Health Workforce Planning, Training and Curriculum Development

BPH/MPH
Prabesh Ghimire
Health Workforce Planning, Training and
Curriculum Development

Health Workforce Planning, Training and Curriculum Development MPH/BPH
©Prabesh Ghimire Page | 2
TABLE OF CONTENTS
UNIT 1: INTRODUCTION TO HEALTH WORKFORCE PLANNING AND DEVELOPMENT ......................4
Definition and categorization of the global and national levels of health workforce..............................4
Process of calculation of required qualified health workforce at market................................................5
UNIT 2: INTRODUCTION TO TRAINING IN HEALTH WORKFORCE DEVELOPMENT............................7
Definition and concept of training............................................................................................................7
Differentiation between education and training......................................................................................8
Administrative considerations in Training................................................................................................8
Types (Models) of Training in Health, area and scope of training..........................................................10
Teaching learning methods (Training method) ......................................................................................11
Discussion on selected training methods ...............................................................................................12
Lesson Planning.......................................................................................................................................16
UNIT 3: PLANNING, IMPLEMENTATION AND EVALUATION OF TRAINING .........................................20
Training needs assessment.....................................................................................................................20
Planning, implementing and evaluating training....................................................................................22
Training Evaluation .................................................................................................................................23
UNIT 4: CURRICULUM DEVELOPMENT ..................................................................................................25
Components of Training Curriculum.......................................................................................................25
Various Models of Curriculum Development .........................................................................................26
Principles of curriculum design...............................................................................................................27
Process/ steps of need based curriculum development ........................................................................28
Curriculum Change..................................................................................................................................30
Match the content, trainees and context/settings.................................................................................31
Collaboration and coordination with different government and non-government curriculum
development institutions........................................................................................................................32
UNIT 5: DELIVERY OF VARIOUS TRANING PROGRAM FROM HEALTH SYSTEMS ...........................33
Overview of Health Training Programs of MOHP, concerned ministries, INGO, NGOs, CBO, and
Bilateral Organizations............................................................................................................................33
Roles, functions and activities of NHTC and RHTC..................................................................................33
Limitations and challenges of training programs in Nepal- Critical Overview........................................35
Health Training in National Health Policy and Three Year Plan..............................................................36
Career opportunities in health training programs..................................................................................37

UNIT 1: INTRODUCTION TO HEALTH WORKFORCE PLANNING AND DEVELOPMENT
Definition and categorization of the global and national levels of health workforce
The health workforce can be defined as all people engaged in actions whose primary intent is to enhance
health"
IOM define a health professional as a "person educated in health or a related discipline employed to
improve health through a population focus".
There are several issues with defining the public health workforce, such as
- Should health workforce include technicians, and a range of support staff and labourers?
- Should health workforce be defined by the credential or education level one attains?
Categorization of health workforce
Presently, a comprehensive definition is not available to categorize a health workforce. The global atlas of
health workforce identifies nine categories of health workforce
Classification Categories of health workforce included
Physicians Generalist medical practitioners and
specialist medical practitioners
Nursing and midwifery personnel Nursing professionals
Midwifery professionals
Nursing associate professionals
Midwifery associate professionals
Dentistry personnel Dentists and dental assistants
Dental technicians
Pharmaceutical personnel Pharmacists
Pharmaceutical assistants
Laboratory Health Workers Laboratory scientists
Laboratory assistants
Laboratory technicians
Radiographers
Environment and public health workers Environment and public health officers and technicians
Hygienists
District health officers
Public Health Inspectors
Food safety inspectors
Community and traditional health workers Community health workers
Family health workers
Traditional and complementary medicine practitioner
Traditional midwives
Other health workers Medical Assistants
Dieticians
Nutritionists
Occupational therapists
Medical equipment technicians
Optometrists, etc
Health management and support workers Health economists
Health managers
Health information technicians
Ambulance drivers
General support staff

The classification of HRH in Nepal also uses similar classification:
- Generalist medical practitioners
- Specialist medical practitioners
- Nursing professionals
- Nursing associate professionals
- Paramedical practitioners
- Ayurvedic medicine practitioners
- Dentists
- Pharmacies
- Environment and public health workers
- Laboratory workers
- Health management and support workers
- Other health workers
Process of calculation of required qualified health workforce at market
The approaches commonly used to calculate future requirements of health workforce include
i. The workforce to population ratio method
- This is a simple projection of future numbers of required health workers on the basis of proposed
thresholds for workforce density (e.g. health educator per 10,000 population).
- This approach is least demanding in terms of data, but does little to explicitly address other key
variables, aside from population growth, that can be expected to affect the type and scale of future
health services provision and the associated workforce.
ii. The health needs method:
- This is a more in-depth approach that explores likely changes in population needs for health services,
based on changes in patterns of disease, disabilities and injuries and the numbers and kinds of
services required to respond to these outcomes.
- This approach entails collecting and analyzing a range of demographic, socio-cultural and
epidemiological data.

iii. The service demands method:
- This approach draws on observed health services utilization rates for different population groups
- The service utilization rates are applied to the future population profile to determine the scope and
nature of expected demands for services, and these are converted into required health personnel by
means of established productivity standards or norms.
- Again, this approach requires consideration of multiple variables, as well as collecting and using the
data relevant to these variables.
iv. The service targets method:
- This is an alternative approach that specifies targets for the production (and presumed utilization) of
various types of health services and the institutions providing them based on a set of assumptions,
and determines how they must evolve in number, size and staffing in accordance with productivity
norms.

UNIT 2: INTRODUCTION TO TRAINING IN HEALTH WORKFORCE DEVELOPMENT
Definition and concept of training
Training is any planned activity to transfer or modify knowledge, skills, and attitudes through learning
experiences.
- Training can reduce or eliminate the gap between actual performance and an organization’s needs. It
does so by changing the behavior of individuals, by giving them the knowledge, skills, or attitudes that
they need to perform to the required standard.
- A health workforce may require training for a variety of reasons, including the need to maintain levels
of competence and respond to the demands of changing circumstances and new approaches and
technologies.
Objectives of training to health workforce
i. Increase knowledge about the special considerations related to health program (e.g. updates from
CB-IMCI to CB-IMNCI- to inform about changes in guidelines for treatment)
ii. Build and strengthen skills in the specific tasks to be completed for efficient functioning of health care
system. E.g. SBA training for skilled birthing services at health facilities.
iii. Training helps to increase the productivity of health workforce that helps the health sectors further to
achieve their long-term goals and targets.
Issues to consider in designing training programs
Nature of Audience Mode of training Length
Trainers to be trained
Senior health officials
Peripheral level health workers
Volunteers
Non-health workers
Pre-service training
On-site job training
Classroom (off-site, in-service
training)
Field training (tours,
observational trips)
Workshops and seminars
Orientation
Short term (orientation)
Medium term (e.g. IUCD training)
Long-term (e.g. SBA training)

Differentiation between education and training
Some useful distinction between education and training can be articulated with regard to process,
orientation, method, content and the degree of precision involved.
Basis for
comparison
Training Education
Meaning  It is a method of imparting specific
knowledge or skills
 It is a typical form of learning
Precision  Usually involves the acquisition of
behaviours, facts, ideas, etc. that are
more easily defined in a specific job
context.
 more job-oriented that person-
oriented.
 Is more person oriented
 It is a broader process of change and its
objectives are less amenable to precise
definition
Process  Mechanistic process which
emphasizes uniform and predictable
response to standard guidance
reinforced by practice and repetition.
 Organic process bringing about less
predictable changes in the individual.
Course and
program
content
 Aims to provide knowledge and skills
and to inculcate the attitudes which
are needed to perform specific tasks
 Provides more theoretical and conceptual
frameworks designed to stimulate and
individual's analytical and critical abilities
Perspective  Focus on narrowly defined objectives  Focus on broad objectives
Involves  Job experience  Classroom learning
Time  Often short term  Comparatively long term, continuous
process
Prepares for  Present public health practice  Future career opportunities
Administrative considerations in Training
There are four important administrative/ logistical considerations in preparing for a training process:
i. Contracts
ii. Administrative support
iii. Venue
iv. Materials and equipment
i. Contracts
- When the facilitator is external to the organization requesting training, the facilitator should clearly
outline the terms for the training based on the organization’s expectations.
• Are they expecting materials production, running workshops and/or follow up? What time frame is
being considered?
• How much money is available to produce materials, pay for workshop costs and participants’ food
and travel costs and to pay the facilitator?
- It is useful to negotiate the facilitator’s terms of reference which set out in some detail exactly what
the facilitator is expected to do and/or produce, to what standard, by when, and at what cost.

ii. Administrative support
- The organizer needs to arrange for following administrative support
• Setting the schedule of events and sending invitations
• Dealing with food and accommodation and with reimbursing traveling expenses of the
participants
• Clerical support e.g. stationery supplies, typing, photocopying, collating and binding, purchasing
materials and equipment needed for training
iii. The Venue
- Ideally, the following conditions should be met in respect to the location for a training workshop:
• The workshop should be held in a location away from the normal place of work of the participants
• The room used should be large enough to hold all participants comfortably
• Seating facilities should be comfortable
• It is also necessary to check the training venue in advance for the availability of relevant
resources such as
Lighting Is this adequate and are there blackout facilities for projection
Electricity Where are the electrical outlets, are extension cords and adapter required?
Furniture Are there enough chairs and tables and is it possible to move them around
Walls Is it possible to post materials on the walls or should flip charts stands are
required?
Kitchen Are foods available at the venue or will it have to be brought in?
Access Is it easy to find or will participants need a map? Parking? Disabled access?
iv. Materials and equipments
- The necessary materials and equipment will depend on the training methods that are used.
- Some will be needed for preparation (e.g. computer, printer and photocopies) and others during the
workshop itself
- It is better to prepare a checklist of materials and equipment in prior
• Materials
• Large and small sheets of paper
• Meta-cards
• Pens, markers of different colors
• Stationeries
• Scotch tape
• Videos/ Slides
• Training manuals
• Equipments
• Chairs and tables
• Audio-video equipments, if necessary
• Board, tripod or stand
• Extension cords
• Printers
• Computer

Types (Models) of Training in Health, area and scope of training
Under national health training system, different types of training are conducted for health workforce
development and capacity building:
Training types Area and scope
1 Pre-service
training
Diploma in Biomedical Equipment Engineering (18 months)
Anaesthesia Assistant Course (1 year)
2 Upgrading
training
In-service upgrading trainings are designed and conducted as per the needs of
program divisions and centers. The training packages aim to develop the skills to
implement new programs and improve job performance. For example,
• Senior auxiliary health
worker training (6 months)
• Senior auxiliary nurse-midwife (6 months)
• Auxiliary nurse-midwife Padnam (P) (6 months)
• Auxiliary health worker-P (6 months)
• Auxiliary health worker(15 months)
• Auxiliary nurse-midwife (18 months)
3 Competency
and clinical
based training
courses
23 courses are offered. Some of the courses include,
 Skilled birth attendance
 Advanced skilled birth attendance
 Non-scalpel vasectomy
 Intrauterine Contraceptive Device (IUCD)
 Postpartum intrauterine contraceptive device (PPIUCD)
 Minilaps
 Implants
 Safe abortion services
 Comprehensive abortion care
 Medical abortion
 PEN protocol
 Comprehensive family planning (CoFP) counseling
 Infection prevention (IP)
4 Refresher
Training
A range of refresher trainings are conducted as per the needs of divisions and
centers to develop the skills for implementing new programs and to improve job
performance. These include
• Refresher training courses for FCHVs and
• Refresher training for skilled birth attendants (SBAs).
5 Orientation
Programs
NHTC supports the divisions and centers to develop orientation packages and
prepare pools of trainers for conducting orientations for health and non-health
workers. For example,
• Program specific orientation to FCHVs
• Orientation to local government on local health planning
• Orientation on Mass Drug Administration
6 Basic Training Basic trainings are organized for Female Community Health Volunteers (FCHVs)
who are newly recruited by the local mother’s group among the member. The
duration of this course is 18 days.
7 Induction
Training
NHTC has begun providing induction training for all health service groups from
2072/73. The one month courses (24 days) are provided for all health service
disciplines.

8 Other trainings • Training on the Transaction Accounting and Budgetary Control System
(TABUCS)
• Biomedical equipment assistant training (BMEAT)
• Biomedical equipment training for users (cold chain, laboratory, X-ray)
Approaches for capacity development of HRH with examples
All above approaches including,
- Observational tours/ trips
- Follow up enhancement programs
- Onsite coaching
- Task-shifting
Teaching learning methods (Training method)
The various training methods that used in different training programs, those having particular relevance in
public health context are summarized below:
Method Used for Advantages Disadvantages
Lecture • Passing on information
and facts
• Giving specific
information
• Allows much material to be
delivered in short time
• Handles a large number of
participants
• Permits lecture to be in full
control
• Learner is passive
• Feedback is limited
Discussion • Stimulating interests and
thought
• Generating possible
solutions to problems
• Developing consensus
• Stimulates learner's
interest
• Involves learners actively
• Time consuming
• Requires learners to
have facts abut the
topic
• Needs to be well
controlled to have value
• Can be dominated by
few active persons
Case study • Solving problems
• Changing attitudes
Building analytical skills
• Involves learners actively
• Allows sharing of learners'
experiences with others
• Stimulates ideas and
discussion of concrete
subject
• Time consuming to
prepare
• Discussion may focus
on areas different from
those intended by
trainer
Role Playing • Developing interactive
knowledge and modifying
attitudes
• Introducing humor and
liveliness into training
• Stimulates interest
• Uses participants'
experiences
• Observers may be
passive
• Those engaged in role
play may learn more
than observers
Group
exercise
• Team building
• Developing interactive
skills
• Studying group dynamics
• Facilitates high
participation of motivated
learners
• Trainer's skills required
to guide the exercise
• Takes time for group to
work in harmony
Brainstorming • Stimulating creative
thinking
• Generating possible
solutions
• Providing diversion
• Promotes active
participation of learners
• Uses learners' experiences
and ideas
• Time-consuming
• Some learners may be
passive
• Required high level
trainers' skills

Demonstration • Showing correct
procedures and required
standards
• Stimulates a lot of interest
• Can be used for large
groups
• Takes efforts to produce
• Good observation by
learners may be difficult
in large group
E-learning • Passing on information
and facts
• Showing correct
procedures
• Allows materials to be
passed on quickly
• Allows participants to
study on their own
locations at their own pace
• Feedback is limited
• Learning is difficult to
evaluate
Some other training methods include
- Buzz sessions
- Fishbowl sessions
- Programmed instruction
- Colloquy
- Dialogue
- Problem Solving
- Seminar
Discussion on selected training methods
Colloquy
A colloquy is a modification of the panel using six or eight persons- there or four representing the
audience and three or four resource persons or experts
- A moderator directs the proceedings.
- The colloquy members, selected from and representing the audience, ask questions, express
opinions, and raise issues to be treated by the resource persons (experts).
- The general audience listens, but occasionally they may participate under the guidance of the
moderator.
When should colloquy be used?
The colloquy may be the correct technique to use when topic and goals point toward doing one or more of
the following
- Stimulating interest in a topic
- Identifying, clarifying or solving problems
- Identifying and exploring issues
- Weighing the advantages and disadvantage of courses of action (e.g. health interventions)
- Bringing expert knowledge to bear on problems and needs as they emerge from discussion
Personnel involved
i. Moderator – Guides the discussions
ii. Resource Person- Usually 1-4 chosen for their particular knowledge in the subject
iii. The audience representative – are able to ask questions and make comments to clarify the topics for
themselves and audience
iv. The audience- The intellectual levels and interest may vary considerably

Advantages
- Permits a large audience to be represented and also offers some opportunity for direct participation.
- Resource persons tend to consider carefully the problems and needs of the participants.
- It encourages the audience to feel responsibility for their representatives and therefore to listen and
participate actively.
Limitations
- Experienced moderators who understand the functioning of the colloquy are not always available.
- The audience and its representatives may not be sufficiently informed to ask meaningful questions.
- The audience members may hesitate to participate actively before experts.
Programmed Instruction
- A programmed instruction is a compute based training that comprises of graphics, multimedia and
texts that is connected to one another and is stored in memory.
- It provides the participant with content, information, asks questions, and based on the answers goes
to the next level of information i.e. if the trainee gives the correct answer; the training is directed to
new information (next session). And if the training gives the wrong answer, the trainee may be
required to review the same session again in more elaborated manner.
Programmed instruction also comes in
• Printed form i.e. books
• Tape
• Interactive video
• E-learning
• Other formats
Advantages
- There is no fixed time interval for learning. Trainees may learn at their own pace.
- Learning by doing maxim of teaching is followed to involve learners in the learning p process
- Immediate feedback to wrong answers is provided, so that learner is able to develop mastery over the
topic.
Disadvantages
- It is very difficult to develop an instructional programs
- Only cognitive objectives can be achieved
- The contents are highly structured; there is no chance for trainees' creativity
- Since the instructions are pre-programmed, this may not meet the diverse needs and interest of the
participants.

Principles to be followed in using different training method
#Criteria for selection of methods and materials for training program
A variety of methods and materials are available for a training program. First it is necessary to realize that
different methods are best for providing different learning experiences for
- Acquiring skills
- Forming attitudes
- Enhancing knowledge
Criteria for selection
i. Training purpose
- The selection of methods and materials in a training should primarily be guided by a purpose of
training:
Purpose Methods and materials to select
To provide information and knowledge Lecture with handouts, reading sessions, charts,
discussions
To provide examples to show tasks and
attitudes
Fishbowl exercises, slides, videos, drama, case-
studies, discussions, role play
To provide practice/skill Demonstration, simulations, supervised practice,
coaching
ii. Training content and subject area
- The content and subject areas of training are also important factors to be taken into considerations in
the process of selecting methods.
- The choice may be influenced by whether the subject-matter is abstract or not, by its level of
complexity and even by the comprehensiveness of the materials and content.
- For example, operational research techniques are based on the extensive use of statistics. It is
usually taught through a combination of lectures and exercises. This may be supported by reading
assignment.
- Public health leadership training may use case-studies, brainstorming, role-playing and various forms
of group discussion.
- It is often desirable to choose several methods if we want to deal with a particular subject or problem.
The methods such as lectures, discussion and case-studies are being virtually in all type of training.
iii. Human factors
a. Trainer
- The trainer should be comfortable in using the most effective training methods and techniques
appropriate to the training objectives.
- Trainers have to assume personal responsibility for choosing the best methods for a particular
training assignment.
- The availability of trainer may also determine the selection of training method. If experts are not
available, methods such as demonstration and panel discussions may not be appropriate.
b. Trainees
- The training methods and materials must stand on the intellectual and education level, the age and
the practical experience of the trainees, and on the social and cultural environment, they come from.

- For example: Use of panel discussions and seminars for training peripheral health workers whose
purpose is to increase skills in delivering particular health services to would mean no importance.
- Use of slides for orienting FCHVs might not be effective, as they learn better through participatory
methods.
iv. Size of the group being trained
- Different learning methods accommodate training audiences of different sizes
• For small group training: Discussion, case-studies, role plays
• For large group: Lectures and discussions, buzz sessions
v. Time and material factors
- In selecting the correct training methods, one should also consider the available time, finance and
training facilities including training equipment and materials.
- For example, preparation time, which affects the cost of the training materials as well, varies for
different methods. As a rule, field training, seminars, panel discussions require long and costly
preparation and may not be suitable for short-term training.
- The length of course also predetermines the kind of method which can be used. Longer the course,
better the chances are that the trainer will be able to use complex case-studies and practical projects.
This implies that, participative methods may not be suitable for short courses.
- Training facilities may also be a limiting factor. Factors such as size of room available for group work
or the accessibility of audiovisual aids should be anticipated and the methods decided well in
advance.
- The unavailability of electricity in rural areas may undermine the use of projected media.
Figure: General process of training method selection

Lesson Planning
Lesson Plan
A lesson plan is a detailed guide used by trainers/instructors for preparing and delivering training to the
participants. A trainer who uses a well prepared and thorough lesson plan to organize and prepare for
training greatly increases the odds of ensuring the quality of learning.
Importance of lesson plan
i. Provides roadmap: Lesson plan contains learning objectives, which guides the direction and methods
of training. This helps to ensure quality of training.
ii. Ensure training quality: Attempting to deliver instruction without a lesson plan may entails risk of
lesson moving beyond objectives, poor time management, logistical issues and lack of clarity about
what to achieve at the end of the training. This clearly impacts the quality and purpose of the training.
iii. Consistency: Using a lesson plan ensures consistency of training across training sites. For example,
with the use of common lesson plan either in the training site (RHTC) at Dhankuta or at Surkhet, all
participants receive the same level of information. This is particularly important in competency based
trainings where consistent practice is must.
iv. Reference for future: When the participants need to be trained again in the future, such as for
refresher, the new trainer will be able to refer to the previous lesson plan and revisit the learning
objectives to meet the additional needs of trainees.
Components of lesson plan
Many different styles and formats for lesson plans exist. No matter which lesson plan format is used,
certain components should always be included.
i. Lesson title or topic
- The lesson title or topic describe what the lesson plan is about.
- For example, a lesson title may be "Media Analysis of Health Education Materials".
- Just by the lesson title, a trainer or learner should be able to determine whether a particular lesson
plan contains information about the topic a learner is planning to reach.
ii. Behavioral or learning objectives
- Learning objectives are the backbone of the lesson plan. All lesson plans must have learning
objectives.
- Many methods for determining and listing learning objectives are available. The specific method used
to write the learning objectives is not as important as ensuring that the trainers understand the
learning objectives for the lesson plan that he//she must present to the trainees.
iii. Instruction methods
- A lesson plan should clearly specify the methods to be used by trainer in delivering the instruction.
- Some of the commonly used methods among others include lectures, group discussions,
brainstorming exercises and role play.
iv. Instructional materials needed
- Most lesson plans require some type of instructional materials to be used in the delivery of the lesson
plan.
- For example, audio-visual aids are the type of instructional material most frequently listed in the
lesson plan- that is, a lesson plan may require the use of a video, or computer.

- Other commonly listed instructional materials include handouts, pictures, diagrams and models.
- Also, instructional materials may be used to indicate whether additional supplies are necessary to
deliver the lesson plan. For example, a lesson plan may list flip charts, markers, meta-cards as the
required instructional materials.
v. Lesson outline
- The lesson outline is the main body of the lesson plan.
- This section lists out all the information/topics that need to be taught to achieve the learning
objectives.
- It also highlights the terms participants should know, which concepts must be presented, which skills
must be practiced and the time duration for each session.
vi. Evaluation methods
- This section should specify the ways for assessing whether the trainees have achieved the desired
learning objectives.
- This may include pre-test and post test measurement, verbal questions and answers or other skill
assessments.
vii. References/ resources
- Lesson plans often simply contain an outline of the information that must be understood to deliver the
learning objectives.
- Trainers may need to refer to additional references or resources to obtain further information on the
particular subject of training.
- The references or resources section may contain the names of books, websites, or even names of
experts who may be contacted for further information.
- By citing references in the lesson plan, the validity of the lesson plan can also be verified.
Principles of lesson planning
The lesson planning should ideally be guided by six key principles:
i. The lesson plan is guided by clearly specified learning objectives
ii. Activities in the lesson plan should follow a logical sequence
iii. Comprehensible input is provided by all relevant stakeholders in lesson planning
iv. There should be multiple opportunities for communicative practice
v. Variety of instructional methods and strategies should be provided to enable trainees to perform at a
higher level.
vi. Ongoing assessments should inform lesson design and implementation
Steps in preparing lesson plan
i. Identifying job performance requirements
- The first step of lesson plan development is to determine the learning objectives. What are job
performances are the trainees expected to achieve as a result of training?
- Is obvious that training is conducted to prepare health workforce to perform a certain job or skill.
- The preparation of learning objective should therefore start by listing down job performance
requirements of health workforce targeted for training.
- This may come from the job description and training need assessment.

ii. Converting performance requirements into learning objectives
- Once the job performance requirements and training needs of health workforce are identified, one
should convert these requirements into the learning objectives. Learning objective can be written with
considerations to following:
o Audience: If the lesson plan is being developed specifically for a certain audience, the learning
objectives should be written to indicate that fact.
o Behaviour:
- The behavior part of the learning objective should be specified using a clearly measurable action
verb.
- The choice of action verb depends on the domain (cognitive, affective or psychomotor) to which a
trainee will achieve the learning objective. For example, if a staff nurse is required to inform couples
about family planning, she may require balanced counseling skills. This may require action verb
specifically from psychomotor domain (skill).
iii. Preparing lesson outline
- One method of creating a lesson outline involves brain-storming the topics to be covered to be
covered and then arranging them in a logical order. The national guidelines and standards may be
referred to ensure that key topic have been included.
- Initially, all the information that needs to be taught to achieve the learning objectives should be listed
out
- The listed topics should then be arranged in a logical order by specifying instruction methods and
time duration required for covering each topic.
- Topics should be presented in order starting from the basic and then moving on to the more complex.
iv. Identifying instructional materials
- Once the lesson plan is outlined, all instructional materials needed to deliver instruction should be
identified and listed in the lesson plan.
- The list should be specific so that exact instructional aid can be identified.
- For example, if the lesson plan is for a COFP counseling lesson for nurses, an instructional material
may be a "COFP counseling instructional video produced by XYZ organization".
- Instructional material may range from handouts to multimedia projectors to the models used during
skills practice.
v. Identifying evaluation plan
- The evaluation plan is the final part of the lesson plan. Each part of the evaluation plan should be
directly tied to one or more learning objectives.
- When writing the evaluation plan into the lesson plan, it should only list out methods of evaluation.
The detail description is not needed in the lesson plan; detailed tools and guidelines may be included
a separate document.
vi. Finalizing the lesson plan
- Before finalizing the lesson plan, an appropriate lesson title should be identified based on the learning
objectives.
- The overall lesson plan should be revised to check if methods, materials, lesson outline and
evaluation are all in conformity with the learning objectives.
- The draft lesson plan may be piloted and modified as required before actual use.

Sample Lesson Plan for Introduction to HIV/AIDS
Course title Sexual and Reproductive Health
Lesson title HIV/AIDS
Duration 05:00 hours
General objective To impart basic knowledge among FCHVs regarding concepts, causes,
clinical features and preventive measures of HIV/AIDS in the community.
Learning objectives Upon the completion of this lesson, FCHVs will be able to
- Describe the concept of HIV/AIDS.
- Explain the causes of HIV/AIDS.
- Identify the signs/symptoms of HIV/AIDS.
- Suggest measures of prevention of HIV/AIDS.
Methods - Lecture
- Video show
- Group discussion
Evaluation measures Pre-test and post test
Verbal questions and answers
Materials and resources HIV/AIDS facilitator’s manual
Flip chart
Posters
Chart paper/markers/masking tapes
References HIV/AIDS Training Resource Kit

UNIT 3: PLANNING, IMPLEMENTATION AND EVALUATION OF TRAINING
Training needs assessment
Training need assessment (TNA) is the process of identifying performance requirements within an
organization and the “gap” between what levels of performance is required and what present level of
performance is.
Purpose of Training Needs Assessment
Assessing individual training necessary for following reasons
- To structure the training program around properly identified needs, so that worthwhile services are
rendered to the community.
- To provides a basis for training curriculum development (content and scope of training)
- To identify right participants for training i.e. to assess (whose? – prospective trainees?) Knowledge,
skills and attitudes, so that the shortcomings are addressed during the training program.
- To avoid/ reduce wasting the resources (money, time and efforts) of the individual or health system.
- To encourage trainees to become aware of their own limits/knowledge – a sound base for future
learning.
A training need can be assessed by observing the prospective trainee’s current knowledge and skills and
comparing them with the ideal knowledge and skills for that position.
Process of training needs assessment
i. Identifying problems
- Determining organizational/program goals and roles and responsibilities
- Analyzing gaps in program and performance
ii. Determining design of need assessment
- Determining the target groups to be assessed, interviewers, methods and schedule.
- Determining the persons in charge of conducting training need assessment.
iii. Collecting data
- Conducting interviews
- Administering questionnaires and surveys
- Reviewing documents on existing trainings
- Observing performance of staffs at work
iv. Analyzing data and identifying training needs
- Conducting qualitative and quantitative analyses
- Drawing findings and indentifying training needs

Approaches for Training Need Assessment
Approaches Purpose (Analysis to answers)
Performance analysis or gap
analysis
Is this issue a skill/knowledge deficiency
How can the deficiency be addressed
Is training the appropriate way to fix this deficiency
Feasibility analysis Why should this training be done?
Is the benefit of training greater than the cost of the current
deficiency?
Needs versus want analysis Why should this training be done?
S the deficiency tied to a need?
Job//task analysis How is the best and correct way to do this work?
How can this job and task be broken down into teachable parts
Target group analysis Who should be trained?
What is known about them to help design and customize this training
Contextual analysis When will the training be presented?
What are other requirements too deliver the training successfully?
Methods of Training Need Assessment
Some of the techniques of assessing training needs are as follows:
TNA Methods Description Strengths Limitations
Survey Staff survey or polls
conducted on paper or
electronically with a variety
of question formats
• Training needs of large
groups can be identified
in a short time.
• Inexpensive
• Data can be summarized
easily
• Provides opportunity for
response without fear of
embarrassment
• Time-intensive to
develop an effective
survey
• May not effectively
explore the root cause of
problems or achieve
potential solutions.
Interview A conversation with
individual staff to gain in-
depth insight of their
perspectives
Information may be both
quantitative and qualitative
• Exploration of unique
qualitative information
(e.g. knowledge, skills,
attitudes) from an
individual's perspective.
• Spontaneous feedback
with likelihood of
receiving factual
information
• Time-consuming for
interviewer and
interviewee
• Requires skilled
interviewer
• Staff may feel
embarrassed to express
their true feelings (e.g.
having poor skills)
Focus Group A group discussion typically
focusing on a particular
performance problem, goal
or task
• Real time interaction
between different
perspectives
• Focus on consensus
building
• Time-consuming for
facilitator and
participants
• Difficult to analyze and
quantify data
• Individual training need
may be difficult to sort
out
Environmental
scanning
Assessment of already
existing data, either internal
or external to the institution
(e.g performance data,
program indicators)
• Inexpensive because
already existing datasets
• Does not require contact
with target audience
• Data sources may be too
broad to answer the
performance problems
that can be addressed
through training

Planning, implementing and evaluating training
The training process (training cycle) involves four major stages
i. Training Need Assessment
ii. Planning
iii. Implementation
iv. Training evaluation
i. Training need assessment
- Discussed above
ii. Planning a training
- Defining the purpose of the training.
- Defining training objectives.
- Selecting trainees
- Selecting training site
- Determining the length of the training
- Selecting training methods
- Selecting and adapting training media and materials.
- Preparing plan for evaluation
- Developing the training course
iii. Implementation
a. Just before training
- Ensuring the availability of required logistics and training materials
- Ensuring seat arrangements are appropriate
- Completing registration and attendance
a. During implementation
- Conducting session as per lesson plan
- Using mix of training methods to encourage learner's interest
- Conducting evaluation sessions as appropriate.
iv. Training evaluation
- Conducting immediate evaluation (reaction level and knowledge level) using score-sheets, pre-test
and post-test and other rating scales.
- Conducting post training follow-up, as needed.
- Note: Evaluation is described in detail below

Training Evaluation
Need and importance of training evaluation
The need for evaluation of training include
- tracking the development of people’s knowledge and skills
- finding out whether the training is appropriate to the trainee and whether the learning is being applied
- identifying gaps and future needs in training
- finding out if the investment in training was worthwhile or whether alternative methods
- to improve performance (e.g. job rotation, incentives) are needed instead
- obtaining information on which to base future training plans and strategies.
The evaluation process of training will be guided by the clear description of these three elements
i. Competency: a set of skills, knowledge and attitudes required to perform health promotion practice
ii. Instructional goal: an activity that would allow a trainee to perform the competency
iii. Learning objective: a precise, measurable statement of what a learner will be able to do upon
completion of instruction.
Levels of training evaluation
The primary purpose of training evaluation is to measure the impact of training at four levels
Level Focus Area of Impact
1 Reaction To what degree participants react favourably to the training
2 Learning To what degree participants acquire the intended knowledge, skills, attitudes,
confidence, and commitment based on their participation in a training event.
3 Behaviour To what degree participants apply what they learned during training
when they are back on the job
4 Result Results: To what degree targeted outcomes occur as a result of the training
event and subsequent reinforcement
Process of training evaluation/ Continuum of evaluation in the training design
i. Before Training
- Understanding overall goals of the instruction or public health program
- Knowing the objective of the departments or teams from which the trainees are drawn
- Deciding on the competency statement and instructional goal.
- Define the learning objective for the training
- Specifying the experience and level of knowledge that the trainees should have.
ii. Beginning of training
- The framework of training evaluation should be explained to the trainees so that they are prepared for
it and understand that it is an integral part of the training process.
- Before the start of the training session, the trainees should be requested to fill the first part of "pre test
and post test" evaluation (Level-2 evaluation) – i.e. trainees should fill up pre-test questionnaire for
knowledge and attitude test.
iii. During training implementation
- The trainees' learning should be verbally evaluated by regular questioning (Level 2 evaluation).
- The learning should also be evaluated through exercises and role plays.
- The trainees should be asked to fill out reaction/learning evaluation forms (Level 1& Level 2
evaluation) at the end of each day.

- At the end of the training course, the trainees should be asked to fill out a level-1 reaction evaluation
form.
- Trainees' knowledge and skills should be evaluated with a level-2 learning evaluation test or exercise.
For example, the trainees should be requested to fill the post test questionnaire or their
skills//competencies should be assessed using skill assessment checklist.
iv. After training
- In some training, level-2 evaluation may be carried out again within a month through a reliable coach
to assess whether the trainees have retained their knowledge and skills ((for example, knowledge
and skill assessment in SBA/ IUCD providers through coaching visits)
- Ideally after 6 weeks-3 months, level-3 evaluation is carried out to check on application of training
skills in the job (e.g. follow up enhancement program for SBA being done by NHTC)
- Level-4 evaluation is done ideally after 6 months, preferably through an independent evaluator who
was not involved in the training. Nepalese health training system lags behind with respect to level-4
evaluation. Such types of evaluation are hardly being conducted.
Methods and tools used in each level of training evaluation
Level of training evaluation Methods/Tools
Level 1: Reaction  Mood chart with variable facial cartoons
 Questionnaires
 Score-charts
 Simple written exercise
 Feedback forms
 Interviews
 Subjective evaluation of trainees' gestures
Level 2: Learning  Pre test and post test exercise
 Verbal questions during the training
 Written tests at the end of training
 Interviews
 Skill assessment
Level 3: Behaviour  Surveys and questionnaires
 Follow-up interviews
 Focus groups
 Follow-up training sessions
 Work assignments based on training
 On the job observation/ coaching visits by independent observer
 Quality Assurance (QA) audits
Level 4: Results  Follow-up questionnaires at program level
 Follow up training sessions
 Program assignments
 Performance monitoring (e.g. no. of deliveries conducted by trained SBA)
 Simulation exercises
 Changes in indicators against baseline

UNIT 4: CURRICULUM DEVELOPMENT
Curriculum
Word of curriculum origin from Latin word currere means ‘a race course’. Based on the origin word it is
referred to ‘a course of study’. According to Taba, 1962, “curriculum is a plan of learning.”
Components of Training Curriculum
i. Aims
- It includes one sentence description of overall purposes of curriculum, including audience and the
topic.
ii. Rationale
- It includes a paragraph describing why the aim is worth achieving.
- This section would discuss on how the curriculum supports national and local standards.
iii. Goals and objectives
- It is the list of learning outcomes expected from participants in the curriculum.
- There are three main domains of learning objectives: cognitive, affective and psychomotor domains.
iv. Audience and pre-requisites
- This component of curriculum defines who the curriculum is for and sets some pre-requisites of those
learners (criteria for selection of participants)
v. Subject matter/content
- It defines the area of endeavor that the curriculum deals with.
vi. Instructional plan
- It defines the activities the learners are going to engage in.
- It also describes the sequence of those activities.
vii. Educational materials
- It describes the list of materials for successful teaching of the curriculum.
- The materials may include books, tables, paper, chalkboard and other special requirements for
classroom setup and supplies.
viii. Assessment and evaluation
- It specifies plans for assessing learning and evaluating the curriculum as a whole.
- It may include description of a model project, sample exam questions or other elements of
assessment.

Various Models of Curriculum Development
There are various approaches/models to develop a curriculum:
i. Four steps approach to curriculum development
- Giles, Mc Cutchen and Zechiel (1942) developed a four step model of curriculum development. The
four steps are
• Selection of objectives
• Selection of learning experiences
• Organization of learning experiences
• Evaluation
- Tyler's (1975) model of curriculum development also has four steps.
- Tyler posed four basic questions to explain the approaches to curriculum development, namely:
• What educational purposes should the school seek to attain?
• What educational experiences can be provided that are likely to attain these purposes?
• How can these educational experiences be effectively organized?
• How can we determine whether these purposes are being attained?
- Kerr's model has also four steps dealing with selection of objectives, selection of content, selection of
learning experiences and evaluation. This approach did not speak about the organization of learning
experiences.
ii. Five step model
- Nicholls and Nicholls recommended this model with addition of situational analysis. This approach
include: situation analysis, selection of objectives, selection of content, methods, and evaluation.
- Wheeler also proposed five step cyclic model made up of: Selection of objectives, selection of
content, selection of learning experiences, organization of content and learning experiences and
evaluation.
iii. Seven step approach
- Taba (1962) proposed her model to curriculum development with seven components
• Situation analysis
• Selection of objectives
• Selection of learning experiences
• Selection of content
• Organization of learning experiences
• Organization of content
• Evaluation
Models of Curriculum on the basis of nature
The different models of curriculum are listed below:
i. Content oriented curriculum
ii. Process oriented curriculum
iii. Behaviouristic model
iv. Competency based model
v. SPICES model (Student oriented, problem based learning, integrated teaching, community based,
electives and spiral)

Principles of curriculum design
Following criteria can be utilized in the selection of content for training curriculum
i. Significance
- The subject matter or content is significant if it is selected and organized for the development of
learning activities, skills, processes and attitude.
- The curriculum content should focus on three domains of learning namely, cognitive, affective and
psychomotor.
- If the trainees come from diverse cultural backgrounds, the subject matter must be culture sensitive
ii. Validity
- Validity refers to the authenticity of the curriculum content.
- It is important that the contents are not obsolete (for example, National Health Policy 1991 instead of
National Health Policy 2014).
iii. Interest
- This criterion is true to learner centered curriculum.
- The learners learn best if the content is meaningful to them. It becomes meaningful if they are
interested in the content.
iv. Utility
- Another criterion is the usefulness of the content or subject matter.
- Learners only value the subject matter or content if it is useful to them
v. Learnability
- The curriculum content must be within the schema of the learners. It should be within their
experiences.
- The theories on psychology of learning should be applied in order to know how subjects are
presented, sequenced and organized to maximize the learning capacity of the learners.
vi. Feasibility
- It means that the curriculum or subject matter can be fully implemented. It should consider the real
situation of health workforce and health system.
- Trainees' must learn within the allowable time and the use of resources available. Curriculum should
not include contents that are impossible to finish.

Process/ steps of need based curriculum development
A curriculum practitioners and implementer may use one or more approaches in planning, implementing
and evaluating a curriculum.
i. Problem identification
- The main reason for developing a curriculum is to train health workforce to enable them to realize the
health sector goals.
- A functional curriculum focuses on the health problems and needs of the society and so in developing
a curriculum these problems form the basis of selecting the knowledge, skills and attitudes to be
inculcated in the learners to equip them to solve their problems and needs.
- In identifying the problems and needs, the learner characteristics, their current status and what they
should be are analyzed.
ii. Need assessment of targeted learners
- At this stage, a need assessment of the targeted learners is embarked upon.
- It involves the process by which the curriculum developer finds out the differences between what is
and what should be.
- The first step of any curriculum development process involves research. This allows curriculum
development to identify key issues and performance gaps will support the need assessment.
- To close this gap, the required knowledge, skills, attitudes must be included in the curriculum.
- As a result of this process, committee members are likely to identify many of the following issues and
trends that will need to be addressed: meeting the needs of trainees, the current expectations,
readiness for change, availability of resources, etc.
iii. Selection of objectives
- In selecting the objectives, the three behaviours: cognitive, affective and psychomotor are borne in
mind. This is to ensure that the curriculum is comprehensive and will produce a desired health sector
results.
- The objectives are important because they help direct the choice of curricular content; suggest what
learning methods will be most effective; enable evaluation of learners and curriculum and suggest
what evaluation methods are appropriate.
iv. Selection and organization of training strategies (methods and contents)
- Training strategies are the detailed means of facilitating learning. It involves manipulation of the
learning environment to motivate learners to learn.
- The strategies involve both the selection and organization of curriculum content and learning
activities.
- With the selection of content goes the task of deciding at what levels and in what sequences the
subject matter will be placed. The activities by which the learners are involved with the content must
be chosen.
- The activities are the means while the contents are the ends. This is why active participation of the
learners in curriculum endeavours is encouraged.
- Today, interactive strategies such as collaboration, use of role plays, small group activities are
encouraged.

v. Implementation
- Implementation is putting into action the planned curriculum. It is the combined efforts of the learner,
the trainer and other stakeholders in ensuring effective execution of the curriculum documents.
- The curriculum must ensure that sufficient resources, political and financial support, and
administrative strategies have been developed to successfully implement the curriculum
vi. Evaluation and feedback
- Most curriculum development models put evaluation as the last step.
- Evaluation and feedback closes the loop in the curriculum development cycle.
- Evaluation plan should be articulated during the design phase to assess the extent of attainment of
the stated objectives.
- Evaluation exposes what the learners have learnt and the gaps to be closed.
- The feedback informs the curriculum developer about the next action to embark on.
Factors influencing curriculum design
The various factors influencing curriculum design are as follows:
i. Political factors
- Education is regarded as a political activity and hence politics influence curriculum. National ideology
and philosophy have a tremendous influence on the curriculum because
• Politics determine and define the goals, content, learning experiences and evaluation strategies
in education.
• Curricular materials and their interpretation are usually heavily influenced by political
considerations.
• Political considerations may play a part in the hiring of personnel.
• Funding of education is greatly influenced by politics.
• Entry into educational institutions and the examination systems are heavily influenced by politics.
ii. Social factors
- Society has its own expectations about the aims and objectives that should be considered when
designing the curriculum. It also has a perception of what the product of the school system should
look like. It is therefore necessary for curriculum designers to take into account these societal
considerations. If this does not happen, the curriculum becomes irrelevant.
- The design of curricular materials and their presentation should accommodate the culture of the
society that the curriculum is seeking to serve.
iii. Economic factors
- One of the reasons why education is financed by governments is to improve the country’s economy.
Therefore, the national curriculum should concern itself with the requirements of the economy.
- Teaching requires classroom supplies such as textbooks, charts, equipments, tools for field study,
etc. Without these materials, learning is compromised. It is therefore crucial that serious consideration
be given to economic demands when designing the curriculum.
iv. Technological factors
- Computers and other forms of electronic media have provided a variety of learning experiences and
have facilitated individualized learning. Curriculum designers cannot afford to ignore technology and
its influence on the curriculum.

v. Influence of learner’s psychology
- Curriculum design is also influenced by learner psychology.
- Theories of learning and learner’s development have to be considered when designing the content of
the curriculum and how it is delivered.
- Learning can be maximized by ensuring that activities and experiences are introduced at the most
‘teachable’ moment.
Curriculum Change
Why change curriculum?
- Existing curriculum did not adequately prepare HRH for the task needed.
- Content was overloaded or was insufficient to train for required knowledge/skills
- Adaptation to changing context: To consider the main directions in which reform is taking place
E.g. new strategy added to the health program.
- Method of delivery was not appropriate
Stages of curriculum change
i. Diagnosis in developed curriculum
- The curriculum developer begins by determining the achievement of the existing curriculum.
- The success/failure of the curriculum in meeting the needs of the trainees as learners (for whom the
curriculum is being planned) is determined.
- The curriculum worker also needs to diagnose the problems, gaps, deficiencies in the existing
curriculum.
ii. Formulation of educational objectives
- After the curriculum needs/problems have been diagnosed, the curriculum planner specifies new
objectives to be accomplished.
- The curriculum developer begins his or her search for new educational objectives by gathering and
analyzing data relevant to trainees' needs and interests.
- The total range of educational needs, social, occupational, physical, psychological, and recreational is
studied.
iii. Selection of content
- The subject matter or topics to be studied stem directly from the objectives.
- Not only should objectives and content match, but also the validity and significance of the content
chosen needs to be determined. i.e. the relevancy and significance of content.
- Following criteria needs to be considered for selection of curriculum content.
• self sufficiency
• significance
• validity
• interest
• utility
• learnability
• feasibility

iv. Organization of curriculum content
- With the selection of content goes the task of deciding at what levels and in what sequences the
subject matter will be placed.
- Maturity of learners, their readiness to confront the subject matter, and their levels of academic
achievement are factors to be considered in the appropriate placement of content.
v. Selection of learning experiences
- The methodologies or strategies by which the learners are involved with the content must be chosen
by the curriculum planners.
- Pupils internalize the content through the learning activities selected by the planner-trainer.
vi. Organization of learning activities
- The trainer decides how to package the learning activities and in what combinations and sequences
they will be utilized.
- At this stage, the trainer adapts the strategies to the particular trainee for whom he or she has
responsibility. The considerations are made on factors such as learner's position and capacity,
context/settings, etc.
vii. Evaluation
- The planner must decide ways to assess how objectives have been accomplished.
- The instructor selects from a variety of techniques and appropriate means for assessing achievement
of trainees and for determining whether the objectives of the curriculum have been met.
Match the content, trainees and context/settings
i. Matching curriculum to local contexts
- The main focus when matching/ adapting a curriculum is to make minor adjustments so it fits local
conditions and trainees' needs.
- To accomplish this, one must be familiar with the audience. Which policies and procedures apply to
the curriculum? What is the current level of knowledge and ability of the learners? Which type of tools
and equipments are feasible for use by learners in performing the skills in their local context?
- These are all questions curriculum development team should be contemplating when reviewing a
curriculum for any adaptations/changes needed to accommodate the intended audience.
ii. Matching curriculum to trainees' needs
- The curriculum should also be reviewed and changed based on learner's limitations and
adapted/changed to accommodate those limitations if possible.
- The curriculum should be at the appropriate educational level of the learners and the pre-requisite
knowledge and skills should be verified.
- All adaptations should be done with one single purpose i.e. meeting the needs of the intended
trainees'.
vii. Changing the content and methods
- Method of instruction is one of the area that curriculum development team may modify.
- Such a modification may be needed to allow trainers to effectively implement the curriculum, but it
should not change the learning objectives. For example, trainees may not be able to effectively
understand a session on gender based violence using lecture method alone. Instead, the curriculum

might be modified to change the method of training to discussion and role play. This would allow the
same information to be taught, just in different methodology.
- Sometimes, the team may also need to modify the content to adapt with the changing context. For
example, with CBIMCI being replaced by CB-IMNCI program, the health workers might require to
know the changes in the management protocols.
Collaboration and coordination with different government and non-government
curriculum development institutions
NHTC is an apex body of Ministry of Health that is responsible for coordination and development of all
training activities including curriculum development. NHTC coordinates and collaborates with number of
government and non-government organizations who can contribute to development of training curriculum.
Some of these organizations/institutions include:
- Divisions and centers under Department of Health Services
- Universities/ academies: Institute of Medicine, Pokhara University, Purbanchal Universty, NAMS,
PAHS, BPKIHS
- Bilateral/ Multilateral organizations and I/NGOs: E.g. Nick Simons Institute, UNICEF, USAID, DFID,
etc.
- Professional associations: Nepal Public Health Association
- Private organizations and independent consultants
- Research organizations: New Era, HERD International
Areas of collaboration in curriculum developments
Sectors involved in collaboration Areas of collaboration and coordination
Health Training Centres (NHTC/RHTC) Stewardship and coordination
Curriculum design, implementation and evaluation
Departments and centers of DOHS and
subordinate bodies
Training need assessment
Curriculum implementation
Universities/ Academia Research for need assessment (identify curriculum
problems/ recommend changes)
Selection and organization of curricular contents
Multi and bilateral organizations, I/NGOs Technical assistance
Funding for curriculum design and implementation
Professional associations Watchdog/ Monitor quality of curriculum
implementation/ Recommend curricular changes
Research organizations Training need assessment
Evaluation of curricular impact and effectiveness
Private and independent consultants Professional contracting (for curriculum development)
Curriculum evaluation

UNIT 5: DELIVERY OF VARIOUS TRANING PROGRAM FROM HEALTH SYSTEMS
Overview of Health Training Programs of MOHP, concerned ministries, INGO, NGOs,
CBO, and Bilateral Organizations
Organizations Training Programs
NHTC/ RHTC See types of training in Health
INGO/NGOs and
Bilateral
Organizations
Support/ Sponsor various pre-service and in-service training programs in
coordination with departments and centers. For example,
Pre-service Training
i. Nick Simon Institute: Diploma in Biomedical Equipment Engineering and
Anesthesia Assistant Training
In-service training programs
i. USAID: Family planning, Logistic Management training, quality improvement
tools in clinical training, human resource support for family planning training
and service strengthening
ii. Nick Simons Institute: SBA, USG, MLP, clinical training skills, OTTM, X-
ray/lab users maintenance training
iii. UNFPA: ASRH, Gender based violence, Human resource support for RH
training and service strengthening
iv. Save the Children: SBA, ASRH, family planning training
v. UNICEF: SBA training, Rural ultrasound technical assistance
vi. Ipas: Safe abortion site training, long-term family planning method
vii. PSI Nepal: Family planning training, medical abortion, clinical training skills
Ministry/ Department
and Centers
All above, including,
i. Child Health Division: FB-IMNCI, CB-IMNCI, Peri-natal Quality Improvement
ii. PHC Revitalization Division: Training on PEN Protocol
iii. Family Health Division: Task Shifting on FP
iv. National TB Center: TB Management Trainings
v. National Centre for AIDS and STI Control: Training on PMTCT
Roles, functions and activities of NHTC and RHTC
National Health Training Centre (NHTC) is the apex body under MOH for overseeing all health related
training.
Objectives:
• To enhance and standardized the training curricula, references, trainers’ capacity and training sites
• To organize training activities to address the need for quality health service providers in diﬀerent level
of health facilities.
• To address the training requirements reflected in national health policies and strategies.
Strategies:
• Assessing, standardizing and accrediting training and training sites.
• Developing and standardizing training packages.
• The institutional capacity development of all training units.
• Conducting pre-service, in-service, orientation, refresher, long-term and short-term trainings as per
national requirements.
• Integrating and institutionalizing training.

• Develop links with professional career development organizations.
• Strengthening the Training Information Management System (TIMS) and training rosters.
Roles and Functions of NHTC/ RHTC
The training and development functions of National Health Training Centre can be categorized in the
following points:
i. Policy development: Formulate policy, strategies and guidelines for National Health Training
ii. Training design: Need assessment, package/curriculum development, update/review
iii. Training management: Planning, coordination, training logistic management, affiliation of training
sites, budgeting and training data management.
iv. Post training support: Follow up, programmatic and clinical support, study/evaluation, continuing
medical education.
v. Quality improvement: Accreditation, capacity strengthening, monitoring and supervision, clinical
mentoring
vi. Conduct training and orientation: Deliver training, recording and reporting of training activities
Activities of NHTC/ RHTC
Some of the activities conducted in FY 2072/73 were:
i. Trainings programs
- Pre-service training and in-service training
- Certification of non-clinical and clinical competency-based training courses
- Skills/ competency based training for health workers
ii. Institutional capacity development
- Physical activities: Development of facilities at RHTC, hospitals and district level training sites.
- Upgrading and maintenance of training sites (renovation and equipment support)
- Training program development
iii. Training manual development
- Revision and development of training manuals in coordination with external development partners:
Minilap, Non-scalpel vasectomy, IUCD, PNC, Infection prevention and package for 5 upgraded
trainings.
iv. New initiatives
- Follow up enhancement program
- Obstetric fistula training
- Primary trauma care management and emergency trauma management trainings
- Blended approaches for non-scalpel vasectomy and UCD training
- Newborn and non-communicable disease (PEN package) trainings

Limitations and challenges of training programs in Nepal- Critical Overview
i. Training need analysis
- There is no established process in place for analyzing the training needs of the whole public sector
health system.
ii. Planning of training
- The training needs analysis should guide the training plan for the whole Ministry (or a series of
central, regional and district training) to address performance gaps. However, the planning process is
fragmented; the NHTC and the divisions develop their own annual training plans independently based
on their own perceptions of need.
- The divisions have their own training budgets and training staffs. These separate plans are not
brought together or coordinated with each other when the annual budget is prepared.
- The second problem is that planning is largely a “top down” process in which most training carried out
at district level is decided by either NHTC or the divisions of the DoHS.
iii. Curriculum design
- In principle, curriculum design should be a process which involves both the selection of relevant
content and the choice of appropriate methods to deliver it in an effective way.
- However, with the exception of the learning packages which have been developed with the
assistance of supporting partners, NHTC’s curriculum tends to focus on the content rather than the
methods and other requirements.
- It tends to be assumed that training will be delivered off the job (in a classroom or at a training site).
On-job training methods, such as coaching by a skilled supervisor, which keep staffs at their place of
work, are not considered.
iv. Quality assurance
- There is no established process in the Ministry for the quality assurance of training delivered by either
the NHTC or the divisions/centers, including the formal accreditation of training programs, trainers
and trainees, curriculum review, resource materials, training sites and facilities, and the monitoring of
the trainer’s performance at the point of delivery.
iv. Evaluation
- Whilst NHTC evaluates training at the levels of participant reactions and learning (using pre-tests and
post-tests), it rarely follows up trainees after they return to their jobs to assess whether they are
adopting new practices, or whether their performance has improved.
- The ultimate test of whether training is effective is whether the Key Performance Indicators are
moving in the right direction
v. Skills in training
- The training professionals at the RHTCs have worked as either health education officers or health
assistants before joining the NHTC. They are qualified to either certificate or diploma level.
- The NHTC as a whole lacks any meaningful skills in training needs analysis, monitoring and training
follow-up.

Health Training in National Health Policy and Three Year Plan
Various policies, plans and strategies have spelled out the provisions relating to training of HRH in Nepal.
i. National Health Policy 2014
- National Health Policy aims to plan, produce, retain and develop skilled human resources to deliver
affordable and effective health services.
- This policy guarantees the opportunity for higher education, trainings within service duration and
participation on profession related studies and researches to doctors and health workers.
- Emphasis has also been laid on master planning of HRH development, unified curriculum
development as well as achieving skill mix of HRH at all areas.
ii. The 2003-2017 Strategic Plan for HRH
- The 2003-2017 strategic plan was intended to
 Specify the direction and growth of human resource growth
 Outline human resource objectives for the medium term, and
 Identify short-term policy actions for the MOH.
- It includes future human resource requirements and supply and examines their implication for training
and training institutions.
iii. Thirteenth Periodic Plan
- The thirteenth periodic plan of Nepal places capacity development of human resource as one of the
major policies.
iv. NHSP-III Strategic Plan (2015-20)
- The NHSP-III strategic plan has defined nine outcomes for the health sector of which strengthening
HRH is one among the first outcomes.
- There are two outputs concerning HRH for achieving the outcome of strengthening HRH.
 Output 1a.1: Improved staff availability at all levels with focus on rural retention and enrollment
 Output 1a.2: Improved human resource education and competencies:
- The focus is on improving the quality of pre-service training and better coordinating in-service training
for health sector staffs.
- Revision of curriculum for formal education has also been focused in the strategy.
- The strategy also proposes innovative methods such as clinical mentoring to improve skills and
competencies

Career opportunities in health training programs
Health Trainers are the individuals who plan, implement and evaluate health training and promotion
programs. These individuals play a crucial role in many organizations in various settings. The career
opportunities in health training programs include:
i. Health Care Settings
- These include hospitals (for profit and public), medical care clinics and other health agencies.
- Here, health instructors are often employed to train professionals on wide range of health care topics
such as infection prevention, counseling skills, provider behavior change communication waste
management, occupational safety and health, etc.
ii. Non-Government Organizations
- Various national and international non-government organizations have been executing number of
health care project across the country.
- These projects involve various technical and non-technical training programs. Large numbers of
health workforce have been occupied by these organizations in the positions of Training Officers/
BCC officers and similar related positions.
- These workforces are particularly involved in wide range of training activities such as training design,
training coordination and implementation, training evaluation, reporting, etc.
iii. Academia
- In academia, professionals can hold the position of health educator or training coordinator.
- As a faculty member, the training coordinator/educator typically has three major responsibilities:
teaching, community and professional service and scholarly research.
iv. Independent consulting and government contracting
- International, national and local organizations, including government agencies such as NHTC
contract with independent consultants for many reasons.
- They may be hired to assess the training needs of health workforce; design curriculum package; plan,
implement, administer health training programs; conduct independent training evaluation; serve as
training resource person; and/or communicate about and advocate for health training.

Health Workforce Planning, Training and Curriculum Development

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