|LETTER TO THE EDITOR
|Year : 2014 | Volume
| Issue : 2 | Page : 223-224
Framework for distance training of laboratory professionals in Sub-Saharan Africa
University of Maryland University College, Maryland, USA
|Date of Web Publication||31-Oct-2014|
331 Hopkins Rd, Baltimore 21212, Maryland
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Marinucci F. Framework for distance training of laboratory professionals in Sub-Saharan Africa. Educ Health 2014;27:223-4
Despite remarkable advancements in access to quality healthcare in sub-Saharan Africa, the demand for adequately trained healthcare personnel persists.  The numerous efforts in strengthening healthcare systems in Sub-Saharan Africa can be successful only if an effective training approach is endorsed and ingrained at a countrywide level into a broader strategy for human resources development. The efficacy of capacity-building of health workers relies on several factors, some country-specific, others dependent on the adopted strategy.
The urgency for medical laboratory professionals is critical due to the massive influx of medical laboratory technology, particularly in the context of human immunodeficiency virus (HIV), tuberculosis, and malaria care and treatment programs.  One major consequence of the increased access to diagnostics is the wide distribution of laboratory technology, even in clinics in rural areas. This scenario requires the players on the ground to explore innovative approaches to offer in-service training in order to maintain high quality laboratory services in these settings. 
However, a major obstacle with in-service distance education in these settings is combining theoretical aspects and hands-on activities, which are both needed for improvement in the competence and performance of medical laboratory professionals. Too often, face-to-face training fails to promote critical thinking and active participation because the only outcome is knowledge transfer with minimum impact on practical skills relevant to daily practice. Additionally, the central training approach has the disadvantage of disrupting medical laboratory services by bringing in laboratory professionals from outside the laboratory. Lastly, the high running costs (e.g. travel, accommodation, per-diem, venue rental) associated with a limited number of trainees make the central face-to-face approach not sustainable.
In response, diagnostic companies have started to provide training material online, but the introduction of point-of-care devices has drastically reduced the amount of on-site users' training. However, even when manufacturers provide hands-on training, this is rarely integrated with content available online and very often limited only to the proper use of the equipment. Without having these two elements interacting, namely on-site training and online material, and without them being part of a broader strategy, it is likely that their impact on the quality of testing is limited. Sub-Saharan Africa accounts for 5.6% of total Internet users worldwide with a penetration among the population of 11.5%. These figures, in addition to lack of expertise, poor information technology infrastructure, and poor computer literacy, show that demand for innovative distance-learning approaches in this region clearly rely on factors other than Internet access. 
The strategy envisioned by the author and based on vast experience in the region focuses on four areas that are crucial for delivering effective in-service training for laboratory professionals in these settings.: Institutional support, instructional strategy, delivery modes, and quality improvement. First, the new in-service training approach should be linked to national licensing agencies for continuing professional development (CPD). Adopting distance-learning courses tailored to in-country needs creates a win-win situation. By increasing the availability of CPD courses and making attendance mandatory, the number of laboratory professionals willing to pay the annual fees for renewing their licenses is likely to increase nationwide.
Second, the instructional strategy adopted should be a combination of face-to-face instruction and media-mediated activities focusing on real-world tasks to facilitate the transfer of knowledge into the skills to be performed in the real-world setting. This approach fulfills the need to apply prior knowledge to real settings by offering learners the opportunity of modeling problem-solving processes in their work environment. A task-centered approach fits perfectly in the strategy of developing quality-oriented distance learning courses. To focus self-learning on the quality of testing, the whole task should consist of all the actions laboratory professionals have to perform properly to provide reliable, high-quality results.
Third, the same instructional strategy should be delivered using different modes according to specific determinants such as the location of the medical laboratory, electricity availability, telecommunications means, postal service and mobile phone networks, available budget, and number of trainees. Regardless of the adopted delivery mode, this approach revamps the telephone as important technology in distance education, as it is essential to ensure learner-instructor communication.
Finally, a solid assessment strategy is crucial to monitor the impact of the training on the overall quality of laboratory operations, and is very helpful in retuning the training strategy over time. This can be achieved by comparing the retention of knowledge of learners and the score of the laboratory obtained using a checklist (e.g., stepwise laboratory quality improvement process toward accreditation or an external assessment scheme). 
In the envisioned strategy, technology is considered crucial to achieve the goals reaching vast audiences, reducing costs, broadening the offer of CPD courses and improving the quality of laboratory services. However, the key factor to effectively implement this strategy is the cooperation between different players at both national and international levels.
First, in-country professional organizations and regulatory bodies have the task of upholding life-long learning among their members. The systematic support for continuous professional development as a requirement to work should be mutually pursued both by laboratory professionals and licensing authorities. Second, private companies should actively promote the hands-on part of the training as part of their on-going customer support initiatives, aiming at ensuring that the equipment countrywide is permanently in good working condition.
Third, the vast amount of training material circulating in-country should be standardized, made relevant for country-specific needs, and readapted to different delivery modes. Fourth, telecommunication companies should participate in this endeavor by reducing the cost of text messages used in two-way communication between learners and instructors.
Finally, local government, mainly through the Ministry of Health and the Ministry of Education, should lead the process of engaging and coordinating the different players with the overall goal of strengthening cooperation. All the elements are already on the ground; it is just a matter of having them effectively interacting with one another.
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