Viewpoint : rethinking PHC training

Focus is on inservice training of health personnel in Africa. (1) Training in and of itself rarely solves health delivery problems, since new skills must be supported by commodities and other system elements. (2) The transfer of technologies and techniques is not a sufficient training goal; training programs should develop skills in policy formulation, data analysis and use, management, and financing. (3) Workshops alone do not constitute an inservice training program, which should also incorporate needs assessment, planning, field follow-up, supervision, and evaluation. (4) Standardized curricula often fail to take into account trainee skill levels and changing local priorities; fewer prepackaged materials and more trainers skilled in curriculum design may be in order. (5) Participatory methods do not guarantee learning; training methods must fit the kind of learning that is sought, the experience and style of the trainer, the time available, and diversity of participants. (6) It is unlikely that "cascade" or "trickle down" training results in improved performance at the peripheral level; more second-generation or direct training at all levels is needed. (7) There is no one administrative structure that can ensure high-quality training. (8) Inservice training may actually work against sustainability. For example, health care delivery is often disrupted while personnel are in training, donor per diems can create expectations among personnel that they will be paid for training, and host governments are often unable to continue funding for special training activities.