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Introduction Since the year 2003, National Center for Global health and Medicine (NCGM) has been implementing a JICA group training: ‘Continuum of Care for Quality Improvement of Maternal, Newborn, and Child Health in Francophone Africa’. During these ten years, we have recognized the difficulty for trainees to adopt their new knowledge and skills, into their own work because of social and cultural differences. To overcome this issue, we had introduced an approach: ‘laboratory method’ for experiential learning. In this method, participants work together in a group to learn through experiences-based analysis. However, we have faced the gap between the ‘laboratory method’ and the whole contents of course. Trainees could not utilize ‘laboratory method’ as a useful tool to learn practical skills in the training. To solve this problem, in the year 2013, we added several new learning styles to make the ‘laboratory method’ more usable throughout the training period.Method and Results We utilized the ‘inception reports’, which all trainees had submitted to JICA before they came to Japan, as an important tool for the ‘laboratory method’. Trainees extracted their common theme from all reports in their group work. Moreover, they used one common ‘matrix’ to analyze their common agenda. Trainees recorded their learning on the ‘matrix’ and revised them if necessary after discussions in regular review meetings. This work helped trainees understand how to put the ‘laboratory method’ into their practice. They also recognized their colleagues and themselves as important ‘resources’ for learning by sharing their own experiences.Conclusion Participants in the group-training course could utilize the ‘laboratory method’ for their learning throughout the course by using a ‘matrix’ as a tool for analysis. The awareness that their colleagues and themselves could be valuable ‘resources’ could be a breakthrough for working after they went back to their countries.
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<p><b>Objectives</b></p><p> The aim of this study was to investigate the knowledge, attitude, and practice (KAP) of healthcare providers regarding the utilization of oxytocin for induction or augmentation of labor.</p><p><b>Methods</b></p><p> A qualitative study composed of direct observation and individual interview was conducted at a national tertiary maternity hospital in Phnom Penh, Cambodia in January and February 2013. The progress of labor in women who received oxytocin for induction or augmentation of labor was directly observed to confirm the healthcare providers’ management of oxytocin infusion. The attending doctors and midwives were individually interviewed after the women delivered. </p><p><b>Results</b></p><p> During the study period, 10 women were observed, and 12 healthcare providers (three doctors and nine midwives) were interviewed individually. Indications for labor induction or augmentation seemed to be appropriate for nine women. However, we found discrepancies between the national protocol and healthcare providers’ knowledge and actual practices. For example, 11 healthcare providers had never read the national protocol for the management of labor induction and augmentation, which implied limited access to the correct knowledge. A misconception was noted in that the sudden increase of oxytocin was not dangerous during the second stage of labor, despite the establishment of a good contraction pattern. Furthermore, a lack of unified initial dose and extremely high maximum dose above that recommended by the national protocol were observed. About half of observed women were not monitored for more than 2 hours from the beginning of oxytocin infusion.</p><p><b>Conclusion</b></p><p> In the present study, lack of knowledge, misconceptions regarding the management of oxytocin infusion, and a large gap between the national protocol and the actual clinical practices were confirmed. To maximize patient safety and therapeutic benefit, dissemination of the national protocol through in-service training is required.</p>
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<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.
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<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.
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The importance of a health information system [HMIS] cannot be ignored because health policies and planning in any country mostly depend on the correct and timely information on various health issues. This paper has endeavored to look into the information system prevalent in Pakistan, with an emphasis on the facility based HMIS and Geographic Information System [GIS]. The main methodology used was interviews with key stakeholder including government officials and donor agencies, besides the literature review of the relevant documents. The results showed that currently HMIS is generating information and its coverage is encouraging, but at the same time it needs lot of room for strengthening at various levels. The HMIS approach seems more 'data driven' than 'action oriented'; there is duplication and lack of coordination among various vertical health information systems. The factor of time lag also holds true as regards receiving of information and its dissemination is concerned. The GIS is relatively a new concept in health sector in Pakistan and consequently application is limited at present. There is a need for strengthening of the whole system with better coordination among various vertical health information systems, which can practically contribute to better decision-makings as well as save wastage of money, men and machinery
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Health , Information SystemsABSTRACT
The importance of medical education and technical cooperation with developing countries is emphasized. As an example, we looked at the residency program of the Department of Surgery, Santa Cruz General Hospital. Provision for postgraduate medical education is quite important in developing countries in order to prevent promising young doctors from leaving the country. Moreover, the curriculum for postgraduate education should be developed in accordance with the health situation of the respective countries. Technical cooperation should be carried out with a long-term perspective, focusing on human resource development, in this case the young doctors. From now on, it will not only be technical experts, but also medical education experts that will be needed in developing countries.