s19629en audit report

8/13/2019 s19629en Audit Report

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Designing and implementing training programs

Summary 52.252.1 Objectives o training 52.3

52.2 Developing a comprehensive trainingprogram 52.3Conducting needs and knowledge assessments Selectingsubject areas and setting learning objectives Learningmethods

52.3 Implementing a training program 52.9Strategies Assistance for the design and implementationof training courses Training and presentation skills

Monitoring and evaluation

Reerences and urther readings 52.16

Assessment guide 52.17

Figure 52-1 Capacity-building ramework 52.3Figure 52-2 Te training process or improved

perormance 52.4Figure 52-3 Seating arrangements or various training

applications 52.14

able 52-1 Subject areas, training topics, and targetgroups 52.5

able 52-2 Comparison o training methods 52.8able 52-3 Issues to consider when designing training

programs 52.11

Box 52-1 Brainstorming: a versatile technique or training,

planning, and problem solving 52.6Box 52-2 Outline o trainers and participants guides orworkshops 52.7

CS 52-1 Follow-up activities to support a drug andtherapeutics committee course or proessionalsin developing countries 52.10

CS 52-2 Using the MP methodology in LaoP.D.R. 52.12

CS 52-3 Creating a pharmaceutical management trainingnetwork in East Arica 52.13

CS 52-4 Measuring the effect o training on pharmaceuticalsupply management at primary health care clinics inSouth Arica 52.15

Annex 52-1 Sources o assistance or training programs toimprove pharmaceutical management 52.18

Annex 52-2 Workshop logistics 52.20

Part I: Policy and economic issues Part II: Pharmaceutical management Part III: Management support systems

Planning and administration

Organization and management

Information management

Human resources management

51 Human resources management and capacity development

52 Designing and implementing training programs
http://www.msh.org/http://www.msh.org/http://www.msh.org/http://www.msh.org/


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52.2 HUMAN RESOURCE S MANAGEMEN

raining is any planned activity to transer or modiyknowledge, skills, and attitudes through learning experi-ences. Personnel may require training or a variety o rea-sons, including the need to maintain levels o competenceand respond to the demands o changing circumstancesand new approaches and technologies. raining by itselcannot solve structural, organizational, or policy prob-lems within an organization, although supportive super-

vision and the use o motivational strategies can helpsustain perormance improvement derived rom training.

Te first step in the design o training involves an assess-ment o training needs. Te assessment comprises

Observing workers perorming normal duties Interviewing workers and others Studying routine reports or perormance reviews,

along with job descriptions Identiying perormance problems

Te second step involves defining the training programslearning objectives. Te learning objectives, which arederived rom the needs assessment, speciy the observable,measurable actions that each learner will be able to demon-strate as a result o participating in the training activities.

Te third step is the creation and implementation o atraining program to improve perormance, taking intoaccount the experience and educational levels o the per-sonnel and the time and resources available or training.Options range rom short courses to long-term place-

ments in academic institutions in the country, in theregion, or overseas, and nonclassroom-based interven-tions, such as on-the-job training, coaching, and mentor-ing. All options must be weighed against the immediateoperational needs o the program or institution, becauseacilities may not have enough personnel to operatewhen staff members go or training.

Te learning outcomes that must be achieved, along withthe training environment, audience characteristics, andthe experience o the trainer, all determine the mix olearning methods and media that will achieve maximumeffectiveness. Methods and media may include lecture,

discussion, case study, role-playing, group exercise,simulation games, brainstorming, and demonstration. Ino published training materialsincluding audiovisualaidsare available, the trainer must develop them.

Development o the training program also includesdesign o the training evaluation, which is carried outduring the course as well as at its conclusion. During thecourse, trainers monitor learner progress and satisaction

to identiy where they may need to make adjustments tothe training program. At the end o the course, trainersshould collect data on how well the learners achievedthe course objectives and how satisfied they were withthe training experience. Whenever possible, the trainershould ollow up with participants afer they return totheir work situations to assess the impact o training onperormance. Data collected during ollow-up can helpidentiy the need or additional training or reinorcemento newly acquired skills, as well as inorm review andrevision o the training materials.

In some countries, availability o basic training and con-tinuous proessional development programs is limited;thereore, many health workers lack access to ormaltraining opportunities and new ideas and approachesthat can improve their work perormance. Well-designed

in-service training programs can help fill this need.

raining should be put into a context o continuousperormance improvement. Changing and improvingpractices require an environment conducive to work,the appropriate learning resources, and the continuoususe o motivational strategies. raining should be basedon competencies: the abilities required to do work to thestandards expected. Tereore, training should resultin changes in work behavior that lead to an improved,efficiently unctioning pharmaceutical managementsystem. At the same time, training alone is unlikely tochange overall supply system perormance unless the

environment and supervisory systems support change(see Chapter 37) and unless individuals are encouragedto maintain changes (see Chapter 51).

Learning requires active involvement. People preer tolearn in different waysthrough visual stimuli, verbalinteractions, and learning by doing. Tereore, offering a

variety o training opportunities and training techniquesis usually more effective than using only one approach.raining can be ormal or inormal, academic or applied,guided or sel-directed, or provided in public agencies orprivate institutions.

raining alone is ofen not sufficient to change behav-

ior or improve perormance. Improved perormance,changed attitudes, and new skills acquired during train-ing may need to be complemented by and maintainedthrough continuing education, supportive supervision,and adequate motivational incentives. In many cases,structural changes, such as workspace improvementsand increased access to supplies and equipment may beneeded to support improved perormance.

S U M M A R Y


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52 / Designing and implementing training programs 52.3

52.1 Objectives of training

Te training o personnel in pharmaceutical managementhas our major objectives

1. Increase knowledge about the special considerationsrelated to pharmaceutical systems

2. Improve attitudes about the importance o pharmaceu-tical management, thus improving the environment

or change3. Build and strengthen skills in the specific tasks to be

completed or efficient unctioning o the pharmaceu-tical system

4. Improve work behavior, so that people unction betterat assigned activities and ulfill their potential

Te goal o these objectives is to increase access to qualitypharmaceutical products and services.

raining should address the needs o three levels o per-sonnel, because it takes all three groups to effect sustainablechange

1. Policy makers, who are responsible or creating theenvironment needed or improved pharmaceuticalmanagement

2. Midlevel managers, who are responsible or planningand supervising activities required in the managementand use o medicines

3. Line or operations-level personnel, who are respon-sible or carrying out the work o pharmaceutical man-agement

A countrys national pharmaceutical program alone isnot in a position to handle comprehensive training orpolicy makers and midlevel managers; many o their learn-ing objectives are best handled through general manage-ment training. However, it is still possible and necessary toreorient this group on pharmaceutical policies and issuesthrough inormation exchange, reports, and seminars.raining or operations-level personnel is critical becausethey ofen lack the basic knowledge and skills necessary to

be effective at their jobs.Finally, training alone will not result in significantly

improved perormance unless it is linked to an enablinginstitutional environment. Tis is illustrated by Figure 52-1,which is a conceptual ramework or building in-countrycapacity or pharmaceutical management services. It illus-trates the concept that health structures, systems, androles, staff and inrastructure, skills, and tools must all beaddressed to strengthen a countrys ability to effectively pro-

vide pharmaceutical services.

52.2 Developing a comprehensive trainingprogram

A training program is composed o a schedule o activi-ties with training goals, learning objectives, subject areas,methods, trainers, trainees, methods o assessment, andlocations. A good training program is designed to addressperormance problems, such as long delays in getting medi-cines rom suppliers to the main stores, delays in distribut-ing medicines rom midlevel stores to end-user units, or

Performancecapacity

Personal capacity

Workloadcapacity

Supervisorycapacity

Facilitycapacity

Support servicecapacity

Structuralcapacity

Systemscapacity

Rolecapacity

Tools

Individual

Institutional

Skills

Staff andinfrastructure

Structures,systems, and roles

Source: Adapted from Potter and Brough 2004.

Figure 52-1 Capacity-building framework


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ailure to ensure quality o medicines. Figure 52-2 showshow a training program is developed, proceeding romproblem identification, through needs assessment, training,and evaluation, to a change in behavior that results in betterperormance.

Te key elements o a training program include needsassessment, course work, learning tasks, and practical appli-

cation. Facilitators introduce new inormation to traineesthrough course work or lectures. Learning tasks or activities,such as case studies or role-plays, provide individuals withopportunities to work with the new inormation in a small-group setting. Practical experiences and application give thetrainees the opportunity to apply the knowledge and skillslearned in a real-lie or simulated situation.

Te current level o the trainees skills will guide decisionson developing a training program specifically or the group.For example, the objectives and goals or a program to trainnew employees will differ dramatically rom those or a pro-gram geared toward experienced technicians learning a new

technique.

Conducting needs and knowledge assessments

A training needs assessment and a pretraining knowledgeand skills assessment are required to help plan an effectivetraining program. Te needs assessment should encom-pass the overall working environment, including the super-

visory structure and the level o employee motivation.Pharmaceutical management training will be effective only

i all areas o the pharmaceutical supply system are assessedrankly and careully.

A knowledge and skills assessment evaluates the partici-pants level o prior knowledge, as well as previous trainingand experience, in the area o interest. Te results o thisassessment are used to develop the training learning objec-

tives, and ultimately, the content.Methods or assessing training needs are outlined below.

Te optimal method depends on the goals o the assessmentand the cadre o the individuals being assessed.

A knowledge assessment can be based on observationo a worker perorming routine duties. Tis review uncov-ers both strengths and weaknesses, but the presence o anobserver may influence the behavior observed. For exam-ple, a clinical worker examining a patient is likely to bemore thorough than usual i someone is watching. Specifictraining needs can be determined more clearly by usingwell-established indicators, such as those on perormancemonitoring and evaluation described in Chapter 48, and

observation methods, such as those described in Chapter28.

Interviews with supervisors, administrators, users o ser-vices, and workers can help determine where perormanceproblems might exist and what skills need to be taught orimproved. I workers ear reprisals rom management, reas-surances about confidentiality o inormation will be nec-essary to obtain good data. In some situations, a trainingneeds analysis can be done by conducting a group interviewin which the staff are invited to identiy competencies interms o knowledge, attitudes, and skills. Staff members ratethemselves on a graph in relation to each o a set o compe-tencies. Exit interviews with workers leaving their jobs can

also be useul. Finally, interviews with users o the servicescan help in assessing levels o satisaction.

Analyses o job and task descriptions may reveal specialtraining needs. Sel-administered, anonymous question-naires or both managers and workers can also be valuable.

Several types o reports are useul needs assessmenttools

Organizational reports, or an overview o the peror-mance o the organization and personnel

External evaluation or appraisal reports, or an out-siders view o the organization and its training needs

(and perormance) Annual or semiannual perormance reviews

Selecting subject areas and setting learning objectives

A training needs assessment should indicate which subjectarea, topic, or target group should be given priority (able52-1). In many countries, some subject areas require moreattention than others, but certain basics must be provided:the selection process needs to be well managed and par-

PERFORMANCE PROBLEM

Desired change

TRAINING PROGRAM

Learning unitsCourses

Practical experiences

Training needs assessment

Evaluation

Change in behavior

PERFORMANCE IMPROVEMENT

Figure 52-2 The training process for improved

performance


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ticipatory; procurement officers need training in efficientpurchasing methods and quantification o pharmaceuticalneeds; distributionproper storage, efficient transporta-tion, and security o medicinesis a continuing concern;and rational use is becoming a major ocus o many phar-maceutical programs.

In addition to these basic pharmaceutical managementskills, staff will benefit rom training in other areas, includ-ing

General management Financial management, budgeting, and accounting Computer systems and inormation management raining program development and management raining materials development Patient and public communications Personnel planning and management Program planning, monitoring, and evaluation Proposal development and writing

Pharmaceutical supply systems ofen run into difficultynot because they lack staff members with technical expertisebut because they lack staff members who have critical man-agement skills. Tus, when considering subject areas, think-ing broadly about which skills are most needed to improvethe perormance o the organization is important.

Afer determining which tasks and competencies arerequired by staff or a particular situation, training goalsshould be established and learning objectives should be

set. Goals will be broad statements about what the trainingintends to achieve: or example, Tis course aims to pro-vide medical stores personnel with the knowledge and skillsto accurately estimate quantities o medicines and relatedcommodities to order.

Objectives, on the other hand, should clearly state whatthe participant must be able to do at the end o the train-ing. Tey must be clear, concise, relevant, easily understood,and measurablein other wordsSMAR (specific, mea-surable, achievable, realistic, and time-bound) (CDC 2009).

Table 52-1 Subject areas, training topics, and target groups

Subject area Training topics Target groups

Selection Essential medicines lists Public formulary Sources of information Safety and efficacy

Cost comparisons Levels of use Hospital formularies National pharmaceutical policy

Policy and decision makers in ministry of health(MOH), ministry of finance (MOF), other ministries

Service providers: doctors, nurses Auxiliary personnel

Pharmacists and dispensers Hospital administrators

Procurement Procurement cycle Purchasing methods Quantification of pharmaceutical needs Scheduling of purchases Terms of payment Selection of suppliers Payment mechanisms Organization of procurement services Quality assurance Make-or-buy decisions Shipment specifications Contracting

Division of planning, MOH Division of finance, MOH Division of administration or purchasing, MOH MOF Central procurement service (if it exists) Central laboratories, MOH Pharmaceutical quality laboratories Drug regulatory bodies Senior MOH/MOF officials for policy decisions (such as

make-or-buy)

Distribution Distribution cycle Information system Port clearing Warehouse operations Packaging and repackaging Transportation Security

Division of planning, MOH Division of administration, MOH Operations personnel in port and warehouses

(central, regional, and district) Transportation

Use Promotion of appropriate therapy Training of health workers Dispensing practices Patient education Information systems Patient adherence Rational-medicine-use indicators

Program directors Program supervisors Doctors Nurses Pharmacists Dispensers Auxiliary and community health workers Drug sellers

Patients and clients


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Tey are, in act, indicators by which course output and per-ormance can be assessed. For example

On completion o the course, participants shouldbe able to

State the rationale and uses or quantification opharmaceuticals and other related commodities

Describe the attributes, uses, and limitations ovarious quantification methods Identiy the data required or each o the quan-tification methods

Because objectives must be measurable, terms such asunderstand or know are not acceptable.

Learning methods

A variety o learning experiences can be used in training,

including

Brainstorming:Members o a small or large group areencouraged to contribute any suggestion that comesinto their heads on a given subject, initially with no criti-cism, but later with a sifing and assessment o all ideas.(Because brainstorming is such a versatile but sometimesmisunderstood method, it is described in detail in

Box 52-1.)Case study:A real situation is presented in a brie paper or

presentation, then analyzed by participants.Demonstration:Te acilitator shows learners how and what

should be done while explaining why, when, and wherean action is taken; participants then perorm the action.

Discussion:A method in which the participants learn romone another, usually with guidance rom a acilitator.

Distance learning:A system designed to build knowledgeand skills o learners who are not physically on-site toreceive training. Facilitators and students may com-municate at times o their own choosing by exchangingprinted or electronic media or through technology that

allows them to communicate in real time.

Brainstorming is a group technique that is useul intraining situations. It also helps work groups be morecreative in decision making and problem solving. Tebasic process is easy. Te acilitator writes the topic orquestions on a flip chart, whiteboard, or blackboard.Group members are asked to call out their ideas in short

phrases that can be written down readily. o keep thediscussion moving, a tight time limit is usually settypically, five to ten minutes. Te acilitator should beprepared to stimulate brainstorming with a ew examplesor prompting questions.

Te creativity o brainstorming is enhanced by giving thegroup the ollowing short set o guidelines beore start-ing

No idea is a bad idea: No matter how odd, unconven-tional, or silly an idea may seem, no idea should beignored.

No discussion of ideas is allowed: Discussion o ideas

can come later. Grimaces, groans, and other nonverbaljudgments discourage creative thinking and should beavoided.

Everybody is encouraged to contribute: Te acilitatorshould try to get everyone to make at least one sugges-tion.

Go for quantity:Tis encourages the maximum con-tribution and discourages people rom screening outpotentially good ideas beore suggesting them.

Build on other peoples ideas: Although discussion oideas is discouraged, generating new ideas rom thosealready suggested is fine.

Afer the brainstorming session, ideas are usually typedup, organized in some way, and brought back to thegroup or discussion.

Although brainstorming can generate many creativeideas, it is not always successul. Some people may bediscouraged rom contributing, and inhibitions mayexist about raising certain ideas. Brainstorming may alsobe dominated by certain individuals or get stuck on onepart o the topic. Sticking to the preceding guidelines willhelp. In addition, methods to make brainstorming moreproductive include

Prepare a broad range o prompts that can be used todirect the groups thinking into new areas i sugges-tions consistently concern one area.

Begin by asking each person to brainstorm individu-ally or a ew minutes and write down ideas. Divide the group into several smaller groups to

brainstorm on the same topic. Ten compile anddiscuss the topics in a larger group.

Limit the number o suggestions by an individualgroup member. Generally, this degree o directnessshould be reserved or situations in which one groupmember dominates the brainstorming session.

Box 52-1

Brainstorming: A versatile technique for training, planning, and problem solving


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e-learning:Participants interact with acilitators throughthe use o some o the many electronic, computer-basedlearning materials that are now available, ranging romCD-ROMs to Web-based systems.

Group exercise:A number o participants undertake anactivity together, ollowed by a critical analysis o the

process involved.Lecture:A direct talk with or without learning aids but

without group participation.Role-playing:Participants act out the roles o those repre-

sented in a given situation.Self-paced:Participants are allowed to learn anywhere, any-

time, and at a pace that suits their levels o skills, knowl-edge, and aptitudes.

Simulation game:A more advanced version o a case study,where participants are given more detailed inormationon a situation, including data sets to analyze. On the basiso their analyses, participants develop and deend a plano action.

Worksheet:A step-by-step approach to identiying prob-lems or solutions through written questions or problems,with space provided or answers.

Te uses, advantages, disadvantages, and trainers roleor some o these methods are summarized in able 52-2.Some o the methods are more suitable or adult participa-tory training, and others work well in ormal academic set-tings (such as lectures or seminars). Most people learn betterin an active rather than a passive ashion. A combination omethods is likely to be more effective than the exclusive useo one method.

Sequencing topics. Sequencing means arranging top-

ics in a logical order during training. In doing so, bear inmind that most people preer to learn in easy and progres-sive stages. Adults, especially experienced trainees, usu-ally preer to start with an overview o the whole coursebeore concentrating on particulars. Te best approach isto sequence topics to build on previously completed con-tent and learning experiences. In addition, spiraling thecurriculum revisits the basic concepts repeatedly, whilebuilding on them. Te trainer should, however, be awareo training atigue and not leave the most complex topicor the end o the course, when learners are likely to bemore tired.

Developing teaching materials. raining materials maynot be available or the kind o in-service training thatwould best suit a particular pharmaceutical managementprogram. Many countries, however, have developed theirown teaching materials using a number o approaches.Tese materials can be requested and used as is or can beadapted to suit specific needs. Materials rom internationalsources are listed in Annex 52-1.

Manuals. Many countries have training manuals thatare not being used effectively by their health workers, ofen

because the workers were not involved or consulted indeveloping them. A better approach is to ask knowledgeablepersons to write on one or two topics; circulate drafs amongselected end users; and develop the final version in a work-shop involving end-users, the authors, and national phar-maceutical management program officers. Tis approachcreates a sense o ownership, which leads to increasedacceptance and use o the materials developed. Te topics

can be compiled inside one cover or distributed as a series oindividual modules.Trainers and participants guides. raining materials

should include guides or both trainers and participants,as well as audiovisual aids. Some o these materials may beobtained rom established programs. ypical contents otrainers and participants guides are outlined in Box 52-2.Both provide structured but adaptable notes and exercisesor each unit. Te participants guide should contain thetechnical content or the unit, including definitions o all

Trainers guides

Summary Learning objectives and content o the unit Preparations that the trainer must make Supplementary reading material

Unit outline and session plan

Prerequisites or participation in the session Components o the session and the estimated time Visual aids to be used

eaching notes

echnical background Instructions or activities

Visual aids (which can be copied onto transparenciesor redrawn on flip charts)

Participants guides

Session guide

Learning objectives and content o the unit Basic inormation the participant must have

beore attending the session Additional reading materials

Session notes (containing basic technical inormation,including definitions o essential terms)

Session activities (with worksheets and instructions)

Box 52-2

Outline of trainers and participants guides

for workshops


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Table 52-2 Comparison of training methods

Method Useful for Advantages Disadvantages Trainers role

Lecture Passing on information andfacts

Giving specific informationrelated to occupation, job,or task

Allows much material to bedelivered in a short time

Handles a large number ofparticipants

Permits lecturer to be in full

control

Learner is passive Little of what is said is

remembered Lecturer receives little

feedback

Provide information Answer questions

Discussion Stimulating interest andthought

Generating possiblesolutions to problems

Consolidating other typesof learning

Developing consensus

Stimulates learners interest Involves learners actively Allows sharing of learners

experiences with others

Time-consuming Requires learners to have

facts about the topic Needs to be well controlled

to have value Can be dominated by a few

active persons

Establish small groups earlyin course

Help groups selectmoderators and rapporteur

Clearly specify tasks foreach group

Assign time limits for eachtask and enforce them

Case study Solving problems Changing attitudes Building analytical skills

Involves learners actively Allows sharing of learners

experiences with others Stimulates ideas and

discussions of concretesubject

Time-consuming to prepare Not easy to validate Discussion may focus on

areas different from thoseintended by trainer

Carefully prepare or readcase and relevant material

Ask provocative questionsto provide key issues fordiscussion

Guide discussion to achieveanalysis, possible solution,

recommendations foraction

Role-playing Developing interactiveknowledge and modifyingattitudes

Introducing humor andliveliness into training

Stimulates interest Is fun Is active Uses participants

experiences

Time-consuming to prepare Observers may be passive Some key points may not

be addressed Those engaged in role-

playing may learn morethan observers

Choose a suitable story toillustrate key points

Debrief (discuss insightsgained from role-playing)

Group exercise Team building Developing interactive

skills Studying group dynamics

Facilitates highparticipation of motivatedlearners

Trainers skills required toguide the exercise

Takes time for group towork in harmony

Prepare carefully to ensurethat everything is organized

Brainstorming Stimulating creativethinking

Generating possible

solutions Consolidating past learning Providing diversion

Promotes activeparticipation of learners

Uses learners experiences

and ideas

Time-consuming Some learners may be

passive

Requires high-level trainersskills

Record suggestions Reorganize into groups Lead discussion at end

Demonstration Showing correctprocedures and requiredstandards

Stimulates a lot of interest Can be used for large

groups

Takes effort to produce Good viewing by learners is

difficult in a large group

Arrange for demonstrationmaterials in advance

Do demonstration aloneto ensure that everythingworks

Observe participantdemonstrations

Correct mistakes promptly Encourage slow learners

Worksheet Performing quantitativeexercises requiringcalculations

Working out solutions for

issues of case studies

Helps learners relate theirgeneral learning to somespecific area of their work

Time-consuming Difficult to prepare

Prepare a worksheet basedon real situations to showdifficulties and successes

Guide the learners but leave

most responsibility withparticipants

E-learning Individual study Passing on information and

facts Showing correct

procedures Working out quantitative

exercises requiringcalculations

Allows materials to bepassed on quickly

Allows participants to studyat their own locations, attheir own pace

Some Web-based systemsallow for communicationbetween participantsworking on the samemodule at the same time

Expensive and time-consuming to prepare

Participants may not havecomputer equipment orcommunications linkscapable of handlingsome forms of electronicplatforms (e.g., Web-based)

Provide backup support fortutoring, coaching throughvarious means, includingtelephone, chat room, andListserv


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essential terms and concepts. Te trainers guide shouldprovide guidance on how the session should be taught.

Audiovisual aids. Audiovisual aids are useul becausethey stimulate the trainee and help reinorce the ideas pre-sented. However, poor visual aids can conuse participants.

Common visual aids include posters, wall charts, chalk-

boards, flip charts, overhead projections, and computer-projected presentation slides. CDs and tapes are commonaudio aids. Videotapes, DVDs, and films are good audio-

visual aids, but their expense ofen makes them impractical.Te equipment and technology support required or someo these approaches may limit their use in certain settings. Irelying on equipment or technology that requires electricity,having a backup option that does not need electricity is animportant consideration.

52.3 Implementing a training program

Tere are two basic approaches to implementing a train-ing program: one is centered on the trainer, who controlslearning contents and experiences; the other is centered onthe learner, with the trainer acting as a guide and provid-ing resources. Tis approach assumes that people are ableand willing to learn i they are given the proper materials inan atmosphere that is conducive to learning. Tis methodis preerred because it is participatory, learners experiencesare shared, and participants have more reedom to learn attheir own speed.

An important aspect to include in a training package isollow-up support to the participants and evaluation o thetraining outcome. Tis support, which should be included

in the training budget, may be in the orm o supervi-sion, coaching, mentoring, setting up a network supportgroup, or simply providing a source o ongoing inorma-tion. Follow-up activities may be conducted in person butmay also be provided by telephone or e-mail. CountryStudy 52-1 shows how a ollow-up plan is used to trackparticipants progress in developing drug and therapeuticscommittees.

Strategies

raining strategies must be appropriate to the educational

level o personnel being trained and to the resources avail-able in the country, easible in terms o the amount o timeand travel involved, and relevant to the job. In some coun-tries, governments ofen place officials in jobs that requirea higher degree o technical capacity than they possess. Insuch cases, managers and trainers need to work together toclose the gap between requirements and ability.

raining programs must consider the resources available.For example, an individual working in a central medicalstore that uses a simple card system or inventory control

should be trained in the operation o that system rather thana computerized system that may never be installed.

raining programs must be easible. Governments maynot be able to allow a senior official to take an extendedtraining leave, regardless o potential long-term benefits.Some officials may not be able to be absent rom work ormore than one week. Similarly, health care providers maynot be able to be away rom the patient population theyserve i no backup staff support is available. Tis actor is oparticular concern in the private sector, where having staffaway rom work will result in acilities losing revenues andin providers losing income.

Preservice training is conducted at established traininginstitutions and is ofen a prerequisite or hiring. In-servicetraining may be offered in a classroom setting or in the workenvironment, either as part o a planned staff developmentprogram or afer an assessment o deficiencies has deter-mined what training is needed at the workplace.

Continuing proessional development allows cadres oproessionals to maintain and improve their knowledgeand proessional competence throughout their careers.Proessional associations ofen develop and sponsor con-tinuing proessional development courses and accredita-tion. A recognized credential can be a powerul incentive or

seeking proessional development; or example, anzaniacreated a new cadre o private-sector drug dispenser, whomay earn a license to work in a government-accredited drugdispensing outlet afer completing a training program andexamination.

Te decision about the kind o training program to usedepends on the issues raised in able 52-3, as well as thecriteria o appropriateness, easibility, and relevance. Acomprehensive training program is likely to include a com-bination o long- and short-term training, observation trips,

THE PROFESSIONAL WORKSHOPPER

Yes. I just got back today,but Im off to another

workshop tomorrow


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conerences and seminars, and in-country counterparttraining.Long-term training. Long-term training is oten

obtained in an institution o higher learning (sometimes inoverseas institutions). Such training, whether in academicor nonacademic settings, is most useul or highly technicalareas, such as research and development o new drugs, qual-ity assurance, pharmaceutical production, improved manu-acturing practices, or advanced areas o patient care. Teprovision o ellowships or doctors, pharmacists, industrial

engineers, and other technical proessionals is most appro-priate here.Tis approach is limited because a pharmaceutical pro-

gram does not have the specific duty to provide basic train-ing, and most programs cannot afford to have top personnelaway or a long time. In addition, i personnel ail to returnto their job, the costs or training new personnel can be high.

Short-term training. Short-term training is usually con-ducted over a period o one to three months in an academicor nonacademic setting. o work eectively, the trainee

Drug and therapeutics committees (DCs) are effec-tive in promoting rational medicine use, but DCs havebeen underused in developing countries. Te RationalPharmaceutical Management (RPM) Plus Program andWorld Health Organization (WHO) designed a course,training materials, and a manual to train health careproviders and administrators who would be involvedin DC activities in developing countries. Te courseincludes fifeen training modules and a field trip to hos-pitals where participants assess the hospital DCs, con-duct medicine use evaluations, and review the ormularyprocess. Te course ends with each participant making aworkplan or uture DC-related activities.

A common problem with training courses is that when

participants go back to their places o work, they mayhave difficulty maintaining their new skills withoutongoing support. Te RPM Plus ollow-on program,Strengthening Pharmaceutical Systems (SPS), addressesthat issue through an innovative ollow-up programdesigned to help participants carry out their DCworkplans and become DC advocates. Te workplansdeveloped in the training are made available on a DCLearning Center website. Te ollow-up program pro-

vides specific technical assistance and support or allDC course participants and local organizations toimplement a DC and related activities. Participants

activities are monitored on the website and through reg-ular e-mail ollow-up and support. echnical assistanceand support or implementing their workplan activitiesare made available to all participants, and through thispost-training support mechanism, participants can sharethe problems they encounter in their work and brain-storm possible solutions.

Between 2001 and 2010, 24 courses were conducted inAsia, Arica, Latin America, and Eastern Europe or 945

people rom 70 countries. Follow-up e-mail contact withparticipants showed that they initiated almost 400 activi-ties based on the training.

Te RPM Plus/SPS process or promoting and support-ing DCs through training and ollow-up o courseparticipants has paid measurable dividends in manycountries. Te ollowing examples show the wide rangeo accomplishments by course participants and other in-country stakeholders

Reduced the percentage o outpatients receiv-ing antibiotics at each visit rom 90 to 60 percent(Kenya)

Established a system that monitors prescribing pat-terns or certain high-use antibiotics (Malaysia)

Developed a generic substitution policy that allowsthe pharmacy to substitute equivalent products,which decreased the average prescription cost by 20percent (Kenya)

Created an adverse drug reaction reporting system(Pakistan)

Analyzed cost o pneumonia treatment, resulting ininstitution o new standard treatment guidelines andmedical records review to assess physician adher-ence (Paraguay)

Perormed ABC analysis, resulting in changes inthe ormulary and in the suppliers o several drugs

(India)raining courses can promote the use o DCs andrelated activities in developing countries, but increasedsupport at the country level plus post-training sup-port and technical assistance are needed to help courseparticipants achieve their objectives. In addition, moreintensive course ollow-up appears to produce enhancedresults in a very short period.

Source: MSH/SPS 2010.

Country Study 52-1

Follow-up activities to support a drug and therapeutics committee course for professionals

in developing countries


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needs to be separated rom everyday work responsibili-ties. Sometimes, when staff members have difficulty gettingaway or an entire week, training may occur on a series oSaturdays.

Tis approach is appropriate or most training needs inpharmaceutical management, especially or top- and middle-level personnel. Prerequisites or effective short-term train-ing include

A sufficient supply o people with appropriate back-ground or education

Courses available in the language o the participants Course design that uses training modules to allow

or flexible curricula to meet the needs o targetgroups

Intensive, practical training so that participantsgain a good mix o inormation and skills in a short

time Adequate ollow-up o graduates, including provision

o continuing education programs, to ensure that theycontinue to unction effectively

In addition to training the target groups outlined in able52-1, this type o program is suitable or the training otrainers (ofen reerred to by the acronym O) who willreturn to their jobs and train others in the techniques andskills they have learned. Tus, short-term training shouldinclude pedagogical and leadership skills and provide someinstitution-building capacities. Annex 52-2 provides urther

inormation on workshop logistics and evaluation.An example o an innovative type o training is themonitoring-training-planning (MP) methodology, whichputs into place an ongoing process to deal with individ-ual training issues in the short term. MP puts the toolsand responsibility or training into the hands o local staff,who tackle specific problems in concise, monthly sessions.See Country Study 52-2 or an introduction and exampleo the MP methodology being used in the Lao PeoplesDemocratic Republic (P.D.R.).

A number o institutions have developed training materi-als and can provide training at the regional or internationallevel. Some private nongovernmental institutions in theUnited States, such as Management Sciences or Health,

and quasi-governmental institutions, such as the Easternand Southern Arican Management Institute in Arusha,anzania, offer training in individual countries. In addition,some institutions are beginning to develop regional train-ing centers in management; Country Study 52-3 illustratesa regional approach to technical assistance and capacitybuilding in East Arica.

Observation trips. Countries that do not have ormaltraining programs but have successully implemented essen-tial medicines programs can offer useul and practical exam-ples or personnel rom other countries. In addition, somemultinational and national pharmaceutical manuacturershave regional or local warehouses, manuacturing plants,

and laboratories that are good sites or visits. Observationtrips work best when combined with short-term training,to reinorce in a practical way the skills learned. Such pro-grams can benefit both the visitors and the institution vis-ited, especially i the trainer accompanies the trainees.

Conferences and seminars. Standardized curricula pre-pared by an international institution can be used to presentat regional conerences and seminars. Tis approach workswell or ocusing on particular components, such as phar-maceutical distribution or use. It is also an effective wayto promote longer training programs, inormation sharingamong developing-country personnel, desire or improve-

ment, and general sensitization o policy makers to theimportance o pharmaceutical management.In-country counterpart training. An outside consultant

with expertise in an aspect o pharmaceutical management,such as computerized inventory, can train counterparts byworking on-site or a period o weeks or months. Short-termconsultancies work best when they are ocused on a specificactivity (or example, a pharmaceutical packaging processor the development o an operations manual). Longer peri-ods (rom two to our years) are required or overall systems

Table 52-3 Issues to consider when designing training programs

Audience Mode Length Location Funding source

Trainers to be trained Senior government

officials Administrators in

government ministries Managers of

donor programs,nongovernmentalorganizations

Managers of facilities indecentralized settings

Line or operations-levelpersonnel

Preservice training On-site job training,

counterpart training Classroom (off-site,

in-service training) Tours, observational

trips Workshops and seminars Courses (short or long

term)

Seminar (two weeks orless)

Short-term course (twoweeks to three months)

Long-term course (sixto twenty-four or moremonths)

Local college oruniversity

National managementinstitute (where oneexists)

International sponsor(for example, WHO,UNICEF, USAID, Danida,SIDA, KfW, and GTZ)

Business Independent private

group Government agency

Government Private organizations Industry University Self Donors

Internationalorganizations

National governmentdonor agencies

Foundations Private charity, such asa church group


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renovation. Meaningul improvements in pharmaceuticalmanagement systems can be made using long-term, on-siteconsultants. Te major limitations are

Expense:International agencies characteristically spend asignificant amount o money a month to support an in-

country consultant.Lack of regional eect:Only the individual country bene-

fits, although participants in a program could train oth-ers.

Lack of appropriate institutional capacity building:Te hostcountry may not be able to continue innovations afer thedeparture o the consultant.

Assistance for the design and implementation oftraining courses

Ideally, training courses are best developed by educatorsskilled in instructional design who have a solid backgroundin and knowledge o the topic areas. However, the skills

Te monitoring-training-planning methodology usesa sequence o steps involving techniques to implementa sustainable health project or program. MP placesthe tools and responsibility or programs in the handso local staff, who learn how to mobilize their ownresources, carry out the MP program, and improvepharmaceutical management in their health acilities.Central- and regional-level managers accompany andmonitor the staff as they implement the new pharmaceu-tical management programs.

Te MP tool relies on the ollowing principles

Te program is continuous, stepwise, and imple-mented in a structured ashion.

Every implementation step is planned in advanceand detailed in the instructions and materials.

Te programs lead to concrete products that areshared among peers. Because MP participants are usually volunteers,

the institution should recognize their efforts. Work is spread among the team o participants so

that everyone takes part. Supervision by all participants o each others

responsibilities and tasks increases accountabilityand improves problem-solving skills.

Sessions must be short and punctual so time andtravel commitments are minimized.

Materials and approach should allow or adaptationto the particular needs o each locale.

MP is unique in that it incorporates monitoring,training, and planning into a single monthly sessionthat achieves tangible results. For one day or less on amonthly basis, participants first review achievementsrom the previous session, analyze inormation abouttheir own situation, study how to take action, and thenplan short-term activities. Each segment sets the stageor the succeeding segment; the planning segment o one

module flows into the monitoring section o the next.For example, i an organization launches a program toimprove warehouse management at the local level, theprogram designers may organize a session on evaluat-ing storerooms, one on improving storage conditions,and another on inventory control. Each session beginswith a report on the planned activities rom the previousmonth; contains a concrete product, such as an evalu-ation, correct storage practices, or an operating inven-tory system; and ends with participants knowing theirresponsibilities and tasks or the next month.

Te Lao P.D.R. National Drug Policy Program promotesrational medicine prescribing in hospitals through theactivities o Drug and Terapeutics Committees; how-ever, when some problems did not respond well to thatapproach, MP was implemented to handle small-scale

training issues. Te use o the MP approach in theLao P.D.R. involved a series o small-group discussionsamong prescribers in individual hospital departments.Afer being trained in the MP methodology, thesegroups defined their problem o interest, selected tar-gets they wanted to achieve, applied a problem-solvingapproach, and monitored indicators to observe theresponse. By using MP, groups requently met definedtargets within two to three monthly training cycles.For example, within three months, Vientiane Hospitalreduced postoperative antibiotic prescription rom 60percent to 49 percent, close to its goal o 45 percent;Mittaphap Hospital reduced intravenous fluid use or

gastritis rom 78 percent to 46 percent and antibiotic userom 40 percent to 20 percent; and Oudomxay Hospitalreduced antibiotic use in outpatients rom 60 percent to45 percent. Initially implemented in eleven provincialhospitals, the MP methodology has been extended toourteen provincial and ourteen district hospitals andwill be extended to all hospitals in the country.

Source: Sisounthone, Luanglath, and Phanyanouvong 2004.

Country Study 52-2

Using the MTP methodology in Lao P.D.R.


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involved in designing and implementing a training pro-gram can be learned by observing good trainers and payingattention to how they use different methods. Many phar-maceutical programs rely on outside organizations, such asManagement Sciences or Health, i+Solutions (previouslythe International Dispensary Association), and WHO tohelp them develop local training programs or provide train-ing opportunities or staff (see Annex 52-1). raining-o-

trainers courses are also requently offered by local, regional,or international training institutes.Another valuable resource or a training program is the

practical experience o organizations and institutions inthe pharmaceutical supply process. Among these are inter-national organizations, governmental and nongovernmentalorganizations, universities, developing-country institutions,and programs already operating in developing countries.

With ew exceptions, however, these organizations havemade technical assistance rather than training their high-

est priority. raining programs have usually been estab-lished on an ad hoc basis to ulfill a specific need ratherthan in a systematic and comprehensive way. But someprograms address specific areas or a particular level in thesupply system or or multiple levels in a vertical diseasecontrol program.

Annex 52-1 lists selected organizations that have practicalexperience in the design or implementation o training pro-

grams, or both. Tese organizations are invaluable resourcesor the development o many types o training programs.

Training and presentation skills

A trainer is expected to be knowledgeable, possess excellentcommunication skills, and be able to communicate at thelevel and in the language o the participants (consecutive orsimultaneous translation may be appropriate or certain sit-uations). o be effective, the trainer should take into account

As a result o major global unding initiatives, countriesin Arica have experienced a tremendous increase in the

volume o pharmaceuticals and health commodities tomanage. However, the weakness in the regions pharma-ceutical management has required interventions to helpbuild in-country and regional capacity to support thescale-up o treatment programs.

With help rom the Rational PharmaceuticalManagement (RPM) Plus Program, the MakerereUniversity in Uganda began coordinating a networko institutions rom Uganda, Kenya, anzania, andRwanda to develop capacity or pharmaceutical manage-ment. Te idea behind the Regional echnical ResourceCollaboration (RRC) or Pharmaceutical Managementinitiative is to create a collaborative group that offers

regional and country advisers with expertise in the sup-ply, management, and use o antiretrovirals and othermedicines. Each country core group is multidisciplinaryand includes pharmacists, social scientists, and represen-tatives rom academic institutions, ministries o health,and nonprofit organizations. In the long term, the RRCplans to incorporate institutions rom other countries,such as Ethiopia and Zambia.

Each countrys core group assumes a role in the coun-trys national pharmaceutical management activities.For example, by conducting national assessments o thepharmaceutical sectors, each group identified key areas

in which to develop and consolidate specific skills in the

supply, management, and use o medicines in their coun-tries. Te country groups then take a regional lead in aspecific area and offer assistance to other groups relatedto this area o expertise. In addition, the groups consultwith ministries o health and other stakeholders regard-ing research activities and the monitoring and evaluationo pharmaceutical management initiatives.

Te RRCs first activity was to assess management oHIV/AIDS pharmaceuticals and commodities in eacho the our countries. Te assessments identified manyproblems, among them inadequate human resourcecapacity to handle the basic unctions o pharmaceuticalmanagement, such as selecting, quantiying, and dis-tributing AIDS-related commodities, including rationalprescribing. As a result, the RRC has placed priority on

training health care workers on how to manage AIDS-related pharmaceuticals.

As a next step, RPM Plus developed generic HIV/AIDSpharmaceutical training materials that can be easilyadapted to train pharmacists, pharmaceutical technolo-gists and technicians, pharmacist assistants, nurses, andstorekeepers. Te training materials were developed witha diverse audience in mind, with content that is neither toocomplicated nor too basic. Te training process is as prac-tical as possible to help trainees apply the lessons learnedin their daily work. Te RRC countries are also incor-porating the monitoring-training-planning approach in

their training programs (see Country Study 52-2).

Country Study 52-3

Creating a pharmaceutical management training network in East Africa


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Figure 52-3 Seating arrangements for various training applications

COMMUNICATION IN SMALL GROUPS (510 PEOPLE)

PREFER THIS NOT THIS

COMMUNICATION AND PRESENTATION IN LARGER GROUPS (1030 PEOPLE)

Presentation

Presentation+

Large group discussion

Presentation+

Large group discussion+

Small groupexercise

SCREENFLIP CHART

SCREENFLIP CHART

SCREENFLIP CHART

SCREENFLIP CHART

SCREENFLIP CHART

SCREENFLIP CHART

Source: Adapted from McMahon et al. 1992.

Key:H= Trainer or presenter.


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the nature o the target group or audience (who are they? arethey senior or line managers?) and their level o knowledgeand skill (have participants been trained in the subject to bepresented or related subjects?).

Preparation. ime used in preparation is time well spent.On average, the amount o time spent preparing the firstpresentation o a course or training session by a personknowledgeable on the topic equals our times that spent pre-senting it. So a one-week course would require our weekso preparation. Afer looking up inormation and consulting

manuals and other resources that are relevant to the subjects(identified in the needs assessment), the trainer choosesappropriate learning methods and puts together a sessionplan. He or she takes steps to acquire or prepare appropri-ate participants guides and audiovisual aids well in advanceo the targeted training date. Te trainer should have thedraf materials peer reviewed by someone who is technicallycompetent in the subject area. Also, i possible, the trainershould rehearse the presentation beore colleagues, keepingin mind issues o time and clarity.

Presentation. he trainer should always come to thetraining venue and the session early to check out the room,

the seating arrangements, and the audiovisual equipment(Figure 52-3). A riendly chat with participants beore thesession creates a more comortable environment.

Formal introductions should take place at the beginningo the first session. One way to do this is to ask pairs o par-ticipants to interview each other; then each presents theother to the group or records the inormation on a wall chartor all to see.

Te actual session should begin with the trainer present-ing the objectives o the course or session and summarizing

its main points. Tese main points are then expanded usingthe chosen learning methods. At the end o the session, thetrainer should always summarize the discussion, makingsure to allow time or questions and clarification.

In developing visual aids, the ollowing points should bekept in mind

Use only one idea per visual aid to avoid crowding. Use large letters and clear drawings. Do not include too much inormation on one slide

(seven lines with seven words per line is a maximumguideline).

Do not use multiple onts, sizes, and colors. Allow plenty o time or preparing the visual aids and

time or obtaining and testing the equipment. est the materials in a rehearsal beore the session,

preerably in ront o critical colleagues.

When using visual aids, the trainer should take care to

Check the visual aids and equipment a ew minutesbeore the session begins.

Always ace the audience, without obstructing theirview, and use a pointer. Switch off the equipment during discussions.

Trainers personal style. Personal appearance and stylecan make a dierence in keeping participants interestduring a session. Te trainer should maintain eye contactwith the group and make sure that his or her voice is clearand can be heard by everybody. When interest appears tobe flagging, the trainer needs to be flexible and willing to

raining in pharmaceutical supply management wasintroduced as part o the Essential Drugs Program inMpumalanga province in South Arica. o study theeffect o the training, a pre- and post-intervention studywas conducted comparing six randomly chosen primaryhealth care clinics that received training to six primaryhealth care clinics that did not receive training. Tethree-day workshop was part o a provincial pharmaceu-tical supply management training cascade.

Te evaluation included a pre-intervention survey, thetraining workshop or staff o the study group clinics, apost-intervention survey one month afer the training,and a second survey three months afer the training. Testudy measured not only supply management outcomes,

such as organization o supplies, record keeping, order-ing and stock control, labeling o medicines, but alsorational-medicine-use indicators, such as patient knowl-edge and advice received rom staff and appropriate useo the essential medicines list. Te results o the evalua-tion showed significant improvements across the rangeo outcome measures in the intervention group, andthe improvements were sustained and even increasedin some instances rom the first to the second post-intervention survey. Te pharmaceutical supply man-agement training not only affected the pharmaceuticalmanagement indicators, but also improved patient careand raised the level o use o the essential medicines list.

Source: Summers and Kruger 2004.

Country Study 52-4

Measuring the effect of training on pharmaceutical supply management at primary health care

clinics in South Africa


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change the schedule, perhaps by introducing a role-play orarranging a short field visit or by inserting an unscheduledbreak to allow participants to stretch or get rereshments.A good story or joke can help revive interest. In a sessionin which participants are divided into small groups, havingthe trainer move rom group to group stimulates interest.

During a long course, allocating time or dinners and othersocial activities is important.

Monitoring and evaluation

Monitoring and evaluation to assess the perormance andprogress o the participants is one o the trainers key roles.Tese assessments should be done as ormative evaluationswhile the course is in progress (or midcourse adjustmentsand fine-tuning), as summative evaluations at the end othe course (to make the course better in the uture), andas periodic ollow-ups afer the training is over to moni-tor outcomes and assess the continuing perormance o

the trainees. Te training outcomes should be measur-able, perormance-based, and directly related to the objec-tives o the training program. For example, i the goal othe training is or the participants to be able to institutea post-exposure prophylaxis program in their workplaces,a relevant outcome measure would be the completion othis activity within a reasonable time rame. Curriculummapping is a method to evaluate the links between coursecontent and outcomes (Plaza et al. 2007).

Country Study 52-4 details a study designed to assess theeffect o pharmaceutical management training on clinics inSouth Arica.

In training, ormative assessment is important, because

the aim o the course is to improve perormance, not tograde the participants. Te trainer can help them learn morequickly and more completely by providing them with con-structive criticism during the course. Te trainer can alsouse the eedback rom evaluations to adjust the content andmethods o the training to better meet participants needs.n

References and further readings

H= Key readings.

Abbatt, F. R. 2004. Teaching for Better Learning: A Guide for Teachers

of Primary Healthcare Staff. 2nd ed. Geneva: World HealthOrganization.HBienvenu, S. 2000. e Presentation Skills Workshop: Helping People

Create and Deliver Great Presentations. New York: AmericanManagement Association.

CDC (U.S. Centers or Disease Control and Prevention). 2009.Writing Smart Objectives. Atlanta: CDC.

Ho, S., D. Kember, C. Lau, M. Au Yeung, D. Leung, and M. Chow. 2009.An Outcomes-Based Approach to Curriculum Development inPharmacy.American Journal of Pharmaceutical Education 73(01):

14. Klatt, B. 1999. e Ultimate Training Workshop Handbook. New York:

McGraw-Hill.Lucas, R. W. 2005. Conducting a Training Needs Assessment, Developing

an Annual Training Plan, Assessing Trainer Competency, ContractingOut for Training.In Human Resource Management Resource Kit.. 2003. Creative Training Idea Book: Inspired Tips andTechniques for Engaging and Eective Learning. New York: AmericanManagement Association.

McMahon, R., E. Barton, and M. Piot. 1992. On Being in Charge: AGuide to Management in Primary Health Care. 2nd ed. Geneva:World Health Organization.

H MSH/RPM Plus Program (Management Sciences or Health/Rational Pharmaceutical Management Plus Program). 2009. AGuide for Implementing the Monitoring-Training-Planning (MTP)

Approach to Build Skills for Pharmaceutical Management.Arlington,Va.: MSH/RPM Plus.

MSH/SPS Program (Management Sciences or Health/StrengtheningPharmaceutical Systems Program). 2010. Promoting Rational

Medicines Use and Drug and erapeutics Committees. Arlington,

Va.: MSH/SPS Program.HNimmo, C. M. 2000. Sta Development for Pharmacy Practice.

Bethesda, Md.: American Society o Health-System Pharmacists.Pike, R. W. 2003. Creative Training Techniques Handbook: Tips, Tactics,

and How-Tos for Delivering Eective Training. 3rd ed. Amherst,Mass.: HRC Press.

Plaza, C. M., J. R. Draugalis, M. K. Slack, G. H. Skrepnek, and K.A. Sauer. 2007. Curriculum Mapping in Program Assessmentand Evaluation. American Journal of Pharmaceutical Education71(02):20.

Potter, C., and R. Brough. 2004. Systematic Capacity Building:Hierarchy o Needs. Health Policy and Planning19(5):33645.

Sisounthone, B., S. Luanglath, and A. Phanyanouvong. 2004. UsingMonitoring-Training-Planning (MTP) to Reduce Irrational Use ofDrugs in Hospitals in Lao PDR. Abstract, International Conerence

on Improving Use o Medicines 2004, March 30April 2, ChiangMai, Tailand.

H Stolovitch, H. D., and E. J. Keeps. 2002. Telling Aint Training.Alexandria, Va.: American Society or raining and Development.

Summers, R. S., and C. H. Kruger. 2004. Impact of Training in DrugSupply Management (DSM) on DSM, Dispensing Practices, andPatient Knowledge and Care at Primary Health Care (PHC) Clinics.Abstract, International Conerence on Improving Use o Medicines2004, March 30April 2, Chiang Mai, Tailand.

rap, B., C. H. odd, H. Moore, and R. Laing. 2001. Te Impact oSupervision on Stock Management and Adherence to reatmentGuidelines: A Randomized Controlled rial. Health Policy Planning16(3):27380.

WHO/EMRO (World Health Organization Regional Office or theEastern Mediterranean). 2006. Training Manual for Community-

Based Initiatives: A Practical Tool for Trainers and Trainees. Cairo:WHO/EMRO.


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Training programs

Was a needs assessment conducted beore the train-ing programs were developed?

Were perormance indicators established? I so, howwere they established and who was involved?

Do the perormance indicators include process, out-put, perormance, and impact indicators? Are theyboth quantitative and qualitative?

What training programs have been held? How many people o each target group have been

trained? What percentage is that o the total targetnumber?

What methods were used or the training? What eedback did the participants give on the

training? What were the evaluation results or knowledge

change? Work perormance change? How much money has been spent on training activi-

ties (i possible, compare budget to actual expen-ditures)? What percentage o the overall programbudget is this?

Sites and institutions

Which institutions provide training or staff workingin the pharmaceutical sector?

Over the past two years, where has trainingoccurred? For whom?

Trainers

At each o the institutions identified, how manytrainers are there?

How many o these people have been ormallytrained as trainers?

In the courses undertaken, what were the evaluationratings o the trainers?

Materials

What training materials were used or the training

courses? Where and how were the materials developed?

When were they last updated? How widely available are the training materials? Do the training materials correspond with current

policies?

A S S E S S M E N T G U I D E


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Annex 52-1 Sources of assistance for training programs to improve pharmaceutical management

The following organizations and institutions offer trainingin selected activities relevant to the pharmaceutical supplyprocess. This listing is not exhaustive, nor is it an endorsement ofthese training programs. For details, these organizations shouldbe contacted directly.

International organizations are listed first, followed by nationaland private organizations and institutions. Also included is alist of short courses on pharmaceutical policy, pharmaceuticalmanagement, rational medicine use, and related subjects.

International organizations

World Health Organization (WHO), 20 Avenue Appia, CH 1211Geneva 27, Switzerland; telephone: 41 22 791 21 11

Department of Essential Medicines and Pharmaceutical Policies;website: http://www.who.int/medicines

Assists member states in the development and implementationof pharmaceutical policies, the supply of essential medicines ofgood quality at the lowest possible cost, and the development

of training in the rational use of medicines. Works closely withWHO collaborating centers on pharmaceutical regulation andquality assurance and control. Provides training in productregistration and computerization of drug regulatory data, aswell as good manufacturing practices (GMPs), analytical control,and preparation of chemical reference substances.

WHOs medicines department provide training programsto support policy makers, ministry of health officials,nongovernmental organizations (NGOs), professionalassociations, and other stakeholders in managing medicinessupply and rational pharmaceutical management. WHOparticipates in regional and national training courses for drugregulators.

WHO/EMP maintains a list of training resources on its website athttp://www.who.int/medicines/training/en.

United Nations Childrens Fund (UNICEF), Supply Division, UNICEFPlads, Freeport, 2100 Copenhagen , Denmark; telephone: 45 35273527; fax: 45 3526 9421; website: www.unicef.org/supply

The Supply Division conducts training on vaccine forecastingat regional immunization meetings and has developeda complete suite of training modules on supply chainmanagement. Through its Procurement Services, the SupplyDivision can arrange for training in procurement and supplyupon request.

United Nations Institute for Training and Research (UNITAR),International Environment House, 1113 Chemin des Anemones,CH 1219 Chatelaine Geneva; telephone: 41 22 917 84 00; fax: 41 22917 80 47; website: http://www.unitar.org

Conducts training and workshops on many areas, includingsocial and economic management, although not specific topharmaceuticals. Offers a number of online training courses.

National and private organizations and institutions

Commonwealth Pharmacists Association, 1 Lambeth High Street,London SE1 7JN, United Kingdom; telephone: 44 20 7572 2364;

fax: 44 20 7572 2508; e-mail: [email protected]; website: www.commonwealthpharmacy.org

Offers the Management of Pharmaceutical Supply, a distancelearning program for all pharmacist and nonpharmacistmanagers involved with pharmaceutical supply procurementand management, especially at the regional level. The coursedoes not require the student to take leave from his or heremployment.

Crown Agents, St. Nicholas House, St. Nicholas Road, Sutton, Surrey,SM1 1EL United Kingdom; telephone: 44 20 8710 6771; fax: 44 208770 0479; e-mail: [email protected]; website:http://www.crownagents.com/Training/CrownAgentsTraining.aspx

Crown Agents offers a number of short courses on generalmanagement and finance topics and in procurement and supplymanagement, including a Certificate in Health Supply ChainManagement. Courses are held in the United Kingdom and in anumber of other countries, including some in Africa and Asia.

Fdration Internationale Pharmaceutique/International

Pharmaceutical Federation (FIP), P.O. Box 84200, 2508 AE, TheHague, The Netherlands; telephone: 31 70 302 1970; fax: 31 70 3021999; e-mail: [email protected]; website: www.fip.org

Provides contact information on more than 900 pharmacyschools worldwide as well as an extensive list of organizationsoffering continuing education and online and distance learningcourses on pharmacy topics. The FIP Foundation for Educationand Research provides a certain number of scholarships,fellowships, and grants every year to assist in the developmentof individuals or groups in the fields of pharmacy practice andpharmaceutical science.

Eastern and Southern Africa Management Institute (ESAMI), P.O.Box 3030, Arusha, Tanzania; website: http://www.esami-africa.org

A regional institution that was designated by the UN Economic

Commission for Africa as the African Centre of Excellence inManagement Development, ESAMI has nine program areas,including training in general financial management and healthmanagement. Clients come from governments, parastatals, theprivate sector, NGOs, and national and regional institutions inAfrica.

i+Solutions, Westdam 3b, 3441 GA Woerden, The Netherlands;telephone: 31 34 848 9630; fax: 31 34 848 9659; e-mail: [email protected]; website: http://www.iplussolutions.org

i+Solutions is a not-for-profit organization specializing inpharmaceutical supply chain management for low- and middle-income countries. i+Solutions offers a variety of courses andtraining programs in pharmaceutical management.

Mahidol University, Faculty of Pharmacy, Sri-ayudhaya Road,

Rajadhevi, Bangkok 10400, Thailand; telephone: 66 02 644 867791, ext. 1301; fax: 66 02 354 4326; website: http://www.pharmacy.mahidol.ac.th/eng

Offers short courses on pharmaceutical management, includinguse of essential medicines, GMP training, and pharmaceuticaleconomics. Organizes professional meetings, conferences, andsymposia as a means of professional continuing education.
http://www.pharmacy.mahidol.ac.th/enghttp://www.pharmacy.mahidol.ac.th/enghttp://www.pharmacy.mahidol.ac.th/enghttp://www.pharmacy.mahidol.ac.th/eng


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Management Sciences for Health (MSH), 784 Memorial Drive,Cambridge, Mass. 02139-4613 USA; telephone: 1 617 250 9500; fax:1 617 250 9090; website: www.msh.org

Center for Pharmaceutical Management, 4301 North Fairfax Drive,Suite 400, Arlington, Va. 22203 USA; telephone: 1 703 524 6575; fax:1 703 524 7898; e-mail: [email protected]

Offers short-term courses in multiple languages on rationalmedicine use and other aspects of pharmaceutical managementand on other topics, including pharmacovigilance, managementinformation systems, and disease-specific pharmaceuticalmanagementsuch as HIV/AIDS, malaria, and tuberculosis. Inmore than thirty years, thousands of health professionals haveparticipated in MSH courses in the United States and othercountries.

Robert Gordon University, School of Pharmacy, Schoolhill,Aberdeen AB10 1FR, Scotland, United Kingdom; telephone: 44 1224262 502; website: www.rgu.ac.uk/pharmacy

The School of Pharmacy offers postgraduate distance learningcourses and certificates for health care professionals to develop

an advanced therapeutic knowledge base and the necessarypractical skills to ensure rational prescribing.

Swiss Tropical and Public Health Institute, Course Secretariat,Socinstrasse 57, CH 4002, Basel, Switzerland; telephone: 41 61 28482 80; fax: 41 61 284 81 06; website: http://www.sti.ch

Offers the two-week course Rational Management of

MedicinesA Focus on HIV/AIDS, Tuberculosis and Malaria.Conducted in English. Other courses in international healthinclude Health Care and Management in Tropical Countries.

University of Heidelberg, Institute of Public Health, Courseinformation: Im Neuenheimer Feld 365, 69120, Heidelberg,Germany; telephone: 49 62 21 56 50 48; fax: 49 62 21 56 4918; website: http://www.klinikum.uni-heidelberg.de/Short-Courses.109912.0.html

Offers short courses in international health. Most of the coursesare post graduate, advanced level, one- and two-week longprograms conducted in English. The institute also offers a one-year masters of science in international health.


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Workshop and support checklist

Advance planning

Goals Objectives, expected outcomes

Needs assessments Content, topics, session Length, time frame Number of participants Implementation approach (e.g., small-group interaction

versus large-group presentations) Materials, including prereading for the participants,

participants and facilitators guides, handouts Participant list Short-term consultants, facilitators or presenters (choosing

the best people to present each topic) Budget, including materials, travel, accommodations Venue: reservations, deposit, other concerns Invitations to participants and follow-up phone calls

Workshop material

Ruled writing pads, pens, pencils with erasers Document binders Flip charts, pens, and markers Blank overhead transparencies and pens Masking tape and transparent tape Stapler and staples Hole punch Photocopying paper Computer paper, printer ribbon, blank diskettes, multiplug

adapter Letterhead stationery and envelopes Paper clips, scissors, Post-it pads, rubber bands, Wite-out,

glue Calculator Name badges

Workshop support responsibility

Logistics: supervision of conference site, meals, breaks, andaccommodations

Finances: payment of cash food allowances, paperwork,and reimbursement for transportation expenses

Secretary for word processing Vehicle and driver Messenger and photocopier

Workshop support facilities

Telephone access (incoming and outgoing) for facilitators On-site (or easily accessible) photocopy machine (with

toner and paper) for low-volume copies Photocopy service site for high-volume copies Computer and printer Overhead projector, extra bulb, extension cord of adequate

length LCD projector and projection screen Sound system and microphones (if needed)

Setup of main meeting room

Opening session and plenary sessions: horseshoe versusclassroom-style seating with extra chairs

Tables for small group work

Break room(s) or area(s) Groups of approximately equal size Overhead and slide projector check: screen that all

participants can see, projector proper distance and anglefrom screen, sufficiently long electric cord, extra bulb

Transparencies and pens Flip charts and pens available for plenary and small groups

Daily preparation of meeting room

Projectors: position, cord, spare bulb, transparencies, pens Blackboard or whiteboard: cleaner, pens Flip charts: location, paper, pens

Workshop administration checklist

Upon arrival at the training site, make sure that theconference room is arranged properly and note anychanges that need to be made. Find out if additionalrooms are available for small-group discussions. Set up aregistration desk near the entrance and a working tablewhere appropriate. Arrange the handouts on a separate

table where they are readily accessible. Set up the projector and test it. Make sure that the

projection screen can be seen easily by all participants. Put the writing pads, pens, and programs into document

binders and place them on the tables. Inform the management of the site about all the practical

arrangements. Put up a signboard at reception displaying the location of

the conference room and registration time. Using the list of participants, prepare the name tags and

spread them out on the registration desk so that theparticipants can collect them as they register. This step canbe done either the evening before or in the morning beforeregistration begins.

Give a copy of the program to the management so thatthey know when to serve tea or coffee and meals.

During the introductory session, make administrativeannouncements: when allowances will be paid (night-out allowances are normally paid at the end of day one;reimbursements for travel expenses are normally paid atthe break on the last day, upon presentation of receipts asdocumentation).

As soon as the last person has registered, type out theparticipant list and start preparing the receipts forparticipants to sign when receiving allowances. Use aduplicate receipt book with a carbon. Mark the receiptnumber against the participants name on the list to makepaying easier.

Type out a separate list for reimbursing transport expensesand make out payment receipts. Fuel and other travelreceipts can be collected on day one when paying out

allowances. Give a copy of the participant list to hotel management,

indicating the participants who are not staying at thesite so that they know how many extra teas and lunchesto charge for. Also, give management the names ofthe people who are settling their own bills (facilitators,secretaries) so that they will not be included in the mainbill.

On the last day, have the hotel management prepare thedetailed bill and check it against the participant list.

Annex 52-2 Workshop logistics

s19629en audit report

Documents