Kenya Health Workforce Training Needs Assessment Report

Repo

aining Need

ort of th

s Assessmen

he RapiHeal

nt of the Hea

id Trainlth Wor

Septem

alth Workfor

ning Nerkforce

mber 2

rce in Kenya

eeds Asin Ken

2012

ssessmeya

ent of the

Rapid Tra

i

Repo

The viewAgency f

aining Need

ort of th

s expressed for Internatio

s Assessmen

he RapiHeal

in this docuonal Develop

nt of the Hea

id Trainlth Wor

Septem

ument do nopment or the

alth Workfor

ning Nerkforce

mber 2

ot necessarilye United Sta

rce in Kenya

eeds Asin Ken

2012

y reflect the tes Governm

ssessmeya

ent of the

views of thement.

e United Stat

ii

tes

Rapid Tra

Suggested citation: Kenya Ministry of Health (MOH) and IntraHealth International, 2012. Report of the Rapid Training Needs Assessment of the Health Workforce in Kenya. Nairobi, Kenya: MOH.

Rapid Training Needs Assessment of the Health Workforce in Kenya iii

TABLE OF CONTENTS

EXECUTIVE SUMMARY .................................................................................................... 9 INTRODUCTION ............................................................................................................ 13

Study limitations ................................................................................................................................... 15 Ethical considerations ......................................................................................................................... 15

RESULTS ......................................................................................................................... 16 TRAINING PRIORITIES ................................................................................................... 17 Priority Training Needs ................................................................................................ 17 Training Priorities According to Health Facility Manager ........................................ 18 Health Workers Trained and to be Trained ............................................................... 19 Training Priorities by Cadre According to the MOH Divisions ................................. 21 CAPACITY TO TRAIN ..................................................................................................... 22 Availability of trainers/lecturers ................................................................................. 22

Training Providers ................................................................................................................................. 24 Clinical Preceptors .............................................................................................................................. 24

Training Resources ...................................................................................................... 28 Access to training services and status of condition ...................................................................... 31 Teaching materials .............................................................................................................................. 31 Financing training ................................................................................................................................ 32

PERSPECTIVE OF REGULATORY BODIES ....................................................................... 33 Availability of training guidelines ...................................................................................................... 33 Availability of training curricula ......................................................................................................... 35 Length of training using approved curricula .................................................................................. 36 Approved CPD providers for training in priority areas .................................................................. 38 Accredited/approved trainers, training institutions and consulting firms .................................. 38 Professional members attained training standards for re-licensure ............................................ 39 Determining training needs for health workers .............................................................................. 40 Post training support ........................................................................................................................... 40 Post Training Support Provided To Training Institutions ................................................................... 41 Methods of evaluation ....................................................................................................................... 42

DISCUSSIONS AND CONCLUSIONS ............................................................................. 43 Training priorities .................................................................................................................................. 43 Number of health workers to be trained ......................................................................................... 43 Trainers in priority areas ...................................................................................................................... 43 Training venues .................................................................................................................................... 44 Access to services and equipment .................................................................................................. 44 Financing of Training ........................................................................................................................... 44 Areas of training experience by training institutions ...................................................................... 45 Average Training days and ability to supply curriculum by training institutions ........................ 45 Availability of guidelines, curricula and CPD providers ................................................................ 45 Professional members attaining re-licensure .................................................................................. 46 Post training support to trainees and training institutions ............................................................. 46

APPENDIX A: PRIORITY AREAS AND SUBTOPICS TO BE COVERED ............................................... 47 APPENDIX B: NAME OF TRAINING FACILITIES BY REGION AND CITY ............................................ 49

Rapid Training Needs Assessment of the Health Workforce in Kenya iv

APPENDIX C: AVAILABLE TRAINING RESOURCES .................................................................... 50 APPENDIX D: ACCREDITED/APPROVED TRAINERS AND INSTITUTIONS ....................................... 51 APPENDIX E : List of Participating Institutions ............................................................ 53 APPENDIX F: Introduction and Consent ................................................................... 56 APPENDIX G MOH APPROVALS ............................................................................... 91

Rapid Training Needs Assessment of the Health Workforce in Kenya v

List of Tables and Figures

Table 1 - Respondents by Type ................................................................................................................. 15 Table 2 - Priority Training needs identified by MOH Divisions and Health Facility Managers ........... 18 Table 3 - Breakdown of Priority Areas by Province for Health Facilities .............................................. 19 Table 4 - Staff Critical to Training by Cadre per MOH Divisions ............................................................ 22 Table 5 - Number of Trainers Trained by Region for all Priority Areas by MOH Divisions ................... 23 Table 6 - Number of trainers/lecturers available by training priority areas (n=17) ............................ 23 Table 7 - Total Number of Health Workers Trained in Last 12 Months .................................................. 28 Table 8 - Training Facility Total Capacities by Region ........................................................................... 30 Table 9 - Availability of Guidelines for Training in Key Training Areas .................................................. 34 Table 10 - Availability of Curricula from Regulatory Bodies .................................................................. 35 Table 11 - Availability of Curricula from Training Institutions ................................................................. 36 Table 12 - Comparing Average Training Lengths by Priority Areas ..................................................... 37 Table 13 - Availability of Approved CPD Providers by Training Priority Areas .................................... 38 Table 14 - Professional Members Attaining Standards for Re-Licensure ............................................. 39 Table 15 - MOH Training priority areas and subtopics ........................................................................... 47 Table 16 - Training priority areas and sub-topics to be covered according to health facility

managers ............................................................................................................................................. 48 Table 17 - Training facilities by region and city ....................................................................................... 49 Table 18 - MOH Divisions and Health Facilities teaching resources ..................................................... 50 Table 19 - Names of Approved Training Providers According to Regulatory Authorities ................ 51 Table 20 - Recommended training providers according to MOH Divisions ....................................... 52 Figure 1 - Total number of health workers at health facilities sampled .............................................. 20 Figure 2 - Percentage of Key Providers Trained in Priority Areas .......................................................... 21 Figure 3 - Training Providers According to Health Facility Managers .................................................. 24 Figure 4 - Total numbers of preceptors by training priority areas for interviewed institutions .......... 25 Figure 5 - Areas of training experience by cadre for training institutions ........................................... 26 Figure 6 - Number of Regulatory Boards that have approved CPD Providers in key training priority

areas ..................................................................................................................................................... 27 Figure 7 - Training Venues Available to MOH Divisions, Training Institutions and Health Facilities .. 29 Figure 8 - Available Training Facilities by Region .................................................................................... 30 Figure 9 – MOH Divisions, Health Facilities and Training Institutions with Access to Training Services

............................................................................................................................................................... 31 Figure 10 - Financing Training - Health Facility Manager Perspective ................................................ 32 Figure 11 - Membership of Sampled Regulatory Bodies ....................................................................... 33 Figure 12 - Post-Training Support to In-service Trainees According to Regulatory Authorities ........ 40 Figure 13 - Effectiveness of Post-training Support for Health Workers .................................................. 41 Figure 14 - Effectiveness of Post-training Support Provided to Training Institutions by Regulatory

Authorities ............................................................................................................................................ 42

Rapid Training Needs Assessment of the Health Workforce in Kenya vi

ACKNOWLEDGEMENTS This Training Needs Assessment (TNA) involved a wide variety of stakeholders. We wish to acknowledge and thank the Permanent Secretaries of both Ministry of Medical Services (Ms, Mary W. Ngari, CBS) and Public Health and Sanitation (Mr. Mark K. Bor, CBS) for giving us an opportunity to carry out this important assessment. Sincere thanks to the Heads of Departments of Human Resource and Development of the two ministries, Mr. David Njoroge and M/s Grace Odwako who facilitated the approval processes and guided the assessment. We also acknowledge USAID and IntraHealth-Chapel Hill for financing and giving technical advice. This Training Needs Assessment could not have been successful without the respondents from Ministries of Health technical divisions, Health facility managers that included provincial directors, training institutions and regulatory bodies. We are grateful to Dr. Leigh Shamblin, Anne Fitzgerald, Flavia Bianchi, Dr. James Mwanzia, Dr. Norbert Rakiro, Prof. Steve Okeyo, David Maingi, Martin Kinyua, Norbert Boruett, Emily Mungai, Joelle Mumley, June Mwende, Wanjiru Kangara, Dr. Hazel Mumbo and Dr. Anastasiah Kimeu for the role they played in this assessment that included technical support in development and review of the questionnaires, data collection, data analysis, report writing and editorial work. We acknowledge the authors; Peter Milo, Assistant Director – Regional Strategy, and Joyce Kinaro, Assistant Director – Monitoring and Evaluation both of FUNZOKenya Project, IntraHealth International.

Rapid Training Needs Assessment of the Health Workforce in Kenya vii

Rapid Training Needs Assessment of the Health Workforce in Kenya viii

LIST OF ACRONYMS AMREF African Medical Research Foundation AMSTL Active Management of Third Stage of Labour APHIA USAID supported Projects focusing on AIDS Population and Health Integrated Assistance CaCx Cervical Cancer Screening CDC Centers for Disease Control and Prevention CHAK Christian Health Association of Kenya CME Continuous Medical Education CPD Continuing Professional Development CO Clinical Officer EMOC Essential Maternal Obstetric Care FANC Focused Antenatal Care ICAP International Centre for AIDS Care and Treatment Programs IYCF Infant and Young Child Feeding IMCI Integrated Management of Childhood Illnesses IMAI Integrated management of adult illnesses KEC Kenya Episcopal Conference KEMSA Kenya Medical Supplies Agency KHSSP Kenya Health Sector Strategic and Investment Plan MEDS Mission for Essential Drugs and Supplies MCM Malaria Case Management MDR TB Multi-Drug Resistance Tuberculosis MIYCN Micronutrients Deficiencies, Maternal, Infant and Young Child Nutrition MO Medical Officer MOH Ministries of Health MSH Management Science for Health PHO Public Health/Environmental Health Officers PMTCT Prevention of Mother to Child Treatment TNA Training Needs Assessment UNICEF United Nation Children Fund VCT Voluntary Counseling and Testing WHO World Health Organization

FOREWORD

The Ministry of Medical Services and the Ministry of Public Health and Sanitation are committed to improving access to affordable health care services in order to accelerate the achievement of national health targets, Millennium Development Goals and Vision 2030. To provide quality health care to all Kenyans, there is a need to have adequate qualified health workforce that can address current and emerging health needs in the country. This can be achieved through training of new health workers, addressing current in-service training needs, strengthening training institutions to increase their admission capacity and lastly to support the regulatory bodies to improve professionalism among the health worker force. The Ministries of Health (MOH) are undertaking reforms that have the potential to promote greater efficiency, accountability and decentralization of health training mechanism in the health sector. In this rapidly changing environment, the Government of Kenya supported by FUNZOkenya carried out a rapid Training Needs Assessment (TNA) to identify the areas of need of the health workforce to ensure that adequate numbers of well-trained health workers are available to provide quality services throughout the country. The following areas were identified as the priority training needs: Cervical Cancer Screening, Prevention of Mother to Child Transmission (PMTCT), Focused Antenatal Care (FANC), Active management of the third stage of labor, Integrated Management of Childhood Illnesses (IMCI), Essential Newborn Care, Pediatric HIV, Commodity Management and use of MOH Monitoring and Evaluation tools. We are pleased that the recommendations in this study provides the Ministries of Health with an opportunity to make evidence based decisions when addressing skills of its workerforce in relation to the training priority needs. Together with the Faith Based Organisations, private sector and development partners, the Ministries are committed to increase numbers of the workforce and improve quality of training in the health sector.

Dr. Francis M. Kimani, MB.ChB, MMed. Dr. Shaanaz Sharif, OGW, MBChB, MMed. DLSTMH, MSc. Director of Medical Services Director of Public Health and Sanitation

Rapid Training Needs Assessment of the Health Workforce in Kenya 9

EXECUTIVE SUMMARY

Background In 2010 the Ministries of Health (MOH) noted that the training programs in the health sector did not give the desired results and therefore discontinued trainings of the health workers that were supported by USAID supported APHIAPlus projects with the exception of orientation training. This left a huge backlog of trainings in the health sector and when FUNZOKenya came into the scene early 2012, it was compounded with a long list of training needs that required validation. It was therefore critical to identify top priority needs as perceived by Ministries of Health (MOH) and also ensure that partners understood the broader needs of the Government through the line ministries. Against this backdrop, the Ministry embarked on a Training Needs Assessment (TNA) and mandated FUNZOKenya which is another USAID funded IntraHealth led project to conduct the assignment to establish and confirm the needs emanating from the APHIAPlus and other USG funded projects working in the health sector. Objectives of the TNA

1 To find out what are the top five training priorities? This assessment question was presented to MOH divisions and health facility managers.

2 For training Institutions the focus on the ability to train/teach the training priority areas identified based on availability of lecturers, clinical preceptors and curricula. Access to resources and equipment such as internet, skill laboratories and teaching aids and their post training evaluation and feedback mechanism was asked.

3 Regulatory authorities were assessed on the following parameters as regards training priority areas; ability to supply guidelines, curricula and presence of approved CPD providers. Lastly, professional members attaining standards for re-licensure and post training support to training institutions and in-service trainees.

Methodology

The TNA was undertaken within a period of 100 days, hence the term rapid Training Assessment. The methodology applied in this study was mixed method that adopted a cross-sectional survey that targeted a total of 77respondence; 8 health technical divisions in the ministry, 46 health facility managers that included provincial directors of health in both ministries at the provincial and district levels that included public, faith based and private health facilities, 17 training


institutions and 6 regulatory authorities. Four sets of questionnaires were designed for each cadre of respondent such that the assessment was tailored to extract key information from each group. Respondents were identified through two methods of sampling: purposive non probability sampling technique in which the probability of getting any particular sample does not have to be calculated and random sampling techniques because this was representation of a larger population and each individual was chosen entirely by chance and each member of the population had an equal chance of being included in the sample. Summary Findings Priority training needs The assessment identified the following as the priority training needs that should be addressed by the ministries of Health; Cervical Cancer Screening training, HIV –PMCT, focused antenatal care, Integrated Management of Childhood Illness (IMCI), new born care, active management of third stage of labour (AMSTL), commodity management and HIV pediatric care. The survey established that less than 12 % of the health workforce had been trained in the priority areas. The survey also established that the Ministries of health facilitators were more engaged in in-service training than other trainers, much of the trainings were hotel based and that most of the trainings were donor funded while more than a third of the health workforce financed their own training. Training institutions In the assessment of training institutions, the findings showed that most of them offered nursing courses compared to other health related courses. It also showed that most of the in-service trainings were for a period of less than 2 week. As post training support, the results found that majority of the institutions used trainers’ follows ups and sending of update as opposed to mentorship and coaching methods. It was also established that majority of the training institutions were attached to health facilities countrywide yet they lacked adequate lecturers to train in the priority areas. More than a third of the training institutions also had access to internet as a resource for learning. Regulatory Authorities

Findings on Regulatory Authorities showed that only the nursing council of Kenya and NASCOP had guiding framework that identified training priority areas for in-service training except in HIV/AIDS courses. With the exception of nurses, all the other five regulatory bodies combined represents less than half of health professional members who attain standards required for re-licensure. The results also showed that regulatory authorities provided ineffective post training support to training institutions and in-service trainees.


Key Recommendations

Based on this Training Needs Assessment, these were the key recommendations;

• As the ministries of health focus on the top training priorities areas in an attempt to improve training, they should also consider the regional specific training needs.

• In order to reach a wider group of in-service health workers, there is greater need for innovative learning methodologies such as on-the job training, mentorship, e-learning and distance learning.

• Training institutions, Ministries of health facilitators, technical departments and divisions

should build their capacity to bring in-service training needs to the standards required.

• For sustainability and cost effectiveness, the ministries of health should use alternative training venues and training institutions instead of hotels.

• The Government should allocate more resources to expand training institutions and

more health workers in-service training.

• There should be faculty development in post training support

• Regulatory authorities to expand CPD to include a broad range of other in-service trainings which are currently not offered

• Development of databases to capture data on training of in-service trainees

• Regulatory authorities to avail CPD courses in the locality of the health care providers

and thus increasing opportunities for re-licensure

• Encourage regulatory bodies to provide equal opportunities for CPD activities/programs with same number of CPD points to all cadres of health workers.


INTRODUCTION

The goal of the Ministries of Health is to improve access to and provide quality health workforce training by supporting increased number of new health workers trained; identifying current health workers training needs; strengthening capacity of training institutions to increase the admissions capacity of pre-service students and regulatory bodies to accredit and monitor trainings. The ministries are also working towards increasing access to loans and scholarships for students; improving training delivery and linking training to health worker re-licensure. It focuses on the needs of health workers across the entire health system (public and private) and intends to equip health workers with the appropriate competencies to respond to health demands and to provide responsive, integrated comprehensive services. The ministries of health are working closely with FUNZOKenya, USG-funded health programs, leading health training institutions in Kenya, the National Health Human Resource Development (HRD) Working Group, and at least 8 regional training hubs to strengthen training capacity, address the quality and accessibility of training for current health workers, as well as support training facilities and regulatory bodies. In the year 2010, the USAID supported APHIAPlus partners were discontinued from carrying out further training in order to enable for the ministries to come up with a well coordinated and harmonized way of training in the health sector. Due to the absence of the training, however, a backlog was created in APHIAPlus supported facilities which negatively impacted on service delivery. The priority training needs identified ranged from HIV/AIDS, reproductive /maternal health, family planning, nutrition, integration of service, and commodity management among many others. The ministries tasked FUNZOKenya which is also a USAID funded project, to take over the trainings and validate the list of priority training needs from MOH and partners, which led to the conducting of this training needs assessment. The assessment was to be conducted within a period of 100 days, hence called a rapid training needs assessment. This would then lead to the implementation of trainings in the health sector.

Objectives of the training needs assessment

1. To identify the top training priorities that the Ministries of health should address when clearing the training backlog

2. To confirm that the training needs identified by partners were in line with the national and regional training priorities of MOH for effective service delivery.

3. To identify challenges and opportunities that Ministries of health should address and take advantage of while increasing access to high quality in-service training to the health workforce.

METHODOLOGY The study applied a mixture of qualitative and quantitative methods that adopted a cross-sectional survey. Mixed methods research offers the best of both worlds: the in-depth, contextualized, and natural but more time-consuming insights of qualitative research coupled


with the more-efficient but less rich or compelling predictive power of quantitative research. The study conducted a desk review and developed four sets of questionnaires that targeted different cadres of respondents. These were administered to a total of 77respondence who included; 8 staff from the health technical divisions of the ministry, 46 health facility managers at the provincial and district levels of the public and faith based facilities. The respondents among these categories included provincial directors of health in both ministries. Also covered were the facility managers from private health facilities. In other categories, 17 respondents from training institutions and 6 from the regulatory authorities were also covered. The questionnaires were used to extract specific information from the respondents. This in turn led to identification of key informant interviews with purposefully selected individuals such as heads of institutions, medical tutors and service providers that included; the staff of Ministry of health technical divisions charged with responsibility of programmatic disease areas, health facility managers at all levels of service delivery and cutting across public, faith based and privately owned facilities. Others included staffs of regulatory authorities and lastly training institutions. It was envisaged that, with this type of arrangement, information from all key players would be validated and triangulated giving a clear picture of the training needs. These interviews aimed at generating discussion on broad training need areas and to identify performance gaps in service delivery of the health worker in relation to lack of requisite knowledge and skills. Priority training areas were broadly categorized into the following thematic areas; HIV/AIDS, maternal and child health, reproductive health and integration of services. Data collection instruments Four sets of questionnaires were developed that targeted the technical departments of Ministry of Health (MOH), in this case divisions of health were to give the national training priorities as far as their mandates were concerned. Regulatory authorities were to provide information on training priority areas that were accredited and hence led to earning of CPD points. Health facility managers were to input on critical training areas that led to enhanced service delivery at facility levels and training institutions were to give inputs on their ability to service training needs identified. The actual training needs assessment commenced in early June 2012 with data collection. Sampling approach Respondents were identified through two methods of sampling: purposive non-probability sampling and random sampling techniques. Purposive and random samplings were both done because the study aimed at gathering information from all technical divisions of MOH. This includes the departments of family health and disease control and prevention, the six regulatory authorities including the Kenya Medical Practitioners and Dentists Board (KMPDB), Nursing Council of Kenya (NCK), Pharmacy and Poisons Board (PPB),Kenya Medical Laboratory technologists and Technicians Board (KMLTTB), Clinical Officers Council (COC) and Kenya Nutritionist and Dietician Council (KNDC), forty six (46) facility managers that targeted all


provincial directors in the Ministry of Medical Services (MOMS) and Ministry of Public Health and Sanitations (MOPHS), medical superintendents of all provincial general hospitals, randomly selected district medical officers of health and medical superintendents of district hospitals, private and faith based hospitals and seventeen (17) training institutions randomly selected. Of the 17 training institutions interviewed, eight (47%) were public, five (29%) were affiliated with faith-based organizations, three (18%) were privately owned, and one (6%) was a non-governmental organization. Six regulatory authorities were also interviewed. Training needs assessment respondents TABLE 1 - RESPONDENTS BY TYPE Respondent type Sample MOH division 8 Training institution 17 Regulatory body 6 Health facility manager (faith based) 6 Health facility manager (private) 6 Health facility manager (public) 34 Total 77 Data collection and analysis A total of seventy seven (77) respondents were interviewed. Data was collected on self-assessment questionnaires that had been sent out two weeks earlier to respondents. The research assistant further interviewed the respondent through face to face interviews and telephone where face-to-face contact was not possible. Data entry was done on EPI INFO and data analysis carried out on both EPI INFO and SPSS platform by a data analyst. Prior to data collection research assistants were trained on data collection. Study limitations It was a rapid TNA and therefore could not give insight on the trends considering that not all training institutions with health science training programmes were interviewed. Neither were all health facility managers interviewed. Given the small sample size, this may not be a true reflection of what is happening in all the training institutions and health facilities. Lastly, the training needs assessment exercise experienced lack of precise data on staffing and the statistics of employees trained from all levels of the respondents. Ethical considerations All research assistants involved in data collection undertook an online course on protecting study participants on the National Institute of Health (NIH) official website and respondents were requested to give consent before being interviewed for compliance with ethical considerations of research. The study protocol and instruments of data collection were reviewed by IntraHealth staff and MOH for appropriateness and authorized.


RESULTS The TNA findings are reported in the following order:

• Training priorities identified by respondents • Current training capacity in the health system

o Availability of trainers o Availability of facilities and equipment

• Ability of Regulatory Bodies to provide performance monitoring support


TRAINING PRIORITIES

Priority Training Needs A total of 54 respondents, including 8 from the MOH Technical Division and 46 Health Facility Managers were presented with a list of 25 potential training topics (including “other”) that had been identified as areas of needs by APHIAPlus projects and other partners and asked to identify the top 5 priority training needs for health workers. As shown in Table 2 below cervical cancer screening training was identified as the most pressing priority with 43% of respondents selecting it as an important training area. It is likely that cervical cancer was considered a greater training priority due to the growing awareness of the burden of the disease and its link with HIV and AIDS although the problem is not prioritized in the Millennium Development Goals (MDGs). Health facility managers confirmed that there was an increase in numbers of cervical cancer cases and health workers were not skillful in diagnosing cervical cancer at an early stage, thus a major training priority.

Other priority training areas highlighted by all respondents include training in PMTCT, Newborn care, management of childhood disease and focused antenatal care. Once disaggregated by type of respondents however, priorities differed; among those from the MOH technical divisions, M&E was selected as the highest training area of need with (50%) of the respondents indicating it as such while among Health Facility Managers, Cervical Cancer Screening was selected the most important training area of need with (46%) of the respondents indicating it as the highest priority need. Other training priorities identified by MOH divisions included Commodity Management (38%), HIV-PMTCT (38%), FANC (25%), HIV-Pediatric Care (25%), IMAI (25%), and IMCI (25%). Other top training priorities according to health facility managers included AMSTL (35%), newborn care (35%), and FANC, PMTCT, IMCI, and pediatric HIV, which were all prioritized by 33% of respondents.


Figure 1 shows a breakdown of the total of 28,347 health workers represented by the Health Facility Managers who participated in the assessment. TABLE 2 - PRIORITY TRAINING NEEDS IDENTIFIED BY MOH DIVISIONS AND HEALTH FACILITY MANAGERS

Priority Training Area MOH Technical Division (n=8)

Health Facility Managers

(n=46)

% of Total Respondents

(n=54) Active Management of 3rd Stage Labor (AMSTL) 0% (0) 34.8% (16) 29.6%(16) Cervical Cancer Screening (CaCx) 25% (2) 45.7% (21) 42.6 % (23) Commodity Management 37.5% (3) 26.1% (12) 27.7% (15) Drug and Substance Abuse 12.5% (1) 15.2% (7) 14.8% (8) Family Planning (FP) 12.5% (1) 10.9% (5) 11.1% (6) Focused Antenatal Care (FANC) 25%(2) 32.6% (15) 31.5% (17) HIV - Nutrition 0%(0) 8.7% (4) 7.4% (4) HIV - Adult ART 12.5% (1) 13% (6) 12.9% (7) HIV - Pediatric Care 25% (2) 28.3% (13) 27.7%15) HIV – PMTCT 37.5% (3) 32.6% (15) 33.3% (18) Infant and Young Child Feeding (IYCF) 0% (0) 15.2% (7) 12.9% (7) Int. Management of Adult Illnesses (IMAI) 25% (2) 21.7% (10) 22.2% (12) Int. Management of Childhood Illnesses (IMCI) 25% (2) 32.6% (15) 31.5% (17) Integration of Services 12.5% (1) 17.4% (8) 16.6% (9) M&E - MOH Tools 50% (4) 21.7% (10) 25.9% (14) Malaria - Case Management 12.5% (1) 15.2% (7) 14.8% (8) Newborn Care 12.5% (1) 34.8% (16) 31.5% (17) Psychology – Pediatric 0% (0) 2.2% (1) 1.8% (1) Supportive Supervision 25% (2) 21.7% (10) 22.2% (12) TB - MDR Mgmt. 12.5% (1) 19.6% (9) 18.5% (10) TB - Mgmt. (Microscopy) 12.5% (1) 8.7% (4) 9.2% (5) TB – Nutrition 0% (0) 4.3% (2) 3.7% (2) TB/HIV Counseling and Testing (C&T) 12.5%(1) 15.2% (7) 14.8% (8) Trauma Counseling 0% (0) 4.3% (2) 3.7% (2) Tables listing subtopics for each priority area suggested by MOH divisions and health facility managers are included as Appendix A.

Training Priorities According to Health Facility Manager

Health facility managers were asked to identify priority training areas of need for their province. In total, 46 facility managers represented all 8 Kenyan provinces. Table 3 shows the number of respondents in each province that prioritized each subject area. Managers from Central Province selected AMSTL and FANC as top priorities. The Coast also selected FANC as a top training priority. The Rift Valley highlighted PMTCT as top training priority while Western Province selected both Cervical Cancer Screening and Newborn Care as their top priority. Training priorities were more evenly dispersed among the Eastern, North Eastern Province (NEP),


Nyanza and Nairobi. Nonetheless, all provinces selected multiple training priorities, indicating a widespread need for training providers and training resources and highlighting a shortage of health providers with training in key areas. Training priorities varied across provinces, as such, remedial actions should be tailored to address the specific knowledge gaps of each province. TABLE 3 - BREAKDOWN OF PRIORITY AREAS BY PROVINCE FOR HEALTH FACILITIES

Training Priority Area

Central

Coast

Eastern

NEP

Nyanza

Rift Valley

Western

Nairobi

Total

Active Management of 3rd Stage Labor (AMSTL) 4 2 1 2 2 1 3 1 16 Cervical Cancer Screening (CaCx) 3 3 3 2 3 2 4 1 21 Commodity Management 2 1 3 3 1 1 1 0 12 Drug and Substance Abuse 0 1 2 0 1 1 2 0 7 Family Planning (FP) 0 0 2 1 0 1 1 0 5 Focused Antenatal Care (FANC) 4 4 1 2 1 0 2 1 15 HIV – Nutrition 0 1 1 0 0 0 2 0 4 HIV – Adult ART 0 2 1 0 0 0 1 2 6 HIV – PMTCT 2 3 2 1 0 4 1 2 15 HIV – Pediatric Care 2 3 1 0 2 2 2 1 13 Infant and Young Child Feeding (IYCF) 0 1 0 3 1 1 0 1 7 Int. Management of Adult Illnesses (IMAI) 3 1 1 3 0 2 0 0 10 Int. Management of Childhood Illnesses (IMCI) 3 2 2 3 1 1 2 1 15 Integration of Services 0 2 0 2 1 0 2 1 8 M&E - MOH Tools 2 1 1 3 1 0 0 2 10 Malaria – Case Management 0 3 1 1 0 0 2 0 7 Newborn Care 3 2 2 2 2 1 4 0 16 Psychology – Pediatric 0 0 0 0 0 1 0 0 1 Supportive Supervision 1 1 1 2 3 1 1 0 10 TB – MDR Mgmt. 2 1 1 1 1 1 1 1 9 TB – Mgmt. (Microscopy) 1 1 1 0 0 0 1 0 4 TB – Nutrition 0 1 1 0 0 0 0 0 2 TB/HIV Counseling and Testing (C&T) 3 2 0 0 0 2 0 0 7 Trauma Counseling 1 0 0 0 0 1 0 0 2

Health Workers Trained and to be Trained

Health facility managers represented 46 different public, private and faith based health facilities across Kenya. These facilities employ a total of 28, 347 health workforce which represents a total of 41.5 % of health workforce in public service (68,185-total numbers of health workers in GOK facilities; (KHSSP; 2012-2018). Figure 1 below represents the distribution of workforce per cadre and nurses represented the largest cadre with over 16,000 nursing staff across the 46 facilities. Respondents were asked to identify workers within their facility who had been trained in the top priority areas (AMSTL, CaCx, Pediatric HIV, PMTCT) as well as those who still needed to be trained. Findings in fig.1 below show the training areas identified by health administrative


officers (human rwho did FIGURE 1

From theall cadresignificanAmong mtrained ibeen traibeen traarea, whein the pathey are

18116%

267010%

8963%

aining Need

HAOs) and esource reconot.

provincial huords to see

uman resouthose who

rce officers iattended tr

in the healthraining in th

h facilities byhe last 12 m

y referring tmonths and t

o the those

- TOTAL NUM

e above scenes. The pernt, elucidatinmedical docn at least oined in at leained. Figuere the denoarticular areabelieved to

335612%

5032%

62

Numbe

s Assessmen

MBER OF HEA

nario, there rcentage of ng a potentctors for exane of the toast one of thres 2 below

ominator is aa. Medical dobe in most n

15215%

1691960%

6712%

er of Pro

nt of the Hea

ALTH WORKERS

was need foworkers tra

tial gap in sample, betwop training he top prior

w highlights all membersoctors, nurseneed of train

oviders b

alth Workfor

S AT HEALTH FFACILITIES SAAMPLED

or training inained compskills and knween 2% anpriorities whities as betwthe percent

s in each cades and clinicning among

by CadreMedical o

Nurses

Medical

Clinical O

PharmacTechs.Public/Enal Health

eofficer

Lab Tech.

Officer

cists/Pharm

nvironmenth Officers

n the top prared to thonowledge and 5% who hile between

ween 1.4% antage of wordre who requcal officers aall the cadre

riority areas ose in needmong the hrequired tra

n 1% and 6nd 3% of clirkers traineduire the skillre emphasiz

es.

identified a of training

health workfaining had % of nursesnical officers

d in each prs and knowlzed here bec

cross g was force. been

s had s had riority edge cause

Rapid Tra rce in Kenya 20

FIGURE 2

The survworkers a1.4% of srepeatedtrained inand Integfor healttrained in

TMOH divand in win this anutritionrequire cPublic Hmuch pri

aining Need

- PERCENTA

ey establishat surveyed selected hea

dly been idenn PMTCT or grated Manah facility man pediatric H

Training Pvisions respo

which coursesrea. For thists and pha

critical traininealth Officeority training

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

TrainAM

4.1%

2.2

s Assessmen

AGE OF KEY P

ed that, accfacilities had

alth workers ntified as a cPediatric HIVagement of anagers, hasHIV.

Priorities ondents alsos. Table 4 be

he top 7 selarmacy technng in PMTCTrs and Comgs as the oth

ned in MSTL

TraiCa

%

1.14%

27%2

3%

nt of the Hea

PROVIDERS TR

cording to hd received trhave been t

critical prioritV and other Childhood I

s been taugh

by Cadreo prioritizedelow summalected priorinologists weT, Cervical Ca

mmunity Heahers.

ined aCx

TrainPed.

%

6%

2%

3

1.4%

alth Workfor

RAINED IN PR

health facilityraining in antrained in cety issue. A littopics such

Illnesses. AMht to 4.1% o

e Accordind which cadrarizes the Trity training ere the mostancer Screenalth Workers

ned in . HIV

TrainPMT

2%

3%

1.91.4%

rce in Kenya

RIORITY AREA

y managersny of the topervical cancettle over 2% as newborn

MSTL, anothof health wo

ng to theres most criraining Needareas, medi

t in need ofning and infs, on the ot

ed in TCT

94%

2.8%

AS

, less than 3p five traininger screeningof health wo

n care, focuseher top priororkers, while

e MOH Ditically need

ds Assessmeical doctors,critical trainant and youther hand d

Nurses

Doctors

Clinical Officeers

3% of the hg priorities. , a topic thaorkers have ed antenatarity training 4.8% have

health Only

at has been l care topic been

ivisions ed to be tra

ent data repo, clinical offing. Nurses

ung child feeo not requi

ained orted ficers, s only eding. ire as

Rapid Tra 21

TABLE 4 - STAFF CRITICAL TO TRAINING BY CADRE PER MOH DIVISIONS

Training area

Med

ical

Doc

tor

Nur

se

Lab

Tech

nici

an

Clin

ical

Off

icer

Phar

mac

y Te

ch

Pub

Hea

lth

Off

icer

Nut

riti

onis

ts

Hea

lth

Info

O

ffic

er

Com

mun

ity

Hea

lth

Wor

ker

Cervical Cancer Screening Yes Yes Yes Yes Yes Drug and substance abuse Yes Yes Yes Yes Yes Yes Yes Infant and young child feeding Yes Yes Yes Yes Yes Yes Yes Int. Management Childhood Illness Yes Malaria case management Yes Yes Yes Yes Yes Yes Yes PMTCT Yes Yes Yes Yes Yes TB/HIV counseling and testing Yes Yes Yes Yes Yes

CAPACITY TO TRAIN

The TNA also captured data on the capacity of the ministries of health and health training institutions to deliver trainings that equip health workers with the appropriate competencies to respond to health demands that include responsive, integrated comprehensive services. The data also indicated that the capacity to provide in service courses primarily exists in the form of MOH facilitators and lecturers from training institutions and consulting firms. This section provides survey findings on the number of and sources of training providers as well as highlights gaps in training human resources for health.

Availability of trainers/lecturers The MOH divisions of health have historically trained trainers in priority areas of need across Kenya. The trainings have been in such areas as HIV/AIDs, tuberculosis, child and adolescent health, nutrition and reproductive health among others in in-service training. These are often conducted in provinces that are traditionally the workers duty location. The numbers of trainers however is not sufficient to meet the current needs of the training backlog. According to table 5 below, in the 12 months preceding the assessment, a total of 255 trainers were trained by the MOH divisions in the 8 regions, with an average of 32 trainers per region in their core mandate disease areas. However, data on trainers at the division’s level could not be easily disaggregated into training priority areas or their precise duty station. This was attributed to the fact that the divisions do not necessarily conduct training as a core mandate and lack of a robust database of tracking trainees.


TABLE 5 - NUMBER OF TRAINERS TRAINED BY REGION FOR ALL PRIORITY AREAS BY MOH DIVISIONS Training area

Central Coast EasternNorth

EasternNyanza

Rift Valley

Western NairobiTotal

Cumulative for all priority areas 31 29 31 32 31 35 31 35 255

Capacity for training also exists at the various training institutions surveyed. Training institutions besides training pre-service where found to have the potential to conduct in-service trainings to health workers. However, the training needs assessment established that training institutions had less than 10% of the human resource capacity of lecturers to address the training priority areas identified by the survey. Training institutions indicated that they had 6% of lecturers in adult ART, TB/HIV counseling and testing and PMTCT, bearing in mind the same pool of trainers are used for pre-service training as well. Table 6 below represents the number of trainers/lecturers available in training institutions by priority areas. A total of 17 training institutions were surveyed. Most of the training institutions assessed have human resource capacity for training in priority areas such as HIV/AIDS, malaria, family planning, maternal and child health and nutrition. The number of trainers in a particular training area range from 1 trainer/lecturer in the institution to 57 trainer/lecturers. TABLE 6 - NUMBER OF TRAINERS/LECTURERS AVAILABLE BY TRAINING PRIORITY AREAS (N=17)

Training priority area

Number of training

institutions Number of trainers/lecturers HIV - Adult ART 15 180 TB/HIV C&T 15 163 HIV - PMTCT 14 152 Malaria - Case Mgmt. 13 141 FANC 13 117 Newborn Care 14 105 HIV – Nutrition 15 106 FP 13 99 IMCI 14 98 AMTSL 12 95 TB - MDR Mgmt. 13 93 Supportive Supervision 13 85 IYCF 11 73 Integration of Services 12 70 TB – Nutrition 13 69 Trauma Counseling 13 69 CaCx 9 66 M&E - MOH Tools 11 56 Others 8 126


Training Providers The assessment established that 76.1% of surveyed health facilities used MOH facilitators for training purposes, 71.7% used their own staff for training and 34.8% of the health facilities used training institutions for training purposes (figure 3). Other providers of training included APHIAPlus partners, USG (USAID) funded projects such as CDC, JHPIEGO, MSH, and ICAP, medical associations such as the Nursing Council of Kenya, UNICEF, Liverpool VCT, updates from MOH, NGOs, KEMSA, MEDS, AMREF and Health Right International. Since facilities can select different trainers from several locations for various trainings, percentages will not add up to 100%. This therefore providers’ vital resource that is readily available for training of in-service health workers in a cost effective manner since providers are within reach. It also provides an opportunity for on- The- Job training (OJT) and other learning methodologies such as mentorship that minimizes health worker being away from duty to be enhanced since trainers are within health facilities. The presence of other providers of training lend’s itself as an opportunity for collaboration of GOK and partners in provision of in-service training in Kenya.

FIGURE 3 - TRAINING PROVIDERS ACCORDING TO HEALTH FACILITY MANAGERS

35 33

16 12

3119

76.1% 71.7%

34.8%26.1%

67.4%

41.3%

MOH trainers Trainers from staff

Training institutions

Consulting firms

National. Organ's(e.g NASCOP)

Others

Providers of training

Frequency (n=46) %

Clinical Preceptors Clinical preceptors are trainers who are based in health facilities with teaching collaboration with training colleges and are charged with the responsibility of demonstrating clinical skills during practicum. The recommended clinical preceptor to student ratio is 1: 10 to 1:15.Training institutions counted a total of 1336 preceptors trained to provide clinical training. The majority of preceptors are able to provide training and clinical supervision in Adult ART (172), PMTCT (136), Newborn Care (133) and pediatric HIV (120) giving a preceptor ratio per institution in the priority areas as follows 1:13,1:11,1:11 and 1:9 for Adult ART, PMCT, newborn care and pediatric HIV respectively. Thus a great potential for in-service training. It is important to note that there


is likelihood that one preceptor could demonstrate one or more skill area since the survey did not establish the total number of skill areas they could facilitate. The chart (figure 4) gives a summary of number of preceptors and the corresponding training priority areas. FIGURE 4 - TOTAL NUMBERS OF PRECEPTORS BY TRAINING PRIORITY AREAS FOR INTERVIEWED INSTITUTIONS

136120

172

124

71 6899

133

62

120

44

7951 57

020406080

100120140160180200

Clinical preceptors

Area of Training Experience Representatives from training institutions were asked to report the cadres for which they have experience in providing training in the key training areas. The cadres of health workers who the training institions had the most experience in providing in-service training were: nurses (19%), clinical officers (16%) and medical doctors (15%) as compared to other cadres. This is attributed to the fact that the 3 cadres form the bulk of the health workforce in Kenya by membership. Encouragingly, all training insituitions have experience in providing training to all types of health workers in all key training areas,hence an opportunity for scaling up in-service training to all cadres of health workforce in Kenya The chart(figure 5) below illustrates training experience by cadre by training area.


FIGURE 5 - AREAS OF

ApproveThe TNAwho are institutiotraining curricula,faculty/le Figure 6Practitionto the rethe followappears providersat the moareas. It shouldrecord kenumberscaution. other are

Public health officers9%

Nutrit10

aining Need

ed ContinuiA also consid

able to tran or organin accredite, adequate ecturers in th

6 representsners and Deesults, there wing prioritythat there as in other arost, 2 regula

d be noted teeping syste of regulatoIt is critical

eas is in urge

Pharm. Te10%

ionists0%

s Assessmen

TRAINING EX

ing Professidered the nuain in prioritnization maned CPD proteaching eqhe subject ar

s the numntists Boardis no regulay areas: PMTare no CPD reas are alsoatory boards

that regulatem, with eleory institutio

to note thaent need.

Clini

chs

HRIO8%

Others3%

nt of the Hea

XPERIENCE BY

onal Develumber of Coty training andated byograms. CPDquipment anreas/program

ber of Reg that have e

atory board tTCT, Adult Aproviders in

o not knowns that have a

tory authoritectronic recoons that havat an efficie

MedicaDoctors15%

cal officers16%

O

alth Workfor

Y CADRE FORR TRAINING INNSTITUTIONS

opment Proontinuing Proareas. A CPhealth profD providersnd materialsm/course are

gulatory auever approvethat has eveART, pediatrn these key . In the rem

approved at

ties in Kenyords that cave approvednt database

l s

Med lab t10%

Nurses19%

techs.%

oviders ofessional D

PD provider fessional regs must mee, training reeas for defin

Developmentis defined

gulatory boet set criteresources, adned CPD acti

t (CPD) provas an indiv

odies to proria; have cudequately travities.

viders idual, ovide urrent ained

rce in Kenya

thorities sued at least oer approved ic ART, and training areamaining traileast one C

uch as the one CPD prov

CPD providcervical can

as; the totalning priorityPD provider

Kenya Mevider. Accoers to traini

ncer. As sul number ofy areas, therr to train in t

edical rding ng in

uch, it f CPD re are these

ya have beenan easily bed CPD provie for mainta

n observed e retrieved. Aders should

aining CPD p

to lack a roAs such, the

d be viewed providers am

obust e low

with mong

Rapid Tra 26

Figure 6 priority a

- Number oareas

of Regulatoory Boards tthat have appproved CPD Providerss in key training

0

1

2

3

4

5

AMSTL

NumberTable 7 hthe numbbe the mopportunPediatric

aining Need

r of Health Whighlights inber of health

most commonity, regardlHIV Care an

AMSTL

CaCx

Commod

ity M

gmt

Drug

& Sub

stance Abu

se FPFA

NC

HIV ‐N

utrition

HIV ‐A

dult AR

T

s Assessmen

Workers Tran – service th providers, on training aess of form

nd PMTCT.

nt of the Hea

ined in the raining activper cadre, tr

area with mat. Other c

HIV ‐P

MTC

THIV ‐P

ediatric Care

IYFC

IMAI

alth Workfor

Last 12 Movities in the rained in eacembers of a

common tra

IMAI

IMCI

Integration of Services

M&E ‐M

OH tools

rce in Kenya

onths last 12 monch technical all cadres reining areas

Malaria ‐Case M

gmt.

New

born Care

Psycho

logy ‐Pediatric

Supp

ortiv

e Supe

rvision

TB ‐MDR

Mgm

tTB

‐Mgm

t (Microscop

y)TB

‐Nutrition

TB

nths. Specificarea. TB dia

eceiving at leincluded HI

/HIV C&T

Trauma Co

unseling

AMSTL

/

cally, it descagnosis seemeast one traIV and Nutr

cribes ms to aining rition,

Rapid Tra 27

Table 7 - Total Number of Health Workers Trained in Last 12 Months Training Area MD Nurse Lab CO Pharm PHO Nutri HIO Other TOTAL PMTCT 37 255 17 104 20 5 43 7 178 666 Ped. HIV Care 21 146 20 158 8 0 5 0 360 718 Adult ART 40 171 47 200 23 0 39 5 164 689 MDR TB 11 36 5 27 5 0 0 0 0 84 TB Diagnosis 33 413 46 313 27 17 55 14 472 1390 Mcm 11 36 5 27 5 0 0 0 0 84 FANC 23 311 13 53 13 5 30 5 151 604 AMSTL 20 350 0 44 25 0 0 0 108 547 FP 5 225 0 19 5 0 0 2 123 379 Newborn Care 27 333 6 55 8 0 34 0 67 530 CCS 30 229 16 45 8 5 30 5 141 509 IMCI 37 322 8 89 8 5 36 5 102 612 Pediatric Psychology 12 54 0 28 1 0 0 0 0 95 Drugs and substance abuse 6 193 0 13 10 10 0 0 163 395 Trauma 22 305 44 83 7 5 9 5 120 600 IYCF 5 176 0 12 5 0 34 0 58 290 TB – Nutrition 38 210 5 48 8 10 64 0 0 383 HIV - Nutrition 142 215 6 218 9 24 110 0 0 724 M&E 26 54 11 50 9 0 6 79 5 240 Integration 27 177 10 38 24 1 27 0 0 304 Supervision 27 112 9 40 13 0 5 0 0 206 Others 32 258 54 103 13 16 5 10 0 491

Training Resources

Ministries of Health divisional heads, training institutions, health facility managers and regulatory bodies were asked to list the physical spaces, equipment and materials available to them for training purposes. This section highlights the gaps in resources and the opportunities for cost-saving and bringing in-service training closer to the health worker.


FIGURE 7 - TRAINING VENUES AVAILABLE TO MOH DIVISIONS, TRAINING INSTITUTIONS AND HEALTH FACILITIES

23 25

41

76 5 72

712

9 9

MOH facility In‐house Hotel Other

Available training venues by respondentsHealth facilities MOH Training institutions

Forty-one health facility managers reported that trainings for their in-service health workers were usually conducted in hotels. 23 facility managers interviewed also cited use of a nearby MOH facility, while 25 reported using their own spaces as venues for training. Nearby MOH facilities and other training venues included hospital boardrooms, farmers training colleges and centers (such as Mabanga and Busia in Western Kenya), provincial general hospitals halls, CME halls, government training institutes which include the Kenya School of Government, Embu, hospitals such as Kapenguria, Kenya Medical Training Colleges campuses (KMTC) in Mombasa, Port Reitz, Nyeri, Mathare Hospital, local dispensaries, provincial general hospital conference halls in Nyanza and Kakamega, KENAFYA, and Tigoni District hospitals. Most MOH divisional heads reported using a fairly equal combination of hotels (7), nearby MOH facilities (6) and their own facilities (in-house) as training venues (5). Other training facilities included government training institutes, like the Kenya Institute of Administration, hospitals such as Kenyatta National Hospital and Mbagathi, the Kenya Polytechnic, Tom Mboya Labour Colleges and missionary sites. Twelve training institution respondents reported using their own facilities for training. However trainings were also held in hotels (9) and MOH facilities (9). Other training venues included: community social halls, district and sub-district hospitals (Burnt Forest, Webuye, Turbo, Teso, Busia, Amukura, Port Victoria, Khunyangu, Pumwani Maternity Hospital, Kiambu, Thika, Mathare, Ruiru, and Busia), provincial general hospitals, universities, skills laboratories, lecture halls, nearby research institutions (e.g. Kenya Medical Research Institute-Kilifi), resource centers, the Liverpool VCT Training Institute, pastoral centres, universities (Great Lakes University of Kisumu


and Masinde Muliro University of Science and Technology-MMUST), government and private institutions, and Kenya Medical Training Colleges - Kakamega. Number of training facilities and capacities The survey established that the 17 training institutions sampled had a total of 68 training locations which included satellite campuses or training collaborations with hospitals distributed across Kenya, (Appendix B)

FIGURE 8 - AVAILABLE TRAINING FACILITIES BY REGION Rift Valley Province had the highest numbers of training facilities owned and or supported by divisions of MOH as compared to other provinces. Such divisions include, Division of Reproductive Health; Division of Leprosy, Tuberculosis and lung Diseases and the Division of Nutrition. In total Nyanza and Nairobi provinces have the highest number of training facilities (27) as compared to other provinces. Table 8 below illustrates the total number of training facilities in each province and their total capacities. In relation to the number of training facilities in each province as illustrated in figure 8 above, Nairobi and Nyanza provinces have corresponding higher capacities to enroll in- service health workers for training. It’s interesting to note whereas you would expect higher numbers of trainers to be available in provinces with higher numbers of facilities and capacities, North Eastern has a higher number of trainers with very few number of facilities and capacities, likewise, Central Province has seemingly higher number of trainers compared to the number of facilities and their capacities (Table 8). This is a clear indication of a disproportionate distribution of trainers of priority areas. TABLE 8 - TRAINING FACILITY TOTAL CAPACITIES BY REGION Capacity Central Coast Eastern Northeast Nyanza Rift Valley Western Nairobi Training Institutions 300 575 630 190 800 560 490 1000

MOH Divisions 20 20 20 20 20 60 20 20

Total 320 595 650 210 820 620 510 1020

1117 15

6

24 20 21 172

1 5

2

33 1 10

Central Coast Eastern Northeastern Nyanza Rift Valley Western Nairobi

Training facilities available, by regionTraining Institutions MOH


Access to training services and status of condition The survey was also interested in establishing access to Internet and skill laboratories by MOH divisions of health, health facilities and training institutions for purposes of training of in-service health workers by introducing and scaling up use of innovative learning approaches such as e-learning, distance, and on the job training (OJT) among many others. FIGURE 9 – MOH DIVISIONS, HEALTH FACILITIES AND TRAINING INSTITUTIONS WITH ACCESS TO TRAINING SERVICES

14.30%

36.40% 36.40%50.0%

43.5%

28.2%

87.50% 86.70% 81.30%

Wired internet Wireless internet Skills labs

% of Respondents Answered "YES" to Having Access to Training Tools

MOH Divisions Health Facilities Training Institutions

Less than 40% of the MOH Divisions had access to Internet or skills labs at their facilities. There was inconclusive data to make an assessment of the quality of service according to respondents. Half of the health facility managers had access to wired internet in their facilities for training purposes, while 43.5% of them had access to wireless internet and 28.2 % had access to skills labs for training. A little over 15% (n=7) of health facility managers believed the wired internet was “excellent” as compared to the wireless internet (at 11%; n=5). Additionally, 6, or 13% of the skills labs were rated as “good”. Over 80% (n=44) of the training institutions had access to training services in regard to wired internet, wireless internet and skills labs. All were found to have access to other resources that included clinical research laboratories, libraries and e-libraries, projectors, training venues and catering services, resource centers, teaching laboratories, classrooms, computer laboratories among many others and video conference facilities. 55% (n=6) of the training institutions indicated good wired internet quality and 42% (n=5) rated their wireless connection as “good”, which results in a great opportunity for e-learning. Teaching materials The MOH divisions had a wide range of resources for trainings at their facilities. They reported that laptop computers (25), DVDs (42) and overhead projectors(7) were available and could be borrowed for use for training in other locations with prior arrangements with the divisions. Table 18 in the appendices summarizes resources within the division and their availability for training.


According to health facility managers, desktop computers (208), laptop computers (61), DVD players (27) and overhead projectors (30) were resources found most available in health facilities for training. Table 18 in Appendix C shows the number of respondents with resources and total number of resources. Laptop/ computers (68), overhead projector (51) DVDS (44), demonstration equipment, reference books/manuals and VCR (21) were resources training institutions were willing to lend and be moved for training purposes. As was the case with MOH divisions, health facilities were willing to lend Laptop computers, overhead projectors, and DVDs with prior arrangements. Financing training The Survey was also interested in identifying sources of financing for in-service training by health facilities. Health facility managers were asked to respond to the question “How do you usually pay for training for your staff? ” and they were to respond by selecting five options and not limited to one choice but to as many as applied. 87% (40 of 46) of health facilities relied on some sort of donor funding to support the training of health workers in their hospitals and clinics (see figure 10 below). The health facility managers also reported that 46% of health workers participants had financed their own trainings. This provides an excellent opportunity for loans and scholarship to be made available to health workers so that they may have access to health training. Other sources of financing training for in-service health workers included Government of Kenya scholarships, APHIAPlus support, KEC/CHAK subsidies in their hospitals, support from pharmaceutical companies, and training through the decentralized training centers (DTC) in reproductive health and hospitals that met training costs for their staff. FIGURE 10 - FINANCING TRAINING - HEALTH FACILITY MANAGER PERSPECTIVE

1712

21

40

9

Ministry training budget

Organization training budget

Staff pay for training

Donor funding Other

How health facilities finance trainings


PERSPECTIVE OF REGULATORY BODIES

Six regulatory authorities representing approximately 62,500 health workers were also interviewed for this training needs assessment. A breakdown showing the number of members reported by each regulatory body is shown in the pie chart below. With the exception of the Clinical officers council(COC) which reported to having 1000 plaster technicians registered under them as clinical technicians – none of the other regulatory bodies reported having substantial membership outside of the primary cadres they represented. FIGURE 11 - MEMBERSHIP OF SAMPLED REGULATORY BODIES

8651

30000

7280

6824

8000

1683Kenya Medical Practioners and Dentists Board (KMPDB)

Nursing Council of Kenya (NCK)

Pharmacy and Poisons Board (KPPB)

Kenya Medical Laboratory Technologist and Technicians Board (KMLTTB)Clinical Officers Council (COC)

Kenya Nutritionist and Dietician Council (KNDC)

Availability of training guidelines One of the functions of a regulatory body is to provide guidelines for training the cadres it represents. All regulatory bodies were asked if they had training guidelines for in-service training. They were asked if they would share training content or syllabus for the priority training areas. The Clinical Officers Council and the Kenya Medical Practitioners and Dentists Board indicated that they had more guidelines for priority training areas to share than other regulatory bodies; however, none of the regulatory bodies participating in the assessment could provide training guidelines in all key training areas. Five of the six regulatory bodies indicated that they had training guidelines to share on supportive supervision, suggesting that supportive supervision training has been institutionalized within the regulatory bodies. Interestingly, although the Nursing Council of Kenya has the most members, the national Council Kenya (NCK) indicated that it had no guidelines for the training priority areas, however it could share


guidelines for training in other training areas such as; mental health, operational research, leadership and management, nursing processes and teaching methodologies. Table 9 presents results in this area. Based on responses presented, it is clear that there are significant gaps in training guidance available from regulatory bodies in Kenya. TABLE 9 - AVAILABILITY OF GUIDELINES FOR TRAINING IN KEY TRAINING AREAS

Key Training Area COC KMLTTB KMPDB KNDC KPPB NCK AMTSL # N/A No No # Yes* CaCx No N/A Yes No N/A No Commodity Mgmt. No N/A No No Yes No Drug & Substance Abuse No N/A No No Yes No FANC Yes N/A Yes No N/A No FP No N/A Yes No N/A No HIV - Adult ART N/A No No No N/A No HIV – Nutrition No N/A No Yes N/A No HIV – Pediatric N/A No No No N/A No HIV – PMTCT N/A No No No N/A No IMAI Yes N/A Yes No N/A No IMCI Yes N/A Yes No N/A No Integration of Services No N/A No No N/A No IYCF No N/A Yes Yes N/A No M&E – MOH tools No No No Yes No No Malaria - Case Mgmt. Yes No # No # No Newborn Care Yes N/A Yes No N/A No Psychology – Pediatric N/A # No No N/A # Supportive Supervision Yes Yes Yes Yes Yes No TB - MDR Mgmt. Yes No No No N/A No TB – Nutrition No N/A No Yes N/A No TB Management (Microscopy) N/A No No No N/A No TB/HIV C&T N/A No No No N/A No Trauma Counseling No N/A No No N/A No *-(for mid-level and tertiary institutions) #- No response provided- Regulatory bodies are in the process of developing guidelines for Continuous Professional Development (CPD). This will provide for general guidelines for providing CPD in specific thematic areas. From the results It is apparent that standardization of these courses needs to be addressed by regulatory bodies. Each of the Regulatory bodies also listed other areas for which they had training guidelines to offer as follows: COC: Kenya quality model for health (KQAMH) checklist KMLTTB: Good clinical laboratory practice KMPDB: Medical legal issues and medical malpractice KNDC: Corporate management and training on governance PPB: Rational drug use


NCK: Mental health, operational research, leadership/management, nursing process, teaching methodology Availability of training curricula Regulatory authorities were asked to list approved curricula that they could share for the provision of HIV/AIDs related and other training in priority areas. The following table summarizes responses from regulatory bodies in this area. TABLE 10 - AVAILABILITY OF CURRICULA FROM REGULATORY BODIES

Key Training Area COC KMLTTB KMPDB KNDC KPPB NCK AMTSL Yes N/A Yes No N/A Yes* CaCx No N/A Yes No N/A Yes Commodity Mgmt. No N/A No No Yes Yes Drug & Substance Abuse No N/A No No Yes Yes FANC Yes N/A Yes No N/A Yes FP No N/A Yes No N/A Yes HIV - Adult ART N/A No No No N/A Yes HIV – Nutrition No N/A No Yes N/A Yes HIV – Pediatric N/A No No No N/A Yes HIV – PMTCT N/A No No No N/A Yes IMAI Yes N/A Yes No N/A Yes IMCI Yes N/A Yes No N/A Yes Integration of Services No N/A No No N/A Yes IYCF No N/A Yes Yes N/A Yes M&E – MOH tools No No No Yes No Yes Malaria - Case Mgmt. Yes No # No # Yes Newborn Care Yes N/A Yes No N/A Yes Psychology – Pediatric Yes # No No N/A Yes Supportive Supervision Yes Yes No Yes No Yes TB - MDR Mgmt. Yes No No No N/A Yes TB – Nutrition No N/A No Yes N/A Yes TB Management (Microscopy) N/A No No No N/A Yes TB/HIV C&T N/A No No No N/A Yes Trauma Counseling No N/A No No N/A Yes #- No response provided In sharp contrast to its responses on availability of training guidelines, the NCK indicated in the TNA that it could provide approved curricula for all of the priority training areas listed. This presents an excellent opportunity to have the NCK share curricula for adaptation/customization by other regulatory bodies. There were no independent curricula for the training in priority areas identified for most of the regulatory bodies interviewed. However the course content in the identified courses are integrated in larger thematic areas like reproductive health, community health, HIV AIDS care, medicine and surgery Training institutions were also asked if they could supply curricula for priority training areas. Table 11 provides a summary of the responses from 17 training institutions. As indicated below,


at least 50% of the training institutions surveyed can provide curricula in AMSTL, CaCx, FANC, FP, HIV services (Adult ART, Nutrition, Pediatric), IMAI, IMCI, Newborn Care, and TB (Diagnosis, MDR management, Nutrition). TABLE 11 - AVAILABILITY OF CURRICULA FROM TRAINING INSTITUTIONS Training area Yes % (N=17)

AMTSL 11 65%

CaCx 9 53%

Drug & Substance Abuse 8 47%

FANC 10 59%

FP 11 65%

HIV - Adult ARV 12 71%

HIV – Nutrition 13 76%

HIV – Pediatric 12 71%

HIV – PMTCT 13 76%

IMAI 9 53%

IMCI 10 59%

IYCF 9 53%

M&E 8 47%

Malaria - Case Mgmt. 10 59%

Newborn Care 9 53%

Psychology – Pediatric 4 24%

TB – Diagnosis 9 53%

TB - MDR Mgmt. 9 53%

TB – Nutrition 10 59%

Trauma Counseling 7 41%

Others 7 41%

When combined, these data indicate that there is an opportunity for regulatory bodies and training institutions to collaborate by sharing curricula.

Length of training using approved curricula Both training institutions and regulatory bodies were asked about the length of their training programs in priority training areas using the curricula they reported having. Training institutions reported that, on average, in-service (CPD) training programs take on average less than 2 weeks (See Table 12 ). This is consistent with a need to minimize health workers’ time away from duty stations. Comparative data on this question from regulatory bodies is sparse. Only five of the six regulatory bodies provided data on this question. The regulatory body that indicated it has approved curricula in each priority area, the NCK, responded by indicating that the training priority areas are integrated into the available pre-service curriculum that takes 3 to 4 years. The data suggest that there are opportunities to investigate this issue further and perhaps more closely harmonize curricula and training schedules between regulatory bodies and training institutions.


TABLE 12 - COMPARING AVERAGE TRAINING LENGTHS BY PRIORITY AREAS

Training area

Average training length (in days) Average length of training in

days as reported by training institutions

Length of training in days as reported by regulatory authorities

COC KMLTTB KMPDB

KNDC KPPB

AMTSL 4.8 7 CaCx 6.4 Drug & Substance Abuse

8.7

FANC 6.5 7 5 FP 17 HIV - Adult ART 4 HIV - Nutrition - 5 HIV - PMTCT 8.7 HIV - Pediatric Care 7.7 IMAI 11 7 IMCI 11.5 8 Integration of Services

6.6

IYCF 7.3 5 M&E - MOH Tools 8.5 3 30 Malaria - Case Mgmt.

7.3 7

7

Newborn Care 7.5 14 Psychology - Pediatric

9.7

Supportive Supervision

- 7

3

TB - Diagnosis 8.5 TB - MDR Mgmt. 6.5 14 14 TB - Nutrition 8.5 5 Trauma Counseling 9.2 From these figures above it is clear for the need to standardize the courses and CPD credits provided for similar courses. This can be achieved through regulatory authorities holding forums for determining what qualifies for cross cadre CPD.


Approved CPD providers for training in priority areas Regulatory bodies were asked if they had approved CPD providers to train in each of the priority areas. Data revealed that there are few approved CPD providers for training in the broad thematic areas where priority areas fall: PMTCT, Adult ART, pediatric ART, CaCx and others illustrated in the table 13 below. This points a critical gap in the CPD accreditation system that needs to be urgently addressed. Whereas the regulatory authorities may have accredited certain institutions and CPD providers in broad thematic areas like reproductive health, midwifery, HIV AIDS Care and Counseling, nutrition, family planning among others, priority may not have been apportioned to identified areas. Therefore Identification, recognition and accreditation of trainers in the priority areas need to be an ongoing process. TABLE 13 - AVAILABILITY OF APPROVED CPD PROVIDERS BY TRAINING PRIORITY AREAS

Key Training Area COC KMLTTB KMPDB KNDC KPPB NCK AMTSL Yes N/A # No N/A N/A CaCx No N/A # No N/A N/A Commodity Mgmt. No N/A # No Yes N/A Drug & Substance Abuse No N/A # No Yes N/A FANC Yes N/A # No N/A N/A FP No N/A # No N/A N/A HIV - Adult ART N/A No # # N/A N/A HIV – Nutrition N/A N/A # Yes # N/A HIV – Pediatric N/A No # # N/A N/A HIV – PMTCT N/A No No No N/A N/A IMAI Yes N/A # No N/A N/A IMCI Yes N/A # No N/A N/A Integration of Services No N/A # No N/A N/A IYCF No N/A # Yes N/A N/A M&E – MOH tools No N/A # Yes Yes N/A Malaria - Case Mgmt. Yes No # # # N/A Newborn Care Yes N/A # No N/A N/A Psychology – Pediatric No # # # N/A N/A Supportive Supervision Yes # # # No N/A TB - MDR Mgmt. Yes No # # N/A N/A TB – Nutrition No N/A # Yes N/A N/A TB Management (Microscopy) # No # # N/A N/A TB/HIV C&T N/A No # # N/A N/A Trauma Counseling No N/A # # N/A N/A #- No response provided-Notably the KMPDB indicated they had no approved CPD providers and it is likely the respondents interpreted the question to mean any knowledge of training institutions and other providers that are accredited to provide training.

Accredited/approved trainers, training institutions and consulting firms For each of the areas in which they have accredited training, regulatory authorities were asked to name trainers, training institutions, and consulting firms that are accredited to provide training. Regulatory authorities identified MOH facilitators and Professional Associations such as


the Pediatric Association, Kenya Obstetrics and Gynecologist Society (KOGS), Kenya Association of people with TB and lung diseases as trainers that can be used for training. Mid-level and tertiary training institutions were mentioned to have the capacity to train in the priority areas. Regulatory bodies provided no information about consulting firms that have been accredited to provide trainings in the identified priority areas. This points at an urgent need by regulatory bodies to make public the priority training needs for the trainers, CPD providers, consulting firms to prepare curricula and apply for accreditation to provide the same. Regulatory authorities recommended that MOH facilitators and associations such as pediatric association, KOGS, Kenya association of people with TB and lung diseases as trainers that can be used for training. Mid and high level training institutions were mentioned to have the capacity to train in the priority areas as indicated in the matrix (Appendix D). Regulatory bodies provided no information about consulting firms. A full list of approved trainers is included in APPENDIX D: Accredited/Approved Trainers and Institutions. Professional members attained training standards for re-licensure Only three (50%) of the six regulators reported data on re-licensure. Data revealed that less than half (43.9%) of the Medical Officers and only 37.5% of pharmacists qualified for re-licensure in the last year. The NCK reported the highest re-licensure rate with 65.8% of nurses meeting re-licensure standards. These data point to significant training gaps for health workers as well as gaps in the capacity of regulatory bodies to monitor health workers’ attainment of training requirement for re-licensure. The Clinical Officers Council, KMLTTB and KNDI are in the process of developing their databases. Development of such regulatory databases may significantly enhance tracking of CPD and re-licensure compliance. The survey identified an enforcement mechanism by the Nursing Council, where an advertisement had been made in the local dailies requesting compliance to this professional requirement. This is reported to have increased the number of persons re-licensing. This may be adopted for all other regulatory bodies. The other explanations that were provided by the respondents regarding the low level of compliance to re-licensure requirement was the un-availability of CPD courses in the locality of the health care providers and the cost of trainings sought far from the health care providers workplace. The annual symposia provided by Pharmaceutical Society as a source of CPD, was for example termed as an expensive source of CPD. This therefore calls for investment in technology options that enhance training access for health workers in remote locations. There is need also to accredit more CPD providers and variety of courses and activities, conferences that count for CPD. In this case, the re-licensure is likely to improve. TABLE 14 - PROFESSIONAL MEMBERS ATTAINING STANDARDS FOR RE-LICENSURE

Cadre Total membership # of members attaining standards for re-licensure Percentage

Medical Officers 8651 3800 43.9% Nurses 30000 19743 65.8% Pharmacists/ PharmTechs 7280 2733 37.5%


Determining training needs for health workers Regulatory bodies were asked to describe the types of performance assessments they conduct to determine training needs for health workers. Respondents identified exit interviews, satisfaction surveys, and stakeholder meetings as ways in which they engage their members to identify training needs. The councils reported that supervision visits they conduct are informal ways of carrying out performance assessments. Consultative meetings with provincial and district hospital in charges were seen as opportunities for identification of training gaps for members, resulting in performance assessment. Only PPB indicated that it had performance assessment tools that could be shared, further suggesting that much of the current performance assessment methods are unstructured and there is an opportunity to create more structured support for training needs assessment in the system. Post training support Regulatory bodies were also asked to indicate what type of post-training support they provide to in-service health workers. 2 of the 6 regulatory authorities used mentorship and coaching as modes of post training support, a third used Internet/email to send updates to their members and one sent updates and used manuals. Regulatory authorities identified the need for new employees and new comers to be inducted on the identified priority areas as well as in other areas critical to their practice. There is need to enhance post training support by regulatory bodies and ensuring that trainings have an impact on practice. Diversified post training support mechanisms including clinical mentorship, training materials and support supervision are in urgent need for scale up. Figure 12 illustrates post training support accorded to members by regulatory authorities.

FIGURE 12 - POST-TRAINING SUPPORT TO IN-SERVICE TRAINEES ACCORDING TO REGULATORY AUTHORITIES

2

33.3

4

66.7

1

16.75

83.3

2

33.3

4

66.7

3

100

0 00

20

40

60

80

100

120

Yes‐n Yes‐% No‐n No‐%

Mentorship/coaching Sending updates/manuals

Sending websites Others


Training institutions also reported on their methods of post-training support. A total of 17 training institutions were surveyed and only 15 responded to the question on post training feedback; eighty percent (12) of the training institutions used follow up as post training support to in-service trainees whereas sending updates via websites was used by 84.6 % of the training institutions. None of the training institutions interviewed used mentorship and coaching as a form of post training support to trainees. When asked about the effectiveness of post-training support provided to in-service workers, none of the regulatory bodies reported that they provided “very effective” support. Two of the six indicated that their support was “someswhat effective” while the remaining four suggested that post-training support was “not at all effective.” This is an area where regulators could require additional support. In contrast, more than half (53.3%) of the training institutions indicated their post training support was very effective and less than 15% (n=2) indicated their follow up to be ineffective. This suggests that training institutions are more confident in their ability to provide effective post-training support for health workers than are regulatory bodies.

02

4

8

5

2

Very effective Somewhat effective Not at all effective

Effectiveness of Post Training Support for In‐service Trainees

Regulatory Authorities Training Institutions

FIGURE 13 - EFFECTIVENESS OF POST-TRAINING SUPPORT FOR HEALTH WORKERS Post Training Support Provided To Training Institutions Regulatory bodies were also asked to comment on the post-training support they provide to training institutions. Responses included: approval of teaching and training curricula; supportive supervision, especially to pre and in-service trainings; inspections for quality assurance and compliance; reviews of curricula; participating in examinations; assessment of training facilities; indexing of students; follow up meetings; sending of circulars and updates through correspondence and the need for quality assurance every four (4) years. Regulators’ self-assessments of the effectiveness of their post-training support for institutions were somewhat more optimistic than that for individuals. Two 2 authorities, KMPDB and NCK, rated the support they provided as “very effective” (see figure 14 below).


FIGURE 14 - EFFECTIVENESS OF POST-TRAINING SUPPORT PROVIDED TO TRAINING INSTITUTIONS BY REGULATORY AUTHORITIES

Effectiveness of post‐training support of Regulatory bodies to training institutions Frequency(#)

Effectiveness of post‐training support of Regulatory bodies to training institutions Percent(%)

2 2 2

33% 33% 33%

0

0.5

1

1.5

2

2.5

Not at all effective Somewhat effective Very effective

Methods of evaluation Regulatory authorities were asked, “What methods of evaluation do you utilize to determine the effectiveness of training”. Responses included: council final examinations, which all are required to pass; review and registration of final examinations; and issuance and renewal of clinical log books for pre-service trainees. Respondents also reported use of a national minimum standards document to evaluate new schools’ attainment of criteria required for training. However, they indicated that they lacked a mechanism to evaluate the adherence of the school over time. On the other hand training institutions were asked, “What methods of evaluation do you utilize to determine the effectiveness of training”. Reponses included administrating pre and post test, summative training evaluation; interviews post training and facilitators evaluation by students.


DISCUSSIONS AND CONCLUSIONS

Training priorities This study established that while there were some differences between the training priorities of the technical divisions of MOH and those of the health facility managers, all priorities noted were in line with those previously identified by the USAID APHIAPlus supported projects in Kenya. The top 8 priorities according to both MOH Divisions and health facility managers were: Cervical Cancer Screening Training, HIV –PMCT, Focused Antenatal Care, Integrated Management of Childhood Illness, new born care, active management of third stage of labour, commodity management and HIV pediatric care. The study established there were regional training differences and therefore it was prudent to have regional specific trainings; table 2 shows regional training priorities. Recommendations The ministries of health with the support of FUNZOKenya, in addressing the backlog training, should focus on the top national training priorities and the unique needs of each province as well. According to this report, most of the training priorities are topics or sessions within broader training areas and therefore there may be need to consider training the entire course. For example active management of third stage of labour is a component within essential obstetric care which would be a comprehensive course to deliver. Number of health workers to be trained The study established that less than 12% of the health workforce had been trained in the priorities areas. This is evidence that training backlog is real and the ministries should identify ways in which the vast majority of the health workforce can access high quality training. Recommendations Innovative learning methods such as distance learning, e-learning, evening, weekend and other methods can be introduced to increase access to training by health workforce in cost effective approaches. There is greater need to involve training institutions at the regional level for wider reach since they are widely spread in the country. Trainers in priority areas The MOH facilitators were engaged in the training of in-service health workers more than any other category of trainers. In addition, training institutions were found with the capacity to train in-service health workers. However, they had less than 10% of lecturers to train in the priority areas despite having facilities country wide with the potential to use for in-service training. Recommendations Training institutions to collaborate with the MOH technical departments to build their capacity for in-service training to reach the standards required and use of MOH trainers and professional associations for in-service training.


Scale up through on-job mentorship programmes to increase in-house training for a wider reach. Training venues The study established that much of the training happened in hotels. However, there was great potential for moving towards MOH facilities nearby, in-house training and other facilities. Hotel based training is unlikely to be effective, especially where clinical skills are to be demonstrated and practiced. It is also expensive due to other related costs such as accommodation among many others, thus reaching out to a small number. Recommendations There is need to use training institutions and alternative cost effective training venues and locations which include faith based facilities such as pastoral centers, government facilities, hospital facilities that include board rooms and clinical areas, thus making training simultaneous and cost effective. Access to services and equipment The assessment established that half of the health facilities had access to internet, whereas more than three thirds of the training institution had access to internet. This therefore presents a unique opportunity for training through e-learning. Laptop computers, projectors and DVDs were resources most available and could be moved from one location to another for training. Recommendations There exists a huge potential for distance and e-learning with the wider reach of internet access. Financing of Training More than 80% of health workforce training in health facilities were donor supported, thus making it not sustainable in the long run and often not reliable beyond the sponsoring project life period. The study established slightly more than 40% of the health workers financed their own training. Recommendations There exists a big potential for the scale up of the health workforce training through access to loan products that are reasonably priced for the vast majority of health workers who finance their own training. With the current flexible loaning policies and competitive loan products among the financial institutions, Training institutions have an opportunity to expand their capacities to meet demand, as they have access to loan facilities. The need for training institutions and health facilities to increase their training budgets and also seeking alternative sources of funds for training cannot be under scored.


Areas of training experience by training institutions Training institutions were found to have experience in training nurses mostly. This was expected as nurses formed the bulk of the health workforce by membership. Recommendations Training institutions need to build capacities to expand their expertise to other cadres for effective service delivery. Average Training days and ability to supply curriculum by training institutions Most of the training curriculums were found to be of less than 2 week training as confirmed by the regulatory authorities’ as well. This seemed to be because the health workers cannot afford to be out of duty for long in training as they are required to be providing health care services. Recommendations Other modes of learning such as distance learning, e-learning and training shortened to allow for shorter periods of face-to-face interaction and longer period of self-directed learning. Half of the training institutions where able to supply curriculum for in-service training in identified training priority areas and hence were able to address the training backlog. Post training support to trainees by training institutions and its effectiveness The study established that follow ups by trainers and sending of updates were the most commonly used methods of post training support by training institutions. None had used mentorship or coaching as methods of support. These demonstrate lack of capacity in post training support. Slightly more than half of the training institutions noted their support was effective. Recommendations Training institutions strengthening was required through faculty development in post training support and performance assessment. Exposure to performance management tools was a priority for training institutions to improve effectiveness of their trainings. Availability of guidelines, curricula and CPD providers A quarter of the regulatory authorities had guidelines to share in training priority areas for in-service health workers. In HIV/AIDs related courses they had no approved CPD providers. Recommendations Training priority identified passed to regulators for award of CPD points. Need for capacity building for the regulators to develop guidelines for areas of in-service training with no guidelines. Encourage regulatory bodies to have cross cadre CPD activities/programs with same number of CPD points across cadres.


Professional members attaining re-licensure With the exception of nurses, less than half of the professional members were attaining standards for re-license and other regulators lacked data on the same. This is a reflection of the following likely scenarios: weak enforcement, guidelines lacking, unclear or manual recording and ineffective databases for maintenance of records. Recommendation Need for capacity building of regulators and need for development of database for accurate recording of member data. Post training support to trainees and training institutions Post training support to in-service trainees was found to be ineffective and the same was true for training institutions Recommendations There is need to build the capacity of regulators to provide on-going support to members and training institutions.


APPENDIX A: PRIORITY AREAS AND SUBTOPICS TO BE COVERED

MOH technical divisions reported that they required training priority areas to be covered as per the national guidelines and emphasized the following subtopics to be covered under the priority area mentioned below: TABLE 15 - MOH TRAINING PRIORITY AREAS AND SUBTOPICS Training Area Sub Topics Adult ART Use of ARVs Managing treatments and

patients

Commodity Management

Food safety and commodity management

Principle of commodity management

Quantification and procurement of commodities. Distribution and storage. Pharmaco-vigilance (monitoring of drugs) management and rationale use of drugs

Drug and substance abuse

Harms of drugs Drug management Prevention of drug abuse

Infant and young child feeding (IYCF)

MIYCN Policy, strategy and guidelines

Infant feeding IYCF and WHO Growth Standards

M&E – use of MOH tools Guidelines and information education and communication (IEC) materials

Data for decision making(the practical aspects )

Data quality assurance Data collection and analysis Use of data for decision making. Reporting data.

Malaria case management

Management of uncomplicated malaria

Parasitology and diagnosis of malaria

Malaria in pregnancy, management, prevention and treatment of malaria in adults

Newborn Care Newborn resuscitation Detection of signs before birth and after birth

Infection prevention

Nutrition and HIV High impact nutrition interventions

Nutrient supplementation Food fortification

Nutrition and TB Nutritional elements in DHIS

Others: Intervention sites, Integrated management of adult illnesses (IMAM)

Post training follow-ups, full long acting and permanent methods of family planning (LAPM)curriculum

Management of non-communicable diseases, Essential maternal obstetric care(EMOC), Maternal newborn care (MNC ) package, full cervical cancer package

Pediatric Psychology Psycho-social support Assessment and referral of children with disabilities

Psychotherapy for parents, guardians and care givers. Management of child abuse

PMTCT The four prongs of PMTCT

Full PMTCT package

Supportive Supervision Follow-up of supportive supervision

Setting of objectives for supportive supervision

Development of supportive supervision tools.

TB/HIV counseling and testing (C&T)

Use of HIV tools


TABLE 16 - TRAINING PRIORITY AREAS AND SUB-TOPICS TO BE COVERED ACCORDING TO HEALTH FACILITY MANAGERS

Training Area Sub topics emphasized PMTCT Care for PMTCT,

dissemination of information

Pediatric HIV care Clinical presentation of HIV in children

Early infant diagnosis prophylaxis for the newborn of HIV positive mother\

Pediatric Resuscitation Primary management of HIV in children Follow up of infected children

Adult ART ART management As required by guidelines Side effects of ART and their management ART monitoring, referrals, dispensing of ART HIV staging and testing

TB/HIV counseling and testing (C&T)

Attitude of health workers towards TB patients

Rapid HIV testing, couple counseling and testing

Relation of TB and HIV PRE and POST TEST

MDR TB Management Assessment and referral of MDR cases

Good management and prevention of MDR

Overview of MDR TB management

Malaria case management New malaria guidelines

Focused Antenatal Care (FANC) Antenatal care, The whole of FANC package

Counseling of pregnant mothers and anemia in pregnancy

Complications that can affect normal delivery investigation/follow up in trimesters

AMSTL (Active Management of 3rd Stage of Labor

Precautions to take during labour and delivery

Post-partum hemorrhage

Newborn Care Birth preparedness Care of underweight and pre-mature babies

How to give episiotomy care and treatment of children

Cervical Cancer Screening Cervical Cancer screening full package

Integrated Management of Childhood Illness (IMCI)

Mother child health (MCH) Model

Neonatal resuscitation

Integrated management of adult illness (IMAI)

emphasis on CD4 counts and staging of HIV

Trauma counseling Abnormal and normal behavior


Feeding of newborn and infection prevention

Nutrition and HIV Epidemiology and clinical presentation of HIV in adults

Commodity Management Adherence Commodity

Identification of commodity

Others Partogram advocacy at community level

How to give episiotomy Cry therapy treatment TB and HIV in pregnancy


APPENDIX B: NAME OF TRAINING FACILITIES BY REGION AND CITY

TABLE 17 - TRAINING FACILITIES BY REGION AND CITY

Coast Province

Coast General

Nairobi

City Centre Kilifi Karen Mombasa Mathare Malindi Kosovo Msabweni Kingsway Building Port Reitz Kenyatta National Hospital PCEA Pumwani ACK Mbagathi Catholic (Mombasa)

Eastern Province

Embu

Central

Karatina Machakos Timau Kitui KMTC Meru Muranga Mwingi Nyeri Thika Sagana

Nyanza Province

Homabay

Rift Valley

Eldoret Nyamira Kabarnet Kisii General Hospital Kapkatet Siaya Loitokitok Kisumu Nakuru Kenya Med. Training Colleges Mosoriot Maseno Turbo Rongo Kitale Ahero Iten Awendo Kapenguria Bondo Kajiado Migori Naivasha General Hospital Lodwar

Western Province

Bungoma

North Eastern Province

Marsabit Busia Garisa Provincial Hospitals Webuye Lowdar Teso Mt.Elgon Kyunyangu Nambale Kakamega Mumias Mmust-Kakamega Pgh Kakamega


APPENDIX C: AVAILABLE TRAINING RESOURCES

TABLE 18 - MOH DIVISIONS AND HEALTH FACILITIES TEACHING RESOURCES

Type of Equipment and Materials

Number Available

MOH Health Facilities Training Institutions

Chalk and board 8 17 101 Computer (Desktop) 22 208 600 Computer (Laptop) 25 61 68 Demonstration equipment 10 7 78 DVD player 8 27 28 DVDs 42 1 44 Flip chart 3 3 113 Manuals/curricula 2 3 46 National Health Policies 10 10 34 Overhead projector 7 30 51 Pamphlets 3 0 35 Reference books/materials 5 5 328 Demonstration charts 2 0 27 VCR 8 3 21 Wall Charts 3 15 141


APPENDIX D: ACCREDITED/APPROVED TRAINERS AND INSTITUTIONS

Table 19 - Names of Approved Training Providers According to Regulatory Authorities

Training Priority Area Trainers Training Institution PMTCT Kenya Obstetric and Gynecological

Society (KOGS)

Pediatric HIV care Pediatric Associations TB Management (Microscopy)

Kenya Association of People with TB and Lung Disease

MDR TB Management MOH Trainers Kenya Association of People with TB and Lung Disease

Malaria case management MOH trainers Focused Antenatal Care (FANC)

KOGS Kenya Association Pediatrics

AMSTL KOGS MOH trainers

Family Planning (FP) KOGS Newborn Care Kenya Pediatric Association

MOH Trainers

Cervical Cancer Screening Mid-level and tertiary institutions IMCI Mid-level and tertiary institutions IMAI Mid-level and tertiary institutions Pediatric Psychology Mid-level and tertiary institutions Drug & substance abuse Mid-level and tertiary institutions Trauma counseling Mid-level and tertiary institutions IYCF KMTC (ALL),University (All) Mid-level and tertiary institutions Nutrition and HIV KMTC (ALL),University (All) Mid-level and tertiary institutions Nutrition and TB KMTC (ALL),University (All) Mid-level and tertiary institutions Commodity Management KMTC (ALL),University (All) Mid-level and tertiary institutions Supportive Supervision KEMRI/CDC KMTC (All), University (All)

midlevel and tertiary institutions UON.KU.JKUAT.MKU.KEMU.KMTCKISII University

M&E – use of MOH tools AMREF KMTC (All), University(All) midlevel and tertiary institutions

Integration of Services Mid-level and tertiary institutions Others: Please specify Kenya Institute of Administration

(KIA) Kenya Institute of Education Mental Training College, Division of Mental Health ,KEMU/Masinde Muliro/KMTC, MCH


MOH Departmental and Divisional Heads were asked to provide the names of trainers, training institutions, and consulting firms who are qualified to provide training in the selected areas, as well as recommended from past experience. MOH trainers were identified by the divisions as having the capability to train PMTCT, TB/HIV counseling and testing, malaria case management (MCM) and drugs and substance abuse. The survey established that divisions recommended training institutions such as the University of Nairobi, Egerton University, Kenya Medical Training Colleges (KMTC), Kenya Medical Research Institute (KEMRI), Maseno University, Kenyatta National Hospital, Mathare Hospital, Lisa Training Institute were recommended against training priorities as shown in the following table. The National Authority for the Campaign against Drug Abuse (NACADA), AMREF and International Baby Food Action Network (IBFAN) were recommended as training consulting firms with the ability to train in priority training areas against their name. The divisions of MOH, by the fact that training is not their core mandate, had limited information in regard to trainers and consulting firms outside MOH structures that they could recommend for training considerations. Table 20 - Recommended training providers according to MOH Divisions

Priority Area Trainers Training Institutions Consulting Firms PMTCT MOH trainers Individual lecturers from the

University of Nairobi who teach privately.

TB/HIV C&T MOH TOTs Kenya Medical Research Institute (KEMRI) on MDR TB management

Malaria case management

MOH trainers KMTC and middle level colleges

AMREF, University of Nairobi, Lisa Training Institute, Maseno University

Drug and substance abuse

MOH trainers MATHARE Hospital, KMTC. Tertiary institutes (universities), Kenya Institute Of Administration, Kenyatta University

NACADA, Alcoholic Anonymous


KMTC, Kenyatta National Hospital (KNH), University of Nairobi, Egerton University

IBFAN


APPENDIX E : List of Participating Institutions No MOH Technical Divisions

1. Division of Child and Adolescent Health (DCAH)

2. Division of Reproductive Health 3. Division of Vaccines and Immunization 4. Division of Nutrition 5. NASCOP (MOPHS) 6. NASCOP (MOMS) 7. Division of Leprosy Tuberculosis and Lung

Disease

8. Division of Malaria Control Regulatory Bodies

9. Nursing council of Kenya (NCK) 10. Clinical Officers Council (COC) 11. Kenya Medical practitioners and dentists

boards(KMPDB)

12. Pharmacy and Poisons Board(KPPB) 13. Kenya Nutritionists and Dietarian institute

(KNDI

14. Kenya Medical Laboratory Technician and Technologist Board (KMLTTB)

Health Facility Managers Provincial General Hospitals (PGH)

15. Embu, 16. Thika 17. Mombasa, 18. Garisa, 19. Kisumu, 20. Nakuru, 21. Kakamega, 22. Machakos 23. Nyeri

Faith Based Organizations (FBO) 24. St Camilus Tabaka 25. Tenwek Mission Hospital 26. AIC Kijabe 27. Nazareth Hospital 28. Maua Methodists


29. St Luke Kaloleni Private Hospitals

30. Port Florence Hospital-Kisumu 31. Highway Maternity and Nursing Home-

Kakamega

32. Al Magdis Clinic-Garisa 33. Nyeri Medical Center 34. Shalom Medical Clinic-Embu 35. Mater Hospital-Nairobi

District Medical officers of Health (DMOH) 36. Likoni District 37. Ijaara District 38. Embu East district 39. Subuki District 40. Ikolomani-Kakamega South District 41. Kisumu East District 42. Nyeri South District 43. Mandera District

District Hospitals 44. Likoni District Hospital 45. Ijaara district Hospital 46. Embu East District Hospital-Runyenges 47. Subuki District Hospital 48. Ikolomani-Kakamega South District Hospital 49. Kisumu District Hospital 50. Mbagathi District Hospital 51. Karatina District hospital

Provincial Directors 52. Central 53. Coast 54. Eastern 55. NEP 56. Nyanza 57. Rift Valley 58. Western 59. Nairobi

Training Institutions 60. Kijabe Nursing School 61. Kenya Medical training College (KMTC)



62. Maseno University 63. Great Lakes University of Kisumu (GLUK) 64. Moi University 65. University of Nairobi 66. Mission Essential Drugs (MEDS) 67. Liverpool VCT Institute 68. MildMay International 69. Kenyatta University 70. St Lourde Nursing school-Mwea Hospital 71. Masinde Muliro University 72. Ortum Nursing School 73. Pwani University 74. Egerton University 75. PCEA Chogoria 76. NEP College of health Sciences 77. Kenya Methodist University

APPENDIX F: Introduction and Consent

Hello, my name is ------------------and we are conducting this training needs assessment (TNA) from IntraHealth FUNZOKenya project on behalf of the Ministries of Health (MOH)-MOMS and MOPHS. The Rapid Training needs assessment (TNA) is about identifying priority training areas for in-service training of health workforce in Kenya and we would very much appreciate your participation in this exercise. I would like to ask you some questions about your department/division/province/hospital/clinic in regard to health workforce training. The interview will take about 20-25 minutes to complete. Your participation in the TNA is voluntary and there is no penalty for refusing to take part. If you are uncomfortable during the interview you may stop the interview at any time or refuse to answer any questions. No information collected will be linked to you directly, and all information will be compiled into a single report with no mention of your identity. Whatever information you provide will be used to prioritize training for health workers based on province/district/county and development of courses that are responsive to health workers needs for effective service delivery. Whatever information you provide will solely be used for the purpose of this exercise. The information you provide will be confidential. We will not record any identifying information such as your name, age, and address on the questionnaire form on which your responses are recorded or in publications.The information you give will be compiled together with those from other areas to make one report and will not be isolated to an individual person. We would like you to give us your consent to continue with the interview. Do you have any questions about the Training Needs Assessment?

Consent to Participate in TNA I have read (or you have read to me) the information above describing the procedures, benefits and risks of participating in this training needs assessment (TNA). I agree to participate as an informant in this TNA. _______________ ________________________________________________ Date Signature or Mark of Subject _______________ ________________________________________________ Date Signature of Person Obtaining Consent



TRAINING NEEDS ASSESSMENT PMO, Medical Superintendents and Facility Managers

Name of Interviewer: ________________________________ Date: ___________________ Tool code: PM_________ Name of Respondent: _________________________________ [A1] Code of Facility: _________ [A2] Province Code: __________[A3] County Code: ____________ [A4] Ownership of facility: Public Private Faith Based Other (check as appropriate) 1. [A5] Number of workers in Facility/Organization/, by cadre including specialist:

CADRE NUMBER a. Medical doctors

b. Nurses

c. Medical Lab Technologists/Technicians

d. Clinical Officers (CO)

e. Pharmacists/Pharm. Techs.

f. Public Health/Environmental Health Officers/Technicians

g. Nutritionists

h. Health Records Information Officers/technicians

i. Others (Please specify)

2. [A6] The following have been identified by APHIAPlus projects and other partners as key training need areas. Please put an “X” by the top five

for which you think training is most critically needed at your facility

KEY TRAINING AREA C KEY TRAINING AREA RITICAL? “X”=YES, BLANK =NOT AT THIS TIME.

CRITICAL? “X”=YES, BLANK =NOT AT THIS TIME.

a. PMTCT n. Integrated management of adult illness (IMAI)

b. Pediatric HIV care o. Pediatric Psychology

c. Adult ART p. Drug and substance abuse

d. TB/HIV counseling and testing (C&T) q. Trauma counseling

e. TB Management (Microscopy) r. Infant and young child feeding (IYCF)

f. MDR TB Management s. Nutrition and HIV

g. Malaria Case Management t. Nutrition and TB

h. Focused Antenatal Care (FANC) u. Commodity Management

i. AMSTL (Active Management of 3rd Stage of Labor v. Supportive Supervision

j. Family Planning (FP) w. M&E – use of MOH tools

k. Newborn Care x. Integration of Services

l. Cervical Cancer Screening y. Others: Please specify

m. Integrated Management of Childhood Illness (IMCI)

3. [A7] For each of the priority areas identified in NO. 2 , please indicate a) how many of your staff, by cadre, have had training in the last 12

months and b) how many still need to be trained?

PRIORITY MEDICAL NURSE MED LAB CLINICAL PHARMACIS PHOS NUTRITIONI HRIOS OTHERS



TAREA/CADRE

OFFICERS ECH OFFICERS TS STS

Priority Area #1 (Description)

a. ____# trained

b. ____# to

be trained

a. ____# trained

b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained Priority Area #2 (Description)

a. ____# trained

b. ____# to

be trained

a. ____# trained

b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to


a. ____# trained

b. ____# to

be trained

a. ____# trained

b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to


a. ____# trained

b. ____# to

be trained

a. ____# trained

b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to


a. ____# trained

b. ____# to

be trained

a. ____# trained

b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

a. ____# trained b. ____# to

be trained

4. [A8] For each of the five priority areas selected above, please indicate any key subtopics that need to be addressed to increase performance at your facility.

PRIORITY AREA/SUBTOPIC

KEY SUBTOPIC 1 KEY SUBTOPIC 2 KEY SUBTOPIC 3






5. [A9] Who usually provides training for your staff? (please check all that apply)

MOH Trainers Trainers from our own staff Training Institutions Consulting Firms National Organizations (NASCOP, etc.) Other (please specify in the space

below)___________________

6. [A10] In the table below please provide the names of trainers, training institutions & consulting firms who are qualified to provide training in these specialized areas and who you recommend from past experience.

PRIORITY AREA TRAINERS TRAINING INSTITUTIONS

CONSULTING FIRMS






7. [A11] How do you usually pay for training for your staff?

Training budget provided through the Ministry Separate training budget provided by our organization Staff pay for their own training Donor funding


Other (please specify)

8. [A12] Where is training usually provide for your staff?

MOH facility nearby (please name: _____________________________) In-house training room/facility Hotel Other training facility (please name: _____________________________)

9. [A13] Do you have access to the following for training at your facility?

COMPONENT YES/NO WHAT IS THE QUALITY/CONDITION OF THE EQUIPMENT/SERVICE? (4= EXCELLENT. 3= GOOD, 2=FAIR, 1=POOR)

Wired Internet Wireless Internet Skills Labs Others (please specify) 10. [A14] Please comment on the availability of the resources listed above:

______________________________________________________________________________

______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

11. [A15] What equipment, teaching aids and resources do you have that FUNZOKenya can utilize while facilitating trainings for health workers in your location (District/County/Province etc.)?

TYPE OF EQUIPMENT AND TITLE OF REFERENCE MATERIALS

NUMBER AVAILABLE (ONLY COUNT EQUIPMENT THAT IS

FUNCTIONAL)

CAN THESE RESOURCES BE MOVED TO ANOTHER AREA

FOR USE? a. Chalk and board

b. Computer (Desktop)

c. Computer (Laptop)

d. Demonstration equipment

e. DVD player

f. DVDs

g. Flip chart

h. Instruction manuals/curricula

i. National Health Policies


j. Over head projector

k. Pamphlets

l. Reference books/materials

m. Relevant demonstration charts

n. VCR

o. Wall Charts

p. Other (please specify)

12. [A16] Please comment on the availability of the equipment listed above:

______________________________________________________________________________

______________________________________________________________________________ ______________________________________________________________________________

13. [A17] Is there any additional information you would want us to know?

______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

End of questionnaire THANK YOU FOR YOUR TIME AND ASSISTANCE!


TRAINING NEEDS ASSESSMENT (TNA): Departmental and Divisional Heads

Name of Interviewer: ________________________________ Date: ________________ Tool code: DD#_________ Name of Respondent: _____________________________ [A1] Code of Facility: ______[A2] Province Code: _______[A3] County Code: ________ [A4] Ownership of facility: Public Private Faith Based Other (check as appropriate)

14. [A6] The following have been identified by APHIAPlus projects and other partners as key

training need areas. Please put an “X” by the top five for which you think health workers most critically need training as per your mandate.

KEY TRAINING AREA CRITICAL? “X”=YES, BLANK =NOT AT THIS TIME.

KEY TRAINING AREA

CRITICAL? “X”=YES, BLANK =NOT AT THIS TIME.

a. PMTCT n. Integrated management of adult illness (IMAI)

b. Pediatric HIV care o. Pediatric Psychology

c. Adult ART p.Drug and substance abuse

d. TB/HIV counseling and testing (C&T)

q. Trauma counseling

e. TB Management (Microscopy)

r.Infant and young child feeding (IYCF)

f. MDR TB Management s. Nutrition and HIV

g. Malaria Case Management

t. Nutrition and TB

h. Focused Antenatal Care (FANC)

u. Commodity Management

i. AMSTL (Active Management of 3rd Stage of Labor

v. Supportive Supervision

j. Family Planning (FP) w. M&E – use of MOH tools

k. Newborn Care x. Integration of Services

l. Cervical Cancer Screening

y. Others: Please specify




15. [A8] For each of the five priority areas selected above, please indicate any key subtopics that need to be addressed to increase performance of your programme.

PRIORITY AREA/SUBTOPIC

KEY SUBTOPIC 1 KEY SUBTOPIC 2 KEY SUBTOPIC 3






16. [A7] For each of the priority areas, please identify which cadres most critically need to be trained in-service in each area (check all that apply)

PRIORITY AREA/CADRE

MEDICAL DOCTORS

NURSE MED LAB TECH

CLINICAL OFFICERS

PHARMACISTS

PHOS NUTRITIONISTS

HRIOS OTHERS


___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A


___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A


___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A


___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A


___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A


17. [A18] For each of these priority areas, how many trainers do you have on staff in each province who can provide training?

PRIORITY AREA # OF TRAINERS ON STAFF BY LOCATION

Central Coast Eastern North Eastern

Nyanza Rift. Valley

Western Nairobi






18. [A10] In the table below please provide the names of additional trainers, training institutions &

consulting firms who are qualified to provide training in these specialized areas and who you recommend from past experience.

PRIORITY AREA TRAINERS TRAINING INSTITUTIONS

CONSULTING FIRMS






19. [A12] Where is the training you support usually provided?

MOH facility nearby (please name: _____________________________) In-house training room/facility Hotel Other training facility (please name: _____________________________)


20. [A19] In which provinces in Kenya does the department/division have training centers/facilities around the country?

PROVINCE # OF FACILITIES

CITIES/TOWN WHERE FACILITIES ARE LOCATED (PLEASE LIST)

TOTAL CAPACITY OF FACILITIES (# OF PEOPLE THAT CAN BE TRAINED AT ONE TIME)

Central Coast Eastern North Eastern Nyanza Rift Valley Western Nairobi

21. [A13] Does the division/department have access to the following for training at its facilities?

COMPONENT YES/NO WHAT IS THE QUALITY/CONDITION OF THE EQUIPMENT/SERVICES? (4= EXCELLENT. 3= GOOD, 2=FAIR, 1=POOR)

Wired Internet Wireless Internet Skills Labs Others (please specify) 22. [A14] Please comment on the availability of the resources listed above:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



NUMBER AVAILABLE (ONLY COUNT EQUIPMENT THAT IS FUNCTIONAL)

CAN THESE RESOURCES BE MOVED TO ANOTHER AREA

FOR USE? q. Chalk and board

r. Computer (Desktop)

s. Computer (Laptop)

t. Demonstration equipment

u. DVD player


v. DVDs

w. Flip chart

x. Instruction manuals/curricula

y. National Health Policies

z. Over head projector

aa. Pamphlets

bb. Reference books/materials

cc. Relevant demonstrationcharts

dd. VCR

ee. Wall Charts

ff. Other (please specify)

24. [A16] Please comment on the availability of the equipment listed above: ______________________________________________________________________________

______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

25. [A17] Is there any additional information you would want us to know?

______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________




TRAINING NEEDS ASSESSMENT (TNA) REGULATORY AUTHORITIES

Name of Interviewer: ________________________________ Date: ___________________ Toolcode: RA_________ Name of Respondent: _________________________________ [A1] Code of Facility: _________ [A2] Province Code: __________[A3] County Code: ___________ [B1] What is the registering body?

Kenya Medical Practitioners and Dentists Board (KMPDB) Nursing Council of Kenya (NCK) Kenya Pharmacy and Poisons Board (KPPB) Kenya Medical Laboratory and Technicians Board (KMLTTB) Kenya Clinical Officers Council (COC) Kenya Nutritionist and Dietician Council (KNDC)

[A5] How many members do you have from the following cadres including specialists?

CADRE NUMBER a. Medical Officers (MO)

b. Nurses




f. Public Health/Environmental Health Officers

g. Nutritionists

h. Health Record Information Officers/Technicians(HRIO)


1. [A20] The following have been identified by APHIAPlus projects and other partners as key training need areas. Please tell us if a) you have guidelines for training, b) there is an approved curricula that can be shared, c) the length of training in days under the approved curricula, and d) whether or not the regulatory body has already approved trainers to provide training in this area.

KEY TRAINING AREA HAVE GUIDELINES TO SHARE? (Y/N)

HAVE AN APPROVED CURRICULUM THAT CAN BE SHARED

LENGTH OF TRAINING USING CURRICULU

HAVE APPROVED CPD PROVIDERS TO

(Y/N) M (DAYS) TRAIN IN THIS AREA (Y/N)

a. PMTCT ___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A

b. Pediatric HIV care

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A

c. Adult ART ___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A


___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A


___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A

f. MDR TB Management

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A


___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A


HAVE AN APPROVED CURRICULUM THAT CAN BE SHARED (Y/N)

LENGTH OF TRAINING USING CURRICULUM (DAYS)

HAVE APPROVED CPD PROVIDERS TO TRAIN IN THIS AREA (Y/N)


___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A

i. AMSTL (Active Management of 3rd Stage of Labor

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A

j. Family Planning (FP)

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A

k. Newborn Care ___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A


___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No


___ N/A


___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A

n. Integrated management of adult illness (IMAI)

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A

o. Pediatric Psychology

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A





p. Drug and substance abuse

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A

q. Trauma counseling ___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A

r. Infant and young child feeding (IYCF)

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A

s. Nutrition and HIV ___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A

t. Nutrition and TB ___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A


___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A


___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A






w. M&E – use of MOH tools

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A

x. Integration of Services

___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A


___ Yes ___ No ___ N/A

___ Yes ___ No ___ N/A

___ days ___ Yes ___ No ___ N/A

2. [A21] For each of the following areas in which you HAVE accredited training, please tell us the

trainers, training institutions, or consulting firms that are accredited by your regulatory body to provide training in this area.

KEY TRAINING AREA TRAINERS TRAINING INSTITUTIONS

CONSULTING FIRMS

N/A

a. PMTCT


KEY TRAINING AREA

TRAINERS

TRAINING INSTITUTIONS

CONSULTING FIRMS

N/A

c. Adult ART



f. MDR TB Management



i. AMSTL (Active Management of 3rd Stage of


Labor


k. Newborn Care


CONSULTING FIRMS

N/A








s. Nutrition and HIV

t. Nutrition and TB


CONSULTING FIRMS

N/A



w. M&E – use of MOH tools




[A22] In the last one year, how many of your professional members attained training standards for re-license and were thus re-licensed

(please fill in the appropriate column in the table below) CADRE NUMBER PERCENTAGE OF

TOTAL REGISTERED MEMBERS

a. Medical Officers (MO)

b. Nurses




f. Public Health/Environmental Health Officers/Technicians

g. Nutritionists

h. Health Record Information Officers


[A23] Please describe the type of performance needs assessment the regulatory body conducts to determine what training health workers

need. ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

3. [A24] Do you have any performance needs assessment tools that you can share with us?

Yes No N/A

4. [A25] What post training support do you provide to in-service trainees (please check as appropriate)?

a. Follow up by trainers (mentoring, coaching, etc.)

Yes No N/A

b. Sending of updates/manuals



Yes No N/A

c. website where learners can get more information

Yes No N/A

d. Other (please specify)

___________________________________________________________________________

___________________________________________________________________________

5. [A26] In your opinion, how effective is the level of post-training support you provide to in-service health workers?

Not at all effective Some what effective Very effective

6. [A27] What type of post training support do you provide to training institutions?

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ [A28] In your opinion, how effective is the level of post-training support you provide to training institutions?


7. [A30] What methods of evaluation do you utilize to determine the effectiveness of training?

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

8. [A17] Is there any additional informational you would like us to know?:

__________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________


TRAINING NEEDS ASSESSMENT (TNA) Training Institutions

Name of Interviewer: ________________________________ Date: ___________________ Toolcode: TI_________ Name of Respondent: ________________________________ [A1] Code of Facility: _________ [A2] Province Code: __________[A3] County Code: ____________ [A4] Ownership of Facility/Organization: Public Private Faith Based Other (check as appropriate) 1. [A29] For each of the following areas below, please indicate the number and type of resources your organization can provide

including a) the # of lecturers/ trainers who can train in-service trainees in the following areas competently as required by MOH technical divisions and departments, b) the # of clinical preceptors who could provide mentoring in this area if needed, c) the cadres for which you have experience providing training in this area, d) the average length, in days, of the training you provide in this area, and e) whether or not you can provide a curriculum to use for training in this area.

KEY TRAINING AREAS

# OF LECTURERS/ TRAINERS AVAILABLE

# OF CLINICAL PRECEPTORS AVAILABLE

FOR WHICH CADRES DO YOU HAVE TRAINING (CHECK ALL THAT APPY)

AVERAGE LENGTH OF TRAINING (DAYS)

CAN YOU SUPPLY A CURRICULUM? (YES/NO)

a. PMTCT ___ Medical Officers ___ Nurses ___ Med Lab Techs ___ Clinical Officers ___ Pharm/Pharm Techs ___ Public Health Officers ___ Nutritionists ___ Health Record Information Officers ___ Others (Please specify)

KEY TRAINING AREAS








___ Medical Officers ___ Nurses ___ Med Lab Techs ___ Clinical Officers ___ Pharm/Pharm Techs ___ Public Health Officers ___ Nutritionists ___ Health Record Information Officers ___ Others (Please specify)

c. Adult ART ___ Medical Officers ___ Nurses ___ Med Lab Techs ___ Clinical Officers ___ Pharm/Pharm Techs ___ Public Health Officers ___ Nutritionists ___ Health Record Information Officers ___ Others (Please specify)

d. TB/HIV counseling & testing (C&T)


KEY TRAINING AREAS

# OF LECTURERS/ TRAINERS






AVAILABLE e. MDR TB

management ___ Medical Officers ___ Nurses ___ Med Lab Techs ___ Clinical Officers ___ Pharm/Pharm Techs ___ Public Health Officers ___ Nutritionists ___ Health Record Information Officers ___ Others (Please specify)

f. TB diagnosis (Microscopy)


KEY TRAINING AREAS







___ Medical Officers ___ Nurses ___ Med Lab Techs ___ Clinical Officers ___ Pharm/Pharm Techs ___ Public Health Officers ___ Nutritionists


___ Health Record Information Officers ___ Others (Please specify)

h. Focused Antenatal care(FANC)


i. AMTSL-Active Management of 3rd stage of Labor


KEY TRAINING AREAS







___ Medical Officers ___ Nurses ___ Med Lab Techs ___ Clinical Officers ___ Pharm/Pharm Techs ___ Public Health Officers


___ Nutritionists ___ Health Record Information Officers ___ Others (Please specify)

k. Newborn care ___ Medical Officers ___ Nurses ___ Med Lab Techs ___ Clinical Officers ___ Pharm/Pharm Techs ___ Public Health Officers ___ Nutritionists ___ Health Record Information Officers ___ Others (Please specify)

L. CERVICE CANCER SCREENING

___ Medical Officers ___ Nurses ___ Med Lab Techs ___ Clinical Officers ___ Pharm/Pharm Techs ___ Public Health Officers ___ Nutritionists ___ Health Record Information Officers ___ Others (Please specify

KEY TRAINING AREAS


# OF CLINICAL PRECEPTORS AVAILABLE FOR WHICH CADRES DO YOU HAVE

TRAINING (CHECK ALL THAT APPY)



m. Integrated management of childhood illness (IMCI)

___ Medical Officers ___ Nurses ___ Med Lab Techs ___ Clinical Officers ___ Pharm/Pharm Techs


___ Public Health Officers ___ Nutritionists ___ Health Record Information Officers ___ Others (Please specify)





P. DRUG AND SUBSTANCE ABUSE

Medical Officers ___ Nurses ___ Med Lab Techs ___ Clinical Officers ___ Pharm/Pharm Techs ___ Public Health Officers ___ Nutritionists ___ Health Record Information Officers ___ Others (Please specify)


KEY TRAINING AREAS






q. Drug and substance abuse


r. Trauma counseling


s. Infant and young child feeding (IYCF)


KEY TRAINING

# OF LECTURERS

# OF CLINICAL



CAN YOU SUPPLY A CURRICULUM?


AREAS / TRAINERS AVAILABLE

PRECEPTORS AVAILABLE

(YES/NO)

t. Nutrition and HIV


u. Nutrition and TB


KEY TRAINING AREAS


# OF CLINICAL PRECEPTORS AVAILABLE FOR WHICH CADRES DO YOU HAVE

TRAINING (CHECK ALL THAT APPY) AVERAGE LENGTH OF TRAINING (DAYS)


v. Supportive supervision

___ Medical Officers ___ Nurses ___ Med Lab Techs ___ Clinical Officers ___ Pharm/Pharm Techs ___ Public Health Officers ___ Nutritionists


___ Health Record Information Officers ___ Others (Please specify)

w. M & E-use of MOH tools




y. Others (Please specify)


2. What are the other human resources do you have available to support training?

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________


3. How many health workers by categorization have you trained in last 12 months in each clinical area?

TRAINING TOPIC MEDICAL OFFICERS

NURSES MED LAB TECHS

CLINICAL OFFICERS

PHARMACISTS PHOS NUTRITIONISTS HRIOS OTHERS

a. PMTCT


c. Adult ART

d. TB/HIV counseling & testing (C&T)

e. MDR TB management

f. TB diagnosis (Microscopy)


h. Focused Antenatal care(FANC)

i. AMTSL-Active Management of 3rd stage of Labor





CLINICAL OFFICERS


k. Newborn care

l. Cervical cancer screening

m. Integrated management of childhood illness (IMCI)






s. Nutrition and HIV

t. Nutrition and TB



CLINICAL OFFICERS


u. Commodity


Management

v. Supportive supervision

w. M & E-use of MOH tools


y. Others (Please specify)

4. [A12] Where is the training you support usually provided?

MOH facility nearby (please name: _____________________________

In-house training room/facility

Hotel

Other training facility (please name: _____________________________

5. [A19] In which provinces in Kenya do you have training centers/facilities around the country?

PROVINCE # OF FACILITIES CITIES WHERE FACILITIES ARE LOCATED (PLEASE LIST) TOTAL CAPACITY OF FACILITIES (# OF PEOPLE THAT CAN BE TRAINED AT ONE TIME)

Central Coast Eastern North Eastern Nyanza Rift Valley


Western Nairobi 6. [A13] Do you have access to the following for training at your facilities?

COMPONENT YES/NO WHAT IS THE QUALITY/CONDITION OF THE EQUIPMENT/SERVICE? (4= EXCELLENT. 3= GOOD, 2=FAIR, 1=POOR)

Wired Internet Wireless Internet Skills Labs Others (please specify)

7. [A14] Please comment on the availability of the resources listed above:

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________




CAN THESE RESOURCES BE MOVED TO ANOTHER AREA FOR USE?

gg. Chalk and board

hh. Computer (Desktop)

ii. Computer (Laptop)



CAN THESE RESOURCES BE MOVED TO ANOTHER AREA FOR USE?

jj. Demonstration equipment


kk. DVD player

ll. DVDs

mm. Flip chart

nn. Instruction manuals/curricula

oo. National Health Policies

pp. Over head projector

qq. Pamphlets

rr. Reference books/materials

ss. Relevant demonstration charts

tt. VCR

uu. Wall Charts

vv. Other (please specify)

[A16] Please comment on the availability of the equipment listed above: _____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

9. [A27] What methods of evaluation do you utilize to determine the effectiveness of training?

___________________________________________________________________________________________________________________



_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

10. [A25] What post training support do you provide to in-service trainees (please check as appropriate)?

a. Follow up by trainers (mentoring, coaching, etc.)

Yes No N/A

e. Sending of updates/manuals

Yes No N/A

f. website where learners can get more information

Yes No N/A

g. Other (please specify)

_________________________________________________________________________________________________________

11. [A26] In your opinion, how effective is the level of post-training support you provide to in-service health workers?


12. [A17] Is there any additional information you would like us to know ?:

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________


Appendix G: MOH Approvals


aining Needs Assessmen

Rapid Tra

nt of the Heaalth Workforrce in Kenya 92

Rapid Tra

aining Needs Assessmennt of the Heaalth Workforrce in Kenya 93

Documents

Kenya Health Workforce Training Needs Assessment Report