The field of health is constantly changing with new and re-emerging disease challenges as well and technological advances. Professional development is critical in ensuring the health workers are abreast with current knowledge and skills and also improve on their professionalism and attitudes. Most of the training institutions have been rigid in adjusting their training needs (both pre-service and in-service) in response to the changing demands in the sector. This has led to constant knowledge and skills gap among the health workers for both those who are fresh from school and those who are in practice.

In response to the knowledge and skills gap, the health workers have had to undertake various in-service courses, workshops and seminars. These in-service courses are mainly supported by the government or development partners who spend huge sums of money annually.

The development of new policies, guidelines, tools and techniques of operations has required the health workers to be updated regularly. Currently such trainings that are supported by USAID/Kenya are offered by various national level and regional partners. Each partner determines how and who is to offer such trainings and this has led to lack of standardization of the trainings across the sector, poor coordination of these trainings leading to wastage of resources as a result of duplication, inequalities, lack of quality assurance and lack of follow-up in some cases. The quality of trainers has also been compromised as well as quality of materials used for training. The health workers also spend too much time in one training after another, further compounding the staffing shortages and in worst cases leading to temporary closure of facilities particularly in some of the hard-to-reach areas. The modalities of trainings have mainly been the traditional class room training which happens in hotels and institutions, as compared to distance or e-learning modes making them very expensive.

USAID/Kenya has taken a deliberate effort to minimize the wastage of resources by consolidating all the trainings under one umbrella mechanism that will ensure quality of the trainings, standardization across the country as well as effective and efficient resource utilization in this era of flat funding. The training mechanism will also ensure further adherence to GHI principles.

Main goals and objectives The training project shall be able to; Support policy and guidelines development for health workers training Conduct regular training needs assessment in collaboration with the various implementing partners, GoK, and FBOs Engage in the development and roll out of training curriculum and consolidate the various disjointed training curricula currently existing especially those for the in-service courses. Develop and roll out other training models such as e learning, distance learning, CMEs, mentorship programs, attachments etc with accredited certification to make them attractive Coordinate and conduct trainings in the most effective and efficient approach Ensure standardized and quality trainings Generate a data base for decision making in matters related to trainings

Key activities to occur in FY 2011 Training Needs Assessment The training project shall be responsible for all trainings undertaken by the USAID/Kenya implementing partners (IPs). This has been an ongoing activity embedded in the various IPs, project description. The needs are broad and in some cases they are generated by the GoK's health sector and Faith Based Organizations (FBOs). Training needs are constantly being generated to meet the dynamic nature of the health sector.

This project will develop a mechanism that will regularly engage in training needs assessments and identification of training gaps, in collaboration with the various key players namely USAID/Kenya IPs, GoK departments and FBOs.

The project will prioritize the needs to ensure that ongoing activities are not interrupted.

Curriculum development Effective trainings require a curriculum which is able to determine the needs of the trainers and trainees, training methods, training environment as well as evaluate the trainings. The training project will identify the curricula that need to be developed, reviewed, strengthened or rolled out.

The project will liaise with the regulatory bodies as appropriate to ensure that the curricula meets the professional regulatory body's standards for purpose of accreditation. The regulatory bodies will approve if the particular course offered under a given curricula will form part of continuous professional development for health workers' retention in the regulatory body's register.

The project will also explore ways of merging the various training curricula so far developed for in service trainings so as to come up with a consolidated training curriculum which can be offered on a modular fashion.

Coordinate and conduct trainings The USAID/Kenya IPs conduct many trainings on a regular basis. The trainings are necessitated by the release of new policies, guidelines, tools or new procedures and medication protocols to mention a few. The trainings are as short as a few hours, a day, weeks or sometimes much longer. Some of these training courses are offered on-site and others are off-site. The modes of implementation differ from class room set up to clinical set up and field visits as well as at times a combination of two or more modalities. Some of the training courses are specific to a region while others cut across the country.

The training project will coordinate and also participate in delivery of the trainings in the most effective and efficient manner. Innovative methods will be used for instance use of ICTs will be encouraged as long as it is practically sound and achievable. The main idea is to minimize the time when the health worker is away from the work station, and at the same time ensure the worker is adequately trained.

Develop standards for quality training Uncoordinated trainings have diluted the quality of the desired behavior change among the participants. The training partner shall establish a standard approach to deliver both regional and national trainings. The project will also ensure that the trainers and training materials are of high quality. The training project will develop quality assurance modalities as well as inbuilt monitoring and evaluation processes for both the trainings and behavior change of the recipients of the various courses.

Develop a data base for decision making The health workers at management and leadership positions have the tendency of participating in the most of the training courses for health workers. This has contributed to inequalities in the number of trainings done by each recipient. In some cases trainings have not positively impacted on service delivery since most of the beneficiaries are not the directly involved in service delivery. The project will develop criteria for selection of training participants and maintain a data base for all the attendees of training courses and also share the information with the decision makers at various levels. This will help identify inequalities in course attendance as well as existing gaps and deficits in knowledge and skills. The data base will also be useful to the regulatory bodies for staff retention purposes where they can inform the employer those who may need recognition, motivation or promotion based on their knowledge and skills.

Policy and guidelines The project will engage in the development of various policies and guidelines related to health workers training or professional development. The end result is to promote good practices within the government structures on continued professional development in response to ever changing needs in the health sector.

Linkages to the Partnership Framework/GHI Principles, The training project will ensure that all the trainings are inline with the GoK health workers training needs as stipulated in the Ministries of health strategic plans and annual operational plans. It will also ensure that the needs of other GoK sectors such as youth, gender and children in relation to health sector are addressed. With this level of coordination it will be much easier for the project to ensure balance in trainings so as not to disenfranchise any region or cadre of health workers.

The project will ensure leveraging on existing mechanisms, training institutions expertise as well as private sector engagement as appropriate. The interventions of this project through sharing of good practices will help to inform policy decisions for long term sustainability and integration into GoK structures.

The project will improve monitoring and evaluation of both the training process and desired attitudinal change of the recipients much more than has been the case in the current disintegrated training approaches.Through the data base and knowledge management the project will enhance the quality of information for research and innovation in this region and globally.

Geographic coverage and target populations The project will be implemented in Kenya at both national and regional levels. The target population will be all health workers in both GoK, and Faith based organizations. Where applicable, the private organizations and private practitioners will also benefit.

Contributions to health systems strengthening The training project will contribute to health systems strengthening through the human resources for health pillar. Knowledgeable, skilled health workers will in the long run ensure good quality of services and effective and efficient resource utilization. In addition, this will have a positive impact on commodities and resource utilization as well as improvement of the overall management of health services.

Cross-cutting programs and key issues The nature of training is cross cutting in various areas, ranging from health systems, diseases and gender issues.

Strategy for cost efficiency over time The project by its design is a cost effective approach from the current disintegrated mechanisms. In its inception the project's start up cost may be reasonably high due to purchase of materials and training aids. However, most of these materials are one-time-buy-item and may be replaced after a long duration of use. On the other hand one training aid like a projector may be used a cross various sessions in various regions as compared to a disintegrated approach where each region would require buying its own or hiring.

Monitoring and Evaluation Plans The project will have its own inbuilt monitoring and evaluation plan for implementation of the various courses and desired behavior change for the recipient. Externally the USAID's regular monitoring and evaluation processes will be applied including, regular field visits, meetings, financial and performance reports and mid/end term review.

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