The process of diagnosing training needs is in some ways like research, we're gathering information. We want to look at available documents. We want to talk to people, interview them. We want to observe and see what's happening. In this section we'll look at the issue of documents and interviews. Overall, examples of these various methods or way of collecting data are shown in this chart. That includes both the method and sources of information. Sources such as the trainees themselves The managers of the agency, their supervisors and the clients in the community. Trainees oftentimes write reports, monthly or quarterly or annual reports on their activities. So, these are examples of documents that we might be able to obtain from the trainees directly, from the health worker directly. We can observe their performance in the field and the clinic and, of course, we can interview them formally. And with questionnaires and pretests, informally in focus group discussions where they can share their views about Their job and about the tasks that they're performing. Information that we can get from agency managers and supervisors. We can obviously obtain documents such as job descriptions, minutes of staff meetings where problems may have been discussed, annual reports. We can observe the facilities themselves. Are the resources that health workers need to carry out their tasks actually available? If we want them to check a child's temperature, are there thermometers? What medicines are available if we want the health worker to prescribe certain things for fevers? What is available in the pharmacy? So, we can observe these kinds of things. And in addition we can interview and talk with supervisors and managers, in depth interviews. Finding out what their concerns are, what their desires are to improve their employee's performance. The clients or the community members are the recipients of the services that the agency and the health workesr have to offer. We want to find out their views also. If there are things like newspapers, there may be articles that document complaints or problems or programs. Or, or concerns that the community has about the health program. There maybe committees in the community, such as a health and development committee. Committee that has minutes of meetings and issues that they have discussed can be made available to review. Observation is important. We can do mapping, walking around, finding out where community resources are located. Where people live in relation to the health and social services that are being offered. We can observe people's health behavior. Where are they collecting their water? Are the practicing hygienic child feeding practices? Ultimately observation of these behaviors will let us whether the health works and the health program have been successful in promoting health in the community. And, of course, we can interview people in the community through surveys and focus groups to find out their own opinions. And their own knowledge about health issues. Again, using this to judge how effective the health agency and the health workers have been. And whether the health workers need additional skills to be able to reach out to the community and improve community health. Examples of some of the documents you might want to find and review in terms of making your training diagnosis include, as we've mentioned before. Job descriptions, performance standards, progress reports that individuals, units, departments produce on a monthly, quarterly or annual basis. Minutes of staff meetings, assuming that staff meetings hold and people do actually take minutes. Professional literature. MedLine searches will help us identify new and evolving procedures to improve people's health that we may want to pass on in the form of training to our health workers. We'd want to certainly review organizational policies. Are there treatment policies? Are there policies in terms of providing certain basic services. Overall, there are files and records of various kinds of events that may occur in the organization. There may be complaints. Grievances, accidents, absenteeism, sickness, turnover, these are evidence that the organization or and or the individual staff may be having problems. These problems may be related to or affect workers' performance. As we talked about in the very early lectures, some of these are issues that are beyond the scope of training and continuing education. They may be more in the area of organizational management. But we still need to be aware of them because these factors can impinge on health workers' attitudes toward their work and quality of their performance. Various definitions of job descriptions include an outline of continuing work assignments. And the scope of responsibility that are sufficiently different enough to warrant a unique job title. Job description can be an up to date explanation of current work requirements. It can be a detailed specification of special knowledge and resources needed to perform the work. This last item is often seen in advertisements for vacancies and new jobs. Want people who have familiarity with malaria control. We want persons who have so many years experience. People who have certain skills. These things are often specified in advertisements. They may not be specified in the job descriptions. We need to look at all of these kinds of things. What are the responsibilities and duties? What is expected to get the job done? And what is needed by the worker to get that accomplished? So, we mentioned the organization often produces plans, progress reports, various kinds of documents that talk about what it intends to do or what it has done. And these, of course, especially in the progress reports hopefully compare what the organization has achieved compared to the objectives it has. And if for example the objectives are not being achieved. That there is a lower immunization coverage than we expected. There are fewer patients coming to the clinic during immunization days we need to find out why. And is it a question of the community members, cultural issues, financial issues on their part? is it a question of organizational resources not being available? The immunizations, the vaccines are not available on time in the right quantity. Or is it a question that the health workers are not performing their job in terms of mobilizing and educating the community as well as they did before to get them to turn out for immunization? So, these plans can give us clues about kind of problems that may require training. As we mentioned, looking over the plans, looking over the reports, do we see any trends? Do we see successes, do we see problems? Is immunization coverage increasing, is it going down? If we're organizing a community program to distribute ivermectin to control onchocerciasis. Are more people coming forward each year or are we having drop offs? Are we reaching our goal of a minimum of 65% coverage in the community? Are there certain segments of the community, maybe women, maybe ethnic minorities that are not being covered. Do we have this information? What are the implications for training? Maybe we find that we have difficulty reaching women and ethnic minorities for our onchocerciasis safe program. We say, why is that? We follow some of the health workers for community meetings and we discover the health worker tends to pull together the male heads of household. And leaves the women behind. Or possibly the women are there but the communication is such that only the older males talk and the women don't. The health worker in that case may not have the skills to know how in a culturally effective way, an appropriate way to bring women into the. The decision-making process so that they are more likely to utilize the service. So again, the plans and reports give us clues but we still need to follow up to find out what's happening. Minutes of meetings can be valuable assuming these meetings are actually held. First question is, who attends? Meetings can be educational. We talked about that under continuing education. Meetings can also be used for problem solving. not just administrative issues. So, if they are educational, if there are presentations being made or if. Serious issues, such as lack of progress on certain things that are being discussed and the group is trying to solve problems. And certain key members of staff are missing or not taking part in that. This is an opportunity being missed for their own continuing education. So, we need to look at this and see if there is evidence of attendance. And then assuming people are there, is there evidence that the meetings are being used for educational purposes not just administrative. Some of the issues that are identified as problems during staff meeting may require more formal inservice training. Technical and service issues. Problems of managing the cold chain, policy and procedural issues, questions about who is eligible for free or reduced price services. Is this being implemented? Are there problems with that? Do health workers understand how to screen in a sensitive way without embarrassing people about their financial situation? Are their human relation or communication issues that need to be addressed in terms of people who don't come for follow up appointments? For example. The Professional Literature is an important source of information about potential training needs. An important documentation source. It's necessary for us to keep up to date with current literature in whatever field we're in. Whether we're working on high blood pressure control, whether we're working in malaria control. We need to be aware of what are the latest procedures, the latest findings, the most appropriate drugs. The most appropriate ways of educating people, communication techniques. And so the literature helps us. One of the problems of course with getting Professional Literature and using that to guide us. Is that in many cases in developing countries people have little access to Professional Literature. Their libraries are often not up to date. Many of the health organizations and services do not have recommended reading room for their staff to keep up to date. Even people involved in organizing training may not have the latest information. And we need to recognize that there are ways of people getting information. We just have to be creative. There are a number of free publications that are put out and by organizations such as Appropriate Resources for Health in Britain. There are groups such as the Amref in Nairobi that have publications and libraries. So, we need to be aware of what's free and what we can get a hold of. One of the things we discovered is that although the internet is spreading access to it is spreading throughout the world, there is a major gap between developed and developing countries. Where people in developing countries have difficulty, one there are few phone lines. Two the quality of internet service providers is poor. So, people looking for new and up to date information may have challenges. Fortunately groups like the center for communication programs at Hopkins put together CDs that can be sent out and used. But health workers need to be aware of this literature, both for this free literature, these information available on the internet. And also how to access things like these free CD-ROMs. It's not just the health workers using that for their own continuing education. But planners for training programs in developing countries need to constantly be on the look out for new sources of literature and information. Another document source of information to help diagnose training needs are policies and changes in policies. One of the issues that is occurring throughout much of the world in terms of malaria treatment is the fact that the parasite is developing resistance to many of the drugs. That have been commonly used and unfortunately many of the less expensive drugs. So, countries are changing their case management policy for malaria. Changing from a chloroquine-based drug to a sulfadoxine-pyrimethamine now that there is a becoming resistance to that. Looking at a drug that's derived from Chinese herbal medicine, artemisinin based-drugs. All of these changes in policy require training also because with new drug regiments people need to know appropriate doses. For appropriate age groups and children. So, anytime policies change in terms of case management for any illness there are implications for training. The second major way of gathering information is literally talking to people or obtaining information directly from people, either verbally or in writing. We are seeking feedback from the various stakeholders in the training process. Stakeholders in the process of an organization's carrying out its task to achieve this goal. What do the different stakeholders think about the performance of workers in the organization and how that could be improved. So, the stakeholders in the training process include the actual workers, the potential trainees, their supervisors and management. Their clients, the people they serve in the community and members of professional bodies and associations. These are the important people that need to be talked with to find out what their perceptions are in terms of worker's performance. These groups need to be involved not only in providing information. But as we mentioned before in terms of the importance of involvement of the organization and the trainees in the training process. They need to help collect the information, help analyze the information to give it meaning for their own organization. We need to look at interviews in the context of our different data collection methods. Documents report on the past or plans for the future. Observations show what the person is doing in the environment in which they work. But interviews can help explain these other methods of data collection. We can observe that a health worker forgets to take a child's temperature. We can observe that a health worker forgets to check the child's growth chart to see if the child is increasing or in weight as appropriate or the child has current immunizations. So, we can observe this but we need to interview people to find out why these observations occur. Why these lapses in behavior are occurring. Documents may indicate that the organization is not meeting it's targets that there are absences, there are accidents. We need to interview the people involved to get their input on why these things occur. Do they know what these tasks are and what the importance of them are? Did they, what are their attitudes toward the work? What are their opinions? What are their values, perceptions in terms of their understanding of the job? So, we need to use the three different methods in combination to get a complete picture of the training needs of the health workers. Interviewing may include several different methods. We can have in-depth, open-ended type of interviews, more informal with employees, employers and clients. In such a context, people may feel more free to share their views, feel less pressured about giving the right or wrong answer. We can use structured questionnaires if we're interviewing a large number of people and we need to get information in a short period of time. Also, questionnaires can form the basis of tests, pretests where we are obtaining information on specific job knowledge And skills these can be used subsequently for evaluation after the training to see if peoples knowledge has improved. In addition to talking to people on individual basis, we can bring together in group discussions. Among the employees and the clients, these focused groups discussions have both pros and cons. On the positive side they can be more efficient in terms of getting views from a number of people in a relatively shorter time. Discussion among people can stimulate each other to think of ideas and have a real debate going. On the other hand, sometimes discussions may not give us a full picture of the steps involved in employee decision making for why he or she did or did not perform a certain task. Sometimes in the groups, if there may be dominant people in the organization that share their views more than others. And people feel that they must go along with the opinion of certain leaders in the group. So, we have to balance this out. Ideally, we should have group discussion among people who are relative equals. So, that you wouldn't include a supervisor together with the workers that he or she supervises so that people can freely talk. Another interview type of technique would be group problem analysis. This can be done in the context of a staff meeting. This can be done in the context of organizing a specific group to look at the problem. We can say, okay, we've found that our attendance in antenatal care has dropped off. What is the reason? We found that we're getting less referrals from our village health workers. What's the reason? And have the employees discuss what they think are the reasons for these problems and how they can be addressed. Other ways of getting input, although they don't sound like formal interviews, include such things as putting up a suggestion box. So, that people, you know, can feel free anonymously to submit their concerns where they think the organization needs improvement. And these can be and reviewed to see their implications for training. Brainstorming sessions during staff meetings. Informal conversations over lunch at breaks at the water cooler. Another thing that can be done, in terms whether there is an organized group discussion for problem solving or a staff meeting, is organizing role play of challenging situations. Health workers may say that people are more often going across the street to the medicine shop and not coming to the clinic first. Why is that? Somebody can play the role of the records clerk that registers people when they come in. Somebody can play the client, and see what really happens. And how clients feel when they're approaching the records office and are asked all kinds of personal questions. So, by role playing these challenging or problem situation, the health workers can get insights and discuss these and share them. Interviews should definitely take place in the community. Again, we need feedback from the people who are the ultimate recipients of the services. They are the ultimate judges of whether the performance of the health worker has been adequate to meet their needs. Focus groups in the community can be done. Again we need to be careful that we put together people of similar background. We wouldn't put old men and younger women in the same group because the younger ones may feel inhibited to talk. Again, the needs of those groups may very, the younger women may be concerned about their children and the kinds of. The care they're getting at the child welfare clinic. The older men may be complaining more about the fact that the health workers don't give them proper drugs to take care of their back ache. So, we need to ensure that these groups are somewhat homogeneous. That would allow people to express their problems and not be inhibited by people of a different age or social class. We can ask people in the community to comment on the performance of the health workers. The attitudes they see the health workers display whether the health workers carry out their duties in a timely manner. Is the clinic open when people need it? Finding out information about how communication of information goes on. Are the health workers sharing vital health information with community members or, or not. We will go into the next section that will look at the issue of observation of training needs. Our third in the three different methods for gathering information for our training diagnosis.
