CASCADING MODEL OF TRAINING AND CAPACITY BUILDING FOR
EAPHLN-PROJECT, A CASE STUDY OF TANZANIA AND RWANDA
This case shows the successes of the cascading model approach for training of Laboratory and other
Health care personnel, designed and utilized by the EAPHLN-Project in participating countries. The
project supports training of health personnel through organizing Regional training, where the
participants from the countries have an opportunity to share experiences and expertise. The
regionally trained personnel are expected to cascade the training by facilitating knowledge transfer to
the lower level facility staff (district and regional/provincial level). The case study presented in
covers successes of cascading model for Biorisk Management training designed and implemented by
the regional project.
BACKGROUND
East Africa Public Health Laboratory Network Project (EAPHLNP)” is a regional World Bank
funded Project, which is being implemented in five countries, namely Kenya, Rwanda, Tanzania,
Uganda and Burundi in collaboration between the East, Central and Southern Africa Health
Community Secretariat (ECSA-HC) and East African Community. The EAPHLN Project has
provided the necessary support to promote increased number of highly qualified and trained
laboratory workforce. The project is supporting both long term (Bachelors, Masters and PhD)
training as well as short-term training in various disciplines that are organized in the Region.
Developing a competent health workforce is a key component of capacity building for the future
improvement in health programs and is critical to delivering on the vision, values and commitments
of global health promotion. Current and future health challenges demand new and changing
competencies to form the basis for education, training development and workforce planning.
International developments in disease prevention & management and evidence-based practice
provide the context for developing health workforce competencies, standards, quality assurance and
accountability in professional preparation and practice.
Having many health professionals travel for training outside their working stations has been a
challenge in terms cost and human resource deprivation as it takes people out of their daily working
context therefore compromising the quality of the services at the facilities. To address the challenges
of getting many staff out of their working station for either a short term or long term training, the
EAPHLNP came up with cascading model of training and capacity building to health personel, The
Project provided training to a core team of experts in each country who can then be used to cascade
and provide training to other health personnel at the national and at the health facility level (satellite
sites). The cascade model helps to provide training of large number of health work force without
incurring too much cost and creating a human resource crisis due to training related travels.
OVERVIEW OF THE PROJECT DESIGN AND THE CASCADE MODEL
The EAPHLNP has five technical working groups, the Disease Surveillance and Operations
Research Technical Working Groups led by Kenya, Laboratory Accreditation and Networking led
by Uganda, The Information and Communication Technology and the Mult Drug Resistance
Tuberculosis led by Rwanda the Performance Based Financing which is co-led by Rwanda and
Burundi and the Training and Capacity Building which is led by Tanzania. ECSA-HC Plays a
facilitating and coordinating role under the project supporting the five participating countries
The EAPHLN-Project through the Regional Training and Capacity Building Technical working
group in Tanzania has supported a number of short term and long term training across the Region.
In these Regional training participants from the supported countries were trained as TOTs in
identified areas of laboratory sciences that are priority to the Region. Therefore at the end of the
training each participant developed implementation plan for rolling out the training when they go
back to the facilities in their home countries. The training is being facilitated by Regional or Local
facilitators as well as international facilitators where necessary. The Muhimbili University of Health
and Allied Sciences located in Tanzania has been providing a Regional oversight to the quality of the
training provided by the project to make sure that the training conducted by the project meets the
internationally agreed standards.
The participating countries had shared responsibilities and developed training modules for different
courses i.e. Laboratory Management (Tanzania), Biorisk management (Uganda), Laboratory Based
Surveillance (Kenya), ICT (Rwanda) and Operations research (Kenya-KEMRI). These training
modules have been successfully piloted for training laboratory staff in the region. These modules
will be converted into e learning format for easier accessibility by staff from satellite and nonsatellite sites in the East African Region and beyond, who would wish to take the online courses.
RESULTS
The EAPHLN-Project has conducted 22 Regional training with 299 health personel trained from all
the five East African countries. The training were in the following disciplines; Laboratory
management, Disease Surveillance and outbreak investigations, Biorisk Management, Basic &
Advanced ICT, procurement training and Laboratory Assessors (auditors) training, Operational
research, ICT-TYPO3, Typo3 refresher course, Procurement, Biosecurity Assessors training,
Procurement Training, Quality Management Systems; and Monitoring and Evaluation. The trained
personel from the Regional training had trained their fellow staff at the National level and those at
the satellite sites, in this case increasing the numbers of trained personel and improve the knowledge
sharing in the Region. Through this model of training and knowledge sharing, the countries under
EAPHLN-Project have been able to train a total of 3,478 for the year 2012-2013. Each country has
trained varied number of participants under this model of approach. Kenya trained 649 out of a
target of 1045 (62%), Uganda 163 out of a target of 150, Burundi trained 40 out of a target of 54
(74%) Rwanda trained 1765 and Tanzania has trained 861 health personnel out of a target of 1160
(74.2%)
Both Tanzania and Rwanda have utilized the cascading model of training effectively for the year
2012-2013 and have succeeded in training large numbers of Health Personel compared to other
countries within the Project. Tanzania trained a core team of professionals on Biorisk management,
IDSR guidelines, Outbreak Management, Infectious Disease Control and Specimen Management at
country level. The participants from these training were trained as TOTs and therefore dispatched to
the satellite sites and cascaded the training to 698 staff at the satellite sites in Kibongoto,
Sumbawanga, Ndanda, Kigoma, Musoma, Mnazi Mmoja as shown in the Table 1.below.
Table 1: Training Conducted & Number of Health Personel Trained at Tanzanian Satellite
Sites
TRAINING CONDUCTED &
PERSONEL TRAINED
Biorisk M
TOT on IDSR
35
30
83
24
NUMBER
OF HEALTH
SATELLITE LABS
TOTAL/SITE
OM
IDC
SM
KIBONG’OTO
65
SUMBAWANG
40
147
A
NDANDA
142
73
55
270
KIGOMA
28
28
MUSOMA
55
32
51
138
MNAZI MMOJA 50
50
TOTAL
698
BM: Biorisk Management, TOT: Trainer of Trainees, IDSR; Integrated Disease Surveillance and Response,
OM: Outbreak Management, IDC: Infectious Disease Control, SM: Specimen Management
Biorisk Management is one of the courses that were successfully cascaded to the satellites in
Tanzania, where 3 staff were trained regionally, when the 3 went back they managed to train 4 other
staff at National level who then formed a team of National facilitators and trained 365 at the 5
satellite sites as shown in figure 1 bellow;
Figure1. Example of cascading Model for Biorisk Training in Tanzania
3 Regionally trained
staff
4 Nationally trained
teams
Kibongoto
Satellite site 35
staff trained
Sumbawanga
Satellite 83 staff
trained
Ndanda Satellite
site 142 staff
trained
Musoma Satellite
site 55 staff
trained
Mnazi Mmoja 50
staff trained
Participants for Biorisk management training in Ndanda Satellite Site
Rwanda has trained a core team of professionals on Biorisk management, Integrated Disease
Surveillance and Response guidelines, Outbreak Management, Laboratory information System,
SLMTA, Good Laboratory Practice, ICT and Specimen Management at country level. The
participants from these training were trained as TOTs and therefore dispatched to the satellite sites
and cascaded the training 976 staff at the satellite sites in Kibungo, Nyagatare, Gihundwe, Byumba,
Gisenyi, NRL and EID as shown in the Table 2 below.
Table 2: Training Conducted & Number of Health Personel Trained at the Rwandan
National & Satellite Sites.
SATELLITE
TRAINING CONDUCTED & NUMBER OF HEALTH PERSONEL TRAINED
Biorisk TOT on IDSR OM LIS SLMTA
GLP
ICT SM
TOTAL/SITE
LABS
KIBUNGO
68
31
20
17 53
189
NYAGATARE 28
14
2
12
56
GIHUNDWE
6
16
22
BYUMBA
68
23
27
118
GISENYI
77
15
22 78
192
NRL
50
26 26
60
162
EID
8
229
237
TOTAL
976
TOT: Trainer of Trainees, IDSR; Integrated Disease Surveillance and Response, OM: Outbreak Management,
LIS: Laboratory Information System, SLMTA: Strengthening Laboratory Management Towards
Accreditation, GLP: Good Laboratory Practice, SM: Specimen Management
Biorisk Management is one of the courses that were successfully cascaded to the satellites in
Tanzania, where 3 staff were trained regionally, when the 3 went back they managed to train 50
other staff at National Reference Laboratory who then formed a team of National facilitators and
trained 241 at the 4 satellite sites as shown in figure 2 bellow;
Figure2. Example of cascading Model for Biorisk Training in Rwanda
5 Regionally
trained staff
8 National staff
trained
Kibungo
Satellite site 68
staff trained
Nyagatare
Satellite 28 staff
trained
Byumba
Satellite site 68
staff trained
Gisenyi Satellite
site 77 staff
trained
NRL 50 Staff
trained
LESSONS LEARNT AND WAY FORWARD
 Cascading model of training may be provide
 An effective way of reaching health personel s especially those in remote areas like the
satellite sites, where many staff can be trained locally without leaving their working
stations, in this case continue offering the services to clients.
 A cost effective way of training compared to sending staff out of their working,
therefore many staff can be trained using minimum resources
 In order the increase access of the training to large number of persons from remote areas,
the project is converting the regionally developed training materials to multi-media to be
used by team at the satellite sites and other remote areas
 The regional training and capacity building TWG is working to upgrade one of the locally
developed courses in laboratory management to be offered as certificate course in the
universities in the region. This will provide training in management of laboratory services, a
skill that has been found missing in many laboratory supervisors in facilities in the region