Evaluation of the Impact of Immunization Second Year of Life Training Interventions on Health Care Workers in Ghana

Abstract

Applying performance-based training interventions that follow adult learning principles and include follow-up activities after training may help to solve specific performance problems and improve health care workers’ performance in immunization service delivery. These strategies facilitate learning, minimize the forgetting curve for health care workers, and should be considered as a standard practice for future training interventions. Key Findings After implementing the immunization Second Year of Life capacity-building interventions, quantitative and qualitative data showed that health care workers (HCWs) reported a modest improvement in knowledge, attitudes, and practices in 3 performance problem areas: lack of knowledge on EPI policy; inconsistent data management, quality, and use; and weak communication about vaccination with caregivers. Trainers in district health management teams used a variety of teaching methods and delivery techniques to facilitate HCWs’ learning and help minimize their forgetting curve. Key Implications National and subnational leaders should take ownership of the capacity-building needs of their immunization workers and leverage existing mechanisms, such as new hire orientation, supportive supervision visits, and monthly data review meetings to empower their health care workers to perform EPI tasks more proficiently. Countries should value budgeting for capacity building of their immunization workforce and for behavior change evaluation to ensure an accurate understanding of capacity-building impact. Stakeholders should define their expectations of specific tangible outputs from training that link to a measurable performance objective, instead of broad “refresher” training. ABSTRACT Introduction: As part of a suite of training interventions to improve the knowledge and practice of immunization in the second year of life (2YL), training of trainers workshops were conducted with regional and district health management teams (DHMTs) in 15 districts in 3 regions of Ghana. Using adult learning principles, DHMTs implemented several capacity-building activities at the subdistrict and health facility levels, including health facility visits, on-the-job training, and review meetings. The current evaluation investigated whether frontline health care workers (HCWs) reported or demonstrated improvements in knowledge, attitudes, and practices after training interventions. Methods: Quantitative and qualitative methods with a utilization-focused approach guided the framework for this evaluation. A systematic random sample of 115 HCWs in 3 regions of Ghana was selected to complete a competency survey before and after training, which focused on 3 core competency areas—Expanded Programme on Immunization (EPI) policy; communication with caregivers; and immunization data management, recording, and use. Interviews and direct observations by data collectors were done to assess HCWs’ knowledge, self-reported attitude, and behavior changes in practices. Results: Of 115 HCWs, 102 were surveyed before and 4 months after receiving capacity-building interventions. Modest but not statistically significant improvements were found in knowledge on EPI policy, immunization data management, and communication skills with caregivers. HCWs reported that they had improved several attitudes and practices after the 2YL training. The most improved practice reported by HCWs and observed in all 3 regions was the creation of a defaulter list. Discussion: Findings of this evaluation provide encouraging evidence in taking the first step toward improving HCW knowledge, attitudes, and practices for 3 core immunization competency areas. The use of learner-focused teaching methods combined with adult learning principles is helpful in solving specific performance problems (such as lack of knowledge of EPI policy).