Thank you for viewing this presentation.
We would like to remind you that this
material is the property of the author.
It is provided to you by the ERS for your
personal use only, as submitted by the
author.
 2012 by the author
Filling the global training gap
Lia D’Ambrosio
WHO Collaborating Centre for TB and Lung Diseases,
Fondazione S. Maugeri, Tradate, Italy
Learning Objectives
• To describe the main training opportunities
on TB, TB/HIV management & control
offered by the international training
agencies.
• To discuss the global training gap
• To identify opportunities to tackle the gap
(role and contribution of theTB PAN-NET
project)
HRD, not training !
HR development need
for global health workforce:
HRH drives health systems!
The STOP TB Strategy – 2010
1.
2.
3.
4.
5.
6.
Pursue high-quality DOTS expansion and enhancement
a.
Secure political commitment, with adequate and sustained financing
b.
Ensure early case detection, and diagnosis through quality-assured bacteriology
c.
Provide standardised treatment with supervision, and patient support
d.
Ensure effective drug supply and management
e.
Monitor and evaluate performance and impact
Address TB-HIV, MDR-TB, and the needs of poor and vulnerable populations
a.
Scale–up collaborative TB/HIV activities
b.
Scale-up prevention and management of multidrug-resistant TB (MDR-TB)
c.
Address the needs of TB contacts, and poor and vulnerable populations
Contribute to health system strengthening based on primary health care
a.
Help improve health policies, human resources development, financing, supplies, service delivery and information
b.
Strengthen infection control in health services, other congregate settings and households
c.
Upgrade laboratory networks, and implement the Practical Approach to Lung Health (PAL)
d.
Adapt approaches from other fields and sectors, and foster action on the social determinants of health
Engage all care providers
a.
Involve all public, voluntary, corporate and private providers through Public-Private Mix (PPM) approaches
b.
Promote use of the International Standards for Tuberculosis Care (ISTC)
Empower people with TB, and communities through partnership
a.
Pursue advocacy, communication and social mobilization
b.
Foster community participation in TB care, prevention and health promotion
c.
Promote use of the Patients' Charter for Tuberculosis Care
Enable and promote research
a.
Conduct programme-based operational research, and introduce new tools into practice
b.
Advocate for and participate in research to develop new diagnostics, drugs and vaccines
The global burden of TB in 2010
Estimated
number of
cases
Estimated
number of
deaths
All forms of TB
(men and women)
8.8 million
(range, 8.5–9.2 million)
1.1 million*
(range, 0.9–1.2 million)
All forms of TB
(in women)
3.2 million (38%)
(range, 3.0–3.5 million)
0.3 million
(range, 0.2–0.4 million)
1.1 million (13%)
(range, 1.0–1.2 million)
0.4 million
(range, 0.32–0.39 million)
HIV-associated TB
Multidrugresistant TB
0.65 million**
~ 0.15million
*excluding deaths among HIV+ people
** prevalent cases
Incidence of TB per 100,000 population, 2010
8
Proportion of MDR among new TB cases,
1994-2010
Estimating the global
international training needs
• Programmatic needs:
200 countries*/territories/entities x 5
persons/yr in average=1,000 persons/yr;
• Clinical needs: 2-3 times higher
*WHO Member States: 194
Search strategy
 Major established mono-thematic courses on
TB and TB/HIV
 Organized by International Organizations
 (WHO,IUATLD, CDC, KNCV, FILHA, ERS,
ATS etc..)
 Duration: > 3 days
 Exclusion criteria: e-learning, PGs at
Conferences, Formal trainings included in
Academic degrees (PhD, MPH, etc..)
At the moment
 Several epidemiological trainings (CDC, The
Union)
 1 managerial based on STB Strategy
(Sondalo, Italy) covering MDR-/XDR-TB,
TB/HIV and IC
 Several mixed ones with regional focus
(FILHA, KNCV, AFRO, JICA)
 Few MDR courses (clinical) and IC ones
 Many under PG format (< 1week)
Majority without validated and standardised materials
Search criteria for assessment
Aims
Target audience
Topics
Training Methodology
Duration
Max number of participants
FILHA Courses: Tartu & Tallin, Estonia
4 formats, short duration:
• 1) Today's Challenges in Tuberculosis Control
• 2) International training Course on Tuberculosis
for Nurses
• 3) International Training Course on
Tuberculosis control
• 4) Training Course on Tuberculosis Infection
Control
1) Today's Challenges in Tuberculosis Control
• Aims: to improve, to update the knowledge and skills of medical
specialists in addressing the changing challenges in TB control in the
Region
• Target audience: medical doctors (pulmonology, infectious
diseases, public health) and professionals working in TB
• Topics: epidemiology, surveillance, diagnostic methods, laboratory
issues, infection control, screening and treatment of latent TB
infection, new innovations in TB management and control, diagnosis
and treatment of MDR-TB, XDR-TB and TB/HIV co-infection.
• Training Methodology: interactive with lectures, discussions and
group sessions based on exercises and case studies. Site visits to
the TB and MDR-TB wards and National TB Register.
• Duration: 4 days; Max number: not specified
2) Training Course on TB for Nurses
• Aims: to strengthen nurse’s role and tasks in TB prevention, diagnosis,
treatment and infection control in the Region, improving cognitive, technical
and communication skills needed in TB management. The course covers
both theoretical and practical aspects of TB management from a nursing
perspective. In addition, the course serves as a training-of-trainers event
(ToT)
• Target audience: nurses involved in TB control activities (outpatient or
inpatient settings), in the civilian and prison sectors in those regions that
are presently implementing the DOTS or DOTS+ strategy.
• Topics: based on the training modules originally provided by CDC, revised
and adapted for local circumstances and translated into Russian
(epidemiology, basic principles of a national TB control programme, TB
prevention, diagnosis, treatment and infection control.)
• Training Methodology: focus on real-life problems, lectures, discussions
and group sessions based on case studies and exercises. Site visits to the
TB and MDR-TB wards and National TB Register.
• Duration: 5 days, Max N°: 25 pp
3) International Training Course on
Tuberculosis Control
• Aims: to enhance capacity for clinical and managerial decision making in
TB control in the WHO European Region with special emphasis on
Eastern Europe
• In collaboration with: NTP of Estonia, the Tartu University Clinics,
IUATLD & WHO
• Target audience: physicians with clinical experience of TB,
intermediate/ high-level management responsibilities in TB control from
national and regional TB Control programmes, Red Cross, other NGOs,
penitentiary care and general health care.
• Topics: diagnosis, treatment and management of TB, MDR/XDR-TB and
TB/HIV co infection. Overview of the epidemiological situation regarding
TB and HIV in the region, surveillance of TB, role of laboratory in
diagnosis and follow up of TB, infection control, drug management,
experiences in implementation of DOTS+ project, cooperation among
different actors and questions of adherence, substance abuse and
human resources.
• Training Methodology: interactive with lectures, discussions and group
sessions based on exercises and case studies and site visits to the TB
and MDR-TB hospital ward
• Duration: 8 days; Max N°: not specified
4) Training Course on TB Infection Control
• Aims: to improve the technical capacity to assess, plan,
implement and evaluate TB-IC measures in health facilities to
strengthen regional TB control programmes
• Target audience: physicians, nurses and technical (IC
equipment maintenance, ventilation) staff involved in TB control
activities from civil and penitentiary settings, HIV/AIDS services
and general health care, staff involved in regional infection
control planning and implementation or training of health
professionals
• Topics: principles related to TB-IC strategy, health facility TBIC assessment, planning and evaluation.
• Training Methodology: lectures, demonstrations, classroom
exercises and field exercises in TB wards, in a laboratory and
at an outpatient clinic.
• Duration: 5 days, Max number: 25 pp
The International Union Against
Tuberculosis and Lung Disease (IUATLD)
courses

Provide the knowledge and skills required by healthcare
professionals and programme managers to develop public
health programmes clinically sound and administratively
effective.
 Training: mix of theory and international best practices,
with emphasis on the challenges presented by limitedresource settings. Union courses serve the needs of
participants from various disciplines
 Work at different levels, and in diverse environments
 Content adapted either for international or national
groups.
IUATLD courses
Technical Courses (english/french/spanish)
 International Course on Clinical Management of DrugResistant Tuberculosis (Bankok)
 International Tuberculosis Course (Arusha, Hanoi):
epidemiological
Health Management Training Courses
 The Union’s International Management Development
Programme (IMDP)
Other technical courses
 Working Together – Strengthening the Implementation of
Collaborative TB/HIV Activities
 Course in operational research
 Courses offered on request
International Course on Clinical Management
of Drug-Resistant Tuberculosis, Bangkok
• Aims:

To provide knowledge and skills to effectively manage
cases of drug-resistant TB, especially MDR-TB.

To introduce to the challenges by XDR-TB and the
approach to treatment of drug-resistant TB from a programme
perspective.
• Target audience: clinicians working in low income settings
• Topics:. clinical and programmatic management of drugresistant tuberculosis MDR-/XDR-TB
• Training Methodology: 5-day interactive course, class
presentations, discussions & practical exercises Max N: 30 pp
International Tuberculosis Course
(Arusha, Hanoi)
• Aims: to provide:
 the key elements of TB control theory
 basis for management of NTP under field conditions
• Target audience: clinicians working in high-burden settings
• Topics:.clinical and programmatic management of drugresistant TB MDR-/XDR-TB
• Training Methodology: lectures and discussions, practical
field experience in the sputum microscopy laboratory, at the
district tuberculosis centre and in the hospital.
Health Management Training Courses
• Organized by The Union’s International Management
Development Programme (IMDP), created to train leaders in public
health with essential skills necessary for managing effective health
programmes (management education).
• Target audience: health professionals workers operating a national
health programme
• Topics: Strategic Planning, Mass Media & Communications,
Budget and Financial Management, Project Management,
Networking and Partnership, Leadership, Human Resources
Supply-Chain Management
• Training Methodology: lectures, role-plays, work simulations, critical
questions and effective solutions, real-life situations and in-class
discussions, techniques for relationship and coalition building
Course on Operational Research
•Three 5-day modules spaced out over 9 months.
•Aims: to develop the practical skills for conducting and
publishing operational research.
Development of a personal research protocol
Data collection and set up an electronic system for data
entry and analysis
Write and submit a scientific paper to an international
peer-reviewed journal
Courses upon request:
TB/HIV Collaborative Activities
•


•
•
•
Course offered upon request from both NAP and NTP of the country
programmes
Aims:
to strengthen the country-level implementation of collaborative TB
HIV activities from the point of view of both the HIV and TB
programmes
to develop a collaborative TB HIV action plan using measurable
indicators from the Global Plan to Stop TB
Target audience: National AIDS and TB Programme Managers,TB
HIV focal persons for NTP, WHO National TB HIV Programme
Officers
Course follow-up: Participants can submit abstracts on their outputs
for the IUATLD Conference and be considered as invited speakers
atn the special NTP/NAP symposium
Duration: 4-1/2 day
Max N°: not specified
Others courses upon request
• Intensive Course in Tuberculosis for Medical
Specialists
• Intensive Course in Tuberculosis for University and
Medical School Faculty
• Intensive Course in Clinical Management of Patients
with Drug-Resistance
• Management of Asthma
• Management of Tuberculosis in Children
Centres for Disease Control and Prevention (CDC)
Division of Tuberculosis elimination
Atlanta, USA
• Continuing Education Activities
• Regional Training & Medical Consultation
Centers
• TB Education & Training Network
• Find TB Resources. org
• TB Education and Training Resources Website,
Searchable database
Continuing Education Activities
Free of charge, 6.5 hours of instruction,
exam, course evaluation, CE certificate.
Self Study Modules on Tuberculosis
(Modules 1-9)
Webinars – Web-based course
Continuing Education Credits
Self Study Modules on
Tuberculosis
• Information about TB in a self-study format
• Basic information on TB: modules 1-6
• Specific TB programmatic information
(Continuing Education): modules 7-9
Web-based course Continuing
Education
Multidrug-Resistant Tuberculosis (MDR-TB)
and Extensively-Drug Resistant (XDR)-TB
(with a joint sponsorship with other USA TB Centres)
• Target Audience: State and local TB program staff and other
clinicians who diagnose and treat TB
• Topics: epidemiology of MDR and XDR-TB, diagnosis, treatment
of MDR and XDR TB, contact management
TB Education and Training
Network
 To network, share resources, and build education
and training skills.
 Provide updated information about TB courses and
training initiatives
 Membership: representatives from TB programs,
hospitals, nursing homes, federal agencies,
universities, the American Lung Association,
Regional Training and Medical Consultation Centers,
international organizations interested in TB
education and training
 Find TB Resources: the TB education & training
resources website (www.findtbresources.org)
KNCV Tuberculosis Foundation
Regional Training onTuberculosis Control
Programme Management (Riga, Latvia)
Aims:to improve TB management skills in:
 Programme planning
 Human resource management
 Finance management
 Laboratory support
 Strengthening partnership and team building
 Surveillance
 Monitoring and Evaluation
Target Audience: Senior staff involved in TB control in the WHO
European region countries
Duration: 8 days Max. N: not specified
Japan International Cooperation
Agency, JICA
Independent governmental agency,providing:
 technical assistance programs/projects for capacity and institutional
development
 assisting economic and social growth in developing countries
 promotion of international cooperation.
JICA trained more than 1500 participants from over 70 countries
since1963.
Technical training program:
Technical field-Country/Region-specific courses for participants from the
developing countries
Target Audience: senior technicians, medical doctors responsible
for the management of laboratory works in TB control program, medical
officers responsible for implementing the NTP.
Duration: from 3 weeks to 1 year Max number: 4 -15 pers
JICA’s courses on TB control
Aims:
 To assist countries with high number of TB
patients, high incidence rate of TB (assistance to
20 out of 22 high-burden countries)
 To give priority on the implementation of quality
DOTS through developing NTP and laboratory
staffs’ capacity for:
 R&R
 Laboratory networking
 Drug management logistics
 Monitoring onsite visits
WHO Collaborating Centre for TB & Lung
Diseases, Italy
Sondalo courses on Stop TB Strategy
(TB, M-XDR-TB,TB/HIV, PPM, IC & more)
Aims: to develop the necessary skills to plan, implement and evaluate a TB control
programme in the MDR-/XDR-TB era, based on the WHO- recommended strategy, the
new “Stop TB Strategy”.
Training methodology innovative centred on a Fictitious Country
•
•
•
•
•
•
•
•
•
To plan and co-ordinate the mission with WHO/ Contracting Agency, local authorities and partners
To review data on the key components of NTP based on the new Stop TB Strategy
Analyse and synthesise the main findings, identify priorities, propose solutions and develop recommendations
Write a report including key information and recommendations relevant for present or future activities according to
the Contracting Agency needs and the kind of mission
Debrief local staff and partners on the main mission’s findings and recommendations.
Submit the report to the Contracting Agency for finalisation and planning of further actions/steps
Design a plan on MDR-/XDR-TB control and implementation of TB/HIV activities
Manage different steps of a GFATM proposal
Calculate ACH (Air Changes per Hour) in different rooms and identify priorities for infection control (with focus on
high MDR-TB and HIV prevalence settings)
Target Audience: key-staff of National TB Programmes, WHO and Partners officers and
Donors managers of TB/MDR-TB and HIV programmes at the national or sub-national
level or staff involved in control programmes (Ministry of Health staff, staff of
international agencies involved in TB/MDR-TB/HIV control, leading national experts
and opinion-leaders involved in TB/MDR-TB/HIV prevention, diagnosis and care)
Coverage: 50% of national central unit staff globally from all the 22 high-burden countries, all
the European WHO Region countries and the majority of countries from all continents
Sondalo training
 10 years, best USAID-funded project 2003-4
 Managerial with clinical components
 Task analysis-based
 Built on the golden 7 rules
 Fully practical
 Measurable outcomes impact (report, recommendations, plan)
 Emphasis on “capacity to do”
 Global attendance
 Standard materials and trained facilitators (ToT)
 Participant’s, Facilitator’s and Course Director’s manuals
 Materials updated twice a year
 Pre-requisite to be registered in the TBTEAM roster
Duration: 2 weeks; Max N°: 24 pp
Role play
Theory
Individual plans, reports
and recommendations
Case study exercise:
presentation and
problem solving
Group exercise,
presentation and
discussion
The 7 golden rules
1. Define the target population for training
2. List the tasks to be performed by the target population on the job
(=job description)
3. List the skills and knowledge needed to do the tasks.
4. Organize the selected skills and knowledge into suitable teaching
units (modules) and develop the training design (including brief
outlines of module content and planned training methods).
5. Draft the teaching units (modules) with learning objectives
6. Expand outlines of modules, including instructional objectives,
draft of main body of text and descriptions of training methods,
examples and exercises.
7. Draft the complete modules, facilitator guidelines and course
director guidelines.
ERS TB trainings










Coordinated and complementary to Sondalo
Within the framework of the ERS School
ToT, quality materials
Continuous rotation of topics around the Hermes ones
Important practical component
Balance between clinical and programmatic components
Careful evaluation
Formats: PGs, External Courses, Seminars, Web Courses, MP
Durations: from ½ day to 5 days
Web bank of training materials
Drawbacks of existing training/materials
•
•
•
•
•
•
•
Not standardised
Not based on Task Analysis
Not based on Learning Objectives
Clinically-oriented
Over-use of frontal lessons
Facilitators are not trained
Evaluation:reaction evaluation
questionnaire/pre-post tests
• Facilitators are not coordinated
Conclusions
• Established major trainings support <400 trainees/yr
excluding those trained via web, during conferences and
within diplomas (PhD, Masters, etc)
• The offer of TB training is far to cover the needs
• The TB-PANNET offers a solid platform for integrated
training, complementing different initiatives into a larger
ERS perspective linking clinicians, public health officers
and other professionalities
• Your opinions and suggestions will be very important to
continue quality improvement and to fine tune future
training offers
THANK YOU!!