Barry Hill1
Márcia Lenzi2

Notes on the training of workers in the health sector

Notas sobre o treinamento de trabalhadores no setor de saúde

1University of Hertfordshire, Wall Hall Campus, Aldenham, Watford - Herts, WD28AT. England, UK.

2Departamento de Ciências Biológicas, Escola Nacional de Saúde Pública. Rua Leopoldo Bulhões, 1480, Rio de Janeiro, RJ. 21041-210, Brasil.

  Abstract The following notes attempt to contribute to questions on planning, design, and evaluation of training courses for technical personnel in the health sector. The authors analyze and compare trainees' views on their courses and point out issues related to planning, implementation, and some benefits of training for trainees' lives.
Key words
Training; Planning; Health Workers; Inservice Training


As observações aqui registradas têm a intenção de contribuir para questões sobre planejamento, desenvolvimento e avaliação de cursos de capacitação de pessoal de nível técnico do setor saúde. Os autores analisam e comparam cursos sob o ponto de vista de sua clientela e apontam algumas sugestões no que tange a construção e avaliação de cursos, além de alguns benefícios que a capacitação traz para a vida desses técnicos.
Treinamento; Planejamento; Profissionais em Saúde; Capacitação em Serviço





It is widely if not universally agreed that enhancing the training of middle-level health care professionals improves the quality of health care practice (WHO, 1990a). What is not agreed on is the most appropriate form and nature of the provision of instruction.

Planning educational programs should include all the components needed to provide quality learning activities, through the identification and analysis of educational needs, the design and implementation of educational activities, and evaluation of the program.

The traditional focus of Human Resources for Health Development (HRHD - WHO) has been on improving planning, education, and training. Still, according to the WHO Study Group for the Development of Human Resources for Health (WHO, 1990b), health workers may need to improve their skills or learn new ones in order to deal with new health programs or programs elements.

The purpose of the following notes is to contribute to questions on planning, design, and evaluation of training courses for health workers as a result of the authors' study on provision of training for this professional group.



Study objective


A training course, whether basic or advanced, should increase people's professional development by enhancing the quality of their skills, knowledge, and attitudes.

Training is an important part of the preparation of health workers. According to Greenfield (1969), it can be described as "a unique competence to deal with a given process, structure or situation which is important to the community but potentially dangerous in the hands of an incompetent ... The three most important aspects of control over the profession are training the new members; certifying the competence of those allowed to practice; and regulating the quality of the members... It is hoped that the professional society will succeed in instilling in each worker a professional attitude and pride in his work that will adhere to professional ethics and to strive to improve his competence".

The study inquires whether some approaches which help in the achievement of training outcomes are applied or not in educational programs for health workers (technicians), as the success of instructional programs is dependent on an approach that considers a number of interacting components. To this end, we performed an analysis of course planning by focusing on its design, development and evaluation.

This study thus focuses on programs for preparing technicians in the health sector, centering on Brazil, but extended to England to form a comparative study.

Three courses were studied: a training course for health care support personnel at two British hospitals - St. Alban's City Hospital and Watford General Hospital, and a course on parasite biology at the Oswaldo Cruz Foundation, a medical institution in Rio de Janeiro (all such training is given to people with very little or no experience in the content areas). 





Central to the training process are the course manager (who makes the decisions on the nature and extent of the courses) and the participants. Both groups have been included in our study methodology.

The fact that there were few course managers and a larger number of participants suggested methods that were appropriate to both individuals and groups. Based on Cohen & Manion (1980), an interview for the the first group and a questionnaire for the second were applied. Both instruments were developed from key issues explored in the literature on planning and developing continuing education for health workers.

The three groups chosen for the participant sample were constructed on the basis of three groups with different characteristics on variables which might affect the outcome, namely age, location, and cultural background.

Data on how courses were planned, implemented, and evaluated were compared and analyzed using a qualitative approach. It was thus possible to gain a different perspective on the subject, since the purpose was to suggest possibilities rather than to provide a rigorous description of how training is provided in the two countries by reaching conclusions related to relevant issues to be considered in an effective training process.





Reflecting the realities of the different contexts, we found differences between courses in Brazil and England in terms of resources, students' initial qualifications, and career development, while close similarities among the three courses were also observed.

The main problems we noted were in the area of needs assessment, the nature of the teaching process - including underlying educational principles and teaching methods -, logistic support, resources, selection of course members, and quality control procedures associated with the course. Concerning needs assessment, we noted that there was only one course for health care support personnel in England where the course members were consulted before and during the course, whereas in the other two courses the students' views were not asked for at these stages, but only during a post-training evaluation. By assessing individual needs and deficiencies, a course provider can plan a more conclusive training program.

Clear specification of course objectives and content in the program was regarded as imperative by students in both countries, and there is clearly an opportunity to improve training provision in this area in both contexts, attempting to avoid both misconception concerning the course description and consequent drop-out.

While those funding the courses - governments in both instances - may be seeking increased competence, there are important additional benefits which appear to lie elsewhere, notably expressed as increased self-esteem among students, the opportunity to take on new responsibilities, motivation, and the wish to undertake further study. Paradoxically, in Brazil, where needs are most pressing, students believe that the course had provided task performance skills less demanding than they were expecting, whereas in England student expectations were largely met, although in both cases they would have preferred more time for practical experience. However, it is worth qualifying these views with the further evidence that it was in the area of the transfer of skills to the working environment that Brazilian students found most difficulty.





We concluded that there are issues relating to course management and design that are evident in both developing countries such as Brazil and developed countries such as England. These have implications for manpower planning, recruitment, health care provision, staff development and career progress, with consequent impact on health systems, individual workers, and the population as a whole.

Although both course providers and course managers considered the courses a success, an acid test would be an objective assessment of task performance before and after the course for those already employed in the health sector and post-course competency-based appraisal for the many who are new to this area when they begin the course.

It is quite clear that for both the curriculum and teaching there is much to be learned in both countries. While it is interesting to note the similarities, there are clear areas in which complementary approaches to enhancement of course design would appear to be of value in both countries.





COHEN, L. & MANION, L., 1980. Research Methods in Education. London: Croom Helm Ltd.         

GREENFIELD, H. I., 1985. Allied health manpower. Journal of Medical Technology, 2:723-726.         

WHO (World Health Organization), 1990a. Expert Committee on Systems of Continuing Education. Geneva: WHO (Technical Report Series, 803).         

WHO (World Health Organization), 1990b. Study Group on the Role of Research and Information Systems in Decision-Making for the Development of Human Resources for Health. Geneva: WHO (Technical Report Series, 802).        

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rio de Janeiro - RJ - Brazil