• Nawaraj Subba, MPH

Background: The ironic remark such as waste of resources on training workshops being conducted for health workers that have been consistently raised by critics is a growing concern in the field of Public Health in such a poor country like Nepal. Department of Health Services (DoHS) / Child Health Section (CHD) had provided budget sponsored by World Health Organization (WHO) to Eastern Regional Health Directorate (ERHD) for organizing the training workshops in low performing districts to increase their low Measles vaccine coverage. ERHD had assigned this researcher as a coordinator as well as facilitator for training workshops. Budget about NRs.40, 000.00 per district was made available. All Health Post/ Primary Health Care Centre Incharges, low performing Sub Health Post Incharges and Cold Chain Assistant were participants. With the help of District Health Office (DHO) / District Public Health Office (DPHO) staff two district level workshops were conducted on Poush 2058 in Sunsari and Morang districts.(1)

Study design:

It is a retrospective study of training workshops, with a

Pre-test Post-test Control group design.                                                                O₁                                  X                      O₂

H₀ = Training workshops do not make any difference (It is just waste of resources)

H₁ = Training workshops do work making different (It is not just waste of resources)

Study Area:

Morang, Sunsari (Training/ Workshop Intervention districts), and Jhapa, Saptari (Control districts).

Rationale of the study: Firstly, Researcher learned what the achievement of regular EPI has been increased right after training workshops as reported by EPI supervisors of those training held districts during supervision. Secondly, sometime people and also even health workers perceived these training workshops as a fashion or waste of resources. Finally, there is no practice of having followed up and evaluation of training program. Organizations limit their target as far as just providing a training or workshop and leave it. So, all of these factors fascinated the researcher to have an evaluation study of those training workshops that were coordinated and facilitated by researcher-self before 16 months.

Objective of Study: To evaluate the consequences of training workshops conducted for health workers on how to raise measles vaccine coverage in Morang and Sunsari districts.

• To identify the situation of achievement whether measles vaccine coverage has been increased or not in those training workshop held (Morang, Sunsari) districts.

• To compare the achievements with adjoining and similar districts where training workshops were not been held.

Method and tools: Health Management Information System (HMIS) data, document study, interview, FGD and t-test.

Data Processing: Epi-Info-6, Excel computer software.

Indicates mean of coverage over last 7 years as well as mean of before and after intervention

Table 1 indicates as mean of coverage of measles vaccination over last 7 years is 78% which is 75% before intervention (Poush 2057 to Mangsir 2058) has significantly increased as 88% after intervention (Magh 2058 to Poush 2059) in Morang district. Similarly, in Sunsari district mean of coverage of measles vaccination over last 7 years in district is 81% which is 78% before intervention (Poush 2057 to Mangsir 2058) has significantly increased as 90% after intervention (Magh 2058 to Poush 2059). Whereas the mean coverage of Jhapa over last 7 last years is 86% that is also same as 86% over before and after intervention. Saptari is experiencing decreasing trend since the mean coverage over last 7 years is 91% and that came down as 88.26% during Poush 2057 to Mangsir 2058 and even came downward as 85.26% during Magh 2058 to Poush 2059.

Table 2 Illustrates target verses achievement over 24 months to make compare the same months' coverage between before and after the intervention in the following districts.

Table 3 illustrating result of Paired ç t ç test

Since the computed value of ç t ç in Sunsari district is 3.23 that is greater than its tabulated value for 11 d.f. is 3.106 at 1% level of significance; the null hypothesis is rejected. Similarly, since in Morang district the calculated value of ç t ç is 2.32 that is also greater than its tabulated value for 11 d.f. at 5% level of significance is 2.201. Therefore, there are significant differences between two means. That's why alternative hypothesis is accepted i.e. Training workshops have done works making differences (It is not just waste of resources).

Table - 4 Illustrates Probability (P-value)

The coverage of Measles vaccine during Poush-057 to Mansir-058 (Pre-intervention period, O₁) and coverage during Magh-058 to Poush-059 (Post-intervention period, O₂) in Morang district where training workshop had been conducted, was statistically significant (P=0.0203). Whereas in adjoining district Jhapa where training workshop was not conducted, the measles coverage between pre-intervention (O₃) and post intervention period (O₄) is almost static. Similarly, the coverage of Measles vaccine during Poush-057 to Mansir-058 (Pre-intervention period, O₁) and coverage during Magh-058 to Poush-059 (Post-intervention period, O₂) in Sunsari district where training workshop had been conducted, was statistically significant (P=0.0406). Whereas in adjoining district Saptari where training workshop had not been conducted, the measles coverage has been slightly decreased during post intervention period (85.64%) than pre-intervention (88.26%). The duration of 24 months (12+12) periods has been taken for evaluation purpose to avoid or minimize the confounding factors in the study.

Figure 1 shows trend of coverage before and after intervention in Sunsari (Case) & Saptari (Control) districts.

• Study is based on the HMIS data from annual reports of DoHS, ERHD.
• Confounding factors such as other training workshops.

• It is solely researcher's initiative and no more external support has been taken.

Conclusion: Training workshops for health workers on how to increase measles coverage in Morang and Sunsari districts has done something works making measurably difference; since results findings having statistically significant in the study.

Recommendation: Such type of training workshops would be useful for those districts having poor EPI coverage.

Acknowledgement: I would like to extend my sincere thanks to all staff of DHO Sunsari and DPHO Morang and also to Statistical Assistants from Saptari and Jhapa districts for making available additional data.