The training need assessment was designed to collect information on training gaps in various clinical RMNH care and identify training needs among health personnel working in sampled health care facilities under the IMPACT project in Mwanza region. The findings of the TNA were critical in guiding the design of the interventions for capacity building among HCPs in the region. The findings highlight the training gaps as perceived by HCPs working in RMNH that indicate training priorities for the study setting in Tanzania.
The findings of this study show that the training needs were the highest in 16 (out of 49) care items. Amongst the identified gaps were: cervical cancer screening and care; basic and comprehensive emergency obstetric and newborn care (BEmONC & CEmONC); sexual and gender-based violence; providing information, education, counselling on family planning to adolescents; and implementing the maternal, infant and young child nutrition programmes. These findings are supported by research in India, Pakistan and Nigeria where gaps were identified in maternal and newborn care, skills in emergence and basic obstetric care among health providers (21-23). However, for the Pakistan study, the gaps were categorized by cadres where medical doctors poorly performed in MNCH in comparison with other cadres. Our study did not perform such a comparison, because this was a perception study, we did not observe HCPs’ performance. The highlighted training gaps correspond with areas in RMNH with poor indicators in Mwanza and the country in general (24), it is therefore not surprising that HCPs perceived these areas as gaps. For example, there is high maternal mortality rate, neonatal mortality rate and perinatal mortality rate (556 per 100, 000 live births, 25 per 1000 live births and 39 per 1000 live births respectively), only 32% use of modern contraceptives methods among women of reproductive age, and 42% of ever married women have experienced spousal violence, whether physical or sexual in Tanzania (19). To enhance providers’ competencies, refresher continuing medical educational programmes relevant to specific health care cadres are required.
Previous studies have highlighted barriers preventing HCPs from attending continued education that include negative attitudes (25), time constraints and limited finance to support training (25-27), child care and home responsibilities(26), lack of opportunity and previous negative experience(27). It is critical to have mechanisms in place that ensure health care professionals are continuously supported to attend relevant on-job trainings that will translate in improved RMNH outcomes. Furthermore, the findings of our study call for a collaborative work between professional training institutions and the government to design innovative continuing educational programmes that not only would respond to the needs of HCPs but also include blended short courses that allow flexibility and enhance their clinical practice for improved quality of care. Additionally, health care managers need to understand factors hindering and motivating HCPs from attending continuing educational programmes and set up strategies to promote and warrant participation. Addressing the training needs of HCPs may contribute towards achieving reduced maternal and neonatal deaths and morbidities especially in low resource settings.
Surprisingly, accessing research resources (i.e. time, money, information, equipment) and identifying research needs and designing locally relevant research were among the topics that received the highest ratings. This findings contradicts a common stereotype on lack of interest for research among clinicians reported in United Kingdom and Bahrain (28, 29). However, the findings from other previous studies indicate a low self -assessed research capacity among nurses (30, 31) and a need for training in research methods among nurses and other HCPs (30, 32, 33). In alignment with our study findings, lack of research resources like time and funding were found to be the most commonly perceived barriers to undertaking research among practitioners in the UK ,USA and Bahrain (28, 29, 34), increased paper work and disruption to work flows (34) and lack of statistical support (29). Among the motivating factors for participating in research included providing benefits to patients, hoping to create knowledge relevant for patient care, finding solutions to difficult health problems and as an opportunity for professional development among clinical staff (34) and research supportive environment such as a research mentor (35). Health care providers in clinical practice are in a unique position to identify health problems and propose relevant evidence based solutions through clinical research. These findings call for innovative strategies for inculcating a research culture and required skills among practicing HCPs including joint research between clinical and academic institutions to design context specific relevant clinical action research with direct impact on patient care.
Overall, the perceived importance on the specific tasks was positively correlated with the overall perceived performance of tasks related to RMNH services. Similarly, findings of a study in South Africa indicated that, the more comprehensively professional nurses were trained, the more competent they felt, and they expressed more negativity towards their work if they perceived they were inadequately trained (36). The fact that the HCPs’ perceived importance of the tasks correlated with their perceived performance underscores the need for ensuring strategies are in place to address the identified training gaps. This implies, HCPs may lack confidence in their performance in the areas that were perceived important but with less ability to perform the tasks that might hinder their overall performance. Conversely, in a study among Tanzanian enrolled nurse midwives, more than 90% of the participants demonstrated both high performance and perceived competence in provision of primary health care services related to family planning, maternal and child care (37). One explanation could be that our study involved HCPs at various levels of care including referral facilities that require advanced skills for provision of RMNH including emergence care as opposed to the above study that only explored the elements of primary health care. Nonetheless, there is a need to tailor the trainings to the needs of the providers, this study was undertaken to determine and contextualize the specific training needs of HCPs in Mwanza.
As expected, majority of HCPs in the studied setting were registered and enrolled nurses constituting 67 percent of all study participants. These findings reflect the overall number of nurses and midwife in Tanzania who constitute more than 60 percent of the total health care workforce in Tanzania(38). Nevertheless, the results may be confounded by higher numbers of registered and enrolled nurse midwives that may not be representative of the training needs among other HCPs.
Limitations
This study was conducted in only one region and therefore might limit the generalization of the findings in broader contexts. However, the sample was obtained randomly thus enabling generalization to the study area. The study used a WHO tool that has not been previously validated within the country. However, in this study, the reliability of the adapted TNA questionnaire was tested and found to be 0.954. Relatedly, indexes for construct validity was found to at acceptable level with CFI equal to 1, (CMIN/DF) equal to 0.000 and RMSEA of 0.185, suggesting the tool to having acceptable reliability and validity.