How rethinking health worker learning and performance management can help reach zero-dose children
It's time to rethink the way we provide learning opportunities and support to our health workers in providing quality care amid ever-changing health challenges.
- 31 May 2023
- 6 min read
- by Katja Schemionek
Globally, 1.5 million people lose their lives to vaccine-preventable diseases every year, and 25 million children are under-immunised. In Gavi-supported countries in 2021, there were 12.5 million "zero-dose" children who did not receive a single vaccine shot. Concurrently, a health workforce shortage is worsening, and concerns about health workers' working conditions persist.
In many low- and middle-income countries (LMICs), health workforce shortages are a major issue. But while efforts are being made to address this, we can't neglect the existing workforce – and need to consider how to improve their performance. When health workers perform well, they're providing high-quality services, which is crucial for increasing the likelihood of desired health outcomes – and which actually helps to relieve the burden on them to an extent.
Widely used traditional lecture-style classroom in-service training and routine supervision have not had the expected impact on health worker performance or quality of care. Therefore, it is worth considering new, innovative approaches
One of the ways to improve performance is to ensure health workers are constantly upskilled and reskilled – which falls under the umbrella of learning and performance management (LPM).
So, what exactly is Learning and Performance Management?
It's a term that includes any strategy that aims to help health workers improve and maintain their performance – and it can be achieved in a number of ways. The good news is that a substantial body of evidence from LMICs shows which strategies are effective, even in the context of workforce shortages.
Not all approaches are created equal, however, and the evidence has shown that widely used traditional lecture-style classroom in-service training and routine supervision have not had the expected impact on health worker performance or quality of care.
Therefore, it is worth considering new, innovative approaches to LPM.
What are some of these effective approaches?
Gavi, the Vaccine Alliance aims to support countries in implementing evidence-based LPM approaches that are tailored to their unique needs and context, based on strategies that have been shown to be effective. The Alliance's findings are as follows:
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Multifaceted strategies that combine training with other interventions, such as supervision or group problem-solving, have greater effects on health worker performance than these interventions conducted in isolation.
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Providing the basics like equipment and supplies is essential, but it should be complemented by interventions that are shown to improve health worker performance.
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Training is more effective when it's conducted on-site where health workers usually work and when it includes clinical practice.
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Supervision is more effective when supervisors receive supervision, participate in problem-solving with health workers and provide mentorship to their supervisees.
Furthermore, health workers have indicated that they prefer workplace-based learning, clinical practice rotations, and decision-support tools. These were ranked as the top three preferred learning approaches in one in-country exploration made by one of our partners.
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Listening to the health workers within a particular country or regional setting is vital to understand their preferences when designing LPM strategies. By putting health workers' needs at the centre, countries can improve their motivation, performance and retention.
Case study: Digitising COVID-19 Vaccine Delivery in Somalia
Somalia successfully implemented a digital solution for ensuring efficient and equitable COVID-19 vaccine delivery. The solution, built on CommCare, includes a mobile and web application for frontline workers and programme administrators, with analytics dashboards for government and programmatic stakeholders. By October 2021, more than 200,000 vaccinees had been recorded in the system, with the aim of eventually administering 1.2 million doses across all 2,500 vaccination sites.
This digital solution has made vaccine delivery easier and improved workflow compared to a paper-based system, while creating reliable data of vaccinees for the first time.
The online registration system enables tracking of campaign progress and equitable distribution, and allows for following up on vaccination status. It includes features such as COVID-19 vaccination registration, eligibility-checking, status tracking and a follow-up workflow tool with an integrated learning module. The tool is adaptable and has potential for use in routine immunisation programmes.
Vaccinators are the primary users of the system, and the digital solution includes learning and training materials that improve efficiency and reduce training burden. This comprehensive tool allowed for a rapid scale-up of vaccinators' skills to roll out vaccines nationwide.
It is also easy to update learning materials and information to better respond to shifting needs as the pandemic evolves. User satisfaction has been high, with one user stating, "It is an amazing tool, we loved using it… it has made it easy to vaccinate."
This digital solution has made vaccine delivery easier and improved workflow compared to a paper-based system, while creating reliable data of vaccinees for the first time.
Practical steps to consider when developing LPM strategies
Changing the way LPM is provided requires a big cultural shift, but can be broken down into actionable steps:
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Start with a situational analysis or needs assessment to identify the areas that need improvement, as well as the causes of those areas of concern.
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Consider the existing resources, partnerships, data, and tools, including digital interventions, that could help address these issues.
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Don't try to solve all problems at once; focus on a few issues that are within your programme's sphere of influence and are programmatically important.
During the COVID-19 pandemic, the use of digital technology for LPM increased exponentially. However, the effects of digital interventions on health worker performance have been mixed, often being small to modest. Therefore, when deciding whether and how to use digital interventions, it's important to base the decision on evidence of effectiveness, suitability for the context and cost.
The effects of digital interventions on health worker performance have been mixed, often being small to modest. Therefore, when deciding whether and how to use digital interventions, it’s important to base the decision on evidence of effectiveness, suitability for the context and cost.
For any LPM strategy, it is important to monitor the performance of health workers and assess the impact of the intervention. If necessary, adapt the intervention, and continuously iterate to achieve greater impact.
Rethinking traditional approaches to healthcare worker learning and performance management can improve health worker performance, leading to better quality of care and better population health outcomes. Evidence-based LPM approaches, tailored to unique country needs and context, can also help reach zero-dose children, and make a real difference in global health.
Learn more about Learning and Performance Management (LPM)
