Training and Capacity Building

Introduction

The digital adherence technologies all have different patient interfaces for example MERMS can be utilized either via the 99DOTS uses blister packs, or evriMED boxes, while Video Supported Treatment uses a customized application, however the healthcare worker (Everwell hub or other customized application dashboards) is to a large extent the same irrespective of the DAT used by the patient.

Effective training on new technologies implemented is critical to ensure healthcare workers (and patients) are able to fully utilize the DAT for optimal efficiency and productivity. This training should be have an impact and must be meaningful and useful to their jobs.

We recommend that training best practices be followed to ensure a successful training.

Goals

After reading the section, you will understand:

  • The standardized DAT training modules

  • How to adapt the training modules

  • How to cascade the training to end-users

Engage health care workers

Engaging health care workers from the start of the DAT intervention development and design will strengthen uptake of the intervention and is the first step of capacity building.

 

 

Embrace a long learning curve

Getting users to change the way they work and habits is the biggest challenge when it comes to training. Research shows that it takes about three weeks to build and have users embrace a routine for something simple (like a new email program); it could take three months to a year for users to fully utilize and maximize a more complex piece of technology.

 

Include peer learning (or “champions”)

Historically, training was only class room based. However research shows that

  • 70% of learning is on the job, while in the process of performing and meeting the everyday work challenges;

  • 20% of learning is on the job as you work collaboratively with others'

  • and the remaining 10% of learning occurs through formal means


Launch training

A standardized training package has been developed to facilitate knowledge transfer and capacity building of TB programme staff. This package can be adjusted and adopted to fit your country setting. To maximize cost, training can be combined with existing district meetings and can be supported by regional project staff.

The standardized training and capacity building package consists of:
1. Training/job aides: printed materials (booklets, worksheets, quick-reference guides)
2. Mixed learning approaches (classroom and interactive)
3. Health facility introductory box: mobile device (e.g. mobile phone/tablet), printed materials (posters, job aids, user manuals, etc.)

Build the capacity “user champions” as master trainers

Using the training and capacity building package, project staff conducted a national two day “training of trainers” workshop for national, regional and district NTP staff where the project will be implemented.

Day 1: Focus on how to use and support the adherence technologies and platform,

Day 2: Aimed towards adherence data utilization strategies to enable differentiated care and workshop facilitation.

Cascade training

Trained staff are well positioned to cascade training to other staff from selected health facilities at the district level.

Some areas included in the training include: supply chain mechanisms, patient registration, mobile app use, and roles and responsibilities for differentiated care strategies were discussed.

A part of this training also includes motivational counselling strategies to support nurses and other healthcare workers to address the underlying challenges of treatment adherence effectively.

Certificates of completion were issued to trained healthcare providers and the introduction box containing DAT relevant materials was provided to each health facility manager for installation at their respective facilities.

Follow-up facility visit

The regional technical coordinator of the project visited all health facilities to provide (additional) support and ensure quality of health facility installation.

Enroll patients on the DAT platform
Patient enrollment was carried leveraging existing processes around treatment activities to ensure sustainable treatment adherence and improvement of treatment success rates.


Monitoring and intervention optimization (to be updated)

Monitoring

  • on-the-job training during first enrollment

  • Supervisory structure and visits

  • high level indicators (process)

  • checklists for facility visits

  • describe process to get feedback from staff and determine ‘pain points’ for users and procedures to minimize them.

  • reports: standardization needed. different per platform. work ongoing by TB REACH and others to provide guidance on reports useful for daily and periodically reporting

  • Technology support structure in-country and from vendor

    • how to deal with system downtime. what does that mean for certain services. e.g. platform unreachable: registration. sms messages not send: follow-up patients.

    • ticketing system overview, roles and responsibilities

Intervention optimization, data utilization

o lessons learned from Uganda in adopting technology design during project implementation

o include on-the-job training during initial enrollment

o dosing implementation data to visualization -- issues, best practices, and tools

o data export issues and platform-related solutions available or in development

o escalation protocols/differentiated care -- issues, best practices, tools in development or planned

o intervention optimization workshop

o detailed indicators

o examples of what can be optimized

o feedback design and approach: qualitative interviews with patients and providers after 4-6 weeks of use (South Africa)

o initial user design workshop with patients and providers (Ukraine) and during project round table discussions

o When to follow-up? what is effective in what setting?

  • Support structure, helpdesk/ticketing in-country and global platform

  • Data utilization and visualization?o lessons learned from Uganda in adopting technology design during project implementation

Generic VOT training materials

SureAdhere has provided several of their training documents and slides as an example, including templates for dosing instructions and instruction sheets on the use of SureAdhere’s mobile application for Android and iOS.

All materials can be downloaded from the resource section below.

 

Project monitoring in the Philippines

In the Philippines, joint monitoring is conducted by the project team with the Department of Health (DoH) and NTP team of the local government units to ensure continuous project and program oversight and direction. Consistency and timely submission of reported paper-based data to the national taxonomic information system of the Department of Health (DOH-ITIS) is monitored. Drug supply chain management and other program commodities are also monitored during the visits.