Rethinking Training Sessions in National Health Programs: From Repetition to Impact

Introduction:

Public health training programs are essential for enhancing the skills of program managers and field staffs for implementation and operationalization point of view.  Over the last five years, I have been involved in these training sessions, conducted by the district or state health department or our medical college. However, these trainings are often repetitive and lack structured follow-up or impact assessment. Despite the high costs involved—including remuneration for participants, resource person fees, and logistical expenses—the effectiveness of these sessions remains questionable¹ .Many participants attend repeatedly due to mandatory orders, while others have never been trained since their posting. These programs need a revamp to ensure they deliver real benefits rather than just fulfilling administrative requirements.

Key Issues:

1. Repetitive Training Without Impact Assessment:
   The same content is delivered repeatedly, with minimal assessment of knowledge retention or application². Many participants view training as a formality rather than a learning opportunity. Some fieldworkers never receive training, while others attend frequently due to official mandates.
2. Lack of Monitoring and Accountability:
   Trainings function more as a bureaucratic exercise than a means to improve public health outcomes³. Post-training evaluations are conducted for formality, with no impact on certification or field application. There is no verification of whether training translates into improved service delivery or programmatic targets.
3. Disconnect Between Training Content and Field Realities:
   Trainers are often external experts with no direct authority or experience in addressing real-world field challenges. Training sessions often fail to address the actual needs of healthcare professionals. For example, last year we conducted a training on NRCP implementation targeting Medical Officers-in-Charge (MOIC) of Community Health Centers (CHCs) and Ayush MOs, with the goal of increasing onsite rabies immunoglobulin administration and vaccine delivery at the CHC level. However, infield practice, it is usually pharmacists and staff nurses who administer the injections, not the doctors. Since they were not included in the induction training, the impact was limited. Many paramedics lack confidence in performing local infiltration of injections, which results in pharmacists hesitating to stock immunoglobulin due to limited usage⁴. Proper targeting of training recipients is crucial for program effectiveness.
4. Inefficient Resource Utilization:
   Significant funds are spent on repetitive sessions without ensuring effectiveness. Participants use training days as an opportunity for government-sponsored leave, further reducing impact. The lack of digital tools and modern learning methods limits engagement and retention.

Potential Solutions:

1. Outcome-Based Training Approach:

   – Develop performance indicators to measure training effectiveness⁵.

   – Ensure training content evolves based on healthcare workers’ needs and field experiences.

   – Implement practical skill assessments instead of generic written post-tests.

2. Stronger Follow-Up Mechanisms:

   – Conduct periodic refresher courses that build on previous sessions rather than repeating basic content.

   – Establish field monitoring teams to assess how training is applied in real settings.

3. Integration of Digital Learning Platforms:
   – Use e-learning modules and mobile-based training for continuous engagement⁶.

   – Incorporate interactive elements like simulations and problem-solving exercises.

4. Better Linkages Between Health Departments and Training Bodies:
   – Ensure that training sessions address real challenges faced by healthcare workers.

   – Give trainers more authority to address field issues raised during sessions.

5. Incentivizing Effective Participation:

   – Link training performance to career growth or financial incentives.

   – Recognize and reward workers who effectively implement learned skills.

Conclusion

Public health training programs are crucial but require significant reform. Instead of repetitive, bureaucratic sessions, trainings should be customized to address real-world challenges and ensure accountability. By shifting to an outcome-based approach, leveraging technology, and improving monitoring, we can ensure that training contributes meaningfully to healthcare improvements rather than remaining a formality. It is time to rethink how we design and execute public health training to maximize its impact.

References:

1. Nongkynrih B, Salve HR, Krishnan A. Training needs assessment of national non-communicable disease program managers in India. J Public Health Emerg. 2021;5. doi:10.21037/JPHE-19-40
2. Singh A, Vellakkal S. Impact of public health programs on maternal and child health services and health outcomes in India: A systematic review. Soc Sci Med. 2021;274. doi:10.1016/J.SOCSCIMED.2021.113795
3. Bhandari S, Wahl B, Bennett S, Engineer CY, Pandey P, Peters DH. Identifying core competencies for practicing public health professionals: results from a Delphi exercise in Uttar Pradesh, India. BMC Public Health. 2020;20(1). doi:10.1186/S12889-020-09711-4
4. Das J, Chowdhury A, Hussam R, Banerjee A V. The impact of training informal health care providers in India: A randomized controlled trial. Science (1979). 2016;354(6308). doi:10.1126/SCIENCE.AAF7384
5. Hawley SR, St. Romain T, Orr SA, Molgaard CA, Kabler BS. Competency-Based Impact of a Statewide Public Health Leadership Training Program. Health Promot Pract. 2011;12(2):202-208. doi:10.1177/1524839909349163