One of the key elements in the successful introduction of a vaccine is sufficient, high-quality training of all health workers involved in immunization, as well as supervisors and immunization programme staff, about the new vaccine and the disease(s) it prevents. Several of the newer vaccines present new challenges to health workers.
These challenges include more complex handling and storage requirements due to increased temperature sensitivity, more complicated immunization schedules and the targeting of ages beyond infancy and early childhood.These challenges make adequate training for the new vaccine all the more critical.
Training in preparation for the new vaccine introduction should cover the following topics:
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which vaccines and doses to provide to children who are “off-schedule” or who are already partially immunized with other vaccines before the launch of the new vaccine;
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The training should also include refresher training to health workers and supervisors on other major aspects of the immunization programme, especially areas where previous programme assessments have identified weaknesses. The training for the new vaccine provides an opportunity to refresh immunization and health workers’
skills and knowledge in such critical areas as:
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s $ATACOLLECTIONANDANALYSISINCLUDINGESTIMATINGDENOMINATORSTHETARGET population) to calculate coverage rates and estimating drop-out rates.
An initial step in planning and designing the training programme is to conduct an assessment of the knowledge, skills and practices of health workers involved in immunization. This information may already be available from a recent programme evaluation. The assessment should highlight the areas where refresher training is especially needed and also inform the development of training materials that are written at the appropriate level for different levels of health workers. A detailed
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45 Training manuals for various new vaccines maybe found at: http://www.who.int/immunization/documents/training/en/index1.html.
46 These can be found at http://www.who.int/immunization/documents/training/en/.
47 The WHO Vaccine Safety Basics course can be found at: http://www.vaccine-safety-training.org/.
training plan and budget should then be prepared and incorporated into the cMYP and annual EPI plan. The plan should include the numbers of levels of training, the length of each level of training, materials to be used and identification of trainers.
As much as possible, the number of levels through which the training is rolled out (e.g., cascade training) should be minimized to maintain high quality of the training.
The training for a new vaccine should be conducted not too far in advance of the vaccine introduction; ideally training for frontline health workers should take place two or three weeks prior to the new vaccine launch. It is also important that the training be followed by supportive supervision to ensure that health workers actually use the skills learned and apply them correctly (see → Section 3.7.2).
The training methods used are also critical to ensure effective learning. People have different learning styles, and studies have shown that adults learn more effectively by doing rather than by passively listening to a lecture. Instead of consisting
simply of a series of lectures and presentations, the training should involve a mix of activities, such as small group discussions, question-and-answer sessions, skills practice, role-playing (e.g., to practice communicating with parents), and field visits – all of which can reinforce key messages. Immunization programmes may want to involve experts from training institutes, universities, training units of the Ministry of Health and others to assist in designing and conducting training that uses effective teaching methods based on adult learning principles.
Countries should also establish procedures and mechanisms to monitor the quality of the training, especially at lower levels of the health system (e.g., if a cascade training approach is used). Administering pre- and post-tests at all trainings is one commonly-used method to evaluate the effectiveness of the training. Another method that countries have been using is to have national-level trainers attend local-level training sessions to monitor their quality, supervise the local trainers and serve as resource persons.
WHO has developed training packages for several new vaccines, including pneumo-coccal conjugate, rotavirus and HPV vaccines. These packages include handbooks for health workers, modules on different topics in Powerpoint slide format, and review exercises.45 Other WHO immunization training resources include the Immunization in Practice modules, a series of modules on immunization training for Mid-Level Managers (MLM),46 numerous job aids, and a WHO e-learning course on Vaccine Safety Basics.47
Does the training fit in with the training plans and policies outlined in the national health plan?
(ASANASSESSMENTOFTHECAPABILITIESSKILLSANDKNOWLEDGEOFHEALTHWORKERS in the area of immunization taken place or is such an assessment planned to inform the training for the new vaccine, including refresher training?
Is the training schedule and timing planned to minimize disruptions in health SERVICESANDTHEhTRAININGLOADvOFWORKERS
Does training for the new vaccine include sufficient refresher training on immunization practices (e.g., injection safety, communications, cold chain MAINTENANCEDATACOLLECTIONANDANALYSIS
Does the training include information on other interventions for health workers to promote or provide for a coordinated approach to disease control?
Is information on the new vaccine being added to the curricula for medical and NURSINGSTUDENTSPRESERVICETRAINING
Will the training provide health workers with new skills that can be applied more broadly to other health services (e.g., in disease surveillance, safe INJECTIONSADVERSEEVENTSMONITORINGDATAANALYSISANDREPORTING
Are there procedures in place to monitor the quality of the training, INCLUDINGTRAININGOFHEALTHWORKERSATTHELOCALEGSUBDISTRICT LEVEL BOX 15. Questions to ask when planning training for the
introduction of a new vaccine
3.7.2