Training needs at district level

Citation: Devadasan N & Elias  M A. (2008) Report: Training needs assessment for district health managers. Institute of Public Health, Bangalore

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Publication type: Technical report


The Government of India allocates significant funds to the states for implementing healthcare. However, in many states the outputs are inadequate, which is reflected in the lower immunisation rates, institutional delivery rates and higher mortality rates. Experience shows that many of these problems are due to the poor management of the health system. Most states in India have a single cadre of health staff. Most of the doctors are clinicians, who are promoted as public health or hospital administrators. They do not have much training in public health or administration. This results in inadequate management of the programmes and inefficient use of resources. There is evidence that imparting appropriate management skills to the district health managers and providing technical assistance will improve the overall performance of the health services.
There is not much information about what a district health manager requires, in terms of inputs, skills and knowledge. In India, nobody has considered the district health team as a single unit; usually it is fragmented into public health and medical wings. The public health element is further divided into various vertical programmes, e.g. Reproductive Child Health (RCH), Malaria control, Tuberculosis control (RNTCP), etc. This results in a very fragmented health system. The existing training programmes focus on their particular requirements and do not lay adequate stress on overall managerial issues required to efficiently administer the district health system. Four districts from the states of Orissa and Karnataka were selected through a purposive sampling for the study. The members of the district health team, namely district health officers (DHOs), medical officers (MOs), nursing officers, programme managers, statistical officers and Community Health Centre (CHC) MOs were contacted and interviewed. Senior-level state government officials were also interviewed. Major institutes in India conducting training courses/programmes in health management were contacted, and relevant details about their training courses collected.
Of the district health team interviewed, 68 per cent was in the age group of 50-60 years, with more than 25 years of work experience. According to    their perception, the most important roles were Human Resource (HR) management, finance management and programme management. The results of the study throw light on the existing training programmes on management, their strengths and weaknesses. It was noted that although 80 per cent of the respondents of the study have attended training programmes on administration, only a few people received training in the last two years. The interviewees offered certain suggestions to improve the training programmes. They stressed the need for an induction training covering management topics. They also felt that the training has to be more comprehensive and the topics have to be dealt with in detail. Most of them felt that the current training programmes are too theoretical, and that there needs to be more emphasis on practical sessions. They also suggested that training programmes should be more interactive, with a greater degree of group discussions and group activities. There is a need for repeated/refresher training, the preferred duration being up to two weeks. It was noted that currently the state or district does not have any monitoring mechanism to ensure that all the MOs receive training. There has to be a separate wing for training coordination at the district level, and a training calendar which could be circulated well in advance; this will avoid repetitions in training and will improve participation. They also suggested an uniform training honorarium for all the trainings and participants. Most of the respondents showed an interest in attending future training programmes on management, the majority opting for interrupted mode training. The preferred months of training were either from October to December or from March to June. Majority of the respondents suggested that the training venue could be either the state capital or the district headquarters. Most respondents felt that a certificate should be given to the participants on completion of training.
Senior officials from the directorate of health and family welfare were also interviewed as part of the study. They reported that district-level officers play a major role in the healthcare delivery system. In their opinion, lack of exposure and training on public health issues is the main reason for poor managerial skills. The existing training programmes are all based only on theoretical knowledge. They suggested that the training programmes should be more fieldwork-oriented.
Based on the competencies required and in consultation with experts in the field of health management, we have drawn up a tentative curriculum that should meet the need of a district health manager. So, while there is a definite demand for district health training on public health and management, there are few providers of such courses, especially tailored to meet the needs of the government. It is hoped that this study would engender such a course.

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