TRAINING OF DIFFERENT CATEGORIES OF HEALTH STAFF INVOLVED IN TB CONTROL

The education of 700 pulmonologists and 5000 primary health care providers (PHCP) and nurces involved in the treatment of patients with tuberculosis has been planned as the part of the Programme activities, which was supposed to take place during 2005. and 2006 (Q2 to Q6). All aims were accomplished as it was planned.

The preparations included:

• Development of guidelines and training materials
• Coordinated activities for selection of printing agencies
• Organisation of training sessions - selecting time ad place for all training sessions
• Coordinated activities for selection of agencies for training organisation
• Developing the program of training activities for the trainings
• Preparing the list of participants for the trainings
• Preparing the invitation letters, certificates, and all necessary materials for the trainings.

TRAININGS OF PULMONOLOGISTS

The first training of pulmonologists was held in Vrnjacka Banja, on March 27. and 28., 2005. 49 (out of 50) pulmonologists were present. All of them were selected to be the educators on the future training courses for PHCP. Physicians that had been selected were those who, in their practise, had a lot of experiance with tuberculosis, like physicians working in TB departements, or were heads of Dispenseries for TB. All of them were pulmonologists, average age 45, with 16 years of occupational experience. Ten of them were working in specialised Institutes for lung diseases, 11 in General hospitals and 27 in Dispensaries for lung diseases.

The table below gives the tame-table of all training courses for pulmonologists that were held during 2005/2006 (Q2 to Q6).

All present physicians were either pulmonologists or specialists of internal medicine working in pulmonology, from the regions close to the place where training was held. In addition, the doctors of other specializations that are dealing with either pulmonary TB (paediatricians) or extrapulmonary TB (infectologists, ginecologists, nephrologists, urologists, surgeons).

At the very beginning of the training, during the registration of the participants, all of them were equipped with all necessary materials (training program, printed books, modules, evaluation forms, pre and post questionnaires, CD’s with lectures).

A mixed type of education (lectures and workshops) was held. A Training course was introduced by 6 lectures on TB (TB as a medical and public health problem, control of TB, surveillance of TB, antituberculous treatment). Detailed lectures dealing individual components of DOTS strategy in a concrete relation to the program of TB DOTS control in Serbia followed. The presentations were completed by a video-sequences and a sufficient time was given to discussions after each presentation.

Workshops form an essential part of the second day of training courses. They were focused on exercises from modules Managements of TB Training for Health Facilities (WHO 2003), particularly those from the module A (Detect of TB) and B (Treat TB patients). Participants were divided into small groups with one facilitator.

Lecturers and facilitators were the members of the National TB Commission or the MoH Expert Team on TB.

The number of physicians dealing with TB educated through these training courses was 626. According to our data, 30 doctors that didn't come, were apsent for long lasting ilnesses or approaching retirement.

The difference between 700 planned and 626 educated TB specialists was the result of the resent MoH premature retirement measures that had started during 2005.

Monitoring and evaluation of the trainings of pulmonologists

The total number of pulmonologists present at the training courses was higher than 90% per every training.

At the begining of the training all participants were aquiped with the appropriate WHO literaturte, translated to Serbian:

WHO: Crofton et all: Clinical tuberculosis

WHO: Brief guide on tuberculosis control for primary health care providers WHO: Treatment of tuberculosis: guidelines for national programmes

WHO: Guidelines for the prevention of tuberculosis in health care facilities in resourse-limited settings

WHO: Module A: Detection of TB

WHO: Module B: Tretament of TB patients

The knowledge of pulmonologists on TB and TB control was estimated before and after the training with the simple pre- and post-questionnaires. These questionnaires consisted of 20 questions. The average percentage of false answers in pre-questionnaires was 31% and in post-questionnaire was 9%, with the improvement of 22%, which was very good.

The thorough evaluation of all elements of the training was done immediately and presented to the participants at the end of the training course before the Certificates of attendance were given to them.

TRAININGS OF PRIMARY HEALT CARE PROVIDERS (PHCP)

The trainings of PHCP started in September 2005. and were finished untill June 2006.There were 94 training sessions with 4666 partitipants in total. The educators were pulmonologists that had been trained during the first training of pulmonologists in March 2005.

The table below gives the time-table of all training courses for PHCP that were held during 2005/2006 (Q2 to Q6).

At the very beginning of the training, during the registration of the participants, all of them were equipped with all necessary materials (training program, printed books, modules, evaluation forms, pre and post questionnaires, CD’s with lectures).

Those training lasted for one day. A training course was introduced by lectures on TB as a medical and public health problem, control of TB, diagnostic procedures and antituberculous treatment. Lectures dealing individual components of DOTS strategy in a concrete relation to the program of TB DOTS control in Serbia followed, with the emphases on the role of PHCP in it. The presentations were completed by a video-sequences and a sufficient time was given to discussions after each presentation.

Monitoring and evaluation of the trainings of PHCP
The total number of PHCP present at the training courses was higher than 90% per every training.

At the begining of the training all participants were aquiped with the appropriate WHO literaturte, translated to Serbian:

WHO: Brief guide on tuberculosis control for primary health care providers

WHO: Guidelines for the prevention of tuberculosis in health care facilities in resourse-limited settings

WHO: A guide for tuberculosis treatment supporters

WHO: Modul A: Detection of TB

WHO: Modul B: Tretament of TB patients

The knowledge of PHCP on TB and TB control was estimated before and after the training with the simple pre- and post-questionnaires. These questionnaires consisted of 15 questions. The average percentage of false answers in pre-questionnaires was 29% and in post-questionnaire was 11%, with the improvement of 18%, which was very good.

The thorough evaluation of all elements of the training was done immediately and presented to the participants at the end of the training course before the Certificates of attendance were given to them.

TRAINING OF NURSES

Nurses working with TB patients were trained during 4 training courses that were held according to the next scheme:

Nurses invited to these trainings were those that were working at a TB depertements, TB Dispenseries, as well as the nurses working in other Health facilities and whose work includes home visites to chronic patients including TB patients.

Trainings of nurses lasted for two days. A mixed type of education (lectures and workshops) was held. A Training course was introduced by lectures on TB as a medical and public health problem, control of TB, prevention of TB and control of the TB infection, treatment. The presentations were completed by a video-sequences and a sufficient time was given to discussions after each presentation.

Workshops form an essential part of the second day of training courses. They were focused on the special role nurses are playing in prevention, control of infection, diagnosis, treatment and surveillance of TB.

Monitoring and evaluation of the trainings of nurses

Number of nurses present at the training courses was 100% per every training. A total number of 247 nurses were educated during 4 training courses.

At the begining of the training all participants were aquiped with the appropriate WHO literature, translated to Serbian:

WHO: Brief guide on tuberculosis control for primary health care providers

WHO: Guidelines for the prevention of tuberculosis in health care facilities in resourse-limited settings

WHO: A guide for tuberculosis treatment supporters

The knowledge of nurses on TB and TB control was estimated before and after the training with the simple pre- and post-questionnaires. These questionnaires consisted of 15 questions. The average percentage of false answers in pre-questionnaires was 16% and in post-questionnaire was 8%, with the improvement of 8%, which was very good.

The thorough evaluation of all elements of the training was done immediately and presented to the participants at the end of the training course before the Certificates of attendance were given to them.

EVALUATION OF ALL TRAINING COURSES

All partitipants had also been equiped with the evaluation forms with questions dealing with different elements of the training course. At the end of the training they were asked to answer the multiple choice questions by using the scale 0 to 4, where 0 was the worst and 4 was the best mark. The average mark for every category was calculated and these marks were never below 3,5.

The mark for overall-the effectiveness of the learning results was in average 3, 82.

Average marks for every category is given in the table below.