Abstract :

Introduction: Continuous in-service training sessions help in updating and upgrading the competency of the public health field staff. Implementation of these sessions with the uniform delivery of the quality assured content has been a challenge in the Sri Lankan well-established preventive healthcare system.

Aim: To describe the implementation, monitoring and evaluation of a novel in-service training strategy of public health staff including Pubic Health Inspectors (PHI) and Public Health Midwives (PHM) conducted in the Colombo Regional Directorate of Health, Sri Lanka from January to June 2018.

Methods: A consultative meeting and a workshop was conducted with the participation of all stakeholders in reviewing the existing in-service training methodology and in recommending the strategies of overcoming the limitations of it. A novel strategy was developed for the implementation of in-service sessions with multi-level implementation and evaluation components. The in-service training sessions were conducted to improve the knowledge and quality of service provision by Public Health Inspectors, Public Health Midwives and other public health staff. Four evaluation indicators were defined. Descriptive statistics and the Wilcoxon signed rank test were used in the evaluation.

Results: By the consultative meetings and workshops, four main weaknesses of the existing in-service training system were revealed, and three characteristics of an ideal system were defined. Two process indicators have shown a coverage of the intervention of 100% while the median satisfaction scores were observed to be 85% or above. Two output/outcome indicators have shown that the interventions have yielded significantly higher post-intervention scores compared to the pre-intervention scores as perceived by the staff members (p<0.05), while the reception of feedback reports was 100%.

Conclusions and Recommendations: The novel strategy is seemingly effective in relation to the four evaluation indicators used. Possibility of implementing similar strategies in other areas must be explored with the view of disseminating quality assured content with uniformity among the public health field staff categories in the monthly in-service sessions.

---

Keywords :

Public health staff; in-service training; Medical Officer of Health areas; Public Health Midwives; Public Health Inspectors

---

References :

1. Gunathunga W, Fernando DN. Assessment of community maternal care performance of public health midwives of a province in Sri Lanka: a multi-method approach. Southeast Asian J Trop Med Public Health. 2000;31(2):310-8.
2. 2Senanayake S, Senanayake B, Ranasinghe T, Hewageegana NSR. How to strengthen primary health care services in Sri Lanka to meet the future challenges. Journal of the College of Community Physicians of Sri Lanka. 2017;23(1):43-9.
3. Perera D, Lund R, Swahnberg K, Schei B, Infanti JJ, team As. ‘When helpers hurt’: women’s and midwives’ stories of obstetric violence in state health institutions, Colombo district, Sri Lanka. BMC Pregnancy Childbirth. 2018;18(1):211.
4. Suriyakumar Mahendra Arnold, Sepali Wickrematilake, Dinusha Fernando, Roshan Sampath, Palitha Karunapema, Pasyodun Koralage Buddhika Mahesh. Distance education in improving knowledge, attitudes and skills of public health inspectors. TAPS 2020;5(2):32-40.
5. Mahesh PKB, Gunathunga MW, Arnold SM, De Silva LSD, Wijeratne MP, Weragoda J. Will prevention be better than cure? The challenge of retaining health staff in the public health sector in Sri Lanka. Journal of the College of Community Physicians of Sri Lanka. 2018;24(1).
6. Pearce J, Mann MK, Jones C, van Buschbach S, Olff M, Bisson JI. The most effective way of delivering a train-the-trainers program: a systematic review. J Contin Educ Health Prof. 2012;32(3):215-26.
7. Yarber L, Brownson CA, Jacob RR, Baker EA, Jones E, Baumann C, et al. Evaluating a train-the-trainer approach for improving capacity for evidence-based decision making in public health. BMC Health Serv Res. 2015;15:547.
8. Office of Provincial Director of Health Services- Western Province. MOH office-Colombo District ND [Available from: http://healthdept.wp.gov.lk/web/?page_id=1417.
9. National Center for HIV/AIDS-Viral Hepatitis-STD and TB Prevention. Types of evaluation. ND.
10. World Health Organization. How to evaluate the programme. ND. Contract No.: 4.
11. Perera S. Chapter 10-Primary Health Care Reforms in Sri Lanka: Aiming at Preserving Universal Access to Health. In: Medcalf A BS, Momen H, et al., editors., editor. Health For All: The Journey of Universal Health Coverage Hyderabad (IN): Orient Blackswan.
12. Jayatilleke AC, Yoshikawa K, Yasuoka J, Poudel KC, Fernando N, Jayatilleke AU, et al. Training Sri Lankan public health midwives on intimate partner violence: a pre- and post-intervention study. BMC Public Health. 2015;15:331.