Training and Developing Medical Personnel in Sierra Leone, Guinea and Liberia: It’s Effects on Post Ebola Recovery in the Health Systems

ABDUL AMID AZIZ JALLOH

Lecturer: University of Makeni & University of Science and Technology Sierra Leone.

ABSTRACT

Addressing critically medical issues with limited knowledge capacity pose several challenges in the health systems. Such challenges can only be addressed if organisations can invest in training and developing employees’ capacity to enhance outstanding performance. Considering the above facts, this study seeks to assess the significance of Training and Developing Medical Personnel in Sierra Leone, Guinea and Liberia, and to examine its Effects on Post Ebola Recovery in the Health Systems. The fortitude for this qualitative research led to the retrieval of secondary sources published on the subject matter and analysis of retrieved information disclosed the constituents of training and development such as: on-the-job and off-the-job training, methods of training, formal and informal training, evaluating and transferring training. Further analysis reveals that training and developing medical personnel in these West African countries has positive effects on post Ebola recovery since employees will be equipped with the required skills and competences to forecast, identify and minimise or eradicate issues that will prompt unexpected health circumstances in the future. The relevance of this study could aid medical practitioners in the three West African countries and is also noteworthy to public and private establishments.

 

KEY WORDS: Training and Developing, Medical Personnel, Sierra Leone, Guinea, Liberia, Post Ebola Recovery, Health Systems

1.0 INTRODUCTION

The role of formal training in organisations today appears to have declined significantly and has been replaced with an emphasis on developing skills (CIPD, 2009). The speed with which skills requirements change in some sectors means that formal, time-consuming, classroom based learning fails to deliver efficiently as required. Furthermore, the growing recognition of human resource development (HRD) as a tool to achieve competitive advantage has raised awareness of the need to embrace learning as a central strategic concern and to be part of the culture of the organisation (Senge, 1990; Pedlar et al., 1997, Garavan, 2007) of which formal training is just one, often small, component. In addition, a government-policy-driven emphasis on individual responsibility for life-long learning and skills development (Leitch, 2006; DIUS, 2007b) gives individuals more responsibility for their own learning with spin-off benefits for the organisation, which reduces the relevance of off-the-shelf, one-size-fits-all group learning. On the other side of this coin is the need to provide employees with workplace-specific skills to reduce the ‘poaching’ of skilled employees which reduces the value of traditional training methods. Employee training equips the employees with adequate skills and knowledge to contribute to the organization’s efficiency and cope with the changes in the environment. There should be a continuous re-assessment of the managerial calibre and skills to cope with environmental changes. Technological changes make the skills obsolete, which necessitates training activities. As a brief review of terms, training involves an expert working with learners to transfer to them certain areas of knowledge or skills to improve in their current jobs. Development is a broad, ongoing multi-faceted set of activities (training activities among them) to bring someone or an organization up to another threshold of performance, often to perform some job or new role in the future (Mahapatro, 2010). Accordingly, strategic concerns and decisions relating to training have moved into the board room. Although trainers and training institutions continue to improve training designs, methods and materials, and develop professional networks and institutions, the policymakers and change managers have taken over the issues of fitting their efforts into overall change strategies, funding and organizational supports. Thus, for ensuring its best possible fit with ongoing change strategies, policymakers and change managers set the specifications which the training has to accomplish (Dwivedi, 2007).  Training has always played an important and an integral part in furthering many kinds of human learning and development. If organizations are to make the best of the training function in their response to and promotion of change, the training function will need to be closely linked with business plans. This means that a detailed training policy needs to be agreed and implemented from the top of the organization and supported by management at all levels. It also means that the training and development function has to be accountable in the same way that other functions are (Buckley and Caple, 2009). Many companies have adopted a broader perspective, which is known as high-leverage training. High-leverage training is linked to strategic business goals and objectives, uses an instructional design process to ensure that training is effective, and compares or benchmarks the company’s training programs against training programs in other companies. High-leverage training practices also help to create working conditions that encourage continuous learning. Continuous learning requires employees to understand the entire work system, including the relationships among their jobs, their work units, and the company. Employees are expected to acquire new skills and knowledge, apply them on the job, and share this information with other employees (Noe, 2010). There has been a considerable shift in the way that individual development is understood and characterised. We have moved from identifying training needs to identifying learning needs, the implication being that development is owned by the learner with the need rather than by the trainer seeking to satisfy that need. This also has implications for who identifies the needs and the way that those needs are met. Current thinking suggests that needs are best developed by a partnership between the individual and the organisation, and that the methods of meeting these needs are not limited only to formal courses, but to a wide range of on-the-job development methods and distance/e-learning approaches. There has also been a shift in the type of skills that are the focus of development activity (Torrington et al, 2005). Hallier and Butts (1999) for example identify a change from an interest in technical skills to the development of personal skills, self-management and attitudes. Lastly, while the focus on development for the current job remains high, there is greater pressure for development which is also future oriented. It has been argued (Reynolds, 2004) that: ‘The transfer of expertise by outside experts is risky since their design is often removed from the context in which work is created.’ This is a fundamental problem and applies equally to internally run training courses where what has been taught can be difficult for people to apply in the entirely different circumstances in their workplace. Training can seem to be remote from reality and the skills and knowledge acquired can appear to be irrelevant. This particularly applies to management or supervisory training but even the manual skills learnt in a training centre may be difficult to transfer. Armstrong (2009), describe this as a problem that can be tackled by making the training as relevant and realistic as possible, anticipating and dealing with any potential transfer difficulties. Individuals are more likely to apply learning when they do not find it too difficult, believe what they learnt is relevant, useful and transferable, are supported by line managers, have job autonomy, believe in themselves, and are committed and engaged. Transfer is also more likely if systematic training and ‘just-in-time training’ approaches are used.

1.1 BACKGROUND TO THE STUDY

Disease outbreaks and catastrophes can affect countries at any time, causing substantial human suffering and deaths and economic losses. If health systems are ill-equipped to deal with such situations, the affected populations can be very vulnerable. The current Ebola virus disease outbreak in western Africa highlights how an epidemic can proliferate rapidly and pose huge problems in the absence of a strong health system capable of a rapid and integrated response. The outbreak began in Guinea in December 2013 but spread into neighbouring Liberia and Sierra Leone. In early August 2014, Ebola was declared an international public health emergency. At the time the outbreak began, the capacity of the health systems in Guinea, Liberia and Sierra Leone was limited. Several health-system functions that are generally considered essential were not performing well and this hampered the development of a suitable and timely response to the outbreak. There were inadequate numbers of trained and qualified health workers. Infrastructure, logistics, health information, surveillance, governance and drug supply systems were weak. The organization and management of health services was sub-optimal. Government health expenditure was low whereas private expenditure – mostly in the form of direct out-of-pocket payments for health services – was relatively high. The last decade has seen increased external health-related aid to Guinea, Liberia and Sierra Leone. However, in the context of Millennium Development Goals 4, 5 and 6, most of this aid has been allocated to combat human immunodeficiency virus infection, malaria and tuberculosis, with much of the residual going to maternal and child health services. Therefore, relatively little external aid was left to support overall development of health systems. This lack of balanced investment in the health systems contributes to the challenges of controlling the current Ebola outbreak. Weak health systems cannot be resilient. A strong health system decreases a country’s vulnerability to health risks and ensures a high level of preparedness to mitigate the impact of any crises. If this Ebola outbreak does not trigger substantial investments in health systems and adequate reforms in the worst-affected countries, pre-existing deficiencies in health systems will be exacerbated. The national governments, assisted by external partners, need to develop and implement strategies to make their health systems stronger and more resilient. Only then can they meet the essential health needs of their populations and develop strong disaster preparedness to address future emergencies. In the short-term, non-governmental organizations, civil society and international organizations will have to bolster the national health systems, both to mitigate the direct consequences of the outbreak and to ensure that all essential health services are being delivered. However, this assistance should be carefully coordinated under the leadership of the national governments and follow development effectiveness principles (Kieny et al, 2014).

 

1.2 RESEARCH AIM

Medical personnel training and development in Sierra Leone, Guinea and Liberia is quite a challenging task as a result of the established medical schools without proper structures, sophisticated scientific instruments/apparatus for practical work and insufficient trained and qualified tutors in handling the prerequisite courses for the various specialties. This situation led to the complications of containing the outbreak since the health systems in these countries lacks the capacity and as a result, brought about the loss of many lives. Considering the critical issues surrounding training and developing the intellectual capital of medical personnel in these West African Countries, this study seeks to examine the elements of training and developing medical personnel in Sierra Leone, Guinea and Liberia and its effects on post Ebola recovery in the health systems.

1.3 RESEARCH OBJECTIVES

The research objectives segment the clustered components in the aim and organise such elements systematically in order to develop a structured review process so as to descriptively explain the relevance of the subject matter. The research objectives are outlined as follows:

  • Describe the definition of training, learning, development and the significance of training and development as investment.
  • Discuss training needs assessment (organisational analysis, task analysis, person analysis) and readiness for training.
  • Explain on-the-job and off-the-job training, strategic training, coaching, mentoring, systematic training, just-in-time training, bite-sized training, human relations training
  • Discuss the features of learning and development strategy, learning culture, the learning organisation, learning theories, contribution of learning and development to organisational performance and comparing learning and training
  • Describe formal and informal learning, the spectrum of learning from informal to formal, motivation to learn, e-learning, blended learning, self-directed learning, evaluating training and transferring training.

 

1.4 SIGNIFICANCE OF THE STUDY

Training and human resource development is a key component in every sector of organisations growth. Governmental and non-governmental organisations operations are effectively and efficiently implemented and objectives are achieved as a result of staff diligence, which is accelerated by training and development. Most successful organisations today realise that training is one of the mechanisms that leads to the achievement of competitive advantage and that kin attention should be paid towards it and sufficient funds allocated for its implementation. Considering the facts expressed, this study is important to the three affected West Africa countries since one of the problems encountered in trying to contain the disease outbreak was as a result of lack of sufficient trained and qualified medical personnel. It is also noteworthy to business establishments and to the management profession since well trained and developed workforce accelerates organisations growth.

 

2.0 LITERATURE REVIEW

Definitions of Training, Learning, Development and Significance of Training and Development as Investment

Training is an organized activity for increasing the knowledge and skills of the people for a definite purpose. It involves systematic procedures for transferring technical knowhow to the employees so as to increase their knowledge and skills for doing specific jobs with proficiency. In other words, the trainees acquire technical knowledge, skills and problem solving ability by undergoing the training programme (Mahapatro, 2010).

 

2.1 Training: Training refers to a planned effort by a company to facilitate employees’ learning of job related competencies. These competencies include knowledge, skills, or behaviours that are critical for successful job performance. The goal of training is for employees to master the knowledge, skill, and behaviours emphasized in training programs and to apply them to their day-to-day activities. For a company to gain a competitive advantage, its training has to involve more than just basic skill development. That is, to use training to gain a competitive advantage, a company should view training broadly as a way to create intellectual capital. Intellectual capital includes basic skills (skills needed to perform one’s job), advanced skills (such as how to use technology to share information with other employees), an understanding of the customer or manufacturing system, and self-motivated creativity (Noe, 2010).

 

2.1.1 Learning: Learning is the means by which a person acquires and develops new knowledge, skills, capabilities, behaviours and attitudes. As explained by Honey and Mumford (1996): ‘Learning has happened when people can demonstrate that they know something that they did not know before (insights, realizations as well as facts) and when they can do something they could not do before (skills). Learning is a continuous process that does not only enhances existing capabilities but also leads to the development of the skills, knowledge and attitudes that prepare people for enlarged or higher-level responsibilities in the future.

 

2.1.2 Development: Development involves the processes by which managerial personnel accomplish not merely skills in their present jobs but also competence for prospective assignments of enhanced difficulties and scope. The higher responsibilities embrace complex conceptual thoughts and analyses, and decision making abilities. The development process relates to the pressures, change and growth patterns. Thus, development as applied to managers embraces all those recognized and controlled measures, which exert a marked influence towards the improvement of abilities of the participant to accomplish his present job more effectively, and enhance his potential for prospective higher responsibilities (Dwivedi, 2007).

 

2.1.3 The significance of training and development as investment: The development of human resource is of utmost significance. While the ‘raw’ human resource can make only limited contribution towards the attainment of organizational goals, the developed human resource—knowledgeable, skilled manpower—can help immensely in the contribution in this respect. Organizations with considerable opportunities for self-development can attract highly promising new entrants. The development of human resource is accomplished through training. Training is a prerequisite to improved performance, preparing human resource for new jobs, transfers, promotions and change-over to modern technology and equipment. In addition to training of new entrants, manpower at all levels requires refresh training from time to time in order to avoid personal obsolescence and improve its competence to hold higher positions. Accordingly, training and development policies and programmes are given top priority, and investment on training, and development has increased tremendously. Thus, these programmes perform a significant educational function and form a valuable source of preparation for performing the present job more effectively and holding new jobs. Indeed, these programmes have become a vital part of the employment costs in modern industrial economies (Dwivedi, 2007).

2.2 Training Needs Assessments (Organisational Analysis, Task Analysis, Person Analysis)

Turning specifically to training, because of the potentially considerable financial and psychological costs involved, a great deal of consideration has to be given to deciding whether to embark on some form of training to meet individual learning and development needs. It is important to appreciate the circumstances which indicate whether or not training is required and there is a need to be thoroughly familiar with the methods, approaches and forms of analysis that have to be used in order to reach the decision to implement training. The criticality of this process cannot be over emphasized bearing in mind the consequences that might arise for organizations which provide too little training or no training at all when a real need exists (Buckley and Caple, 2009).

 

2.2.1 Organisational Analysis: Organizational analysis involves identifying whether training supports the company’s strategic direction; whether managers, peers, and employees support training activity; and what training resources are available (Noe, 2010). In the broad organizational analysis, trainers compare what the organization is doing and what it should be doing. Trainers focus attention on organizational objectives, skills, inventories, organizational climate, and indices of efficiency, including costs for labour, materials, and distribution (McGehee and Thayer, 1961).

 

2.2.2 Task Analysis: Task analysis (sometimes called operations analysis) is a systematic collection of data about a specific job or group of jobs used to determine what employees should be taught to achieve optimal performance. Results of a task analysis typically include the appropriate standards of performance, how tasks should be performed to meet these standards, and the knowledge, skills, abilities, and other characteristics that employees need to possess in order to meet the standards (Werner and DeSimone, 2012).

2.2.3 Person Analysis: Person analysis helps to identify employees who need training, that is, whether employees’ current performance or expected performance indicates a need for training. The need for training may result from the pressure points, including performance problems, changes in the job, or use of new technology. Person analysis also helps determining employees’ readiness for training. Readiness for training refers to whether (1) employees have the personal characteristics (ability, attitudes, beliefs, and motivation) necessary to learn program content and apply it on the job and (2) the work environment will facilitate learning and not interfere with performance. This process includes evaluating person characteristics, input, output, consequences, and feedback. A major pressure point for training is poor or substandard performance. Poor performance is indicated by customer complaints, low performance ratings, or on-the-job incidents such as accidents and unsafe behaviour. Another potential indicator of the need for training is if the job changes such that current levels of performance need to be improved or employees must be able to complete new tasks (Noe, 2010).

2.2.4 Readiness for Training: Effective training requires not only a program that addresses real needs, but also a condition of employee readiness. Readiness for training    is a combination of employee characteristics and positive work environment that permit training. The necessary employee characteristics include ability to learn the subject matter, favourable attitudes toward the training, and motivation to learn. A positive work environment is one that encourages learning and avoids interfering with the training program (Noe et al, 2011).

2.3 On-the-job, Off-the-job Training, Strategic Training, Coaching, Mentoring, Systematic Training, Just-in-time Training, Bite-sized Training, Human Relations Training.

 

2.3.1 On-the-job Training: On-the-job training (OJT) is probably the most common approach to training. It can range from relatively unsophisticated ‘observe and copy’ methods to highly structured courses built into workshop or office practice. Cannell (1997) defines OJT as training that is planned and structured that takes place mainly at the normal workstation of the trainee – although some instruction may be provided in a special training area on site – and where a manager, supervisor, trainer or peer colleague spends significant time with a trainee to teach a set of skills that have been specified in advance. It also includes a period of instruction where there may be little or no useful output in terms of productivity. These traditional methods are still very popular ways of teaching new skills and methods to employees, and they can be very effective. However, there are many acknowledged weaknesses that still persist in many organisational practices. There is often a lack of structure and design in the training given, which leads to the passing-on of bad or even dangerous working practices (Cannell, 1997).

 

2.3.2 Off-the-job Training: Off-the-job/external training, or training that takes place outside the employing organization, is used extensively by organizations of all sizes. Large organizations use external training if they lack the capability to train people internally or when many people need to be trained quickly. External training may be the best option for training in smaller firms due to limitations in the size of their training staffs and in the number of employees who need various types of specialized training. Whatever the size of the organization, external training occurs for several reasons:

  • It may be less expensive for an employer to have an outside trainer conduct training in areas where internal training resources are limited.
  • The organization may have insufficient time to develop internal training materials.
  • The HR staff may not have the necessary level of expertise for the subject matter in which training is needed.
  • There are advantages to having employees interact with managers and peers in other companies in training programs held externally (Mathis and Jackson, 2011).

2.3.3 Strategic Training: Training is used strategically to help the organization accomplish its goals. For example, if sales increases are a critical part of the company’s strategy, appropriate training would identify what is causing lower sales and target training to respond as part of a solution. Strategic training can have numerous organizational benefits. It requires HR and training professionals to get intimately involved with the business and to partner with operating managers to help solve their problems, thus making significant contributions to organizational results. Additionally, a strategic training mind-set reduces the likelihood of thinking that training alone can solve most employee or organizational problems. It is not uncommon for operating managers and trainers to react to most important performance problems by saying, “I need a training program on X.” With a strategic focus, the organization is more likely to assess whether training actually can address the most important performance issues and what besides training is needed.

Training cannot fix all organizational problems (Mathis and Jackson, 2011).

2.3.4 Coaching: The Industrial Society (1999) defines coaching as: ‘The art of facilitating the enhanced performance, learning and development of others.’ It takes the form of a personal (usually one-to-one) on-the-job approach to helping people develop their skills and levels of competence. Hirsh and Carter (2002) state that coaching is aimed at the rapid improvement of skills, behaviour and performance, usually for the present job. A structured and purposeful dialogue is at the heart of coaching. The coach uses feedback and brings an objective perspective. They noted that the boundaries between what a coach, mentor, counsellor or organization development consultant do are inevitably blurred – they all use similar skills. The need for coaching may arise from formal or informal performance reviews but opportunities for coaching will emerge during normal day-to-day activities.

 

2.3.5 Mentoring: Mentoring is the process of using specially selected and trained individuals to provide guidance, pragmatic advice and continuing support, which will help the person or persons allocated to them to learn and develop. It has been defined by Clutterbuck (2004) as: ‘Off-line help from one person to another in making significant transitions in knowledge, work or thinking.’ Hirsh and Carter (2002) suggest that mentors prepare individuals to perform better in the future and groom them for higher and greater things, i.e. career advancement. Armstrong (2006) describe mentoring as a method of helping people to learn, as distinct from coaching, which is a relatively directive means of increasing people’s competence. It involves learning on the job, which must always be the best way of acquiring the particular skills and knowledge the job holder needs. Mentoring also complements formal training by providing those who benefit from it with individual guidance from experienced managers who are ‘wise in the ways of the organization.

 

2.3.6 Systematic Training: Armstrong (2006) state that training should be systematic in that it is specifically designed, planned and implemented to meet defined needs. It is provided by people who know how to train and the impact of training is carefully evaluated. The concept was originally developed for the industrial training boards in the 1960s and consists of a simple four-stage model such as:

  • Identify training needs.
  • Decide what sort of training is required to satisfy these needs.
  • Use experienced and trained trainers to implement training.
  • Follow up and evaluate training to ensure that it is effective.

 

2.3.7 just-in-time Training: Just-in-time training is training that is closely linked to the pressing and relevant needs of people by its association with immediate or imminent work activities. It is delivered as close as possible to the time when the activity is taking place. The training is based on an identification of the latest requirements, priorities and plans of the participants, who are briefed on the live situations in which their learning has to be applied. The training programme takes account of any issues concerning the transfer of learning to the job, and aims to ensure that what is taught is seen to be applicable in the current work situation (Armstrong, 2010).

2.3.8 Bite-sized Training: Bite-sized training involves the provision of opportunities to acquire a specific skill or a particular piece of knowledge in a short training session that is focused on one activity such as using a particular piece of software, giving feedback, or handling an enquiry about a product or service of the company. It is often carried out through e-learning. It can be a useful means of developing a skill or understanding through a concentrated session or learning activity without diversions and is readily put to use in the workplace. But it can be weak in expanding individuals’ intellectual capacity and holistic (or ‘whole view’) understanding of the business – essential qualities to enable employees to respond creatively to the challenges of today’s knowledge economy. It can also be facile and too restricted and relies on the support of line managers, which is not always forthcoming. It is best for training employees in straightforward techniques that they can use immediately in their work or to complement, not replace, longer courses or developmental processes (Armstrong, 2009).

 

2.3.9 Human Relations Training: Human relations training embraces broad areas including leadership, small group processes, communications, formal and informal organizations, morale and motivation, and building work teams. This method purports to develop among participants an understanding among themselves so that they take into account the needs and aspirations of others. It stresses on attitudes and emotions, and develops leadership styles conducive to high morale and motivation. The human relations training is largely used with supervisors (Dwivedi, 2007).

2.4 Features of Learning and Development Strategy, Learning Culture, The Learning Organisation, Learning Theories, Contribution of Learning and Development to Organisational Performance, Comparison of Learning and Training.

 

2.4.1 Features of Learning and Development Strategy: A learning and development strategy should be business-led in the sense that it is designed to support the achievement of business goals by promoting human capital advantage. But it should also be people-led, which means taking into account the needs and aspiration of people to grow and develop. Achieving the latter aim, of course, supports the achievement of the former. Learning and development strategy is underpinned by a philosophy and its purpose is to operationalize that philosophy. It is fundamentally concerned with creating a learning culture that will encourage learning and will provide the basis for planning and implementing learning activities and programmes. This concept of a learning culture is associated with that of the learning organization (Armstrong, 2009).

 

2.4.2 Learning Culture: A learning culture is one that promotes learning because it is recognized by top management, line managers and employees generally as an essential organizational process to which they are committed and in which they engage continuously. Reynolds (2004) describes a learning culture as a ‘growth medium’, which will ‘encourage employees to commit to a range of positive discretionary behaviours, including learning’ and which has the following characteristics: empowerment not supervision, self-managed learning not instruction, long-term capacity building not short-term fixes. He suggests that to create a learning culture it is necessary to develop organizational practices that raise commitment amongst employees and ‘give employees a sense of purpose in the workplace, grant employees opportunities to act upon their commitment, and offer practical support to learning (Reynolds, 2004).

2.4.3 The Learning Organisation: The concept of the learning organization has caught the imagination of many people since it was first popularized by Senge (1990) who described it as follows: The learning organization is one ‘where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning how to learn together. Pedler et al (1991) state that a learning organization is one ‘which facilitates the learning of all its members and continually transforms itself’. Wick and Leon (1995) refer to a learning organization as one that continually improves by rapidly creating and refining the capabilities required for future success. As Harrison (2000) comments, the notion of the learning organization remains persuasive because of its ‘rationality, human attractiveness and presumed potential to aid organizational effectiveness and advancement’. However, Scarborough et al (1999) argue that ‘the dominant perspective of the learning organization concept is that of organization systems and design.

2.4.4 Learning Theories: There are a number of learning theories, each of which focuses on different aspects of the learning process as applied to people in general. The main theories are concerned with:

2.4.4a Reinforcement Theory: Reinforcement theory is based on the work of Skinner (1974). It expresses the belief that changes in behaviour take place as a result of an individual’s response to events or stimuli and the ensuing consequences (rewards or punishments). Individuals can be ‘conditioned’ to repeat the behaviour by positive reinforcement in the form of feedback and knowledge of results. This process is known as ‘operant conditioning. Gagne (1977) later developed his stimulus-response theory, which relates the learning process to a number of factors, including reinforcement, namely:

  • Drive – there must be a basic need or drive to learn.
  • Stimulus – people must be stimulated by the learning process.
  • Response – people must be helped by the learning process to develop appropriate responses, i.e. the knowledge, skills and attitudes that will lead to effective performance.
  • Reinforcement – these responses need to be reinforced by feedback and experience until they are learnt.

 

2.4.4b Cognitive Learning Theory: Cognitive learning involves gaining knowledge and understanding by absorbing information in the form of principles, concepts and facts and then internalizing it. Learners can be regarded as powerful information processing machines (Armstrong, 2009).

2.4.4c Experimental Learning Theory: People are active agents of their own learning (Reynolds et al, 2002). Experiential learning takes place when people learn from their experience by reflecting on it so that it can be understood and applied. Learning is therefore a personal ‘construction’ of meaning through experience. ‘Constructivists’ such as Rogers (1983) believe that experiential learning will be enhanced through facilitation – creating an environment in which people can be stimulated to think and act in ways that help them to make good use of their experience.

 

2.4.4 (d) Social Learning Theory: Social learning theory states that effective learning requires social interaction. Wenger (1998) suggested that we all participate in ‘communities of practice’ (groups of people with shared expertise who work together) and that these are our primary sources of learning. Bandura (1977) views learning as a series of information-processing steps set in train by social interactions.

 

2.4.5 Contribution of Learning and Development to Organisational Performance: Studies on the relationship between learning and development activities and organizational performance have included those by Benabou (1996) and Clarke (2004). The research by Benabou examined the impact of various training programmes on the business and financial results at 50 Canadian organizations. The conclusion reached was that in most cases a well-designed training programme can be linked to improvements in business results and that return on investment in training programmes is very high. A national survey of training evaluation in specialized healthcare organizations (hospices) conducted by Clarke (2004) showed that while there appeared to be some links between training and performance it was not possible to reach firm conclusions about causality. However, the study reached the important finding that where organizations undertake assessment of their training and development (both formal and informal learning) then there is a greater belief in the positive impact training and development has in the organization. While it is possible and highly desirable to evaluate learning, establishing a link between learning and organizational performance is problematic. It may be difficult to distinguish between cause and effect. Hendry and Pettigrew (1986) warn that it is risky to adopt simplistic views that training leads to improved business performance because it is more likely that successful companies will under certain conditions increase their training budget.

 

2.4.6 Comparison of Learning and Training: Learning should be distinguished from training. ‘Learning is the process by which a person constructs new knowledge, skills and capabilities, whereas training is one of several responses an organization can undertake to promote learning’ (Reynolds et al, 2002). The encouragement of learning makes use of a process model, which is concerned with facilitating the learning activities of individuals and providing learning resources for them to use. Conversely, the provision of training involves the use of a content model, which means deciding in advance the knowledge and skills that need to be enhanced by training, planning the programme, deciding on training methods and presenting the content in a logical sequence through various forms of instruction. A distinction is made by Sloman (2003) between learning, which ‘lies within the domain of the individual’ and training, which ‘lies within the domain of the organization’. Today the approach is to focus on individual learning and ensure that it takes place when required – ‘just-for-you’ and ‘just-in-time’ learning.

 

2.5 Formal and Informal Learning, The Spectrum of Learning from Informal to Formal, Motivation to Learn, E-learning, Blended Learning, Self-directed Learning, Evaluating Training and Transferring Training

 

2.5.1 Formal Learning: Formal learning is planned and systematic. It makes use of structured training programmes consisting of instruction and practice that may be conducted on- or off-the-job. Experience may be planned to provide opportunities for continuous learning and development. Formal learning and developmental activities may be used such as action learning, coaching, mentoring and outdoor learning (Armstrong, 2009).

 

2.5.2 Informal Learning: Informal learning is experiential learning. It takes place while people are learning on-the-job as they go along. Most learning does not take place in formal training programmes. People can learn 70 per cent of what they know about their job informally. A study by Eraut et al (1998) established that in organizations adopting a learner-centred perspective, formal education and training provided only a small part of what was learnt at work. Most of the learning described to the researchers was non-formal, neither clearly specified nor planned. It arose naturally from the challenges of work. Effective learning was, however, dependent on the employees’ confidence, motivation and capability. Some formal training to develop skills (especially induction training) was usually provided, but learning from experience and other people at work predominated. Reynolds (2004) notes that: The simple act of observing more experienced colleagues can accelerate learning; conversing, swapping stories, cooperating on tasks and offering mutual support deepen and solidify the process. This kind of learning – often very informal in nature – is thought to be vastly more effective in building proficiency than more formalized training methods.

 

2.5.3 The Spectrum of Learning from Informal to Formal: The distinction between formal and informal learning may not always be precise. Watkins and Marsick (1993) described a spectrum of learning from informal to formal as follows:

  • unanticipated experiences and encounters that result in learning as an incidental by-product, which may or may not be consciously recognized;
  • new job assignments and participation in teams, or other job-related challenges that provide for learning and self-development;
  • self-initiated and self-planned experiences, including the use of media and seeking out a coach or mentor;
  • total quality or improvement groups/active learning designed to promote continuous learning for continuous improvement;
  • providing a framework for learning associated with personal development planning or career planning;
  • the combination of less-structured with structured opportunity to learn from these experiences;
  • designed programmes of mentoring, coaching or workplace learning;
  • formal training programmes or courses involving instruction

 

2.5.4 Motivation to Learn: People will learn more effectively if they are motivated to learn. The motivation to learn can be defined as ‘those factors that energize and direct behavioural patterns organized around a learning goal’ (Rogers, 1996). As Reynolds et al (2002) comment, ‘The disposition and commitment of the learner – their motivation to learn – is one of the most critical factors affecting training effectiveness. Under the right conditions, a strong disposition to learn, enhanced by solid experience and a positive attitude, can lead to exceptional performance.

 

2.5.5 E-learning: E-learning was defined by Pollard and Hillage (2001) as ‘the delivery and administration of learning opportunities and support via computer, networked and web-based technology to help individual performance and development’. E-learning enhances learning by extending and supplementing face-to-face learning rather than replacing it. It enables learning to take place when it is most needed (just in time as distinct from just in case) and when it is most convenient. Learning can be provided in short segments or bites that focus on specific learning objectives. It is ‘learner-centric’ in that it can be customized to suit an individual’s learning needs – learners can choose different learning objects within an overall package. The main potential drawbacks are the degree of access to computers, the need for a reasonable degree of literacy, the need for learners to be self-motivated, and the time and effort required to develop and update e-learning programmes (Pollard and Hillage, 2001).

2.5.6 Blended Learning: Blended learning combines online learning, face-to-face instruction, and other methods for distributing learning content and instruction. Blended learning courses provide learners with the positive features of both face-to-face instruction and technology-based delivery and instructional methods (such as online learning, distance learning, or mobile technologies while minimizing the negative features of each. In comparison to classroom delivery, blended learning provides increased learner control, allows for self-directedness, and requires learners to take more responsibility for their learning—all factors consistent with the recommendations of adult learning theory. In comparison to pure online learning, blended learning provides more face-to-face social interaction and ensures that at least some of the instruction is presented in a dedicated learning environment. Blended learning uses the classroom to allow learners to learn together and to discuss and share insights, which helps bring learning to life and make it meaningful. Blended learning has been found to be more effective than face-to-face instruction for motivating trainees to learn and for teaching declarative knowledge or information about ideas or topics. It appears that blended learning capitalizes on the positive learning features inherent in both face-to-face and Web-based instruction. Interestingly, learners react more favourably toward classroom instruction than blended learning. This may be because blended learning courses are more demanding, requiring a greater time commitment because of the use of two learning approaches (Noe, 2010).

 

2.5.7 Self-directed Learning: Self-directed or self-managed learning involves encouraging individuals to take responsibility for their own learning needs, either to improve performance in their present job or to develop their potential and satisfy their career aspirations. It can also be described as self-reflective learning (Mezirow, 1985), which is the kind of learning that involves encouraging individuals to develop new patterns of understanding, thinking and behaving. Self-directed learning can be based on a process of recording achievement and action planning that involves individuals reviewing what they have learnt, what they have achieved, what their goals are, how they are going to achieve those goals and what new learning they need to acquire. The learning programme can be ‘self-paced’ in the sense that learners can decide for themselves, up to a point, the rate at which they work and are encouraged to measure their own progress and adjust the programme accordingly (Mezirow, 1985).

 

2.5.8 Evaluating Training: Training should be evaluated several times during the process. Determine these milestones when you develop the training. Employees should be evaluated by comparing their newly acquired skills with the skills defined by the goals of the training program. Any discrepancies should be noted and adjustments made to the training program to enable it to meet specified goals. Many training programs fall short of their expectations simply because the administrator failed to evaluate its progress until it was too late. Timely evaluation will prevent the training from straying from its goals (Mahapatro, 2010).

 

2.5.9 Reasons for Evaluating Training: Companies are investing millions of dollars in training programs to help gain a competitive advantage. Companies invest in training because learning creates knowledge; often, it is this knowledge that distinguishes successful companies and employees from those who are not. Research summarizing the results of studies that have examined the linkage between training and human resource outcomes (attitudes and motivation, behaviours, human capital), organizational performance outcomes (performance and productivity), or financial outcomes (profits and financial indicators) has found that companies that conduct training are likely to have more positive human resource outcomes and greater performance outcomes. The influence of training is largest for organizational performance outcomes and human resource outcomes and weakest for financial outcomes. This result is not surprising, given that training can least affect an organization’s financial performance and may do so through its influence on human resource practices (Noe, 2010).

2.5.10 Transferring Training: Trainers should design training for the highest possible transfer from the class to the job. Transfer occurs when trainees actually use on the job what knowledge and information they learned in training. The amount of training that effectively gets transferred to the job is estimated to be relatively low, given all the time and money spent on training. It is estimated that about 40% of employees apply training to their jobs immediately after training. Among those who do not use the training immediately, the likelihood of it being used decreases over time. Effective transfer of training meets two conditions. First, the trainees can take the material learned in training and apply it to the job context in which they work. Second, employees maintain their use of the learned material over time. A number of things can increase the transfer of training. Offering trainees an overview of the training content and how it links to the strategy of the organization seems to help with both short-term and longer-term training transfer. Another helpful approach is to ensure that the training mirrors the job context as much as possible. For example, training managers to be better selection interviewers should include role-playing with “applicants” who respond in the same way that real applicants would. One of the most consistent factors in training transfer is the support new trainees receive from their supervisors to use their new skills when they return to the job. Supervisor support of the training, feedback from the supervisor, and supervisor involvement in training are powerful influences in transfer (Mathis and Jackson, 2011).

 

METHODOLOGY

Developing the knowledge capacity of medical personnel has a vital role in combating disease outbreak and addressing critical medical issues. Increasing such intellectual capital is important but retaining it posed several challenges since other countries desire trained and qualified medical personnel and are ready to offer attractive employment contract, which their home countries could not afford to pay and as a result, these countries experience brain drain. The retention aspect of trained and qualified medical personnel is not the focus of this research. This study seeks to assess the significance of training and developing medical personnel in the three West African countries and to examine its effects on post Ebola recovery in the health systems. The thrust for this qualitative research led to the retrieval of information from secondary sources published on the subject matter which will be critically examined in order to establish meaningful conclusion.

 

RESULTS AND DISCUSSION

Training and staff development has a key role in enhancing employee performance. Competitive advantage is achieved as a result of employees’ outstanding performance which is stimulated by the knowledge that resides in them. An organisation that embarks on developing staff intellectual capital is always seen to be the most successful and its operations are sustained in a competitive arena. Achieving strategic objectives has been and will continue to be the desire of every organisation whether private or public and such desire can only be attained if companies consider the relevance of investing in training and development.

The implementation of a training programme requires an assessment of the need for such training which includes organisational analysis which describes the relevance of the training towards organisations strategic objectives, task analysis which discloses the knowledge capacity an employee should possess to be able to perform a specific task and person analysis which identifies the employee that needs training. The aforementioned should be properly analysed in order to determine a successful implementation of a training programme. Also, organisations should be able to establish facts about the employee’s readiness for a training since unpleasant attitude towards training will result to fruitless endeavour.

Organisations should distinguish its training programme since certain skills can be learnt on-the-job whereas others can only be attained through external or off-the-job training. Training conducted on-the-job should be effective and facilitators or tutors administering such programmes must ensure that trainees grasp the content delivered and can demonstrate positive outcome in its implementation on the job. Coaching and mentoring helps in the conduct of training within the organisation and also human relations training shapes an employee’s relationship with colleagues in order to maintain harmonious working relationship and foster team spirit which leads to organisation’s growth. Off-the-job training programmes are most times conducted in situations wherein an organisation does not have the capacity to facilitate a particular training and as a result, hire training consultant or sends employees to training establishments for further capacity building.

Learning is a culture organisations should imbibe and a learning organisation progresses and serves as a model to rivals firms. Organisational performance in a competitive environment is determined by its commitment in learning and discovering new skills, competences and technologies that makes them distinct. Organisations must ensure that it develops a learning strategy (the path way) that leads towards the successful implementation of what has been taught.

Selecting the best method of learning that suits a particular situation and addresses a critical work challenge is of paramount importance. Employees should be motivated to learn so that their performance will be outstanding. Even though some are intrinsically motivated, but also the extrinsic aspect stimulates them and reinforces the intrinsic. Whatever training or learning method used, it should be followed by an evaluation process to ascertain its impact either negatively or positively and must also ensure that it is effectively transferred to the job.

SUMMARY AND CONCLUSION

Training and developing the knowledge capacity of medical personnel is relevant in every nation as it helps to improve their performance level and minimise critical medical issues and can also be able to contain unexpected outbreaks. The secondary information retrieved from sources published on the subject matter was critically examined and such content disclosed the significance of training and developing medical personnel. Facts analysed establish that the successful implementation of organisations activities requires diligent workforce, which is empowered by the relevant training and development programme. Sources further disclosed that training and developing medical personnel in Sierra Leone, Guinea and Liberia has a positive effect on post Ebola recovery in the health systems, since the major problem identified in containing the spread of the virus was as a result of lack of sufficient knowledge capacity in the health systems and that trained and developed medical personnel will prevent such spread in the future. Also, a well-trained and developed medical team will be able to forecast and identify unforeseen medical issues in which mechanisms will be put in place to combat identified experiments.

This study emanated from a qualitative perspective and restricted its data collection from secondary sources. Nevertheless, further research could be conducted on similar study, using both primary and secondary data in order to ascertain first-hand information and describe specific components of training and development.

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