R E S E A R C H A N D E VA L U AT I O N R E P O R T

Rapid Assessment of the Health Worker In-Service Training Situation in Ethiopia: Survey of Training Program Provider Practices and Key Informant Interviews

MARCH 2014 This assessment report was prepared by University Research Co., LLC (URC) for review by the United States Agency for International Development (USAID) and authored by Fikreab Kebede, Keneni Gutema, Abyot Asres, Tana Wuliji, and Emily Lanford of URC. The work described was conducted under the USAID Health Care Improvement Project and the report completed under the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, both made possible by the generous support of the American people through USAID and its Office of Health Systems. The Ethiopia in-service training assessment was supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

RESEARCH AND EVALUATION REPORT

Rapid Assessment of the Health Worker InService Training Situation in Ethiopia: Survey of Training Program Provider Practices and Key Informant Interviews MARCH 2014

Fikreab Kebede, University Research Co., LLC Keneni Gutema, University Research Co., LLC Abyot Asres, University Research Co., LLC Tana Wuliji, University Research Co., LLC Emily Lanford, University Research Co., LLC

DISCLAIMER The views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

Acknowledgements The authors would like to thank the Federal Ministry of Health for their advice and leadership in facilitating stakeholder consultations in the design and development of this assessment, identifying inservice training program providers to participate in the assessment and convening key stakeholders to review and discuss the assessment findings – especially the Honorable State Minister Dr. Amir Aman, Dr. Fitsum Girma and Mrs. Rahima Shikur. The Federal Ministry of Health Technical Working Group on health worker in-service training contributed actively throughout the assessment process and played a key role in shaping the design of the assessment and guiding the identification of respondents. Many thanks to the Jhpiego led consortium in the USAID Ethiopia Strengthening Human Resources for Health Program for their collaboration in hosting the stakeholder workshop where the assessment findings were reviewed, discussed and used to develop the national strategic framework for in-service training. Special thanks to Dr Samuel Hailemariam and Mr. Eshete Yilma of the USAID Ethiopia Mission staff for their guidance and support. The authors would like to appreciate Ms. Diana Frymus, USAID Washington, for her ongoing support and advocacy for health worker training improvement. Finally, the authors have appreciated the many hours and efforts taken by the assessment respondents to participate in this assessment, the information and insights they have shared have been critical towards our enhanced understanding of the in-service training situation in Ethiopia and priorities for improvement. This report was prepared by University Research Co., LLC (URC) under the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, which is funded by the American people through USAID’s Bureau for Global Health, Office of Health Systems. The project is managed by URC under the terms of Cooperative Agreement Number AID-OAA-A-12-00101. URC's global partners for USAID ASSIST include: EnCompass LLC; FHI 360; Harvard University School of Public Health; HEALTHQUAL International; Institute for Healthcare Improvement; Initiatives Inc.; Johns Hopkins University Center for Communication Programs; and Women Influencing Health Education and Rule of Law, LLC. The assessment was designed and implemented under the USAID Health Care Improvement Project with the assessment publication finalized with the support of ASSIST. The assessment was funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). For more information on the work of the USAID ASSIST Project, please visit www.usaidassist.org or write [email protected].

Recommended citation: Kebede F, Gutema, K, Asres A, Wuliji T, Lanford E. 2014. Rapid assessment of the health worker inservice training situation in Ethiopia: Survey of training program provider practices and key informant interviews. Research and Evaluation Report. Published by the USAID Health Care Improvement Project. Bethesda, MD: University Research Co., LLC (URC).

TABLE OF CONTENTS List of Tables and Figures ............................................................................................................... i  Acronyms ....................................................................................................................................... ii  EXECUTIVE SUMMARY ......................................................................................................................iii  I.  INTRODUCTION .......................................................................................................................... 1  A.  Rationale .............................................................................................................................. 1  B.  Study Context ....................................................................................................................... 1  C.  Assessment Objectives......................................................................................................... 2  II.  METHODOLOGY ......................................................................................................................... 2  A.  Study Design ........................................................................................................................ 2  B.  Sampling............................................................................................................................... 2  C.  Description of the Study Sample ........................................................................................... 3  D.  Data Collection ..................................................................................................................... 3  E.  Survey Validation Process and Findings ............................................................................... 4  F.  Analysis ................................................................................................................................ 6  III.  RESULTS ..................................................................................................................................... 6  A.  Types of Education and Training Provided ........................................................................... 6  B.  IST Program Provider Staffing .............................................................................................. 6  C.  IST Resources and Infrastructure ......................................................................................... 7  D.  Training Content ................................................................................................................... 8  E.  Trainees................................................................................................................................ 9  F.  Length, Frequency, Modalities, and Locations of IST ........................................................... 9  G.  IST Program Provider Practices, Linkages, and Interaction ................................................ 12  H.  Stakeholders’ Recommendations on Priority IST Issues ..................................................... 29  IV.  DISCUSSION ............................................................................................................................. 29  A.  Relation to Other Evidence ................................................................................................. 29  B.  Limitations .......................................................................................................................... 30  V.  REFERENCES ........................................................................................................................... 30  VI.  ANNEXES .................................................................................................................................. 31  A.  Annex I: In-service training program provider and training program questionnaire ............. 31  B.  Annex 2: Key informant interview guide .............................................................................. 41 

List of Tables and Figures Table 1: In-service Training Program Providers, Ethiopia, July 2012.................................................... 3  Table 2: Survey Response Validation Findings: Available Infrastructure and Educational Resources .. 4  Table 3: Survey Response Validation Findings: Availability of Training/Learning Materials and Methods of Training Delivery ................................................................................................................ 5  Table 4: Survey Response Validation Findings: Number of Training Programs Provided..................... 5  Table 5: Survey Response Validation Findings: Training Facilities and Additional Infrastructure ......... 5  Table 6: IST Provider Staffing Levels with Training Evaluation Competencies ..................................... 7  Table 7: Percentage of Surveyed IST Program Providers with Infrastructure for Training ................... 8  Table 8: Percentage of Surveyed IST Programs Offering Various Content Areas ................................ 8  Table 9: Training Programs by Cadre Trained ...................................................................................... 9  Table 10: Frequency of Trainings Jan 2011-Dec 2011 ....................................................................... 10  Table 11: Training Sites, by Region: Urban vs. Rural and Type of Site .............................................. 11  Table 12: IST Program Provider Practices ......................................................................................... 12  Table 13: Formal Recognition of IST Program Providers and IST Programs ...................................... 20  Figure 1: Types of Training offered by IST Providers (% of IST providers), 2011 ................................. 7  Figure 2: Resources Available to IST ProviderTeaching Staff and Trainees......................................... 7 

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Figure 3: Word Cloud of main training topics ........................................................................................ 8  Figure 4: Length of Surveyed Training Programs ............................................................................... 10  Figure 5: Average Percent of Training Programs Delivered Through Each Modality .......................... 11  Figure 6: IST Program Provider Practices for Developing Learning Materials and Curricula .............. 18  Figure 7: Training evaluation methods used ....................................................................................... 18  Figure 8: Types of Partners IST Programs Cited Working With .......................................................... 26 

Acronyms AIDS ASSIST CBO CDC EHNRI FBO FMOH FTE HCI HIV HMIS HRIS IMCI IST I-TECH MEPI-AAU NGO PEPFAR PMTCT RHBs SNNPR TWG URC USAID USG

Auto-Immune Deficiency Syndrome USAID Applying Science to Strengthen and Improve Systems Project Community-based organization U.S. Centers for Disease Control and Prevention Ethiopian Health and Nutrition Research Institute Faith-based organization Federal Ministry of Health Full-time equivalent USAID Health Care Improvement Project Human immunodeficiency virus Health management information system Health resource information system Integrated management of childhood illness In-service training University of Washington International Training and Education Center for Health Medical Education Partnership Initiative-Addis Ababa University Non-governmental organization U.S. President’s Emergency Plan for AIDS Relief Prevention of mother-to-child transmission of HIV Regional Health Bureaus Southern Nations, Nationalities and Peoples Region Technical working group University Research Co., LLC United States Agency for International Development United States Government

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EXECUTIVE SUMMARY This report presents the results of an assessment of in-service training (IST) provided to health care workers in Ethiopia. Undertaken in 2012, the assessment used a questionnaire to elicit information from bodies providing IST (referred to in this report as IST providers) and an interview guide to elicit the views of key stakeholders, such as representatives of the Federal Ministry of Health (FMOH), professional associations, donors, and IST program providers. With the ultimate goal of providing IST programs that would be effective, efficient, and sustainable, the Ministry, the U.S. Agency for International Development (USAID) Mission in Ethiopia, and the USAID Health Care Improvement Project (HCI) with the support from PEPFAR had collaborated in 2011 to define practices that would improve IST. They identified a short list of “practices” that would help the Ministry achieve its goal. The practices involved training design; delivery; follow-up/ monitoring; evaluation/capacity building; standardization and institutionalization; the tracking of training (e.g., who has been trained in what); and linkages among health care workers and community health workers, para-social workers, program managers, and policy makers. An example of such practices is “Our organization provides technical assistance to build the capacity of other IST program providers.” The assessment sought to analyze the IST situation in Ethiopia and provide evidence to inform policy, planning, and implementation to 1) improve IST effectiveness, efficiency, and sustainability and 2) standardize and institutionalize the practices that caused such improvement. The findings would identify the strengths, weaknesses, and best practices in IST and inform the development of 1) a database to track IST training and 2) a strategy to standardize and institutionalize IST.

Methods Mixed methods were applied in this assessment including a survey of IST program providers and a survey for each IST program they offered in the calendar year 2011, as well as semi-structured key informant interviews with opinion leaders. All 63 IST program providers identified by the FMOH were invited to participate in this study and 20 purposively selected opinion leaders were invited to participate in the key informant interviews. The survey of IST providers and IST programs were applied using the Internet and received responses from 34 (55%) civil society organizations, development partners, United Nations agencies, donors and funding agencies, Ministry technical units, regional health bureaus, and academic and training institutions. The 20 interviewed stakeholders represented the Ministry, regional health bureaus, professional organizations, donors, the private sector, and IST program providers. The qualitative analysis used a thematic approach, resulting in “themes” that are named, described, and illustrated in tables in the report.

Results: Ethiopia’s IST situation The survey asked IST providers what kinds of training they provided between January and December 2011: 94% of trainings had been IST and 65% had been training-of-trainers, while pre-service and post-graduate trainings numbered far fewer, with each below 30%. IST providers’ staffs ranged from nine to 750 full-time equivalents; 53% of IST program providers had one or more FTE staff competent in designing curricula, and 53% had two or more FTE staff with training competencies. Key informants mostly agreed with the need to partner with local IST program providers to build their capacity for sustainability; however, they also had concerns on feasibility and how this would be coordinated. With regard to resources and infrastructure, most respondent IST providers provided access to computers and Internet to their staff, but only about half extended these facilities to trainees. Journal access was even less available, and having rooms for training even less so (rooms were accessed at hotels and other venues). From the 34 IST providers responding to the survey, details of a total of 72 IST programs offered in 2011 were submitted. HIV and AIDS programs were provided most frequently (28%), followed by communication skills (22%), and family planning (17%). No IST program covered human resources management, injuries and violence, or social work and care. Recipients of training were most frequently nurses, then health officers, and then physicians and rarely information system or lab personnel, health extension workers, and midwives.

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The assessment looked into 16 best IST provider practices (e.g., “Our organization provides technical assistance to build the capacity of other IST program providers”), asking survey respondents about the frequency with which each engaged in each practice on a five-point scale (“rarely” to “always”). The best practices that were reported most frequently to be always practiced related to describing to trainees the purpose of training and its objectives (79%, Table 12, line 9), ensuring compliance with national efforts (71%, Table 12, line 4), and having programs be formally recognized (59%, Table 12, line 2). The report also presents scenarios of ideal provider practices that had been selected from the IST Improvement Framework and that the stakeholders were asked to comment on. The framework was developed by the Federal Ministry of Health IST Technical Working Group, and an example of a scenario is, “All IST providers are formally authorized or accredited by local/national authorities to provide training programs.” For example, many providers (responding to the survey) claimed to have been authorized/accredited, but (interviewed) stakeholders called for better authorizing mechanisms. Similarly, 65% of IST providers said they submit IST information to a training-tracking mechanism all or most of the time, but stakeholders suggested that such mechanism should be strengthened.

Recommendations In reviewing the findings of this assessment, stakeholders prioritized IST actions as follows: 1) designing/implementing an IST strategy, 2) standardizing IST, 3) accrediting and licensing IST, 4) setting IST monitoring and evaluation guidelines, 5) establishing an IST database (tracking mechanism), 6) setting IST policy direction, 7) institutionalizing IST, 8) ensuring the accountability and commitment of trainees to share their knowledge, 9) linking IST to pre-service trainings, and 10) getting key partners to work together. They also recommended a focus on program impact, cost, approaches to curriculum standardization, alternatives to off-the-job training, potential assistance from higher education institutions, and the tracking of IST data.

Limitations The involvement in the technical working group (TWG) in the design of the survey instruments, and qualitative interviews might have influenced their response in the survey. Thus the findings presented in this report may not adequately represent all IST program providers and programs offered in Ethiopia. Nevertheless, the study gained insight from the relatively high number of IST programs reported by those IST providers who did take part and serves as the most comprehensive IST assessment to date.

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I. INTRODUCTION This report describes the methodology and results of a rapid assessment of in-service training (IST) provided to health care workers in Ethiopia between January and December 2011. Undertaken in 2012, the assessment used a questionnaire to elicit information from IST providers and an interview guide to elicit the views of key stakeholders, such as representatives of the Ministry of Health and donors, as well as IST program providers. The assessment sought to analyze the IST situation in Ethiopia and provide evidence to inform policy, planning, and implementation to 1) improve IST effectiveness, efficiency, and sustainability and 2) standardize and institutionalize the practices that caused such improvement. The findings would identify the strengths, weaknesses, and best practices in IST and inform the development of 1) a database to track IST training and 2) a strategy to standardize and institutionalize IST. With these goals in mind, the Federal Ministry of Health and USAID Health Care Improvement Project (HCI), with input from the IST Technical Working Group (TWG), designed and implemented a rapid assessment of the national IST situation; IST program provider practices; and key stakeholder opinions on IST priorities, issues, and strategic development. The findings were presented in a workshop in 2012 and used to inform the development of the Federal Ministry of Health’s (FMOH’s) Strategic Framework for IST. This framework calls for the standardization and institutionalization of IST programs to facilitate better, more harmonized, and locally owned training that is more sustainable (details of the workshop and strategic framework are published in Kebede et al. [1]).

A. Rationale Scaling up health care services is not possible without significant investments in IST to build the capability of health workers to competently, safely, and efficiently provide quality services. While IST has been widely seen as an effective way to enhance health workers’ knowledge and skills [2], many IST programs in Ethiopia had been found in a previous rapid assessment to be weak with poor planning, coordination, and quality. The percentage of health care providers offered IST was observed to be low, and even when IST programs were in place, they were often not needs based [3]. The effectiveness, efficiency, and sustainability of IST programs could be further improved if health workers, training program providers, Ministries of Health, donors, and partners worked together toward an evidence-informed vision for such improvement. The assessment design process revealed the following key challenges in Ethiopia that potentially impede progress toward IST standardization and institutionalization: 1. 2. 3. 4. 5. 6.

Limited and/or inadequate training evaluations; Training duplication, where health care workers repeatedly receive the same content; Poor coordination among IST providers, Inadequate training quality; Fragmented training systems; and Fragmented and incomplete guidance for IST, where the guidance is provided by multiple sources.

The TWG and development partners agreed to objectively inform the direction of the IST strategic development process. The FMOH and HCI, with input from the TWG, designed and implemented a rapid assessment of the national IST situation; IST program provider practices; and key stakeholder opinions on IST priorities, issues, and strategic development.

B. Study Context Ethiopia policies, plans, and initiatives toward IST improvement The Ministry’s Human Resources Directorate drafted an IST implementation guideline with the aim of standardizing and harmonizing the delivery of IST. As part of this process, the Ministry established and worked closely with the IST TWG. Efforts have been undertaken to introduce training programs for Ethiopian health care providers that will place greater emphasis on improving the quality of service delivery [4]. The U.S. government (USG) also launched the five-year Strengthening Human Resources for Health project in 2012. One of its major components is strengthening health worker competencies through IST throughout the

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country [5]. The FMOH led the development of the IST guide, as well as a concept note outlining strategies for the institutionalization and standardization of training programs to facilitate better, more harmonized, and locally owned training that is more sustainable. Global Health Worker IST Improvement Framework The development of the rapid assessment and the strategic framework was informed by a global activity in 2011 in which FMOH and USAID Ethiopia collaborated to define practices that would improve IST effectiveness, efficiency, and sustainability. Between June and December 2011, HCI facilitated a process that engaged training providers, professional and regulatory bodies, Ministries of Health, development partners, donors, and experts to develop and reach consensus on an improvement framework for IST. The development process involved 89 participants representing 26 countries and comprising stakeholder groups and experts (including the Ethiopian FMOH and USAID Mission). They engaged in five rounds of content development and review (a modified Delphi approach); the last round was an external validation of recommendations developed during the first four rounds. The resulting improvement framework recommends practices agreed upon by the stakeholders and experts to improve IST. It covers the following themes [6]: 1. Strengthening IST systems, 2. Coordination of training, 3. Continuum of learning from pre-service to in-service training, 4. Design and delivery of training, 5. Support for learning, and 6. Evaluation and improvement of training. In this connection, the FMOH and TWG identified a shortlist of practices from the framework relevant to Ethiopia’s priority interests and needs. The FMOH and TWG then agreed to undertake a rapid assessment of the prevalence of these practices and the stakeholder opinion on their desirability and feasibility and strategies for their implementation. The FMOH and TWG also decided to undertake a structured group process where the TWG and IST experts and key stakeholders would collaborate to design and reach a consensus on a national IST strategic framework that would focus on improving IST effectiveness, efficiency, and sustainability.

C. Assessment Objectives The assessment’s objectives were to analyze the current IST situation in Ethiopia and provide evidence to inform policy, planning, and implementation to 1) improve IST effectiveness, efficiency, and sustainability and 2) standardize and institutionalize the practices that resulted in such improvement. The assessment aimed to: 

Analyze Ethiopia’s IST situation;



Analyze IST provider practices in training design; delivery; follow-up/monitoring; evaluation; capacity building; standardization and institutionalization; tracking the trainings of health care workers by training recipient; and linkages among health care workers, community health workers, para-social workers, program managers, and policy makers;



Identify the strengths, weaknesses, and best practices in IST;



Inform the development of a database for health sector in-service trainings; and



Inform the development of a strategy for the standardization and institutionalization of health sector in-service trainings.

II. METHODOLOGY A. Study Design This assessment utilized a cross-sectional, mixed-methods study design and included a questionnaire for self-completion by IST program providers and structured interviews of key informants.

B. Sampling Seventy-six IST providers were initially identified by the FMOH, IST TWG, and entities that implement and/or support IST. All providers were included in the study sample. Similarly, the FMOH and TWG

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identified 20 key IST stakeholders to participate in the interviews. The study group believed that 20 would ensure a sufficient yet manageable sample.

C. Description of the Study Sample Of the 76 IST providers identified by the FMOH and TWG that had been asked to complete the survey, eight did not provide training, contact details were incorrect for four, and one was a duplicate. These 13 were thus excluded leaving a total of 63 IST providers that were invited to participate in the study. Thirty-four IST program providers (54.8% response) completed the IST program provider survey for 72 IST programs and 28 did not respond. The FMOH and TWG identified the 20 key IST stakeholders to enable the development of a representative sample of informants to share their experiences, expertise, and guidance on strategies to improve IST. In identifying these stakeholders, the FMOH and TWG sought to ensure an institutional and geographic mix. Included were: three representatives from the FMOH, two from regional health bureaus (RHBs), eight from IST program providers, two from professional associations, four from donors, and one from the private sector. One RHB representative declined the interview due to an inability to attend a face-to-face meeting. This representative was replaced by another RHB representative, maintaining the desired balance of representation. Respondent IST program providers: Most IST providers were NGOs (local and international), including development partners. Of the 34 respondents representing IST program providers, 32% were from local NGOs; 30% were from international NGOs; 21% were from public sector entities; and 15% represented such institutions as professional associations, multilateral organizations, and academia. Details of ownership and organization type are shown in Table 1. Table 1: In-service Training Program Providers (n=34), Ethiopia, July 2012 Ownership type % (n) Government

21 (7)

Private for profit: local

3 (1)

Private non-profit: local NGO

32 (11)

Private non-profit: international NGO

30 (10)

Other

15 (5)

Organization type Training institution

15 (5)

Health facility

3 (1)

NGO, FBO, CBO

59 (20)

Multilateral agency

3 (1)

Company/business

3 (1)

Donor, foundation

3 (1)

Note: FBO: faith-based organization; CBO: community-based organization.

D. Data Collection The rapid assessment used both quantitative (online survey) and qualitative (structured key informant interviews) to collect information that would achieve the study objectives. Quantitative data were collected online using a survey administered through SurveyMonkey software (Annex 1). A pre-test of the online questionnaire was administered in institutions that were not included in the actual assessment and resulted in minor changes to the instrument. This effort was designed and managed by the headquarters office of University Research Co., LLC, which manages HCI, in Bethesda, Maryland, USA. A local consultant followed up the data collection process, mainly communicating with the surveyed institutions so that their responses would be provided by the desired date. He also helped resolve respondents’ difficulties in responding to the online survey. Survey data were stored electronically and transferred to SPSS for analysis.

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Interviews were conducted from June 27th to July 27th, 2012. The interview instrument proposed “scenarios,” brief statements describing an alternative situation to one known to exist in Ethiopia (Annex 2). For example, one scenario was “All in-service training program providers are formally authorized or accredited by local/national authorities to provide training programs.” All in-service training informants were asked to share their opinions of the scenarios as well as answer questions. The study team also developed a guide providing instructions to data collectors. The study team then shared a draft of the instrument with the FMOH and TWG and then refined it. Two experienced consultants were hired to manage the qualitative data collection and analysis. Before administering the instrument, they practiced using it to identify and manage problems that might have presented during data collection. Interviews were digitally audio-recorded and transcribed for analysis.

E. Survey Validation Process and Findings Of the 34 program providers who completed the survey, four were chosen at random and asked to supply supporting documentation or evidence to verify their answers to certain questions. This exercise sought to confirm the accuracy of the providers’ responses. Survey answers were validated either through site visits to see the claimed infrastructure and training materials or by gathering and reviewing literature from providers to confirm training materials and the number of available training programs. Validation results are presented in the balance of this section, first through text and then in tables.

Infrastructure and educational resources available to teaching staff Four of these providers each stated in the survey that both computers and Internet access were available to teaching staff, but the site visits could confirm the existence of such access at only three (75%). Furthermore, all four also claimed to have access to up-to-date references, but the documentation they provided was sufficient to confirm only three of these claims (75%). Lastly, while two of the four indicated in their survey responses that teaching staff had access to journals, neither of them provided sufficient evidence to support this claim.

Infrastructure and educational resources available to students/trainees Three of the randomly selected providers reported that computers were available to students/trainees, and one also claimed that Internet access was available to them. These responses were confirmed at 67% and 100%, respectively. Additionally, three indicated that up-to-date references were available to students/trainees, and the documentation each provided was sufficient (100%). Finally, one provider stated in its survey responses that teaching staff had access to journals, which could not be confirmed (0%). See Table 2. Table 2: Survey Response Validation Findings: Available Infrastructure and Educational Resources (n=4) Availability to teaching staff Availability to students Resource

Number indicating resource was available

Availability confirmed

Confirmation (%)

Number indicating resource was available

Availability confirmed

Confirmation (%)

Computers

4

3

75%

3

2

67%

Internet

4

3

75%

1

1

100%

Up-to-date references

4

3

75%

3

3

100%

Journals

2

0

0%

1

0

0%

Availability of training/learning materials and methods of training delivery All four selected providers indicated in the survey that learning materials were used in training programs, and all four submitted sufficient evidence to confirm their reports (100%). Furthermore, all four also stated that they had one of the following training offerings: full-time, classroom-based

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training; part-time, classroom-based training; workplace-based training; distance learning; and Elearning (Table 3). Table 3: Survey Response Validation Findings: Availability of Training/Learning Materials and Methods of Training Delivery (n=4) Number of positive Number Confirmation responses confirmed (%) Availability of learning materials used in training programs

4

4

100%

Training options offered (e.g., full-time, classroom-based training; part-time classroom-based training; workplace-based training; distance learning; E-learning)

4

2

50%

Curriculum for training programs

4

3

75%

Number of training programs provided In order to confirm the number of training programs offered, the selected providers were asked for documentation to prove the existence of each they had reported on the survey. Such reports could be confirmed by only one of the three (33%) organizations that responded positively to this survey question (Table 4). Table 4: Survey Response Validation Findings: Number of Training Programs Provided (n=4) Number indicated Number confirmed (Y/N) Organization 1

10

N

Organization 2

No response

N/A

Organization 3

4

N

Organization 4

29

Y

Training facilities and additional infrastructure Site visits to these program providers were done to validate responses related to training facilities and infrastructure (Table 5). Only one stated in the survey that it possessed halls with a 50+ capacity and classrooms for