/ 14 January 2008

Healthcare by numbers

Thousands of South African nurses are doing it for themselves when it comes to extending their skills and training — with the aid of locally developed distance learning courses.

The Perinatal Education Programme (PEP) was set up in 1989 by Professor Dave Woods, then at the University of Cape Town, and colleagues who wanted to improve the skills of healthcare workers caring for pregnant women, mothers and infants. Successive reports on maternal and infant care revealed rising mortality rates and a high level of preventable child deaths, with lack of skills and knowledge among healthcare workers a contributing factor.

Woods said there is a demand from healthcare workers for further training, but traditional ongoing professional development courses often fail to meet that need.

Such courses often are focused on major healthcare facilities and are expensive and require dedicated trainers. Often they are inappropriate for the health needs and facilities available to patients and healthcare workers outside major centres, especially those in rural areas. Yet these are the environments where the death toll among women and children is highest and nurses and midwives are the sole source of immediate medical help.

Doctors, medical students, midwives and nursing students have all done the distance learning courses, which are gaining in popularity because of the flexibility they offer people already working and the knowledge boost they give students.

As a side-benefit they encourage cooperation among colleagues, because students work together in small groups. Woods said the degree of self-motivation required to do such distance learning courses demonstrates the desire to learn among healthcare workers. So far more than 10 000 people have received certificates for passing the exams and more than 50 000 copies of the two-course manuals have been distributed to students in Southern Africa.

The PEP courses are revised and expanded continuously to take into account changing knowledge, technology and the needs of women, children and healthcare workers. The two main courses focus on maternal care and newborn care, with each course taking an average of a year to complete.

The PEP courses give continuing professional development points to healthcare workers. Negotiations are under way to register the courses with the South African Nursing Council.

Students study the 15 theory units in each course at home and then in small study groups every three weeks. The study meetings are held during working hours. Practical skills and implementation of theory are developed in nine skills workshops. The exams require a score of 80% to pass. Each manual costs R200, but successful students are reimbursed the money from a fund established by the benefactor in the United States. Shorter supplementary courses are available that focus on particular areas, such as HIV/Aids.

Woods said research into PEP shows a consistent improvement in knowledge, attitudes to patients and care of patients among healthcare workers who complete the courses compared with those who do not. Improvements include better clinical knowledge and even simple administrative skills, such as more accurate recording of data, which help individual patients and healthcare administrators.

Nurses who complete the course report greater job satisfaction and confidence: an important factor as South Africa continues to face the drain of healthcare workers into the private sector, other professions and out of the country.

Finding and keeping suitable staff is a problem even for foreign organisations looking to do medical research and clinical trials in South Africa. A strategy adopted by some is to improve skills of employees, hoping not only to develop workforce talent, but also to retain skilled individuals when the next dollar-funded research organisation comes poaching.

One research institution doing this is the Aeras Global TB Vaccine Foundation (Aeras), which works with the South African TB Vaccine Initiative (Satvi) to develop new TB vaccines at a site in the Western Cape. Jen Page, the assistant director of professional development and training at Aeras, said the professional development programme in South Africa is intended to obtain formal recognition for the skills staff develop while working on clinical trials.

This increases job interest and motivation and allows staff to receive financial recognition of their skills by getting paid more. It is a way of giving something back to the communities that host the growing number of clinical trial workers at the site.

More unusually, a supplementary pilot project concentrates on people who complete matric, but don’t have professional qualifications. The volunteer counsellors, home-based care assistants, outreach workers — and even cleaners — are eligible to participate in the programme, which is being designed to take employees from matric right up to a degree at the University of Cape Town in a biologically related subject.

Satvi’s Professor Greg Hussey said most professional development programmes are directed towards academia, such as postgraduate qualifications. “These are not applicable to other kinds of healthcare workers who form the backbone of such research programmes, such as nurses and technologists. We try to bring these people up to speed. We try to develop a programme that will train them to a level where they are confident enough to do research and to give them qualifications.”

The pilot project goes one step further, said Hussey, by identifying the competent people who are doing menial tasks because they have not had a chance to acquire skills and find better jobs. “

Our policy is that if we hire people who do the job, we want them to develop their own potential further, not just the academics, but also people working at the coal face, the cleaners, clerks and data capturers. They get the chance to develop and add skills that are marketable, and this affects staff retention. If people have goals they can work towards, this improves the working relationship, making the environment a much more pleasant place to work because people have aspirations.”