oblasts from 1,644 to 2,4 – an increase associated with a HIV-infection outbreak in this region at that time.
Figure 8.2 Number of training activities per specialist in 2006 and 2007
Source: Facility survey
During interviews with managers of organizations and service providers, the issue of building HR capacity in the field of HIV/AIDS was an important concern. Interviewees asserted that compared to other Central Asian countries, The Kyrgyz Republic has a relatively strong workforce, particularly in the NGO sector. Respondents gave examples of staff members of particular NGOs providing services in neighboring countries as international consultants. The role of the GFATM and CAAP grants in this process is significant. In the frame of these programs specialists have opportunities to participate in different international events (trainings, conferences) and receive new knowledge. CAAP is funding the creation of Regional Training Centers in four Central Asian countries - Kyrgyzstan, Kazakhstan,
Uzbekistan and Tajikistan. Each Center has own specialization. For example, in Kyrgyzstan it will be the Center on Harm Reduction Programmes that will provide training for staff of all four countries.
At the same time respondents emphasized a range of factors hindering improvement of training activities.
GHIs provide training at irregular intervals. Despite the fact that GFATM and СААР, as well as a number of donors and international organizations, pay considerable
attention to training, nevertheless training sessions tend not to be provided on a regular basis. Because of the rapid turnover in staff, staff find it necessary to train new-comers themselves. Thus, 10 out of 26 respondents mentioned that they provided consulting and training sessions for staff members of their own and other organizations (Table 8.4). One respondent noted that the quality of the training has declined as a result:
Of course, everyone tries to learn in the workplace, however, these are different things when a trainer trains and when someone listened to and told to another one. These are different things. A trainer should be able to explain and establish good understanding (fragment of the interview, NGO)
44 See Fig. 7.6. in the Interim Report “Global HIV/AIDS initiatives and their impact on health care system of the
KR”, April 2008, http://chsd.med.kg 3,7 1,6 1,6 2,4 1 1 4,1 3 2 1,6 0 1 2 3 4 5 Bishkek, Chui
Osh, Jalal Issyk-Kul Gov. organ-s NGO
2006 2007
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High percentage of social and outreach workers need training. As noted above, there is considerable overlap between these two groups, and there are few qualified staff. Respondents cited examples of particular workers who had little understanding of the ideas and ultimate ends of those activities in which they took part. One of the managers of an organization shared his experience:
For 16 days I have been on my business-trip and saw many projects and almost half of all outreach workers need training. When they plan training probably they
[organizers of the training activity] have no information or resources. I believe they do not plan the way to cover everybody. Why do they all the time provide training
activities in Bishkek, and we come from Osh? Well, manager goes every time…they arrange separate training for outreach workers and train them. (interview fragment, NGO)
Training opportunities are unevenly distributed. This feature is equally typical both for NGOs and government organizations, and there are various factors that explain this pattern. Respondents explained that, typically, a manager takes part in training sessions, meetings, and roundtable discussions. In one of the surveyed organizations a frontline provider mentioned that when a manager is not able to participate in these activities usually they stand in. But that person cannot specify topics for the training sessions or conferences, and often it is felt the person is present for sake of appearances.
Furthermore, managers sometimes did not make rational decisions about who received training, or the training topics:
[The program] needs to train in the way that there is a feedback. It needs to send those people for training who will continue work in this direction, it is necessary to monitor this training [to ensure] it is not for no reason. (interview fragment,
government organization).
These examples suggest that training activities may be having limited impacts on capacity development. If the focus is limited to building the capacity of managers, then this will cause problems for the sustainability of the organization. If a manager makes a decision to leave, that organization will either just stop functioning, or some services will no longer be covered.
Low HR capacity in governmental organizations compared to NGOs. Low HR capacity in terms of levels of training relating to HIV and staff numbers providing HIV- related services continues to characterize governmental organizations in the Kyrgyz Republic. Respondents noted:
It is necessary to upgrade staff members in governmental organizations. They are better in NGOs… Governmental organizations should be stronger, however, it comes out conversely, all information and works are provided in NGOs… (interview
fragment, NGO)
In the AIDS Center capacity of personnel is weak … if they decide to leave in a couple of months, it would be again necessary to train staff members. 2-3 people [benefit] and the others sit for no reason in particular… (interview fragment, governmental organization)
Shortage of doctors with knowledge and experience in HIV/AIDS prevention and treatment. However, an outbreak of HIV infection in hospitals in the south of the country is a factor that has contributed to growing recognition of this problem among health professionals. For example:
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Medical community was interested very much in training activities on HIV prevention… (interview fragment, governmental organization)
In addition, there is a significant shortage of 1) doctors with available experience and skills in providing prevention and care/ART to HIV-positive patients, particularly children, as one respondent noted „…old doctors leave, new ones are not able to understand
specificity, young doctors don‟t want to come‟; 2) lack of professional
psychologists/psychotherapists capable of delivering qualified psychological support to PLWHA and PSFHA45.
Absence of a system for monitoring the training process. Most of the above mentioned problems are exacerbated by the absence of an efficient system to monitor the training process in HIV/AIDS issues such as who receives training, the quality and appropriateness of training and changes of skills/practice of trained specialists. With this information, it would be possible to introduce timely improvements in the efficiency of training activities.
Nevertheless, the experiences of the Family Medicine Center specialists who worked on the CAAP Grant implementation deserve mention. In the process of training activities, initial and final knowledge levels of the participants were assessed. After training was completed, a twofold monitoring of trainees‟ performance was provided according to specifically developed indicators.
8.5 Motivation, financial incentives and satisfaction
A number of key motivating factors to work in AIDS service organizations were reported by respondents. Empathy/commitment and financial/salary factors were the most common factors (11 and 9 people out of 23 respondents respectively). 5 people from representatives of governmental medical organizations and 6 people from NGOs noted that during the last 12 months they received financial bonuses and premiums from their employer. In
organizations, there is a tendency to introduce different incentives for personnel. Thus, 5 people from Osh and Issyk-Kul oblasts mentioned that their organization helped to pay for accommodation, 8 people mentioned that their organization allocated funds for transport costs, and 9 people mentioned that their organization paid their health insurance.
Compared with respondents‟ comments during the baseline survey for this report, in 2008 far fewer respondents cited the opportunity to participate in training activities as a motivating factor: just 4 people out 22 replied positively to the question “Did you get funds to cover daily costs while attended training sessions?”
Despite weak training opportunities, 2008 data showed a high level of job satisfaction, with 19 people out of 26 respondents replying positively to the statement “I am satisfied with my job” (Table 8.7).
45
This fact is also mentioned in Final Report of Ketlin Ferrer MD, Susan Ghilespy MD PhD, Stefaniya Michale, MSW. International Pediatric Institute of Beilor with Mission in Kyrgyzstan, 10/6/2008.