ABSTRACT
In 2013, the Government of Japan issued “Japan Revitalization Strategy”, in which facilitation of overseas expansion of Japanese drugs, medical equipment, health services, and health system through Public Private Partnership (PPP) is included. In alignment with this strategy, ministries and agencies have initiated on various health project, one of which is “Project for global growth of medical technologies, systems and services through human resource development”funded by the Japan Ministry of Health, Labour, and Welfare from 2015. As an administrative organization of this project, National Center for Global Health and Medicine (NCGM) has organized 119 project for 4 years from 2015 to 2018. This report summarizes the experiences and the results of evaluation in terms of program management, expansion of introduced health technologies and the health impact. As the results, the overall project management was satisfactory from the viewpoints of varieties of project, the execution rates. Then, health technologies were adopted in the national guidelines or policies and 17 introduced medical products were purchased by local governments. When it comes to health impacts, 19646 health staffs were trained through this program for 4 years and 912334 persons were estimated as beneficiaries by 29 project in 2017. Based on data shown as above, the overall achievement of this program should be considered satisfactory. Since this program is unique among other PPP program in Japan as well as other countries as the program scheme to promote expansion of medical products through human resource development, the experiences should provide some insights about the ways to facilitate PPP in health sector. In order to extract the Tips of good practices for future activities, further analysis on each project is necessary.
ABSTRACT
<p><b>Introduction</b></p><p> The Direction Office of Healthcare Activities (DOHA) started around 1998 in Vietnam offers training provision for all lower- and higher-ranked hospitals. An understanding of the factors responsible for the success of this unique training provision system can be useful in implementing appropriate human resource development strategies in the health sector. Furthermore, the reviews about the changes in the training provision styles can offer us clues on how to connect training provision with visible clinical improvement. </p><p><b>Method</b></p><p> We reviewed the policy papers from the ministry of health in Vietnam, the activity reports of DOHA in the training center of Bach Mai hospital, which is a high-ranking hospital, JICA (Japan International Cooperation Agency) reports, and NCGM (National Center For Global Health and Medicine) reports from 1997 to 2015.</p><p><b>Results</b></p><p> DOHA was founded as a government-led health provision system in Vietnam with strong policy guidelines. However, to expand their activities, strengthen the capacity of training in hospitals, and establish a financial mechanism for training, there was a need to empower lower-ranked hospitals. </p><p> To enhance the training impact of the clinical field in lower-ranked hospitals after training provision, staff of higher-ranked hospitals were dispatched to lower-ranked hospitals to provide on-the-job training (1816 project) and training provision with equipment preparation in lower-level hospitals to overcome environmental difficulties in implementing techniques that they had learned (Satellite hospital project).</p><p><b>Conclusion</b></p><p> “Strong policy commitments”, “a viable financial system”, and “bottom-up empowerment” were needed to establish nation-wide continuous medical education system in Vietnam. To connect training provision with improvement in the clinical field, “integrated approaches for multiple factors in clinical fields like clinical environment changes and extended follow-ups“ by providing training are needed.</p>
ABSTRACT
<p><b>Purpose</b></p><p> The training for “Strengthening Human Resource Development for Nursing and Midwifery in Southeast Asia” was implemented in order to strengthen the nursing education system in Cambodia, Laos, Myanmar and Vietnam. The purpose of this study was to evaluate the training using the training evaluation guide suggested by WHO; and to explore factors for training program to be effective, issues, and lessons.</p><p><b>Methods</b></p><p> The WHO training evaluation guide which has five evaluation levels was modified as a tool to evaluate the training. Data were collected from training evaluations questionnaire, meeting records during training, and records of interviews conducted during follow-up visits. The factors for training to be effective, issues, and lessons were inductively identified by methodological triangulation from the results of training evaluations, the summary of training feedback from participants and the results of action plan progress. </p><p><b>Results and Discussion</b></p><p> The training was evaluated as effective that not only achieved “Level 1: Reaction and Satisfaction” and “Level 2: Learning”, but also “Level 3: Behavior”. The factors for training to be effective were (1) practical content through sharing experiences amongmulti-country participants in neighboring countries, (2) selection of suitable trainees by setting the training language as the native language of each participating country, (3)lecture documents in native language facilitated sharing of the learning with relevant people in one’s own country, (4) maintain trainees’ motivation to implement action plans following an agreement with trainees during the training to confirm action plan progress through follow-up visits, and (5) pre-visitingeach participating country to explain the training outline makes relevant people’s much understanding of the training and interest in the action plan. Lessons learned were the importance of the definitions of technical terminology in each country’s native language and the efficacy of follow-up visits. Future issues are: “Level 4: Results”, support for each participant’s needs and “Level 5: Impact”, the development of mechanisms for continued sharing of experiences.</p><p><b>Conclusions</b></p><p> Our evaluation confirmed the effective factors for training, issues, and lessons. These are needed to be considered for the future training.</p>
ABSTRACT
<b>Introduction</b><br> Even though many oversea training programs end in developing an action plan from what they learned during the course, follow-up opportunities are quite limited. Group training program on maternal and child health for Francophone African countries are conducted in Japan since 2003, organized by National Center for Global Health and Medicine and funded by Japan International Cooperation Agency. Follow-up activities in Senegal and Benin are reported with lessons learned.<br><b>Methods</b><br> Training organizer team made a semi-structured interview with 11 trainees, 6 superintendents and 4 Japanese advisors, asking “Do trainees implement what they planned at the end of the training course in Japan? If not, what are the difficulties implementing their plans?”Organizer team also provided some interventions to solve the problems they faced.<br><b>Results</b><br> In Senegal, actions were not implemented yet, because plans were shared neither with their superintendents nor with Japanese advisors working with trainees as project counterparts. Organizer team set up a meeting with all stakeholders to clarify the objectives and outcomes of the training course within the concept of the project. This process made the superintendents understand and support the action plans, and facilitated to start implementing them. In Benin, trainees started activities by themselves based on their action plan under a small financial support from a Japanese advisor. It was rather easy, because they were decision makers of a hospital, but they faced difficulties to manage the staff to continue the activities. Organizer team encouraged them to continue the activities during the meeting in the hospital.<br><b>Conclusions</b><br> Appropriate participants can be selected and training could be effective, when cooperation project are well defined and the role of advisors is clear in the follow-up. Involvement of decision makers or superintendents for the selection and follow-up process can be a contributing factor to improve the effectiveness of the training.
ABSTRACT
<b>Purpose</b><br> Every year, a lot of training programs by Japan International Cooperation Agency (JICA) are conducted in Japan. However, the method of monitoring and evaluation of those trainings are not always conducted other than simple questionnaire survey. The purpose of this research is to demonstrate the significance of daily recording and analysis of the trainee’s voice as a way of the improvement of the quality of training.<br> Bureau of International Cooperation in National Center for Global Health and Medicine (NCGM) conducted detailed monitoring and evaluation for “JICA training for Maternal and Child Health in French speaking African countries in 2009” which NCGM itself had planned training curriculum and implemented the training. The key word of this training was “Continuum of care”. At the end of the 5 weeks training, NCGM expected the trainees to obtain comprehensive understanding of continuum of care, especially two different perspectives, which were “the health system” and “the dignity of individual client”.<br><b>Method</b><br> NCGM training team kept recording the trainee’s voice, then analyzed them every day during five weeks’ training. At the end of the training course, the team divided trainee’s voice into several categories, and then analyzed their time-dependent change.<br><b>Results</b><br> The everyday recording and analysis of the trainee’s voice made NCGM training team possible to differentiate the trainee’s fundamental interest and understanding from simple guesses or curiosity. Based on the result of daily analysis, the training team could introduce unscheduled discussion or fine-tuned the contents of lectures for better understanding of trainees. The trainees’ interpretation about “continuum of care” showed obvious change before and after the training. The active learning program by using Laboratory method gave deeper impact on trainees than the expectation of training team. At the end of training course, the trainees formulated concrete and detailed action plans. The purpose of their action plans was to establish the continuum of care from aspects of both “the health system” and “the dignity of individual client” by analyzing the existing stakeholders and institutions, and ensuring a collaborative linkage among them, which were exactly the expected outcome.<br><b>Conclusion</b><br> Daily recording and analysis of the trainee’s voice was effective and useful to monitor the training. The comprehensive analysis at the end of training course revealed the short impact of the training on trainees, which could be used as a self evaluation tool for the training team.<br> NCGM plans to visit the trainees’ workplace in their home countries for middle and long term monitoring and evaluation. The results will be feed backed into the training curriculum of next year.