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Table 2 Lessons learned during implementation of the PALM PLUS package

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

Health Care Worker Support
• Regular, sustained peer-based support is an essential component for an in-service training program
• Educational outreach can assist with training of new staff in the context of frequent staff turnover as it may facilitate peer-based support networks
• Educational outreach training methods and symptom-based algorithmic guidelines may be useful for training multidisciplinary staff if adapted to their scope of practice
• Financial incentives are highly valued by health care workers for motivation, but this should not inhibit the development of alternative incentive strategies if expectations of success consider the broader health sector compensation challenges in resource-limited settings
Trainer and Mentor Support
• Peer-based support and mentorship is equally essential for trainers and mentors
• Building sufficient training capacity is critical, and risk mitigation strategies for potential staff turnover should be considered early in the planning stages of implementation
• Sustained engagement of motivated trainers is key to training program success; this can be achieved through establishing both formal and informal networks for information sharing
Health System Support
• Linking a training program to continuing professional development credits motivates health care workers and trainers and mentors in uptake of training programs
• Having a small budget available for in-service training at health facility also increases uptake of in-service training programs – a little goes a long way!
• Regular maintenance of training logs helps with efficient and equitable allocation of training to health care workers, and an on-line, web-based tool is a convenient way to implement this