Abstract
BackgroundLike many sub-Saharan African countries, Malawi is facing a critical shortage of skilled healthcare workers. In response to this crisis, a formal cadre of lay health workers (LHW) has been established and now carries out several basic health care services, including outpatient TB care and adherence support. While ongoing training and supervision are recognized as essential to the effectiveness of LHW programs, information is lacking as to how these needs are best addressed. The objective of this qualitative study was to explore LHWs responses to a tailored knowledge translation intervention they received, designed to address a previously identified training and knowledge gap.MethodsForty-five interviews were conducted with 36 healthcare workers. Fourteen to sixteen interviews were done at each of 3 evenly spaced time blocks over a one year period, with 6 individuals interviewed more than once to assess for change both within and across individuals overtime.ResultsReported benefits of the intervention included: increased TB, HIV, and job-specific knowledge; improved clinical skills; and increased confidence and satisfaction with their work. Suggestions for improvement were less consistent across participants, but included: increasing the duration of the training, changing to an off-site venue, providing stipends or refreshments as incentives, and adding HIV and drug dosing content.ConclusionsDespite the significant departure of the study intervention from the traditional approach to training employed in Malawi, the intervention was well received and highly valued by LHW participants. Given the relative low-cost and flexibility of the methods employed, this appears a promising approach to addressing the training needs of LHW programs, particularly in Low- and Middle-income countries where resources are most constrained.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0580-x) contains supplementary material, which is available to authorized users.
Highlights
Like many sub-Saharan African countries, Malawi is facing a critical shortage of skilled healthcare workers
While few studies have examined the use of knowledge translation (KT) strategies to improve health care outcomes in low- and middle-income countries (LMIC), KT strategies may be ideally suited to addressing the ongoing training needs of lay health workers (LHW) programs, given their success and relative low cost
Characteristics of participants Thirty-six healthcare workers participated in 45 interviews, with 14–16 interviews conducted at each time point, and 3 participants interviewed at all 3 time points, as planned
Summary
Like many sub-Saharan African countries, Malawi is facing a critical shortage of skilled healthcare workers In response to this crisis, a formal cadre of lay health workers (LHW) has been established and carries out several basic health care services, including outpatient TB care and adherence support. While shown to improve access to basic health services and positively impact a variety of health outcomes [2,3,4], lack of ongoing training and supervision are recognized barriers to LHW effectiveness [3] Despite this awareness, information is lacking as to how LHW training and supervision needs may best be addressed, in order to maximize the quality and impacts of LHW contributions [3, 4]. While few studies have examined the use of knowledge translation (KT) strategies to improve health care outcomes in LMICs, KT strategies may be ideally suited to addressing the ongoing training needs of LHW programs, given their success and relative low cost
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