Contact for this presentation:

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Health Care Provider Performance
Review (Presentation at the Bill and Melinda
Gates Foundations summit Teach to Reach
Innovative Methods for Immunizations Training,
November 2, 2015, Seattle, Washington)

• Contact for this presentation
• Alexander K. Rowe, MD, MPH
• Malaria Branch, Division of Parasitic Diseases
  and Malaria, Center for Global Health
• Centers for Disease Control and Prevention
• Mailstop A06
• 1600 Clifton Road
• Atlanta, GA 30329
• United States
• Telephone [phone] Fax
  1-404-718-4815 Email axr9_at_cdc.gov
• Saved as HCPPR Phase 2\Trips\2015_11 Seattle Vax
  Learning Summit\HCPPR Teach to Reach Summit BMGF
  2015 v1.ppt
• last updated November 1, 2015

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Teach to Reach Summit Panel Learning in the
field
Alex Rowe, MD, MPH Malaria Branch, Centers for
Disease Control and Prevention
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Learning in the field

• Focus of Teach to Reach is on training learning
• In low- and middle-income countries (LMICs),
  training often occurs in classroom setting
• Panel explores approaches outside classroom to
  improve training and learning, with ultimate goal
  of improving health worker (HW) practices
• Panelists will describe their approaches, then a
  conversation to learn more (note your questions)
• To provide context on improving HW practices in
  LMICs results of large systematic review

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Health Care Provider Performance Review

• Systematic review of the effectiveness of
  strategies to improve HW performance in LMICs
• Investigators CDC, JHU, MSH, WHO, Harvard
• Includes any quantitative study of effectiveness
  of any strategy to improve HW performance in
  LMICs
• HW broadly defined public or private-sector
  HWs in hospitals, clinics, or
  communities
• Eligible study designs controlled trials and ITS
• 497 studies from 1960s to late 2000s update
  underway
• Following results on improving any HW practice
• Effect sizes are -point change (e.g.,
  intervention increases from 40 to 50, effect
  size 10 -points)

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Illustrative results (N100 study comparisons)
Strategy Median effect size (-points)
Supervision high-intensity training 26
Patient/community support strengthen infrastructure regulation/governance other mgt techniques supervision low-intensity training 25
Patient/community support low-intensity training 13
Group problem solving low-intensity training 12
High-intensity training only (gt5 days interactive edu) 12
Low-intensity training only (lt5 days or no interactive edu) 8
Supervision only 7
Printed or elec. information or job aids for HWs only Near zero
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Factors associated with training effectiveness

• Analysis of 96 studies to understand what makes
  training more or less effective
• Interaction between train duration topic
  complexity
• Longer training seems to increase effectiveness
  by 2 to 3 -points per added
  day for training on multiple health topics
• But not for single-topic training (no sign.
  association)
• Clinical practice, use of multiple educational
  methods, and on-site training might improve
  effectiveness more research needed to confirm

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Training duration versus effect size among
studies with training lt20 days /- other
components
Multiple topics
Effect size (-points)
Single topic (essentially flat)
Days of training
Note Predicted effect sizes adjusted for other
strategy components, baseline, and on-site
training.
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Conclusions

• Many studies exist on many strategies in LMICs
• To improve HW practices
• Training alone tends to have modest effect
• Training other components (e.g., supervision)
  might be better
• Effectiveness of training seems to depend on
  duration and topic complexity
• To date, importance of training methods,
  attributes of trainers, and training location are
  unclearperhaps because of limitations in how
  research is reported
• Panel will provide additional, detailed insights
  on training and learning outside of the classroom

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Extra results
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