervision visit to a one- on-one "training" in graphing of indicators.

While this might seem as a more time-consuming process, as opposed to teaching everyone at the same time, it has several distinct advantages. First it saves money by reducing the number of training seminars. Second, it develops the role and self-worth of the supervisor as someone who comes to teach, rather than simply to inspect. Third, supervision/training increases the opportunity for dialogue that can uncover additional problems and solutions. In contrast to the health centers, provincial and hospital levels have received little or no training in RPHC since funding is not yet been made available. The evaluation team suggested that RHDS explore ways to begin this "training" through informal discussions, presentations and meetings. For example, RHDS might invite a well functioning health center management committee to facilitate discussion of the principles of co-financing and co-management with provincial health personnel.