NAIROBI, KENYA — When Ruth Wayua Muia began supervising nurses in a clinical setting, she often harassed and scolded them in a futile attempt to improve their skills.
“I thought I was the police, criticizing and punishing them,” Muia confided. “When I left they felt so bad. Even me, I felt bad. And the worst part was when I went back in, it would be the same problems from the same people. I couldn’t understand why they just couldn’t learn what we were training them.”
Then Muia, the National Reproductive Health Training Coordinator in Kenya’s Ministry of Medical Services, participated in a Jhpiego-sponsored, capacity-building program focused on teaching government health workers how to train and mentor clinical skills. She realized her training style was a big part of the problem.
“I learned that if you want people to improve, you must get them to notice exactly what they are doing compared to what they should be doing,” Muia says. “Then they identify their own gaps and come up with solutions. You’re not the police. You are their problem-solving partner.
“Now they are happy to see me,” she says, smiling broadly. “They are really improving too. Now I am feeling so good!”
Since mid-2009, Jhpiego’s ACCESS Uzima project, supported by the U.S. Agency for International Development, has developed and rolled out an innovative, mixed-media training package designed to build clinical training and supervision skills among national-, provincial- and district-level government trainers. So far, more than 100 Kenyans across the country have completed the program, which targets personnel within the health ministry who are responsible for updating providers.
The Challenge of Staying Current
Training and supervision are a key function of both the Ministry of Public Health and the Ministry of Medical Services, across all programs—reproductive health, HIV/AIDS, tuberculosis (TB), malaria and child health. If Kenyan public health doctors and nurses are to give patients the highest quality care, they must keep their skills up to date as the medical field evolves. Training alone isn’t enough. Doctors and nurses need mentoring and supervision to make sure theory is put into correct practice.
Though essential, skills updates can be problematic. Understaffed facilities struggle (or close) when a staff member is away for long residential trainings. Often the material covered in refresher trainings is not practical. And few government trainers use the proven, adult-focused training techniques that keep participants engaged and build observable improvement in skills. “I did so many trainings where I would just stand and read pages of PowerPoints,” says James Mugo, the training coordinator in the Government’s TB department. “I would invite in other speakers who would contradict each other. We didn’t answer participants’ questions—we just told them to wait until the session covering their issue.”
Modified Computer-Assisted Learning (ModCAL)
To address some of these issues, Jhpiego’s Training Skills course begins with a set of interactive learning modules that the participants receive on CD or flash drive several weeks before the planned training. Participants work through the user-friendly modules at their own pace. Once they have completed all of the computerized lessons, they must pass a knowledge test to qualify to participate in a week of group training. The face-to-face phase focuses entirely on building the practical skills necessary to be a great trainer and effective skills supervisor.
Mugo was impressed with the creative techniques used to make the training more powerful. “It was not like any training I have ever seen. You are never just sitting—everything is learned by doing. We are the ones trying out the techniques, and getting feedback,” he says.
Mugo particularly appreciated the creative use of technology in the sessions: “Every session is filmed, so we see what we are doing,” he says, “You see the truth about yourself.”
Making Good Trainers Great!
Rosemary Kamunya, Jhpiego’s Senior Training Advisor in Kenya, is leading the ModCAL Training Skills effort. “We have to teach them how to do clear demonstrations, how to give feedback, how to organize themselves. We practice making good training materials, and a logical training plan,” says Kamunya. “We work on how to ask open-ended questions, how to use reflective listening and how to summarize. We learn how to give feedback that works . . . . They discover for themselves what works.”
Kamunya says the mixed training model minimizes the time in the classroom. “That means nurses can stay at their posts where they are needed. Also, the advantage of classroom training is getting people to practice skills together and receive coaching,” she adds.
Investment in the Future
To ensure results are sustained beyond the life of the ACCESS Uzima project, Kamunya chooses two to three participants from each session to mentor. These people co-facilitate the next round of classes, while Kamunya closely coaches them.
“It’s not enough to have just a pool of trainers with better training skills,” she says, explaining Jhpiego’s vision. “The ministry must also have the ability to create more of these people. They must have master trainers of their own. That is sustainability.”