Faculty of Humanities and Social Sciences, University of Winchester, Winchester, UK.
Tropical Health and Education Trust (THET), London, UK.
Global Health. 2018 Oct 22;14(1):100. doi: 10.1186/s12992-018-0420-3.
Global health partnerships (GHP) between high or low-middle income countries are considered one of the best approaches to health systems strengthening. They typically involve highly skilled healthcare workers who volunteer to deliver capacity strengthening projects overseas, often in the form of peer-to-peer support through training and mentoring. Given GHP's strong focus on education and training, a common assumption is that training of trainers (ToT) is a strong predictor of sustainability because of its potential for up-skilling the workforce rapidly, cheaply and exponentially by developing local educators. Our aim is to test this assumption and identify the strengths and limitations of this approach by analysing qualitative data from a set of GHP funded by the UK Department for International Development through the Tropical Health and Education Trust.
Our analysis identifies some of the common features of the ToT model and a number of limitations that can prevent it from being both effective and sustainable. Whilst most GHP strive for the long-term sustainability of the training by focusing on adequate training provision and support of local trainers, the wider issues that can facilitate or prevent the continuation of training are not always considered. We propose a conceptual framework (TRAIN) for ToT interventions to help inform practice and project evaluation. We illustrate the applicability of our framework through five case studies, each chosen to illustrate one aspect of the framework.
TRAIN is intended as a starting point for further refinements and discussions about the factors affecting capacity building strategies based on training cascades. Although we envisage its usefulness to GHP as a guidance to design and operationalise ToT, we recognise that in practice it may be difficult to implement it in its entirety. The key message underlying TRAIN is that the sustainability of a cascade depends on a number of factors being present or developing at different operational levels during the course of a project. These are crucial to transform the opportunities that ToT affords to health systems in developing countries into the actual achievement of a training cascade that ultimately upskills the workforce and improves health outcomes in these countries.
高收入或中低收入国家之间的全球卫生伙伴关系（GHP）被认为是加强卫生系统的最佳方法之一。它们通常涉及高技能的医疗保健工作者，他们自愿在海外提供能力建设项目，通常以培训和指导的同行支持形式。鉴于 GHP 对教育和培训的强烈关注，人们普遍认为培训师培训（ToT）是可持续性的有力预测因素，因为它有可能通过培养当地教育工作者快速、廉价和指数级地提高劳动力技能。我们的目的是通过分析由英国国际发展部通过热带卫生和教育信托基金资助的一系列 GHP 的定性数据来检验这一假设，并确定这种方法的优势和局限性。
我们的分析确定了 ToT 模型的一些共同特征和一些可能阻止其既有效又可持续的限制。虽然大多数 GHP 都通过关注充分的培训提供和对当地培训师的支持来努力实现培训的长期可持续性，但并非总是考虑到可以促进或阻止培训继续的更广泛问题。我们提出了一个 ToT 干预措施的概念框架（TRAIN），以帮助为实践和项目评估提供信息。我们通过五个案例研究来说明我们框架的适用性，每个案例研究都选择来说明框架的一个方面。
TRAIN 旨在作为进一步完善和讨论基于培训级联的能力建设策略的影响因素的起点。尽管我们设想它对 GHP 的有用性在于作为设计和实施 ToT 的指南，但我们认识到在实践中，要完全实施它可能很困难。TRAIN 背后的关键信息是，级联的可持续性取决于在项目过程中不同运营层面上存在或发展的一系列因素。这些因素对于将 ToT 提供的机会转化为发展中国家卫生系统的实际培训级联，最终提高这些国家的劳动力技能并改善卫生成果至关重要。
