Scaling Up Treatment for the Global AIDS Pandemic: CHALLENGES AND OPPORTUNITIES by Institute of Medicine of the National Academies

Author:Institute of Medicine of the National Academies
Language: eng
Format: epub
Tags: Health and Medicine : Diseases - Other. Health and Medicine : Global Health
Publisher: NATIONAL ACADEMY PRESS
Published: 2004-11-30T00:00:00+00:00

General Health-Sector Training

Clearly, given the decreasing number of well-qualified and highly trained health workers in resource-constrained settings, there is a need for cost-effective training programs that better prepare graduates for working in the field and on the front line. Ironically, however, donor support has generally tended to be overly skewed toward training as opposed to staff retention and human resource system improvement, such that the already financially strapped national governments are often left with the burden of bearing recurrent costs, such as salaries. Moreover, donor-supported training programs generally are not very well coordinated, are focused too heavily on in-service training as opposed to much-needed preservice training, and do not address the underlying causes of poor staff morale. In Malawi, 10 percent of all donor expenditures in fiscal year 1997 were dedicated to training (amounting to US$4.5 million, including $2.2 million for out-of-country workshops, $1.5 million for out-of-country short- and long-term training, and $0.8 million for other training initiatives). Alternatively, if this amount had been devoted toward supplementing the meager salaries of the civil service health-sector workforce, it would have translated into a US$473 salary increase for 1 year for each of Malawi’s 9,500 health-sector civil servants (a roughly 50 percent raise over the typical salary)—a comparison that did not go unnoticed among these civil servants (USAID, 2003).

Although there have been few quantitative assessments of the relative cost-effectiveness and value of preservice versus in-service training programs, the focus on in-service training (e.g., conferences, workshops, site visits) is questionable despite providing short-term solutions:

• In-service training diverts attention away from preservice training programs that create new practitioners and from the urgent needs of those programs.

• It tends to cover only a certain proportion of the workforce.

• It is usually not sustainable after donor funding ends.

• In-service workshops tend to be held in hotels rather than out in the field, and are not exam based.

• These workshops can be disruptive as they require workers to leave their posts in the field (although it can also be argued that the workshops could, if conducted appropriately, improve morale and provide a much-needed break for overworked staff).

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