Supporting middle-cadre health care workers in Malawi: lessons learned during implementation of the PALM PLUS package

Table 1 Comparison of standard and PALM PLUS training approaches of health care workers

Standard training approach by Malawi Ministry of Health	PALM PLUS training approach
Centralized by health district	Decentralized (on-site at individual clinics)
Presentations (primarily didactic and unidirectional) by external experts	Educational outreach (facilitative, case-based) by trained peer facilitators
Large groups (50-100 participants); little discussion or interaction between participants and trainer	Small groups (10-15 participants); discussion and interaction among participants and between participants and trainer encouraged
Disease specific care	Symptom-based and integrated care
Written, narrative guidelines with figures, tables and algorithms, text-heavy	PALM PLUS clinical tool consisting of algorithm- and symptom-based guidelines in a single spiral-bound book, with graphical interface
Financial training allowances given to individual participants	No financial training allowances given to individual participants
Individual staff trained one at a time	All staff at a health facility learn at the same time
Conducted over 1–14 consecutive days	Conducted over 8–12 training sessions over a three-to-four month period