Page 97 - GHES-2-4

Global Health Economics and
Sustainability
Sustainable, competent health trainers

5 Department of Obstetrics and Gynaecology, Royal Free London Hospitals Foundation Trust, London, United Kingdom
6 Department of Paediatrics, Western Isle Hospital, Western Isles NHS Trust, Scotland, United Kingdom
7 Department of District Health, Palghar, Maharashtra, India
8 Independent Consultant, St John’s, Newfoundland and Labrador, Canada

1. Introduction communication skills, time management, teamwork, and
respectful behavior (Skills and interests [health trainer],
A competent public health workforce is an important National Health Services, 2015). However, evidence-based
pillar of the health system and is necessary to improve guidelines for the selection and recruitment of trainers for
population health (Barbazza et al., 2015; Beaglehole & public health training programs are limited in India and
Dal Poz, 2003). However, maintaining health worker require further research. Similarly, evidence for pedagogies
competencies requires continued, intensive efforts. While and processes of training in the public health system using
pre-service training lays the foundational skills, it must be a ToT model are lacking.
supplemented with regular refresher training and updates
to sustain these skills and competencies. Therefore, the In this context, training intervention research was
need to invest in in-service training and continuous undertaken in Western Maharashtra. The intervention
professional development of the health workforce is of employed a ToT model and was implemented as a pilot
paramount importance. To be effective, training programs project in Pune District (2017 – 2019) and later scaled up to
must focus on evidence-based training techniques Palghar District (2019 – 2022). The present paper describes
provided by competent faculty possessing appropriate the pedagogy, process, and effects of implementing the
clinical and pedagogical skills (Zhao et al., 2013; Nicol ToT model in the Palghar district, aiming at developing a
et al., 2019; Laskaratos et al., 2014). Moreover, an urgent sustainable resource of competent trainers for in-service
need for transformation in training approaches is evident, training within the local public health system. Although
as traditional didactic techniques with passive instructions India has achieved significant declines in maternal (Meh
have minimal impact on learning outcomes (Bluestone et al., 2022) and under-five (Bango & Ghosh, 2023; Patel and
et al., 2013). Case-based learning, clinical simulations, Olickal, 2021) mortality rates over the years, maintaining
and skills practice with feedback are highly effective in this progress requires building a skilled workforce capable
engaging participants and achieving positive learning of providing quality obstetric and newborn care and is
outcomes, including increased knowledge, skills, and considered one of the urgent necessities (Exemplars in
confidence in health-care delivery (Bluestone et al., 2013; Maternal and Newborn Health India Study, 2023). Studies
Harris & Bacon, 2019; Karvande et al., 2020). conducted in Asian countries (Ariff et al., 2010; Khan et al.,
Workforce capacity can be strengthened at multiple levels 2019), including India (Iyengar & Iyengar, 2009; Rao et al.,
by utilizing a training cascade. The training of trainers (ToT) 2019), have pointed toward the maternal newborn health
model is based on selecting trainers who have the ability to (MNH)-related skill deficits among health providers.
acquire, understand, and transfer knowledge and skills to Hence, MNH care was considered for undertaking this
trainees or peers while also ensuring the sustainability of intervention research to build the capacities of frontline
these skills over the long term (Understanding the Training health providers working in the rural public health system
of Trainers Model [CDC], 2019; Mormina & Pinder, 2018). of Western Maharashtra, India.
Various studies have shown the benefits of the ToT model 2. Methods
in implementing evidence-based public health practices
(Olayo et al., 2019.; Hiner et al., 2009; Yarber et al., 2.1. Setting
2015; Nitturi et al., 2021; Rowe et al., 2021). This model The study was conducted in Palghar District, in Western
is considered strongly predictive of sustainability due to Maharashtra. This district has a population of 2,990,116
its ability to rapidly, cost-effectively, continuously, and (About District, n.d.), with a majority of tribal communities
exponentially upskill the workforce (Mormina & Pinder, in six of its eight rural blocks. Low birthweight babies,
2018). Furthermore, qualified trainers can act as health teenage pregnancies, and anemia are some of the high-
facility-based mentors to continually reinforce the lessons risk factors related to adverse outcomes in MNH in
learned during clinical practice. Palghar (End Malnutrition, MLD Community Care, n.d.;
In addition to essential clinical knowledge and skills, Project Spotlight Palghar, End of Project Evaluation, n.d.).
non-technical attributes for ToT trainers include good Due to these reasons, the Government of Maharashtra

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