Training Needs Assessment of Service Providers

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Training Needs Assessment of Service Providers: Targeted Intervention for HIV/ AIDS in Jharkhand, India a

Anant Kumar & Prakash Kumar

a

a

Department of Rural Management , Xavier Institute of Social Service , Ranchi , India Published online: 23 Jul 2013.

To cite this article: Anant Kumar & Prakash Kumar (2013) Training Needs Assessment of Service Providers: Targeted Intervention for HIV/AIDS in Jharkhand, India, Journal of Evidence-Based Social Work, 10:4, 365-372 To link to this article: http://dx.doi.org/10.1080/15433714.2012.664053

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Journal of Evidence-Based Social Work, 10:365–372, 2013 Copyright © Taylor & Francis Group, LLC ISSN: 1543-3714 print/1543-3722 online DOI: 10.1080/15433714.2012.664053

Training Needs Assessment of Service Providers: Targeted Intervention for HIV/AIDS in Jharkhand, India Downloaded by [Indian Institute of Adv Studies] at 21:53 23 July 2013

Anant Kumar and Prakash Kumar Department of Rural Management, Xavier Institute of Social Service, Ranchi, India

Training needs assessments are pivotal for any capacity building program. Building capacity of service providers and staff involved in HIV/AIDS intervention programs is crucial because of the distinct nature of such programs. It requires specific knowledge, skills, and attitudes that are of utmost importance, influencing the reach of the program and its impact in halting and reversing the epidemic. This study was conducted to identify the training needs assessment of personnel involved in targeted intervention for high risk populations vulnerable to HIV infection in Jharkhand, India. Through the study the authors critically examine the existing training needs and gaps and suggest strategies to address them. Keywords: Capacity building, HIV/AIDS, service provider, targeted intervention, training, training needs assessment

INTRODUCTION HIV/AIDS is a communicable epidemic which has negative consequences for individuals (WHO, 2005), families (Ashford, 2006; Bor, Plessis, & Russell, 2004; Duraisamy, 2003; ILO, 2003; Pradhan, Sundar, & Singh, 2006; Ying-Ru, Shetty, Reddy, & Habayeb, 2005), societies (Bharat, Peter, & Tyrer, 2001; Ramani, Mavalankar, Tirupati, & Chand, 2008), and particularly high risk group communities (female sex workers, men having sex with men, injecting drug users, migrants, and truckers). Considering the changing nature of the epidemic (Coker, 2006; McArthur, 2009) and its spread, it needs to be addressed to halt and reverse the epidemic (NACO, 2006; United Nations, 2001, 2011) and to achieve the millennium development goals (Goal 6, target 7). With this aim, National AIDS Control Organisation (NACO)1 launched the country-wide targeted intervention (TI) program2 in India. Subsequently, it was also realized that for the better implementation of the program, building the capacities of staffs and service providers was equally important (Bharat & Mahendra, 2007; U.S. Department of Health and Human Services, 2010). Building capacities of targeted intervention non-governmental organizations (NGOs) and their staff was felt to be particularly necessary because the epidemic is leaving a significant proportion of their beneficiary groups sick, further impoverished, and more vulnerable, and thereby directly undermining the The article was written under the capacity building program of the State Training and Resource Centre at Xavier Institute of Social Service, Ranchi. The authors are thankful to NGOs and their staff for participation and cooperation in the assessment process. We would also like to thank Dr. Rohit Vishal Kumar for his help in data analysis, Subhash Chandra Rai for his help in data entry and tabulation, and Prakash Chandra Dash for reviewing the manuscript. Address correspondence to Anant Kumar, Department of Rural Management, Xavier Institute of Social Service, Dr. Camil Bulcke Path, Ranchi 834001, India. E-mail: [email protected]

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A. KUMAR AND P. KUMAR

FIGURE 1 Targeted intervention capacity building framework

program impact (James, 2005). To address and fill this gap, State Training and Resource Centres (STRC)3 were established in states to assess the training needs gaps and to build the capacity of TI NGOs and their staffs (see Figure 1 for STRC capacity building framework).

OBJECTIVES The objective of the authors in this study was to conduct the training needs assessment of TI staffs (program managers [PM], counselors, and outreach workers [ORWs]) to assess their existing knowledge, skills, and attitudes and to develop a strategy to address those gaps through training, supportive supervision, and handholding by STRC.

METHOD The study was conducted by administering a questionnaire,4 focus group discussions, and evaluator’s observations and comments. Separate questionnaires were designed for the service providers and staffs to assess their knowledge and skills. The questionnaire covers the questions related to knowledge of HIV/AIDS and targeted intervention program components such as program knowledge, planning and management skills, monitoring and supportive supervision, financial management, outreach planning and its tools, peer education, behavior change communication, referral and linkages, and skills (communication, facilitation, problem solving, and rapport building). An evaluator’s comments contain observations, process, and quality with regard to the performance of staff in targeted interventions based on the National AIDS Control Organisation’s indicators and guidelines. The sample size of the study was 60, representing PMs (20), counselors (20), and

TARGETED INTERVENTION OF HIV/AIDS IN JHARKHAND, INDIA

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ORWs (20). The questionnaire, focus group discussions (FGDs) and evaluator’s observation were collected by the STRC training staff.

FINDINGS AND DISCUSSION


Findings from the training needs assessment (TNA) of PMs, counselors, and ORWs are given below (see Figure 2). The assessment of existing knowledge and skills were graded as A (good), B (average), and C (poor) based on their responses. PMs Although there were individual differences in terms of knowledge and program management skills among managers, the TNA shows that they have good knowledge about the spread of HIV, difference between HIV and AIDS, regular medical check-up, and presumptive treatment. The weak areas where more than 50% of managers were not able to answer correctly and needs further training were syndromic case management and anti-retroviral therapy (ART) adherence (55%). PMs knowledge about project planning and management skills were found to be good and satisfactory. They have a good understanding of the work plan (80%), role of TI staffs (65%), and program implementation (65%). The areas which need further training for better program management are knowledge of outreach planning and its tools. Their knowledge about monitoring and supportive supervision was also found to be good. Nevertheless, they need further training on indicators of TI components and monitoring indicators. Knowledge about financial management was found to be good, however they need more clarification and in-depth understanding of financial management. They have good knowledge about the typology of the target, core, and bridge group, nevertheless they need further training on peer led approaches and TI programs. They showed average knowledge about behavior change communication and hence need further training on it. They have knowledge about referral and linkages but need further training. They have good knowledge about the integrated counseling and testing center (ICTC) and the concept of preferred private providers (PPP) in STI management but are weak in the areas of community care and the Directly Observed Treatment short course (DOTS). In terms of skills, it was observed that they are good in rapport building, problem solving, communications, and facilitation skills. Counselors The counselor’s knowledge about the program, counseling, and services also varied. They had good knowledge about spread of HIV, difference between HIV and AIDS, regular medical checkups, relation between STI and HIV (63%), and window period (74%) where as 58% of them had poor knowledge about Prevention of Parents to Child Transmission (PPTCT), opportunistic infections, syndromic case management, universal precaution (42%), and ART adherence (47%). Counselor’s knowledge about counseling skills also varied. They demonstrated good knowledge about pre- and post-test counseling (74%), STI counseling (63%), and counseling documentation (58%) whereas they were found to possess poor knowledge about shared confidentiality (63%). Counselor’s knowledge about TI was good. They were having good knowledge about typologies of target, core, and bridge groups and average knowledge about the TI program and peer led approach in TI. Counselor’s knowledge about behavior change communication and sex, sexuality, and gender were found to be average and there is need for further training on ABC (abstinence, be faithful, and correct and consistent condom use) methods of HIV prevention, condom demand estimation, and sex and sexuality. It is interesting to note that condom use to prevent HIV is still

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FIGURE 2

TI staff and service provider knowledge and skills (in percentage).



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precariously low in India, where only 22% of women and 37% of men aged 15–24 are using condom during higher-risk sex (United Nations, 2011). Counselor’s knowledge about referral and linkages were also found to be average and they need further training on community care centers and DOTS. Counselor’s communication and rapport building skills were found to be good.


ORWs The assessment findings show that ORWs have good knowledge about the spread of HIV, difference between HIV and AIDS, and sign and symptoms of STI, where as they showed poor knowledge related to opportunistic infections and syndromic case management. They also showed poor knowledge about outreach planning (50%), outreach planning tools (35%), and community led outreach (20%). ORWs’ knowledge about the core task of peer educators (70%) was found to be good. Their understanding of the TI program was found to be average and only 40% of them were able to correctly explain the TI program and 55% about the typologies of the target group. Their knowledge about referral and linkage were also not found to be satisfactory where only 20% of ORWs were able to explain correctly about the community care center, 25% about ART and link ART, and 30% about DOTS. Nevertheless, 75% of them were found to have good knowledge of ICTC. ORWs skills need to be further strengthened as only 60%t ORWs reported good communication skill. These findings show that there are differences in the level of knowledge among service providers and staffs. Analysis of Figure 2 reveals that the counselors and the ORWs display narrower latitudes of knowledge and skills (in many components) as compared to the PMs. For instance, most indicators show that PMs have better knowledge in comparison to counselors and ORWs. PMs showed better knowledge of presumptive treatment, regular medical check-ups, and spread of HIV. The same trend is found in terms of PMs’ knowledge about the targeted intervention program, typologies of the target group, peer led approaches in it, and core and bridge groups in comparison to counselors and ORWs. PMs also showed better referral and linkages related to knowledge such as ICTC, working with PPPs in sexually transmitted infection, and ART and link ART in comparison to counselors and ORWs. In communication, facilitation, and problem solving skills PMs knowledge was also found to be better than counselors and ORWs. Ideally, in all of these components, counselors and ORWs should have knowledge on par with PMs, if not better. This shows that counselors and ORWs need intensive training and special attention on components which are directly related to their work. Table 1 enlists the weak areas in which

TABLE 1 Areas in Which More Than 50% of Staff and Service Providers Showed Poor Knowledge Program Manager

Syndromic case management Opportunistic infections Community care centers DOTS program Sign and symptoms of STI

Counselor

Syndromic case management Opportunistic infections Community care center DOTS program Sign and symptoms of STI Presumptive treatment Targeted intervention Peer led approach in TI PPP in STI management ART and link ART

Outreach Worker

Syndromic case management Opportunistic infections Community care centers DOTS program Problem solving skills Presumptive treatment Targeted intervention Peer led approach in TI PPP in STI management ART and link ART Core and bridge group


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more than 50% of staff and service providers showed poor knowledge and where improvement is crucial. One of the reasons behind such knowledge gaps can be traced to the three aspects of TI NGO, via structural, functional, and systemic. The structural gaps which affect the program intervention are poor salary, insufficient travel allowance, security concerns, and high pressure on the staff to achieve the target. At the functional level, high pressure on staff to achieve the targets on paper, multiple reporting formats, geographical reach, lack of NGO experience in the health and HIV program, and late release of funds hampers the program. Most TI NGOs are performing well on paper but their services are not reaching the high-risk population. In such a situation, it is expected that knowledge retention will go down and vary because the service providers are not using the acquired knowledge in their day-to-day intervention. The training programs have their own limitations. It is a challenging task to train staff and service providers’ who are not well qualified, un-experienced, de-motivated, and have not received their salaries for months. SUGGESTIONS AND RECOMMENDATIONS Considering the varied knowledge levels among existing service providers and staff, it would be a challenge for the State Training and Resource Centre to address this knowledge and skills gap and achieve parity in terms of knowledge about HIV/AIDS and targeted intervention program. Nevertheless, it is hoped that by bringing changes in the training pedagogy, exposure, handholding, individual focus, and supportive supervision, their knowledge, skills, and capacities can be enhanced. Specific suggestions and recommendations which may help in addressing the training needs gap are as follows. Changes in training pedagogy such as inclusion of audio-visual medium, documentaries, films, case studies, role play, discussion and interactive sessions, group work, and integration of traditional and community based methods (RATN and KHI, 2009) may be one strategy considering the service provider and staff existing knowledge. Apart from periodic refresher training, development of self learning module may help them in further strengthening and retaining the knowledge. Orientation programs for the service providers and the staff in organizations should be made mandatory for better understanding of the targeted intervention program. This will help participants to contextualize the learning. Creation of an information resource center and e-learning (EACEA, 2008), e-library, and e-support group (SAATHII, 2006) may help in knowledge sharing, learning new things, and shared experiential learning. The TI NGOs need to work together and learn from each other’s experiences, challenges, and solutions to strengthen their intervention strategies. The existing evidence shows that TI NGOs are hardly putting any effort into finding mutually supportive solutions to their shared problems—which is important considering that many of their problems and issues are similar. Development of implementation sites into learning sites and inclusion of on-site mentoring could be a strategy for better learning and exposure as staff and service providers would be able to see the evidence of some best practices that they can suitably adapt in their own environment. This will help the participants to easily grasp and understand the concepts, program innovations, and implementation. Apart from these, a major challenge is maintenance of the quality of staffs in terms of varying educational qualification, experience, motivation, low remuneration, high turnover (Mozumder & Nora, 2009; Sogarwal, Bachani, & Venkatesh, 2010) and the lack of systems in TI NGOs. It is critical to enhance the remuneration to get experienced and motivated staff. Lack of ownership, political will, and enabling environment are other challenges which need to be addressed at the organizational level (Pact, 2009). Otherwise, investment in trainings will hardly give the expected results.


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CONCLUSION Training and capacity building of diverse groups has always been a challenge for the trainers, particularly where there is a significant knowledge gap and variance in the participants’ qualification, experience, and motivation. Nevertheless, with suitable and appropriate training pedagogy and by bringing changes to the organizational environment, work culture, and systems, these challenges can be met to a large extent.


NOTES 1. National AIDS Control Organisation is a nodal agency for formulation of policy and implementation of programs for prevention and control of HIV/AIDS in India. 2. Targeted interventions are a specific set of interventions in HIV/AIDS Control Programmes meant specifically to reach out to high risk behavior groups comprising female sex workers, injecting drug users, men having sex with men, migrant workers, and truckers. 3. State Training and Resource Centre is established by National AIDS Control Organisation to develop a sustainable system for the capacity building (of staffs and service providers of NGOs and CBOs) to impart quality training. 4. The tools used in the study were developed by State Training and Resource Centre, Child in Needs Institute, Kolkata, West Bengal.

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