This study employed a cross sectional quantitative survey design. Data for this study were collected as part of the baseline TNA for the IMPACT project conducted in 2017. Health care providers working in RMNH of selected health facilities responded to a self-administered questionnaire to identify individual priority training needs.
Study setting
This study was conducted as part of the 2017 baseline survey for the IMPACT project in Mwanza region in Tanzania. The IMPACT is implemented by a consortium of Aga Khan Development Network (AKDN) agencies, namely the Aga Khan Health Services Tanzania (AKHST), Aga Khan Foundation in Tanzania (AKFT), and the Aga Khan University East Africa (AKU EA), in partnership with the Tanzanian Government through Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) and President`s Office Regional Administration and Local Government (PO RALG) at national, regional, district levels and local communities. The study took place in selected government-owned and designated faith-based healthcare facilities in all eight councils of Mwanza region: Buchosa, Ilemela, Kwimba, Magu, Misungwi, Nyamagana, Sengerema and Ukerewe (18). This region is located in the northern part of Tanzania with about 3 million inhabitants (18).
Study Population
The participants included all HCWs who were a) working in the labour ward and assisting the deliveries; and 2) working in reproductive and child health clinics (under-five clinic, family planning, immunization units) at the time of the study. The study included HCWs who could fluently communicate and understand either Kiswahili or English language and provided written consent to participate. We excluded non-RMNH care providers and those who were sick during data collection.
Data collection tool
The TNA tool was adapted from a validated WHO/Hennessy-Hicks tool (21) with 49 items focusing on capacity and training needs of RMNH health personnel. Prior to actual data collection, the researchers visited the field to familiarize with the context and gain insights on the planning of the study and the intervention. Field visit notes and the existing evidence from the study context inspired the modification of the Hennessy-Hicks training needs analysis questionnaire. This questionnaire has been internationally validated and considered successful in identifying and prioritizing training needs at the individual, group or organizational level (21). Inspired by this tool, researchers developed a questionnaire with 49 items to assess individual training needs of HCWs in reproductive healthcare in general for maternal, adolescents and newborns (36 items), leadership and management skills (9 items), and research skills (5 items). The reliability and validity of the developed TNA questionnaire was determined and the reliability of the adapted was found to be 0.954. The indexes for construct validity indicated that Comparative Fit Index was equal to 1, minimum discrepancy per degree of freedom (CMIN/DF) was equal to 0.000 and the root mean square error of approximation (RMSEA) was equal to 0.185. This indicates that the TNA questionnaire has acceptable psychometric properties.
Data collection procedure
Data was collected from HCWs working in 36 sampled government-owned and designated faith-based healthcare facilities (7 hospitals, 12 health centres and 17 dispensaries) using the modified and an internationally validated questionnaire. The self-administered questionnaires were distributed to 153 participants by research assistants supervised by one of the researchers from the research team. The eligible RMNH providers were identified by the in-charge of the health facility.
Four research assistants with experience in data collection in RMNH were involved. They were trained for nine days around the best practices on data collection, obtaining informed consent, adherence to ethics as applied to human subjects’ research and data security measures.
Pilot study
A pilot was conducted in one government hospital that was selected based on how similar its characteristics were with the facilities that were to be included in the TNA baseline survey and this facility was excluded in the actual survey. The results from the test were discussed with research assistants, clarifications made, and minor modifications done including adjustment of the flow of the questions.
Sampling and sample size
All health care workers responsible for RMNH were all eligible to participate in this study. Participants were selected from 36 out of 80 stratified random sampled health facilities supported by the IMPACT project. The healthcare facilities involved 7 out of 8 hospitals in eight districts in the region, 12 out of 19 health centres, and 17 out of 53 dispensaries in Mwanza. All healthcare workers in RMNH who were available at the time of the survey were included in the study. There were no any refusals and some who did not meet the inclusion criteria were excluded.
Data analysis
The Statistical Product and Service Solutions (SPSS, version 25.0) was used for data entry and statistical analysis. Both descriptive and inferential statistics were analyzed. The HCWs provided ratings on: a) how important is the task to their caring role (Rating A) and b) how well the task is currently performed (Rating B) (21), and the differences in scores were calculated to identify the greatest training needs among the studied tasks (21). The greater the difference between rating A and B, the greater the training need and was categorized as a top priority i.e. important task, but not well performed. Where a task scored low on both A and B, the task was considered a low priority i.e. unimportant task, but not well performed. Where both ratings were rated high, the task required no training i.e. an important task, well performed. The difference in aggregate scores were analyzed indicating the percentage of participants who scored at least five for A minus the percentage of participants who scored at least 5 for B. The Chi-square test and correlation coefficient was used to determine the relationship between sociodemographic and task performance and perceived importance between HCWs.