Page 103 - GHES-2-4

Global Health Economics and
Sustainability
Sustainable, competent health trainers

in the primary health system. India is projected to face providers endorsed the appropriateness of this approach.
a shortfall of approximately 0.7 million skilled health This training intervention, built on a hybrid platform with
workers required to achieve the 25:10000 ratio of skilled an appropriate blend of virtual and in-person training
health workers to the population by 2030 (Karan et al., activities, proved to be effective for the delivery of the
2021). In this context, the current training intervention, training content and for reinforcing knowledge and skills
which includes a training cascade involving Pune CTs, even during the COVID-19 pandemic. Other studies
Palghar MTs, and Palghar health providers, demonstrates have validated the usefulness of a virtual platform for
a model for upskilling existing human resources within conducting training during the COVID-19 pandemic
the public health system. (Mun et al., 2022).
This training intervention adopted a TOT model Training of trainers is generally a short-term program
and demonstrated its effects on developing sustainable, with few opportunities for MTs to conduct supervised
competent trainers within the public health system. The training (Fernandes et al., 2007). Longer time frames are
content and criteria for assessment of TOT are documented needed for trainers to learn, assimilate, and then teach
(Esau et al., 2020); however, little evidence is available others (Mormina & Pinder, 2018), and newly trained
about the approach, implementation steps, or prerequisites trainers need to be supported beyond the initial training
of TOT for achieving expected gains (Mormina & Pinder, event (Understanding the Training of Trainers Model |
2018). The TOT planning and evaluation require capturing Healthy Schools [CDC], 2019). The opportunity to do this
outcomes as well as process measures, demonstrating both may be missed at a typical one-time TOT event. Gradual
the ultimate aim and the steps required to achieve it (Kelly and staggered involvement of Palghar MTs and continued
et al., 2015). This paper has attempted to describe the support by Pune CTs with periodic guidance from UK
necessary elements of the methodical approach and the experts provided an extended opportunity for the newly
outcomes of the TOT intervention. trained Palghar MTs to unlearn and learn, assimilate,
An appropriate initial choice of trainers is a prerequisite accept, and act on constructive criticism, and then conduct
for a successful TOT intervention. Key attributes of training of health providers under continued mentorship.
an effective trainer include enthusiasm, willingness to This scale-up intervention proved to be an important
teach, patience, insight, confidence, communication step in strengthening Pune CTs as competent mentors.
skills, leadership, capacity for self-reflection, ability to Under their mentorship, the newly trained Palghar MTs
be constructively critical, and above all, motivation to were empowered to implement the training intervention
help others (Mormina & Pinder, 2018; Baron, 2006). seamlessly and effectively.
The Pune pilot project demonstrated the importance The Palghar MTs reported increased capacity and
of systemic investments in creating and sustaining motivation in performing their clinical tasks. This concept
competent, motivated, and updated trainers and conducive of perceived increased ability to perform tasks successfully
environments for the absorption of learning among is termed “self-efficacy,” and self-efficacy following
ANMs (Karvande et al., 2020). The Palghar scale-up continuous education is known to increase knowledge and
phase deliberately invested efforts to identify and recruit motivation to implement the new knowledge for patient
appropriate candidates with essential attributes, which care (Fusco & Ohtake, 2019). However, self-reporting
is known to minimize the attrition of skilled resources of gains or positive effects of intervention could be
(Mormina & Pinder, 2018). overestimated (Mash et al., 2018). In the present research,
Appropriate training pedagogy is the next essential the qualitative data from in-depth interviews with and
for effective training interventions. The adult learning observations of the Pune CTs, UK experts, and project
process can be transformative and transformational researchers endorsed this increased ability of Palghar MTs,
(Esau et al., 2020; Merriam, 2008; English & Irving, thus minimizing the possibility of overestimation.
2000). Hence, a conscious shift in the teaching style of the Studies have recommended that to avoid attrition
trainers was achieved by developing them as adult learner- of trainers, becoming a trainer should be recognized as
centric facilitators and effectively using a simulation- a career path and not just an adjunct duty (Mormina &
based learning approach, which has been shown to be of Pinder, 2018). Reluctance to releasing staff for training
proven benefit in training intervention research (Mun and perceiving it as an unnecessary burden imposed on
et al., 2022; Tavares et al., 2014; Mash et al., 2018). The a system with limited human resources has been reported
positive outcomes of the current training intervention in in other studies (Mormina & Pinder, 2018; Hague et al.,
terms of increased confidence among Palghar MTs and 2015). There was no such reluctance to release Palghar
enhancement in clinical knowledge and skills of health MTs for participating in the training. However, at times,

Volume 2 Issue 4 (2024) 8 https://doi.org/10.36922/ghes.2963