Systems analysis of STN training prior to project design : technical and feasibility studies project, secondary technical nurse training project design, Ministry at Health, Arab Republic at Egypt

This report identifies factors crucial to achieving project goals and objectives, analyzes aspects of Egypt"s health care system that impede the effectiveness of STN"s, and suggests project design changes. STN"s are front line workers in all Ministry of Health (MOH) facilities. Improvements in STN training are badly needed, but improvements alone will not meet Egypt"s MCH/FP health care needs. An outreach component is essential - fewer than 20% of recipients of MCH/FP services come directly to MOH facilities. However, it would be unrealistic to expect intensive sustained home visiting by STN"s. Therefore, consideration should be given to expanding the project into a primary health care manpower development project and training both STN"s and dayas (who perform the vast majority of home deliveries in both urban and rural areas). The generally complementary experiences and interests of STN"s and dayas should enable them to work together. The project, as expanded, should include STN curricular revision, pre-service skills-upgrading training for both STN"s and doctors; short skills-upgrading programs for dayas; and in-service training for practicing STN"s. Training should focus on perinatal care, oral rehydration therapy, family planning, and lower respiratory disease treatment. The MOH has already decided to certify dayas where conditions warrant, and experience with a prior project has confirmed the value of brief skills-oriented retraining of health center staff. This report also discusses current STN performance, the ability of the MOH to provide adequate training facilities, the importance of career mobility and advanced training for STN"s, STN attrition and retention problems, and STN wages, working conditions, quarters, and nonmonetary incentives. Charts and figures compare nurse-daya attributes and circumstances, summarize the proposed skills content of various training activities, and illustrate the proposed nurse manpower training flow and potential project phasing.