A systematic review of the training of health care workers within essential medicines supply programs in developing countries

Abstract

Background Deficiencies in Health Care Worker performance in developing countries are due to a variety of causes. These include for instance lack of health resources, low skill, undefined work processes. Regardless of the cause of poor Health Care Worker performance, the traditional solution has been to provide training. Consequently, many health training programs are conducted. These include the training activities within Essential Medicines supply programs. The training programs employ variety of approaches and methods. Developed on developed country models, the methods and approaches are often program depended. Incidentally, there is growing evidence that these resource-intensive training programs are not always effective. The evidence for the training effectiveness and sustainability appears weak or lacking. Therefore; demand is growing for other interventions that might help improve Health Care Workers‟ performance more efficiently and cost-effectively. Objectives To investigate the effectiveness of training Health Care Workers within Essential Medicines supply programs in developing countries. this research will focus on pharmaceutical and clinical care practices at the Primary Health Care level in selected developing country regions, the impact of training will be explored. Specifically, the factors affecting the training program sustainability will be examined. Search strategy Using a pre-defined search protocol, the Cochrane Library was initially searched for existing reviews including reviews currently being undertaken in this area of research. The search was limited from 1990 to 2010 time period. The search activity was extended to MEDLINE, PubMed and Cinahl indexing databases. Scopus and Web of Science citation databases were also searched for a comprehensive location of relevant studies. Google Scholar and organisational websites were searched for relevant published and non published literature. Finally, reference lists of retrieved articles were checked for additional articles relevant to the study topic. Selection criteria Trials eligible for inclusion in the review included cluster randomised controlled trails, randomised controlled trials employing various randomisation methods. In addition, intervention studies that objectively measured medicine use practices or health outcomes by Health Care Workers were eligible for inclusion. Data collection and analysis Using a pre-determined study inclusion criterion, relevant studies that qualified on all inclusion criteria were selected for review. Data from full articles was extracted using a standardised form and assessed for study quality. A meta-study was not a primary objective of this study and was not appropriate. Results Twelve randomised controlled studies met inclusion criteria. These employed varied randomisation procedures. Three studies focused on training in pharmacy supervised sites including untrained medicine retailer shops. The other eight studies focused on training interventions with clinical care workers. All studies focused on health services within primary care settings. Conclusion The result of the twelve reviewed studies showed training activities delivered in repeat sessions leads to improvements in Health Care Workers‟ performance. This study found evidence that training is better than no training and the knowledge from one training program may be transferable to other programs and work sites. However, because of the small number of studies, differences in training methods, and weaknesses in study designs, it was not possible to conclude that in general, training improves Health Care Workers‟ performance in primary care settings. Consequently, well designed trials are therefore needed to provide strong reliable evidence on what these training programs achieve. To guide policy decisions regarding which training intervention to invest in, such studies should also include data on resources and cost-effectiveness of training interventions

Date of Award	2011
Original language	English
Supervisor	Gabrielle Cooper (Supervisor) & Rachel DAVEY (Supervisor)