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Table 4 Training for LHWs delivering BPHS in PHC sectors

From: Competency building for lay health workers is an intangible force driving basic public health services in Southwest China

Themes Sub-themes Results Sample of illustrative quotes
Training opportunity status All the LHWs and leaders stated that the CDC, Health and Family Planning Commission (HFPC) and hospitals regularly organized trainings for them. Generally, the hospital provided professional trainings for us once or twice each year. The institution in charge of the PHC sectors often provided 2–3 trainings to us. (LHW responsible for chronic diseases management in PHC sector in Chongqing)
Every year the municipal CDC organizes a professional trainings. There are10–20 professional trainings provided by our CHC. (LHW responsible for health education in PHC sector in Chongqing)
Every year the institutions in charge of the PHC sectors at all levels organize regular trainings for each BPHS project. (Director of BPHS department in Chongqing PHC sector)
problems Over one third of the LHWs claimed they actually participated less in trainings due to a lack of LHWs to deliver BPHS everyday they were offered training opportunities. Similarly, most of the leaders stated that the heavy workload to deliver BPHS by few LHWs, and so, the PHC sectors had difficulty allowing LHWs to participate in trainings. I seldom take part in any training because we do not have enough staff to do the work. (LHW responsible for health management for the aged in PHC sector in Chongqing)
There is requirement for each PHC sector to arrange for LHWs to participate in trainings. I am not unwilling to have LHWs join trainings. However, I have so few LHWs to deliver BPHS daily, and we cannot complete the work if I arrange for one or two LHWs to participate in trainings. Therefore, although we welcome this kind of training, we can’t have staff take part in the training if participating in training results in no LHW to undertake work. (Director of PHC sector in Chongqing)
needs All the LHWs expressed their wish to receive more training opportunities and their hope for effective, fruitful training, such as training about professional knowledge and skills. We hope that our country could offer some responsive trainings for us every year, such as trainings on health management for the aged, which should be specific about how to guide the aged to have a healthy lifestyle…..(LHW responsible for health management for the aged in PHC sector in Guizhou)
Organizational institution status All the leaders reported that HFPCs at all levels organize trainings. Training institutions often include hospitals, medical universities, professional health institutions (CDC) and the PHC sectors themselves. They (HFPCs) offer specialized trainings on BPHS organized at the municipal level. At least five or six LHWs could participate in it. It is the training on the management of pregnant women this time, and it would be about planned immunity or chronic disease management next time. This is the training at the municipal level. There are two or three trainings at the district level. There may be some trainings from the CDC that are provided for all the public health personnel in the region. If there is any change to deliver BPHS, the hospital in change of our PHC sector would organize trainings for our staff. (Director of PHC sector in Chongqing)
problems According to some leaders, current training institutions are not appropriate to deliver training. There is no systematic training and no professional institutions to undertake training regarding patients with severe mental illness and chronic disease management. I think it is best to send our staff to the professional agencies to receive training. For example, training about patients with severe mental illness in the Mental Health Centre and training on chronic disease management in the CDC. We need practical trainings. It is good for PHC sectors to provide trainings themselves. (Director of PHC sector in Chongqing)
As for the current training for public health personnel, such as job-transferring training and cadremen training, it was not implemented very well. What’s more, just short trainings cannot provide much systematic knowledge. (Director of PHC sector in Chongqing)
needs Some of the LHWs welcome systematic trainings instead of fragmented ones. Most of the leaders thought trainings on professional projects should be provided by professional institutions. It is best to systematically organize and provide trainings that can avoid repeated trainings. (LHW responsible for health management for the aged in PHC sector in Guizhou)
… Take the management of patients with severe mental illness, for example, this training need professional institution. (Director of BPHS department in Chongqing PHC)
Training content status A majority of LHWs thought the current trainings mainly focused on polices and service specifications for BPHS. The main contents of the trainings are public health service standards, policies, and the specifications to fill out related forms. (LHW responsible for health management for the aged in PHC sector in Guizhou)
problems 1. Most of the LHWs thought current trainings concentrated on policy interpretation, form filling, and system operation. Some leaders reported that the current trainings were not responsive to needs and did not focus on the core competencies of public health, such as professional knowledge and skills.
2. More than half of the leaders complained there was no needs assessment before trainings, which resulted in trainings that do not meet needs regarding the delivery of BPHS and so do not promote the competencies of LHWs to deliver BPHS.
Ah, …, most trainings focus on how to fill out the form related to HR. I do not think it is of great practical significance. (LHW responsible for chronic diseases management in PHC sector in Chongqing)
We need to know what the BPHS projects are, and we need to know how to deliver those projects, such as the methods and techniques. These can be obtained through training, but…. (Director of BPHS department in Chongqing PHC)
Some trainings begin with the policy on BPHS and rarely involve professional knowledge. Surely we need to know related policies, but I think that it is more important for us to have related professional knowledge than knowledge about the policies …. The training is not responsive. For example, training in the field of maternity and child care should offer related professional knowledge. The training on hypertension patient management should offer professional knowledge of hypertension. We lack professional knowledge. (Director of PHC sector in Guizhou)
Sometimes the trainings at the provincial level did not meet needs. I have attended some of the trainings before. I feel that those trainings are too theoretical and are not based on our actual needs, so they is not very useful. (Director of PHC sector in Guizhou)
needs The majority of the LHWs hoped that they could receive more training about professional knowledge and communication skills and that the training would be more systematic and responsive their needs. In addition to professional knowledge and skills, the majority of the leaders added that trainings on service skills were still in need. There should be more trainings on professional knowledge and skills and communicative skills as well. (LHW responsible for health education in PHC sector in Guizhou)
Current trainings mainly focus on policies and requirements. We should not only master the basic knowledge of public health services but also the skills to deliver BPHS. These can be obtained through training, but…. (Director of BPHS department in Chongqing PHC)
For them (LHWs to deliver BPHS), it is necessary to master some medical knowledge to do health guidance and to have professional knowledge. Second, LHWs need to communicate with residents when they deliver BPHS, and so, it is very important to have communication skills. (LHW responsible for chronic diseases management in PHC sector in Guizhou)
For example, I delivered health education to residents for many years. First, I need professional knowledge; second, communication and coordination skills are very important, which require more training. (Director of BPHS department in Chongqing PHC)
I think that it’s necessary to assess training needs to improve training efficiency. (Director of PHC sector in Chongqing)
Training approach status All the LHWs indicated that the main training approaches are lectures and meeting that are mostly focused on theory knowledge training, and sometimes, there are some practice demonstration trainings and simulation trainings. Lectures given by leaders or professionals from the CDC and simulation trainings on how to carry out chronic disease management. (LHW responsible for health management for the aged in PHC sector in Chongqing)
The form of the trainings is lectures, from HFPCs or the CDC, or by attending meetings in hospitals. (LHW responsible for chronic diseases management in PHC sector in Guizhou)
problems Most of the leaders and the LHWs considered the training more theoretical instead of focusing on practical skills, which resulted poor outcomes. The only form of training is lectures without any clinical practice. (LHW responsible for health management for the aged in PHC sector in Guizhou)
Generally, the main form of trainings lectures on theory. There is little training on practice skills. (Director of PHC sector in Chongqing)
needs A large number of the LHWs believed that practice-based training was a key to promoting their competence, such as on-site guidance, field observations, and clinical practice. In terms of theoretical knowledge training, it is a good choice to use a network to disseminate trainings through which LHWs could choose their time and site to receive trainings at their convenience Training should be based on practice, and this kind of training is useful. Current training through lectures once every 3 months based on theoretical materials had less effect. (LHW responsible for chronic diseases management in PHC sector in Chongqing)
It’s a pity that I never attend the trainings because of my busy work. I love studying. I like to study through yishitong, which is a medical information service platform. The doctors on the platform are warm hearted, and I can ask them questions online. (Director of PHC sector in Guizhou)
Training period status The majority of the leaders and LHWs reported that most of the current trainings were short, from a few days to a few weeks or to one month at most. The training is often short, and it usually lasts one week or two weeks, one month at most. (Director of PHC sector in Chongqing)
There are 4–5 trainings per year, and each training lasts 2 to 3 days. (LHW responsible for health management for the aged in PHC sector in Guizhou)
problems The vast majority of the leaders and LHWs thought the short trainings could not promote LHWs’ professional knowledge and competency. They (LHWs) often attend the short trainings, and it is hard for them to have systematic learning. (Director of PHC sector in Chongqing)
needs The vast majority of the LHWs considered that long-term systematic training was needed to promote job competency instead of fragmented training. Training time is too short, and it should be arranged based on training content. (LHW responsible for health management for the aged in PHC sector in Guizhou)
Training materials and team status Many leaders pointed out the lack of useful training materials, except for the specification of BPHS, and the trainers were physicians from general hospitals, specialized hospitals, the CDC or teachers from medical universities. At present, the trainers are mainly from general hospitals, specialized hospitals, CDCs and medical universities. The main training materials are the specifications of BPHS. Trainers usually selected their preferred training materials. (Director of PHC sector in Guizhou)
.…. Many trainers are from specialized hospitals, and they do not know the requirements to deliver BPHS very well. More often, they talk more about theory. (Director of PHC sector in Chongqing)
problems Some leaders reported that there are no qualified trainers or training materials. For example, the training for new LHWs delivering BPHS is not so good. The training is often short and not systematic. LHWs could just learn how to deliver BPHS during work. There is no good trainers or good training materials to train them about how to deliver BPHS. (Director of PHC sector in Chongqing)
There are no fixed trainers. There are no qualified training materials except for the specifications of BPHS. (Director of PHC sector in Guizhou)
needs Some leaders believed that qualified training materials and trainers were needed to improve the training effects. I think we need more investment in training, such as inviting some qualified trainers to give lectures, and developed training materials involving different subjects. We should invite experts to organize trainings. The research on this issue is still lagging behind. (Director of PHC sector in Chongqing)
  1. Notes: BPHS refers to basic public health services; HR refers to health record; PHC refers to primary health care; LHWs refer to lay health workers;
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