Outline of the Project
Project Name
Project for Strengthening the Need-Based In-Service Training for Community Health Nurses
Target Countries
Fiji, Tonga, and Vanuatu
Target areas
Fiji: MOH headquarters and all health divisions (Central & Eastern, Western, and Northern divisions)
Tonga: Tongatapu, Vava'u, Ha'apai, Eua, the two Niuas (pilot areas for Output 4: Tongatapu and Vava'u）
Vanuatu: All 6 Provinces (1 pilot province: Shefa and 5 non-pilot provinces: Torba, Aanma, Penama, Malampa, and Tafea)
Project Period
Fiji: From the 20th of October 2010 to the 19th of October 2013
Tonga: From the 24th of January 2011 to the 23rd of January 2013
Vanuatu: From the 22nd of May 2011 to the 21st of May 2014
Implementation Agencies
Fiji: Division of Nursing Services, Ministry of Health, the Republic of the Fiji Islands
Tonga: Reproductive Health Nursing, Hospital Nursing, and School of Nursing, Nursing Services, Ministry of Health, the Kingdom of Tonga
Vanuatu: Human Resource Development and Training Unit, Ministry of Health, Vanuatu College and Nursing Education, Vanuatu Nursing Council, and Shefa Provincial Health Office
Background
According to the recent World Health Organization (WHO) estimates, there has been a shortage of four million health professionals worldwide. In order to achieve the internationally agreed Millennium Development Goals (MDGs) human resource development becomes an urgent task. The small islands in the South Pacific region are no exceptions - the substandard level of remuneration and poor working conditions give little incentive for young adults to pursue their career in the field of health. In addition, migration of health personnel to neighboring counties such as Australia and New Zealand continues to grow, creating a significant labor shortage. These factors are believed to have a direct impact on the quality of health services provided in the region.
In the Pacific region, nurses, midwives and nurse aid play a core role in providing community health services. For the recent years, in addition to the increasing trend of medical doctors and experts migrating to foreign countries, a growing number of human capital outflows of mid-level nurses is observed. Furthermore, due to the lack of adequate recruitment and training plans, a regional imbalance in the distribution of health personnel and the absence of nursing supervisors have been occurred, adversely affecting the supply of community health services.
Nevertheless, as such problems cannot be solved simply by enforcing immigration control measures, the Ministry of Health (MOH) has been encouraged to implement a policy which improves the employees' working conditions and induces incentives to work domestically.
Under these circumstances, JICA implemented a project entitled, "Project for In-Service Training of Community Health Nurses in Fiji" from 2004 to 2008. Through the project above, a need-based in-service training model for community health nurses in the central division of Fiji was developed, and positive outcomes have been observed in the pilot area to a certain degree. In response, the government of Fiji, Tonga and Vanuatu requested JICA to implement a project entitled "Project for Strengthening the Need-Based In-Service Training for Community Health Nurses" (hereafter referred to as the project). The project focuses on incorporating the model developed in the previous project into the national policy to effectively disseminate the impact of the project at national and regional levels.
Overall Goal
Fiji and Tonga：Quality of community health services improves.
Vanuatu：The entire NB-IST system is designed, piloted, and scaled up nationwide.
Project Purpose
Fiji and Tonga：The mechanism of the NB-IST is strengthened.
Vanuatu: A field-adjusted model of Supervision and Coaching (S&C) is undertaken in the pilot province on a regular basis.
Outputs
Fiji:
- The NB-IST policy takes effect.
- A nationally standardized M&E system for the NB-IST is operated.
- A mid-level nursing management training course (including community health context) is conducted.
- All types of IST for CHNs are adequately coordinated at divisional level.
- The progress and results of the Project are shared among and beyond Fiji, Tonga and Vanuatu.
Tonga:
- The various guidelines for smooth implementation of the NB-ISTs are available and being used.
- Planning and funding for the NB-ISTs are better coordinated.
- An adequate number of nursing supervisors with skills of supervision and coaching (S&C) and NB-ISTs are readily available.
- A nationally standardized M&E system for the NB-ISTs is operated in the pilot area for the evidence-based career development support and succession planning.
- The progress and results of the Project are shared among and beyond Tonga, Fiji and Vanuatu.
Vanuatu:
- The framework of S&C piloting is designed and available.
- Zone supervisors in all provinces are equipped with S&C skills.
- S&C is being practiced by zone supervisors on a routine basis in the pilot province.
- The progress and results of the Project are shared among and beyond Vanuatu, Fiji and Tonga.
Activities
Fiji:
| 1-1 | Organize a working group responsible for designing and monitoring impact studies of the NB-IST |
| 1-2 | Conduct impact studies of the NB-IST in Central & Eastern division and present its results |
| 1-3 | Design and propose the NB-IST policy based on the result of the impact studies |
| 1-4 | Train divisional officials on implementation of the NB-IST policy |
| 2-1 | Design and prepare the NB-IST M&E guidelines and tools |
| 2-2 | Train Divisional/Sub-divisional Health Sisters on the M&E |
| 2-3 | Assess the M＆E performance at divisional regular meetings and annual nursing supervisors meetings |
| 3-1 | Organize a working group for a mid-level nursing management training course |
| 3-2 | Review and redesign a mid-level nursing management training course in the context of the NB-IST |
| 3-3 | Train the current and would-be mid-level managers |
| 4-1 | Re-define the roles and responsibilities of the Divisional Training Committees |
| 4-2 | Hold regular Divisional Training Committee meetings |
| 5-1 | Conduct telephone- and/or video- conferences among the project teams of the three countries |
| 5-2 | Conduct the Third-Country Training Program(s) in Fiji for the counterparts of Tonga and Vanuatu |
| 5-3 | Dispatch Fijian counterpart(s) as the Third-Country Expert(s) to Tonga and/or Vanuatu |
| 5-4 | Present the progress and results of the Project at international conference(s) |
Tonga:
| 1-1 | Conduct baseline and end-line surveys for the NB-ISTs practices and impacts |
| 1-2 | Review the Job Descriptions (JDs) for public health/clinical nurses, and the draft Competency Standard (CS) |
| 1-3 | Finalize and propose the CS for public health and clinical nurses |
| 1-4 | Develop operational guidelines, manuals and reporting forms for the NB-ISTs |
| 1-5 | Train public health and clinical nurses on the CS, operation guidelines, manuals, and reporting forms |
| 2-1 | Determine at what level of the MOH headquarters IST coordinator(s) is/are assigned |
| 2-2 | Identify potential candidates for and appoint the most adequate one(s) as IST coordinator(s) |
| 2-3 | Increase awareness on importance of the NB-ISTs in the MOH system |
| 2-4 | Review and propose the TDC’s additional roles to coordinate the NB-ISTs with other types of ISTs |
| 2-5 | Collaborate with the TDC for the sustainability of the NB-ISTs |
| 3-1 | Identify potential candidates for and appoint the most adequate ones as nursing supervisors |
| 3-2 | Design training program on S&C (e.g. curricula, teaching and learning materials, and certification) |
| 3-3 | Train nursing supervisors on S&C skills |
| 3-4 | Assist nursing supervisors to conduct S&C and NB-IST for CHN in the pilot area |
| 4-1 | Design and prepare the NB-IST M&E guidelines and tools |
| 4-2 | Train nursing supervisors and the central MOH officials on the M&E |
| 4-3 | Assess the S&C performance in pilot islands by regular visits and Annual Review and Planning Workshop for public health nurses |
| 5-1 | Conduct telephone- and/or video- conferences among the project teams in the three countries |
| 5-2 | Participate in the Third-Country Training Program in Fiji |
| 5-3 | Present the progress and results of the Project at international conferences |
Vanuatu:
| 1-1 | Prepare the action plan for S&C through the third-county training program in Fiji for the central/provincial counterparts |
| 1-2 | Define and document the roles, responsibilities, required competencies and entitlement of zone supervisors for the S&C piloting |
| 1-3 | Prepare the draft Competency Standard (CS) for community health nurses |
| 1-4 | Develop the draft operational guidelines and monitoring tools for S&C |
| 2-1 | Design the zone supervisors training program (curricula, modules, and certificates) and planning |
| 2-2 | Train zone supervisors in all provinces on S&C operation |
| 2-3 | Design the provincial health managers training program (curricula, modules, and certificates) and planning |
| 2-4 | Train provincial health managers in all provinces on S&C monitoring |
| 3-1 | Assist zone supervisors in the pilot province to prepare annual S&C costing and logistic plan in their duty zones |
| 3-2 | Assist the MOH to secure the budget for S&C operation in the pilot province |
| 3-3 | Advice zone supervisors to conduct S&C for community health nurses (CHNs) |
| 3-4 | Monitor S&C performance of zone supervisors in the pilot province |
| 4-1 | Conduct telephone- and/or video- conferences among the project teams in the three countries |
| 4-2 | Participate in the Third-Country Training Program in Fiji |
| 4-3 | Present the progress and results of the Project at international conferences |
Inputs
Japanese side
(1) Dispatch of Experts
- Experts (Project Management/Health Policy, Project Coordination/Nursing, M&E system, Nursing Management Policy, S&C, Impact Study)
(2) Provision of Equipment
- Office equipment
- Other machineries and equipment
- Printing guidelines and training materials
(3) Covering Other Costs
- Training costs
- Costs for S&C monitoring in the pilot province
Fijian side
Fiji:
(1) Counterpart Personnel
Main Counterparts
- Project Director: Permanent Secretary, Ministry of Health
- Project Manager: Director of Nursing Services, Ministry of Health
Other Counterparts
- Divisional Health Sisters of all health divisions, National IST Nursing Coordinator, IST Nursing Coordinators of all health divisions
- Director, Fiji School of Nursing
- Nurse Practitioner Coordinator, Fiji School of Nursing
(2) Facility
- Project office at the MOH
(3) Covering Other Costs
- Training costs (to be shared with Japanese side)
- Recurrent costs (salary for MOH counterparts, domestic duty travel costs for MOH counterparts, and utilities such as communication, electricity and water)
Tonga:
(1) Counterpart Personnel
Main Counterparts
- Project Director: Director of Health, Ministry of Health
- Project Manager: Chief Nursing Officer, Ministry of Health
Other Counterparts
- Matron, Vaiola Hospital
- Supervising Public Health Sister, MOH
- Principal, Queen Salote School of Nursing
- IST coordinator
(2) Facility
- Project office at the MOH
(3) Covering Other Costs
- Training costs (to be shared with Japanese side)
- Recurrent costs (salary for MOH counterparts, domestic duty travel costs for MOH counterparts, and utilities such as communication, electricity and water)
Vanuatu:
(1) Counterpart Personnel
Main Counterparts
- Project Director, Director General, Ministry of Health
- Project Manager, Manager of Human Resource Development & Training Unit (HRDTU), Ministry of Health
Other Counterparts
- Principal, Vanuatu College of Nursing Education
- IST Coordinator HRDTU
- Shefa Provincial Health Managers
- Chairperson, Vanuatu Nursing Council
(2) Facility
- Project office at the MOH
(3) Covering Other Costs
- Training costs (to be shared with Japanese side)
- Recurrent costs (salary for MOH counterparts, domestic duty travel costs for MOH counterparts, and utilities such as communication, electricity and water)
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