Okay, our final section will be looking at

the different components and processes of continuing education.

As I mentioned before Amref said that continuing education is

a process of combating continuing ignorance.

Health workers who do not have an opportunity to gain new skills,

to hear about new ideas,

will not only continue to practice outdated procedures,

but they may even forget what they did know in the beginning.

So continuing education should help

people remember what they learned in their basic training,

it addresses job realities,

problems that come up that were never taught in school,

changes in the job due to new circumstances and technologies.

Obviously continuing education is a lifelong process,

and I think most of you who are listening to this

now are involved in continuing education,

so you know what we're talking about.

As in epidemiology, if you take that,

you want to know who is at risk of a problem.

So who is at risk of continuing ignorance?

Health workers in isolated settings,

who have very few supervisory visits,

inadequate reading materials or none at all,

maybe they can't afford subscriptions,

the mail service is poor,

they don't have links to the Internet,

health workers who have little opportunity to attend meetings and

seminars and health workers who interact with few professional colleagues.

Isolation is not necessarily a rural or urban issue.

You can be isolated in a busy urban setting working for a private clinic.

You may be one of few staff,

you don't have time or funds to attend meetings and seminars,

you may be too busy to meet with other professional colleagues,

keeping your clinic open at all hours not attending professional meetings,

there's really nobody to come and supervise you.

So it doesn't mean that you are isolated

only if you're in a rural clinic 20 miles from the district headquarters.

Continuing education strategies are

various and can be adapted to almost any work setting.

Staff meetings can be made educational within the workplace.

Different members of staff can be asked to prepare a topic and present at meetings,

staff who have attended a workshop can come back and report what they've learned.

Continuing education includes attending professional meetings, conferences and seminars.

Supervision itself can involve coaching and teaching,

in addition to what most people complain

about is that the supervisor is only there to criticize them,

or the supervisor can also in the process work alongside the employee,

do things together, pass on knowledge and skills.

Another important continuing education strategy that's very

informal and can be done anywhere whether you're on the train commuting,

whether your'e in a break time and get a chance to look at

the computer or pick up a magazine is self study with books,

journals and as you're doing now through distance education.

Radio and mass media programs can be educational,

rural extension programs in the past have in fact focused on educational programs,

you get staff or farmers or teachers together to listen to the program and discuss it.

But also there are educational programs that occur as part of regular programming

on the radio and TV and if you watch those you can educate yourself.

Exchange visits are another continuing education strategy.

There may be clinics that have for example developed

a good program for TB control and management,

a good program for voluntary testing and counseling for HIV and exchange visits

visiting those clinics and seeing how they do it is

an important and useful continuing education tool.

And of course formal in-service training courses that may be resulting

in somebody obtaining a certificate or another type of continuing education.

We found in rural districts in Nigeria that not

all health workers are equal when it comes to opportunities to have continuing education.

We looked at both public health workers and also workers in private facilities.

And many people use both public and private facilities,

that's why it's important to be aware of the services they offer.

We interviewed 165 health workers

almost evenly divided between the local government health department,

staff of the federal hospital in

the area and also staff of various private hospitals and clinic.

These were either run by licensed nurses or set up by a doctor and run by nurses.

We asked specifically about four kinds of continuing education experiences;

in-service training where people would actually go attend a workshop or a meeting,

supervision and educational supervisory visit,

staff meetings that had educational content and whether

the employee engaged in any form of self study, most particularly reading.

The chart shows that

the most common form of continuing education among the respondents was staff meetings.

Now, as you can see,

the total 144 respondents that there were

approximately 21 respondents who didn't have any form of continuing education,

which is quite frustrating.

The self study option was reported by many.

Supervision was not what one would hope.

One would hope that at least there'd be

a good supervisory visit at least every six months,

but that was not the case.

And approximately a third

had an in-service training opportunity within the previous five years.

We found that these continuing education experiences

varied by the sector in which the health worker was based.

In-service training was much more common

among people in either the local or state government sector.

Few private health workers had recent opportunity to attend a workshop.

Supervision was more likely to occur for local government staff.

The private clinics again these are small independent operations and

so everyone there on site there

really aren't supervisors coming from anywhere to see them,

and transportation difficulties meant that

the state hospital workers did not receive

many supervisory visits from the state capital from the state ministry of health.

Staff meetings were equally common among local government and

private facility and almost everybody reported some form of self study.

There weren't too many differences in continuing education and gender,

but we can see from the chart that in the area of

self study more male health workers reported that they engaged in this.

This may not be surprising because in a traditional African setting,

even if a woman works in an office or on the farm or trades in a shop,

she still has to go home and fetch water,

cook food, take care of the children,

there are not modern amenities to help with these things and

the free time available to practice self study is much less.

So, if there are not formal CE experiences in the job setting such as supervision,

staff meetings and workshops,

then female health workers are at a disadvantage for continuing education.

One thing that is not on the charts,

but we also found that health workers who had informal training,

who had not attended a school of nursing or midwifery or medical school,

but had learned on the job,

what they would call auxiliary nurses were at the bottom of

the totem pole in terms of their opportunities for any kind of in-service training.

And this again they were providing

services in the private clinics often running the private clinic,

when the owner a nurse or a doctor was not present and

yet they were the least likely to have continuing education access.

Some of the lessons we learned from this study;

again the government health staff have greater access to in-service training,

and the reason for this is that most donor programs,

whether it's U.S. government,

USAID programs for promoting child survival or UNICEF programs or other donors like

DFID these donor programs had traditionally

focused on governments and government workers.

Therefore the private sector was missing out.

Fortunately these days donors are taking

an interest in recognizing the important roles of the private sector,

but still continuing education opportunities are

disproportionately favoring people in the public sector.

Another thing we found out the policymakers tend to

forget that the private sector provides a large share of services.

One of the examples that we'll talk about later

is that of patent medicine vendors, private medicine shops.

In fact, they try to ignore or pretend they don't

exist because health policy makers think that they're dangerous,

but the law allows them to sell.

One of the major difficulties

in acquiring health information to get a good picture of what

happens in a country is that

private sector facilities are not involved in collecting health information.

So policymakers forget that they exist and focus only on

that share of the health sector that they can control,

and that's a mistake and it denies

continuing education training opportunities for people outside the public sector.

So clearly private sector staff need updating on new procedures,

on new equipment because they provide a large amount of service to the community.

These lessons that we've just discussed about local health worker,

continuing education experiences in Nigeria,

can help us summarize some of the important things that we've covered in this lecture.

So we can see they had few opportunities for training.

Fortunately most had some chance for continuing education,

so that there were other opportunities for learning on the job.

But that these were influenced in large part by personnel management issues,

the kind of facility that they worked in,

how their needs were looked after,

what kind of staff were hired,

what their job qualifications are,

were key issues whether there were

policies that enabled them to attend training and continuing education,

looking at broader management issues where organizations

got financial and material resources through donors.

So, we can see that the context in which training

occurs is influenced by the overall management of the organization, its funding,

its policies, by specific decisions about

personnel issues and hiring and opportunities and benefits,

and then within that context continuing education and training occur.

Continuing Education

Understanding and Strengthening Health Systems

Meet the Instructors