An assessment of a ‘training-of-trainers programme for clinic committees’ in a South African district: a qualitative exploratory study

Abstract

Background In South Africa (SA), clinics and community health centres are the predominant primary level health care facilities in the public health sector. As part of legislated health governance requirements, clinic committees (referring to those for clinics and community health centres) were established to provide management oversight and bring to bear the perspectives and participation of communities at Primary Health Care (PHC) facilities. Clinic committees need training in order to better understand their roles. Facilitators in a district of SA were trained through a designated programme, called the ‘PHC Facility Governance Structures Trainer-of-Facilitator (ToF) Learning Programme‘, in preparation for the training of clinic committees. This paper explores how the programme had evolved and was experienced by the trained facilitators, in a district in SA. Methods We employed a retrospective qualitative case study design, guided by the Illuminative Evaluation Framework, with the training programme in the selected district as the case. The study assessed whether the intended aims of the training programme were clearly conveyed by the trainers, and how participants understood and subsequently conveyed the training programme intentions to the clinic committees. Key informant interviews and focus group discussions were conducted with trainers and managers, complemented by a review of relevant policy and legislative documents, and published literature. Study participants were purposively selected based on their involvement in the development, facilitation or training of the programme. Thirteen individuals participated in the study, and 23 (national, provincial and partner) documents were reviewed. Results Despite the different perceptions and understandings of the ToF Learning Programme, its overall aims were achieved. Trainers’ capacity was strengthened and clinic committees were trained accordingly. The training programme holds promise for possible national scale-up. The high quality of the interactive posters can be considered equally valuable as a training tool as the training manuals. Conclusions Trainers’ capacity was strengthened and clinic committees were trained accordingly, despite deviations in implementation of the original training approach and plan.

Lessons from community participation in primary health care and water resource governance in South Africa: a narrative review

“…Despite wide coverage, there were no studies available on how health committees’ function in provinces other than Eastern Cape, Western Cape and Gauteng. Nevertheless, these described limited participation due to lack of political commitment, lack of support from the health system, lack of resources and limited participation by facility managers and local government councillors [ 8 , 35 ]. Without support, health committees cannot do their jobs properly.…”

Building sustainable local training capacity in maternal and newborn health within the public system-A training intervention research in Palghar District, western Maharashtra, India

“…Adult learning process can be transformative and transformational. 28,[32][33][34] Hence a conscious shift in the teaching style of the trainers was attempted by making them adult-learner-centric facilitators and effectively using simulation-based learning approach which has been valued in training intervention research. [35][36][37] The positive outcomes of the current training intervention in terms of increased confidence among Palghar MTs and enhancement in clinical knowledge and skills of health providers demonstrated the appropriateness of this approach.…”

“…They also mentioned adapting to evidence-based practices and avoiding harmful practices which were previously followed without assessing their clinical relevance or checking This training intervention adopted a TOT model and presented its effects on developing sustainable competent trainers within the public health system. There are several studies that document the content and criteria for assessment of TOT 28,29 however little evidence is available about the approach, implementation steps or prerequisites of TOT for achieving expected gains. 10 The TOT planning and evaluation require capturing outcome as well as process measures, the ultimate aim and the steps required to achieve it.…”

A ‘training of trainers’ programme for operational research: increasing capacity remotely

“…A ‘Training of Trainers’ (ToT) approach was used to accommodate the varied and diverse skills of participants, the local contexts, the desire to scale up training activity and ultimately contribute to strengthening the health system [ 11 ]. A ToT approach was purposely used to allow training of a cohort in a compressed time frame, as opposed to a year of experiential learning [ 12 ]. This was necessary because the traditional SORT-IT programme relies on the use of a mentorship model to provide participants with hands-on experience, which requires a substantial investment in terms of human resources [ 13 ].…”