Implementation of distance learning IMCI training in rural districts of Tanzania

Abstract BACKGROUND: The standard face-to-face IMCI training continues to be surrounded by concerns of low coverage of trainees, absenteeism of trainees from health facility for prolonged time and high cost of training. Consequently, distance learning IMCI training model is increasingly promoted to partly address some of these challenges in resource limited settings. This paper examines participants’ accounts of implementation of the paper based IMCI distance learning training programme in the three district councils in Mbeya regionMETHODS: A cross-sectional qualitative design was employed as part of an endline evaluation study of PSBI implementation in Busokelo, Kyela and Mbarali District Councils in Mbeya Region of Tanzania. KII were conducted with purposefully selected policymakers, partners, programme managers and healthcare workers including beneficiaries and training facilitators.RESULTS: About 60 KIIs were conducted of which, 53% of participants were healthcare workers composed of nurses, clinicians, and pharmacists and; 22% were healthcare administrators including DMOs, RCH coordinators and programme officers. The findings indicate that DIMCI was designed to address concerns of standard IMCI by enhancing efficiency, increasing outputs and reducing training costs. DIMCI included a mix of brief face-to-face orientation sessions, several weeks of self-directed learning, group discussions and brief face-to-face review sessions with facilitators. DIMCI course covered topics related to management of sick newborns, referral decisions and reporting with nurses and clinicians as the main beneficiaries of the training. The problems with DIMCI included technological challenges related to limited access to proper learning technology such as computers and unfriendly learning materials, personal challenges including work-study-family demands, and design and coordination challenges including low financial incentives contributing to defaulters and limited mentorship and follow-ups due to limited funding and transport.CONCLUSION: DMICI appears to have been implemented successfully in rural Tanzania, it facilitated training of many HCWs at a low cost and resulted into improved knowledge, competence and confidence among HCWs in management of sick newborns. However, technological, personal, and design and coordination challenges continue to face learners in rural areas that need to be addressed to maximize the success of DIMCI.