Figure 1
Global Health Multilateral Partnership showing stakeholders involved in the project from Mozambique and the UK.
Letshego provided the local sponsorship for the project via a long-term partnership with Primary Care International (PCI). The Mozambique Institute of Health Education and Research (MIHER) acted as the administrative recipient of the PCI/Letshego funding. INS is the research and implementing partner and will have a role in promoting incorporation of research results into policy. The Ministry of Health – through the National Health Service – is the owner of the health facilities and will be the future adopters. Abbreviations: DSCM – Maputo city health directorate, HCM – Maputo Central Hospital and HGM – Mavalane General Hospital.
Figure 2
Staged approach and major outputs of Global Health Partnership.
The strategy incorporated a global health partnership that contributed to knowledge transfer in training of evidence-based guidelines and to the creation of a collaborative training site. Contributions from the technical partner in the different stages of the project and main outputs are shown. Abbreviations: INS – Instituto Nacional de Saúde; MGH – Mavalane General Hospital; MoH – Ministry of Health; PCI – Primary Care International; T1 – Trainees Cohort 1; T2 – Trainees Cohort 2; T3 – Trainees Cohort 3.
Figure 3
The content of the training curriculum in the workshops.
Shown with the pie area corresponding to the proportion of time allocated to each theme. The training package duration was 24 hours spread over 8 hours daily. This includes time spent on participant registration, adequate refreshment breaks, monitoring and evaluation quiz, post course evaluation questionnaire, certificate presentation and taking of group photograph. See Appendix 1 for more detail.
Figure 4
Implementation of Training of Trainers cascade.
Table 1
Evaluation Tools for Training Workshops.
| TOOL | DESCRIPTION |
|---|---|
| Knowledge & Self-Reported Clinical Skills and Confidence. |
|
| Participant’s End of Course Evaluation of Training Activities Delivered by Local Trainers. |
|
| Program Evaluation by Local Trainers. |
|
Table 2
Knowledge & Self-Reported Clinical Skills Confidence Pre- and Post-Training. T1 – Trainees Cohort 1; T2 – Trainees Cohort 2; T3 – Trainees Cohort 3.
Table 3
Challenges and Lessons learned, presented alongside the five key elements of the TRAIN* framework to promote ToT sustainability (*TRAIN = T – Talent, R- Resources, A-Alignment, I-Implementation, N-Nurture) [15].
| CHALLENGES | DESCRIPTION | LESSONS LEARNED | |
|---|---|---|---|
| T | Engagement of TRAINERS | Due to conflicting clinical priorities and heavy workload, there is high risk of low motivation and poor retention in training. |
|
| Diverse background of TRAINEES | Due to extreme shortage of trained doctors in Mozambique, all types of non-physicians and mid-level clinicians who provide frontline care in primary health facilities, were involved in the training cascade. |
| |
| R | Logistical and administrative challenges | Resources and administrative procedures required for training include change in timetables and displacement from their health facilities to the training site. |
|
| A | Alignment with local health policy | There was a need to align the training content with local health policies, task-shifting strategies, and structure of the national health system. |
|
| I | Implementation in a different context and environment | For implementation, adaptations to the content of guidelines and training materials were needed, due to different drug availability, level of frontline health professionals and prescription norms. |
|
| N | Nurturing the program to ensure sustainability | In the context of high service demand and under-resourcing of the health services there is a risk of suspension of the program once the external support ends. |
|