Placing learning needs in context: Distance learning for clinical officers in Tanzania

Figures & data

Table

Practice points
Design of a framework for distance learning in Tanzania benefited from an inquiry orientation. Identification of learning needs carried more relevance when placed in the Tanzanian context. Educational development in Tanzania demands responsiveness and dialogue with project partners. Management and resources issues may threaten sustainability of education projects.

Table 1.  AMO trainees’ learning needs (Priority 1) (n = 27)

Difficulties that AMO trainee faces when managing STIs & HIV/AIDS	Further learning that AMO trainee may need to help them deal with the difficulty and improve patient care
We are lacking the counselling skills on STIs and HIV & AIDS (4)	Training on the counselling skills (4)
Counselling skill of patients and/or their relatives (3)	Counselling skills and psychology (3)
Lack of counselling skills (4)	Training on counselling (4)
Counselling knowledge (2)	Special counselling short course (2)
Lack of knowledge on counselling skills (3)	Training on counselling (3)
Lack of knowledge on counselling skills in HIV/AIDS	Training on counselling
How to break news to patients–lack of counselling skills	Training on counselling
They tend to hide most important information	Counselling training needed
Unopenness of most of the patients	Counselling skills to clinicians
Lack of skills, and training in voluntary counselling and testing	Training on counselling and case management
Lack of drugs	Good supply of drugs from government, ordering and materials management skills (2)
Inadequate drug supply for STI Shortage of modern sophisticated drugs	To supply with enough drugs for STI treatment
Lack of awareness about STIs and HIV/AIDS of some individuals	Provision of health education to the individual and communities about HIV/AIDS
Lack of knowledge on STIs and HIV/AIDS	More training on STIs and HIV/AIDS
Proper management of venereal warts	Modernized treatment and cure

Table 2.  AMO trainees’ learning needs (Priority 2) (n = 27)

Difficulties that AMO trainee faces when managing STIs & HIV/AIDS	Further learning that AMO trainee may need to help them deal with the difficulty and improve patient care
Inadequate and not motivated health staffs in general, so do those who are dealing with treatment of STIs and HIV/AIDS (big work load in the increasing number of HIV/AIDS patients)	Training of more people to increase number of health staffs
Lack of trained laboratory staff	Special and sustainable on-the-job training
Partners, especially men, are not ready to come for treatment of STI/HIV if their wife is found with the problem	To educate both partners on the advantages of treatment and use of protective measures
Difficulties in partner tracing, e.g. some partners feel ashamed to come for treatment	Health education to the community on problems associated with venereal diseases, to incorporate STI management in other medical services
Difficult to trace the partner	How to get the partner treated
Lack of knowledge about STI/HIV in the community	To have time for doing community sensitization on STI/HIV/AIDS so that they may come early for treatment
Stigma in the community	Health education to the community
Accurate information on ARV drugs (2)	Training on ARVs (2)
Updates on ARV drugs	Training on ARVs updates frequently
ARV knowledge (4)	Special ARV knowledge a short course (4)
Shortage of drugs and other supplies (6)	Ordering and materials management skills (6)
Shortage of drugs and other supplies (2)	Training in ordering management system (2)
Poor availability of drug supplies	Advice to Ministry of Health and NGOs dealing with STIs and HIV/AIDS
Lack of adequate drugs and instruments	Further learning on drugs concerning STIs and HIV/AIDS
Improper management of STI (single partner)	Health officers must make sure both partners are treated properly
Laboratory diagnosis of STIs and HIV/AIDS (2)	Short course on laboratory diagnosis of STIs and HIV/AIDS (2)

Table 3.  COs’ learning needs (Priority 1) (n=12)

Difficulties that CO faces when managing STIs and HIV/AIDS	Further learning that CO may need to help them deal with the difficulty and improve patient care
Syndromic management of STIs is difficult due to inadequate materials and knowledge	To improve the knowledge in recognizing and managing STIs
To identify HIV/AIDS from individual patient's history	To get knowledge about STD and HIV/AIDS history taking
How to identify patients with STIs and HIV/AIDS	To get knowledge about HIV/AIDS through history taking
To diagnose HIV/AIDS patients clinically by staging patients	Advanced skills in how to diagnose and categorize patients
The patient with encephalitis following HIV	To know proper management of CNS involvement/manifestation.
Neo-natal cases	Needs more skills and knowledge on early diagnosis and treatment
HIV/AIDS very high. Lack of drug trained personnel	Help and improve medical performance
Delay of the patient to attend health facilities	Health education to the patient to attend immediately at the hospital
Delay in seeking medical care	Health education (IEC) to communities on STIs and HIV/AIDS
Inability to counsel HIV infected cases	To be provided with knowledge and skills of HIV/AIDS counselling

Table 4.  COs’ learning needs (Priority 2) (n = 12)

Difficulties that CO faces when managing STIs & HIV/AIDS	Further learning that CO may need to help them deal with the difficulty and improve patient care
Inadequate skills in how to prevent and manage the transmission of STI from pregnant woman to unborn child	To improve the skills in prevention and managing the transmission of infection from pregnant woman to unborn child
To treat patient with mental illness contracting HIV/AIDS	To know more about HIV/AIDS in cases of thus type
Lack of good follow up to patients	Will help to improve medical personnel to make good follow up
To know how to treat the opportunistic infection	Advanced knowledge on how to treat different opportunistic infection especially complicated ones
Paediatric cases in HIV	Needs more skills and knowledge on early diagnosis and treatment of PCP
Prior knowledge on prescribing ARVs; caring for HIV/AIDS patients	To learn about care and treatment of HIV/AIDS patients
Poor equipment	Make good for patient to consult with general hospital
Shortage of education and training to manage the STI and HIV patient	Improve more education and training for staff
Communication with the clients	Counselling sessions
Counselling of HIV/AIDS patients to undergo lab check up (VCT)	HIV/AIDS patients
Convincing a patient of STI and HIV/AIDS to take part in being checked (lab)	To get knowledge of counselling of these particular patients
Compliance with STI and HIV/AIDS drugs	Health education (IEC) to patients

Collated comments on Unit 1–Syndromic approach

Review focus	Comments	Suggested improvements
Clarity and relevance of stated learning outcomes.	Clear and understandable (5)–OK (1).	Minor things–names used for case studies do not match with gender–needs changes.
Written guidance on how to use the Study Guide.	Was clear, in good order easy to catch it, well elaborated, fine and friendly for user.	Need to indicate which papers to find abbreviations and acronyms.
The role played by the reflective journal.	Useful, very interested and teachable, makes people think more to solve problems, there should be a space for learners reflections, good.	Include in the guidance part - learner is required to add his/her own reflection and what to do about it.
Relevance of content to Tanzanian context.	Useful but not enough for upgrading from CO to AMO, not much differ, relevant (2) Lab. Tests mentioned are not common in rural areas.	Should include pathogenesis of these infections. Better to squeeze the relevant content to meet Tanzanian guidelines e.g. flow charts (3) Use examples which are clear to all. Mention gram stain Culture and sensitivity.
Understanding probabilistic theory and perspective pg 1-9	Useful, well understood (2), explained clearly.	References should include those which are available at our setting (cf Newton's Law).
Syndromic approach to STIs–usefulness.	Useful (5), easier for a clinician to manage case with laboratory investigations.	Nil
Clarity and interpretation of flow charts.	Useful but incomplete, don't cover all the important things, clarity can be improved, rearrangement needed, add referral system.	Should include 2nd treatment on follow up (20, also HIV counselling, the 3 vaginal discharge charts should be combined into one (2), few changes on yes/no better to use the Tanzanian Guideline, referral system required from health centre to hospital.
Usefulness of case histories.	Used Juma as female–while man, good increased knowledge, useful (4).	Change name (2).
Quality and usefulness of source (reading) materials.	Good (2), useful (4).	Minor corrections needed.

Collated comments on Unit 2–Counselling

Review focus	Comments	Suggested improvements
Clarity and relevance of stated learning outcomes.	Clear and relevant (2); clear and relevance; stated learning outcomes are clear and very relevant for the learners; they are clear and relevant for the proposed distance learners
Written guidance on how to use the Study Guide.	Good and clear, understood; relevance; it is OK; OK, very good guide to use; it is well-explained and can be easily understood, the information is valid.
The role played by the reflective journal.	Good and useful; a bit difficult; it is clear; very important to be used because it keeps on reflecting the continuity; the reflective journal is essential for indicating reflection on your counselling.	Better to use term diary instead of journal; should be made much easier for them to understand; the word journal to be addressed as diary.
Relevance of content to Tanzanian context.	Relevant; relevance; up to what we reached to-day it seems that it is relevant; content is very very relevance for the Tanzanian COs; the content is relevant to the needs of COs.	We made small/minor changes accordingly; very minor corrections made.
Usefulness of case discussions at the start and end of Study Guide.	Useful; very useful; they are very useful although we made some changes for better understanding; are very useful case discussions; usefulness at the start; allows the learner to pre-test himself, utilize experience and ability to assess learning, at the end to test competency.	The answers for case discussion should be at the end of the manual; but the answers be available at the annex; answers we wish to be written in Annex; answers to questions asked in case studies to be written at end as annex.
Development of counselling techniques, including mini dialogues.	Useful part of the manual, well elaborated; very useful; it is useful during consultation/counselling to know patient's problems; very useful because it will help in consultation and/or looking for risk reduction, for behaviour change; good skill counselling.	Practical part should be emphasized in face-to-face learning; should be stationed for practicals for every assessment; it needs practice.
Link between counselling skills and clinical diagnosis/testing.	Relevant and useful; very good; counselling skills and clinical diagnosis are a good link because if you have skill you could do very good in diagnosis; good skilled counselling will ultimately be utilized in clinical diagnosis/testing and make it effective.
Relevance of counselling theory.
Quality of Study Guide text and suitability of photocopied readings.	Good quality; very important; it is clear (readable); is good because it helps the CO to have a wide knowledge to practice skills; photocopied readings are well elaborated and useful for the learner to obtain additional information to add in more understanding.	Keep it up!