Ministry Of Health in Cooperation with

The Impact of On –The–Job (OTJ) Training on the

Performance of Health Workers in PHC unites (Hama
Health Governorate –Suran District's health centres)
Graduation thesis to obtain Specialization degree in
Health Systems Management

Management of Health Systems Studies Centre

2002-2003

Prepared By:
Dr. Mohammed Ibrahim Al-Bittar

Supervised By:
Dr. Ameer Ali Hassan
Liverpool University

January 2004
 Table of Contents

Topic Page
Cover Page A
Acknowledgement B
Contact Address & No. C
Table of Contents D
Abstract E
List of Basic Terms F
1 Chapter 1 : Background 1
2 Chapter 2 : Review of Literature 3
2-1 Importance of Training for PHC 3
2-2 Continuing Education 4
3-2 On-The- Job Training 5
4-2 Advantages & Disadvantages of On-The-Job Training 6
5-2 Evaluation of Training 7
3 Chapter 3 : Objectives 10
4 Chapter 4: Methodology 11
4-1 Approach 11
4-2 Important Variables 11
4-3 Sampling, Study Sample & Community 11
4-4 Data Collection Techniques and Tools 11
4-5 Collecting Data 12
4-6 Processing and Analyzing Data 13
4-7 Ethical Considerations 14
4-8 Testing Methodology 14
4-9 Intervention 15
5 Chapter 5 : Project Management 17
5-1 Team and Work Plan 17
5-2 Management and Monitoring 19
5-3 Result Utilization Plan 19
6 Chapter 6: Study Findings 20
6-1 Characteristics of Sample 20
6-2 Impact of Training on Staff Satisfaction 25
6-3 Impact of Training on Staff Knowledge 27
6-4 Impact of Training on Professional Efficiency of Staff 29
5- 6 Knowledge Versus Skill 30
6-6 Descriptive Study for Training status 34
7 Chapter 7 : Discussion of Findings 38
7-1 Staff Satisfaction 38
7-2 Change of General Knowledge Level 39
7-3 Change of General Performance Level 40
7-4 Knowledge and Skill Relation 41
7-5 Discussion of Training Status 42
Summary 44
Recommendation 45
Annexes 47
Basic Tables of Study 48
Questionnaires and Forms 65
Budget 87
Documents 88
References 98
 Abstract

"On-The-Job Training" is one of the continuing training methods

used to improve the performance of health workers in PHC programmes
within their working environment, and apply the knowledge and skills to
meet the actual health requirements of the community they serve. The PHC
Directorate in the MoH develops training plans and PHC departments in
Health Directorates participate in implementing them. However, the impact
of this training on the efficiency of health workers is not known. Moreover,
its future impact on the quality of health services provided and the
community they serve is not known as well. In Hama Health Directorate, the
PHC department performs the training and at 2003 it performed the training
by using the OTJ training in seven health centers.
The study aims is to know the method of training management in
PHC Directorate, and to recognizing the impact of training on the
performance of health workers in Hama Health Governorate health centers
(as an example), and to know the impact of training on the staff satisfaction,
knowledge and skills. It also aims at knowing the method and of training
implemented in PHC programmes in general and its problems.
The pre- & post-study pattern was performed between 11/1/2003
and 31/12/2003. Based on the findings, the improvement of the efficiency
of health workers in the study group was defined by adopting the school
evaluation methods based on the measurement of satisfaction, Knowledge
and performance. This has been done three months before starting the
training and three months after its completion. The findings have been
studied and compared statistically to find the implications of the differences.
The study reviewed available reports on previous training through the
expertise of the researcher in training and conducting interviews with
trainers and training supervisors.
The satisfaction of the study group with training was 78%, and the
training has achieved remarkable improvement in the level of general
knowledge for the study group in general by 11 % for the first group and
24% for the second group. The training method and duration had its impact
on this result. However, this training did not have impact on acquisition of
skills. And there is no direct link between the acquisition of knowledge and
skills, and the improvement of knowledge does not necessarily imply
improvement of skills. And consequently no impact on the quality level of
services provided.
The study found that training performed in PHC department (in Hama
Governorate) has not been methodological, and there are discrepancies in
documentation, implementation, and evaluation, and this doesn't meet the
importance of the subject.
A group of recommendations were made including the establishment
of an independent system for continuing education which will be responsible
for training management (from planning till evaluation ), and the training
should take into consideration the characteristics of adult learning and the
job description and to meet the training needs of health centers that are
based on the actual needs of citizens , and ensure improving the efficiency
of health worker in order to increase the quality level.
 List of Essential Terms

 Continuing education: the educational process which follows the basic

education and continues during the work of health worker, and aims to help
health worker for saving their competencies and improve them, and to develop
new knowledge and skills. ( WHO, 1984)

 Performance: accomplishing a job or assignment by someone, and the level of

performance means the level of success. (Gilbert,1989)

 In-site: this indicates to the site of training when the training happens at the
work place, divided to two type on-the-job and off-the-job.

 On-The-Job training “or “in-service education “: training occurs during work in

a job, provided or obtained while at a job. It happen under supervision , without
discontinuing the daily work of the trainer, and this what distinguishes it from
basic training which enable the trainer to obtain some job.

 Off-The-Job: means that the worker leaves the work site to take a private course
or programme, and that happens when the trainee is cut off his daily functional
duties.

 Evaluation: the gathering information process and reaching a decision about
the benefit of one of the study courses. It is used to improve the quality of the
course or what is called (Formative Evaluation), which is different from
(Certifying Evaluation). It is also used to suggest the entire benefit for the study
course, and it is known as (Summative Evaluation). (Abbat,1980)

 The Directorate: used to refer to the Directorate of Primary Health Care in the
Directorate of Hamah.

 Health Work are the doctors, nurses, doctor helpers and the traditional therapists
working in health system.

 Relevance: the degree of relation or harmony between the training courses on

one hand, and the population resources and their health needs on the other
hand. (Gilbert,1989)

 Competence: is the required professional ability to do specific jobs, and

noticeable readiness to do a specific act. It is a hidden ability that appears at
action (Guilbert 1989), and a collection of abilities and personal adjectives and
roles. Or, it is a social attitudinal concept which means ability to accomplish
 skills and roles as what standard peoples expect. And the study uses it in the last
meaning. (Eraut, 1999)

 Skill:it is used here in the broadened meaning to describe using or applying

knowledge or experience (cognitive skills and the psychomotor and
communication skills). (Abbat,1980)

 Satisfaction index : it is calculated by multiplying the obtained score from the

evaluation (from 5) by (20) and then divides it on participants' number. And any
item that is less than (60%) should be taken care of, and if this wasn't available,
we should take care of the lowest (5) items and the highest (5). And it is
calculated as: Satisfaction Index= (20+100)/2 (Guilbert 1989).