Community Health Practitioners Registration Board of Nigeria

(CHPRBN)

REPORT OF TRAINING NEEDS

ASSESSMENT FOR COMMUNITY
HEALTH WORKERS IN SOUTH-SOUTH
GEOPOLITICAL REGION OF NIGERIA

SEPTEMBER 2014
 REPORT OF TRAINING NEEDS ASSESSMENT FOR COMMUNITY HEALTH
WORKERS IN SOUTH-SOUTH GEOPOLITICAL REGION OF NIGERIA

The authors’ views expressed in this publication do not necessarily reflect the views of the
United States Agency for International Development (USAID) or the United States
Government.

USAID Nigeria provided funds to the CapacityPlus project led by IntraHealth International to
support an integrated program of human resources for health strengthening activities to be
implemented at both national and subnational levels. The overall goal of this program is to
increase the availability of health workers to meet the HIV/AIDS, maternal and child health
(MCH), reproductive health, and other priority health needs of underserved populations
through sustainable and scalable human resources for health interventions. Implementation
is targeted at both federal and state levels through active engagement with a range of
agencies, including federal and state ministries of health, the Community Health Practitioners
Registration Board of Nigeria, training institutions, and regulatory councils.

Recommended Citation

Shiono Bennibor, Samuel Ngobua, Rebecca Bailey, Dr. Ananaba Alozie, Joseph Eton, Amanda
Puckett, 2014. Report of Training Needs Assessment for Community Health Workers in South-
South Geopolitical Region of Nigeria.
ACKNOWLEDGEMENTS

The training needs assessment (TNA) for community health workers is the brainchild of the
Community Health Practitioners Registration Board of Nigeria (CHPRBN) with support from
USAID through the CapacityPlus project of IntraHealth International and the Federal Ministry
of Health. The assessment process involved a host of relevant stakeholders at the national
and state levels.

The support from the CHPRBN leadership and in particular Mr. Shiono Bennibor, the
registrar/chief executive officer (CEO), is appreciated immensely. The consultant for this
activity, Dr. Alozie Ananaba, is highly appreciated also for his due diligent and hard work.

All participating stakeholders are given special mention and appreciation from the state
ministries of health and Primary Health Care Management Board of Akwa Ibom, Cross River,
and Rivers States.

We thank Samuel Ngobua (the chief of party for IntraHealth International in Nigeria), Joseph
Eton, and the other members of the IntraHealth team—Pius Emmanuel Uwamanua, Amobi
Andrew Onovo, and Rahinatu Hussaini—for providing an enabling environment for this
assessment to be conducted as well as their technical inputs in the review and finalization of
the tools and the draft report. We are grateful to Dr. Tony Udo of the HRH branch, Federal
Ministry of Health and his team for their support during the assessment. We also thank the
IntraHealth headquarters team for their technical input and oversight for this project. Special
thanks to Rebecca Bailey for her insightful technical contributions to the project.

Finally we thank all those whose names have not been mentioned here. They deserve every
commendation for their commitments to the realization of this document.
CONTENTS

ACRONYMS ................................................................................................................................................................. i
EXECUTIVE SUMMARY ........................................................................................................................................... ii
SECTION ONE: BACKGROUND............................................................................................................................ 1
SECTION TWO: STUDY OBJECTIVES.................................................................................................................. 2
2.1 Main Objective .............................................................................................................................................. 2
2.2 Secondary Objectives ................................................................................................................................. 2
2.3 Expected Benefits and Value .................................................................................................................... 2
SECTION THREE: METHODS................................................................................................................................. 3
3.1 Study Site......................................................................................................................................................... 3
3.2 Sampling Strategy and Study Population ........................................................................................... 3
3.2.1 Sample Size............................................................................................................................................. 3
3.2.2 Sampling Procedure ............................................................................................................................ 4
3.3 Study Instruments/Tools ........................................................................................................................... 4
3.4 Data Collection .............................................................................................................................................. 5
3.4.1 Preparatory Phase ................................................................................................................................ 5
3.4.2 Fieldwork ................................................................................................................................................. 5
3.5 Data Processing ............................................................................................................................................ 5
3.5.1 Data Entry................................................................................................................................................ 5
3.5.2 Data Quality Assurance ...................................................................................................................... 5
3.6 Data Analysis .................................................................................................................................................. 6
3.7 Ethical Considerations ................................................................................................................................ 6
SECTION FOUR: RESULTS...................................................................................................................................... 7
4.1 Study Response ............................................................................................................................................. 7
4.2 Sociodemographic Characteristics ........................................................................................................ 7
4.2.1 Gender Characteristics ....................................................................................................................... 7
4.2.2 Age Characteristics ............................................................................................................................. 8
4.2.3 Designation/Cadres ............................................................................................................................. 8
4.2.4 Highest Level of Education ............................................................................................................... 8
4.2.5 Years of Experience.............................................................................................................................. 9
4.2.6 Type of Training Institution Attended .......................................................................................... 9
4.2.7 Facility Location .................................................................................................................................... 9
 4.2.8 Access to and Utilization of Information Technology by CHWs ........................................ 9
4.3 Assessment of Training Needs at the Competency Domain Level ......................................... 10
4.3.1 Competency Domain Areas ................................................................................................... 10
4.3.2 Need Scores Based on Competency Domains ............................................................... 11
4.3.3 Need Scores Based on Individual Skills within Broader Competency Domains 13
4.3.4 Need Score Analysis by Competency Domain and CHW Cadre.............................. 14
4.3.5 Need Score Analysis by Competency Domain and CHW Years of Experience .. 15
SECTION FIVE: RECOMMENDATIONS ........................................................................................................... 17
SECTION SIX: APPENDICES ................................................................................................................................ 18
Appendix 1: Training Needs Assessment Questionnaire ................................................................... 18
Appendix 2: Matrix of Competency Domains and Individual Skills ............................................... 25
Appendix 3: Individual Skills Assessment Table .................................................................................... 27
LIST OF TABLES

Table 1: Sample size distribution across states ............................................................................................. 4

Table 2: Study response across states and LGAs ......................................................................................... 7
Table 3: Gender, age and designation of respondents.............................................................................. 7
Table 4: Educational characteristics of respondents ................................................................................... 8
Table 5: Access to and utilization of IT by CHWs...................................................................................... 10
LIST OF FIGURES

Figure 1: Study location in three South-South states................................................................................. 3

Figure 2: Rural-urban distribution of PHC facilities ..................................................................................... 9
Figure 3: Competency domains for public health practitioners .......................................................... 10
Figure 4: Analysis of need scores by competency domain ................................................................... 12
Figure 5: Competency domain ranking by need score ........................................................................... 12
Figure 6: Assessment of individual skills within broader competency domains, aggregated by
domain ...................................................................................................................................................................... 13
Figure 7: Aggregation of need scores for individual skills within competency domains .......... 14
Figure 8: Need scores by competency domain and CHW cadres ..................................................... 14
Figure 9: Need scores by competency domain and CHW years of experience............................. 15
ACRONYMS

ACT Artemisinin-based combination therapy

CHEW Community health extension worker

CHO Community health officer

CHPRBN Community Health Practitioners Registration Board of Nigeria
CHW Community health worker
CPD Continuing professional development
GCE General Certificate of Education
IST In-service training
IT Information technology
JCHEW Junior community health extension worker
LGA Local government area
NECO National Examinations Council of Nigeria
NPHCDA National Primary Health Care Development Agency
OSCE Objective structured clinical exam
PEPFAR President’s Emergency Plan for AIDS Relief
PHC Primary health centre

PMTCT Prevention of mother-to-child transmission of HIV

RSE Relative standard error

SSCE Senior School Certificate Examination

STI Sexually transmitted infection

TNA Training needs assessment

USAID United States Agency for International Development

WASC West African School Certificate

i
EXECUTIVE SUMMARY

The training needs assessment (TNA) was conceptualized as a follow-on activity to the
findings from a 2013 CapacityPlus assessment of PEPFAR-funded in-service training (IST) in
Nigeria. 1 One of the recommendations from the IST assessment report was to ensure
broader access to new developments in knowledge and technology, as well as sustainability
of training, by integrating the IST contents into preservice education curricula and continuing
professional development (CPD) programs.

Based on the current implementation arrangements of CapacityPlus, the South-South region

was purposively selected for the pilot of this TNA. Specifically, Akwa-Ibom, Cross River, and
Rivers states were systematically sampled as representatives of the South-South region. It is
anticipated that a broader and more inclusive survey that will involve other geopolitical
regions of the country will be conducted, and secondary analysis from the findings to inform
the design of a national CPD and re-licensure initiative will be implemented by the
Community Health Practitioners Registration Board of Nigeria (CHPRBN).

This assessment explored community health extension worker (CHEW) and community
health officer (CHO) perceptions of globally accepted competency domains for public health
practitioners across the areas of importance, and confidence in their ability to demonstrate
those competencies. To corroborate findings at the domain level, the assessment also
assessed CHEWs and CHOs at the individual skill/ability levels, which are appropriately
mapped to the competency domain areas. Need scores were calculated for each competency
domain and individual skill/ability levels. The assessment also attempted to identify the
extent of dependence between the need scores and various background characteristics of
respondents including age, level of education, years of experience, and CHEW or CHO cadre.

A need score ranking placed the need for computer and information technology access and
skills as the top priority among CHEWS and CHOs who participated in the study. Financial
planning and management and public health science skills ranked a close second and third.
No significant association was demonstrated with study participants’ background
characteristics, implying that a uniform IST/CPD and re-licensure program can conveniently
be established along the lines of the prioritized competency domain areas.

The study was not without limitations and these included challenges with access to certain
health facilities, need to have proportionate sample allocation across the community health
worker cadres in the study population, and the need to conduct a broader and more
representative assessment across the other geopolitical zones in the knowledge of the
sociocultural differences that exist across the regions.

1
Burlew R, Puckett A, Bailey R, Caffrey M, Brantley S. Assessing the relevance, efficiency, and sustainability of HIV/AIDS in-
service training in Nigeria. Human Resources for Health 2014, 12:20 doi:10.1186/1478-4491-12-20. http://www.human-
resources-health.com/content/12/1/20

ii
SECTION ONE: BACKGROUND

Achieving universal health coverage requires a dynamic and skilled health workforce.2 Yet
most African countries suffer from critical health workforce shortages, poor distribution,
inappropriate skills mix, and inadequate performance. Nigeria is one of 36 sub-Saharan
African countries in the midst of a health workforce crisis with a shortage of skilled medical
personnel at the primary health care level. Inadequacy of optimal numbers of health workers
with the appropriate skill set is most pronounced in the rural and remote regions of Nigeria
where 52% of the population lives.3

There is no doubt that training is an important contribution toward the development and
maintenance of health worker competencies for delivering quality services. For training to be
effective, a training needs assessment is required to determine the gaps between what is
currently in place and what is actually needed. Needs assessment results provide information
regarding the areas of training needed and the individuals in need of such training.

To increase the availability of skilled health workers in Nigeria to meet the HIV/AIDS, family
planning/reproductive health, maternal and child health, and other priority health needs of
underserved populations, CapacityPlus, a USAID-funded global health workforce project led
by IntraHealth International, is supporting the Federal Ministry of Health and other
stakeholders to carry out an integrated program of human resources for health (HRH)
strengthening activities. Implementation of sustainable and scalable interventions is targeted
at both the federal and state levels through active engagement with a range of agencies,
including federal and state ministries of health, the National Primary Health Care
Development Agency (NPHCDA), training institutions, and regulatory councils.

In 2013, CapacityPlus presented findings from an assessment of PEPFAR-funded in-service

training (IST) in Nigeria. One recommendation from the IST assessment report was to ensure
broader access to new developments in knowledge and technology, as well as sustainability
of training, by integrating IST content into preservice education curricula and continuing
professional development (CPD) programs. Following this recommendation, CapacityPlus in
2014 conducted a training needs assessment in collaboration with the Community Health
Practitioners Registration Board of Nigeria (CHPRBN) to determine ideal content for CPD
linked with the council’s requirements for re-licensure of community health extension
workers (CHEWs) and junior CHEWs (JCHEWs). The South–South region of Nigeria was
selected as a pilot region for this assessment in view of ongoing activities by CapacityPlus in
this region. The assessment results will inform modifications to the design and delivery of
IST/CPD for CHEWs, including revisions to curricula, course modality, and overall
management of the program within the council’s existing infrastructure. Similar studies are
needed across the country’s other geopolitical regions to inform a broader national
approach to IST/CPD and CHEW re-licensure in Nigeria.

2
http://www.afdb.org/en/news-and-events/article/a-dynamic-and-skilled-health-workforce-is-key-to-universal-health-
coverage-13285/
3
http://www.ncbi.nlm.nih.gov/pubmed/20136347

1
SECTION TWO: STUDY OBJECTIVES

2.1 Main Objective

To conduct a training needs assessment to determine ideal content and the most suitable
approach for developing and implementing an IST/CPD course linked with the CHPRBN
requirements for re-licensure of CHEWS and community health officers (CHOs).

2.2 Secondary Objectives

q To determine the expressed needs and training priorities for practicing community
health workers (CHEWs and CHOs)

q To determine prioritized training needs for community health workers (CHEWs and
CHOs) from the perspective of the regulatory body for purposes of CPD and re-
licensure.

2.3 Expected Benefits and Value

The assessment sought to derive perceptions of training needs from health workers. Results
of this study will contribute to the body of knowledge to inform modifications to the content
of IST/CPD, including revisions to curricula, course modality, and the overall management of
the program within the existing CHPRBN infrastructure.

2
SECTION THREE: METHODS

3.1 Study Site

Figure 1: Study location in three South-South states

The study was conducted in three states in the South-South geopolitical zone of Nigeria
(Figure 1). This was a purposive sample of states based on the current implementation
presence that the CapacityPlus project has in the three states in particular and the south-
south geopolitical zone in general. It is presumed that this provided a good pilot location
and the findings here would further inform the design of similar studies across the other
geopolitical regions in the country.

3.2 Sampling Strategy and Study Population

The sample population was CHEWs and CHOs working at the primary health center (PHC)
level in the study states. The assessment was designed and implemented as a cross-sectional
descriptive study with a two-stage stratified sampling design. The first stratum was the local
government authorities (LGAs) in each of the three states. Within each state, two LGAs were
randomly selected. All PHCs within the LGAs were eligible for the study. Using a quota
technique, community health workers (CHWs) within facilities in each LGA were serially
interviewed to achieve the estimated sample size of workers to be interviewed in that LGA.

3.2.1 Sample Size

The sample size was calculated using desired relative precision (relative standard error or
RSE) of 10%, 80% power, a design effect of 2.0, and 20% adjustment for non-response (from

3
facility refusals or abandoned facilities). In addition, the sample size assumes that each PHC
has an average of two CHWs per facility.
A sample of 6 clusters (LGAs) with 20 CHWs to be interviewed per LGA was determined
making a total of 120 CHWs (Table 1), for a desired precision of 80%.

Table 1: Sample size distribution across states

State LGA Sample Size

Akwa Ibom Uyo 20
Abak 20
Rivers PH 20
Asari Toru 20
Cross River Odukpani 20
Akpabuyo 20
Total 120

3.2.2 Sampling Procedure

Stage 1—Selection of clusters (LGAs): The LGA listing of each state was generated and served
as an initial sampling frame for this level of sampling. Two LGAs were randomly selected for
each state.

Stage 2—Selection of facilities: Within each selected LGA, the LGA facility directory extracted
from the national facility directory was used to generate a sampling frame. A random
selection of 10 facilities per LGA was done with the knowledge that all selected LGAs had at a
minimum 10 PHCs per LGA.

Stage 3—Selection of CHWs: A census of community health workers willing to participate in

the study was done for each selected facility. However, to meet the desired study precision,
interviews were extended to other PHCs within the LGAs to increase the size of the sample
interviewed. This was deemed acceptable as all CHWs within the selected LGAs were
considered eligible for the assessment.

3.3 Study Instruments/Tools

Structured data collection tools were developed for the study and were administered to
respondents who had provided consent to participate in the study. The tools are attached as
appendices to this report.

The tools adopted both the competency domain and individual skill/ability assessment
approach using the two dimensions of: 1) importance or relevance; and 2) confidence.

A gap score (difference between importance and confidence) was calculated thereafter. Gap
scores were determined by calculating the difference in percentages or difference in means
between the two dimensions.

Information on basic demographic indices was also collected.

4
3.4 Data Collection

3.4.1 Preparatory Phase

After the questionnaire was agreed upon by all stakeholders, it was pretested in two PHCs in
a state that was not selected for the survey. The questionnaire was then revised in light of
the results from the pilot survey (see Appendix A for final version). Note is made that the
individual competency component was a crosswalk between the existing job descriptions for
the various community health cadres and other international best practice examples. 4

3.4.2 Fieldwork
Teams and training: Interviewers and supervisors were carefully selected to be culturally
acceptable, to have good knowledge of the local language, and to have experience in facility
surveys and work related to human resources for health. The assessment team in each state
consisted of staff from CapacityPlus, the state primary health care management board, local
government, and the facility.

Stakeholder sensitization: Local authorities were contacted for approval to conduct the
survey. Visits were made to the relevant directors of public health in the states, the local
government civil service commission, and the PHC coordinators in each LGA. During the
visits, the purpose and procedures of the survey were explained to them.

Interviews: Each selected facility was visited. The questionnaire was administered to at least
one staff in each level of CHW cadre present. Where some cadres were not represented or
the desired interviewee numbers were not met, more representatives were sought in other
facilities.

3.5 Data Processing

3.5.1 Data Entry

Data collection was done using paper-based tools administered by the survey team. These
questionnaires were collated and entered into an online platform created using the Qualtrics
online survey software™. The data were collated centrally in real time and data entry errors
identified and field teams notified for correction. At the end of the exercise, the entire
database was exported to MS-Excel formats and cleaned again before import into STATA 13
for analysis.

3.5.2 Data Quality Assurance

At the end of each day, the CapacityPlus staff member reviewed all questionnaires for
completeness and possible inconsistencies and ensured that missing information was
corrected while still in the field. In addition, spot checks were performed on 10% of
interviews conducted by each fieldworker. A central-level real time quality check was also
carried out by the consultant using data pulled from the Qualtrics platform on a daily basis.

4
Place, Janet. Draft PHTC Common Training Needs Assessment Protocol 3-15, HRSA, 2013.

5
3.6 Data Analysis
Analysis was done using STATA 13 and consisted mainly of computation of need scores for
the domain and individual competency levels. These were also cross-tabulated by other
background characteristics of respondents to determine possible variability in need scores
attributable to these background characteristics.

3.7 Ethical Considerations

There are no obvious ethical concerns associated with the study. Personal information about
respondents in the survey was not collected, and only respondents who signed the informed
consent forms were interviewed.

6
SECTION FOUR: RESULTS

4.1 Study Response

Table 2: Study response across states and LGAs

State LGA Sample Size Respondents

Akwa Ibom Uyo 20 18
Abak 20 17
Rivers PH 20 25
Asari Toru 20 23
Cross River Odukpani 20 11
Akpabuyo 20 13
Total 120 107
Response Rate 89%

This section presents the findings of the community health worker survey in Cross River, Akwa Ibom, and
Rivers states.

Of the estimated sample size of 120 CHWs to be interviewed, a total of 107 respondents participated in the
survey, representing an 89% response rate (Table 2).

4.2 Sociodemographic Characteristics

Table 3 shows the background characteristics of respondents who took part in the survey.

Table 3: Gender, age and designation of respondents

N =107 %
Respondent's Gender
Male 13 12.1
Female 94 87.9
Age Group
< 30 yrs 28 26.2
30-39 yrs 42 39.3
40-49 yrs 23 21.5
>50 yrs 14 13.1
Current Designation of Respondent
JCHEW 20 18.7
CHEW 60 56.1
CHO 20 18.7
Other 7 6.5

4.2.1 Gender Characteristics

Most respondents (87.9%) were female, while 12.1% were male. This ratio reflects the general gender
distribution for this cadre of the health workforce, particularly in the southern part of Nigeria.5

5
IntraHealth International. Human Resources for Health Situation Analysis, Cross River State, July 2013.
7
4.2.2 Age Characteristics
Three-fifths (60%) of respondents were within the 30-59 year age range, with 26.2% of respondents less
than 30 years of age. The mean age was 37.4 ± 9.4 years while the modal age was 40 years. This indicates
that the respondents were of a relatively mature age and could confidently express their perceptions of
importance of certain skill sets and their confidence in their ability to demonstrate same as applicable.

4.2.3 Designation/Cadres
Over half (56%) of the respondents were of the CHEW cadre of workers, while 18.7% were JCHEW. CHOs
were 18.7% of respondents. This is in keeping with the observations made with the age of the respondents
where the older respondents tended to be CHEWs.

To become a JCHEW, a candidate has to have had four credit level passes at WASC, NECO, or GCE O-level
at not more than two sittings as an entry requirement (West African School Certificate, National
Examinations Council of Nigeria, or General Certificate of Education). Course work is for two years, after
which a certificate in community health is awarded.

CHEWs are required to have had four credit level passes at WASC, NECO, or GCE O-level at not more than
two sittings. A diploma in community health is usually awarded at the end of the three-year training.

A CHO is the most senior member among the community health practitioners in Nigeria. To qualify for the
CHO training, the candidate must be a holder of a diploma in community health, with no less than two
years of post-qualification experience plus five credit level passes in SSCE (Senior School Certificate
Examination), WASC, NECO, or GCE O-level at not more than two sittings. S/he can also be a CHEW with
five years’ experience with five credit level passes in SSCE, WASC, NECO, or GCE O-level at not more than
two sittings. They must also possess a valid practice license. The course duration is two years; a higher
diploma in community health is awarded on successful completion of course work.6

Table 4: Educational characteristics of respondents

Highest level of education N =107 %

Basic certificate 20 18.7
Diploma 60 56.1
Higher diploma 20 18.7
Other 7 6.5
Years of practice after obtaining higher qualification
Less than 1 year 5 4.7
1-5 years 35 32.7
Greater than 5 years 67 62.6
Training institution attended
Public (government-owned) 97 90.7
Private (private or faith-based) 10 9.3

4.2.4 Highest Level of Education

About 18.7% of respondents had basic certificate as their highest level of education, while 56.1% had a
diploma. Another 18.7% had higher diplomas, while 6.5% had other qualifications (Table 4).

6
CHPRBN. Curriculum for Diploma in Community Health, 2006
8
4.2.5 Years of Experience
A great proportion (62.6%) had over five years of practice experience (Table 4). Only 4.7% had practiced for
less than a year since their highest qualification. This might suggest that IST/CPD will need to be tailored for
an experienced audience, and this will need to be properly considered in interpreting the rankings of the
training need scores. This will need to be further validated by conducting similar studies across other
geopolitical regions in the country. Another potential import of this finding is that the use of more practical
approaches to training would benefit this group of health workers who, with experience, might have
corrected for the gaps in didactic learning. However, to make conclusive inferences, a study of equivalent
proportions across cadres and years of practice will be required to provide large enough and comparable
sample sizes across cadres.

4.2.6 Type of Training Institution Attended

An attempt was made to map the type of training institutions from which health workers graduated. This
was to explore possible differences at the fundamental levels of training based on public–private
differences. Most respondents (90.7%) graduated from public-owned institutions, while 9.3% graduated
from private (including faith-based) institutions (Table 4). This difference in proportions is not unexpected,
with over 90% of the existing training institutions being publicly owned.7

4.2.7 Facility Location

Figure 2: Rural-urban distribution of PHC facilities

The study also tried to map the geo-location of the

primary health care facilities where respondents were
practicing by rural–urban classification. Distribution by
location of health facilities where the interviewed CHWs
were practicing showed that 86.9% of respondents
practiced in PHCs located in urban areas, while 18.1%
practiced in PHCs s located in rural areas (Figure 2).

4.2.8 Access to and Utilization of Information Technology by CHWs

Computer ownership: The assessment collected information around CHW access to and use of information
technology (IT) both for work and for personal use. Only 6.5% of respondents (n=7) attested to owning a
computer (Table 5). This indicates the very low IT penetration for this cadre of health workers, particularly
for CHEWs over 30 years of age who represented the majority of the study population, and potentially limits
the opportunity to improve learning access through the use of information technology.

Access to computer at work: Of the 107 respondents, only 12% had access to a computer at work that could
be used for learning or training, while 87.9% had no such access. This reinforces the existing limitations to
the use of IT for training CHWs.

7
CHPRBN
9
Table 5: Access to and utilization of IT by CHWs

Use of a computer: The study also tried to

Access to IT infrastructure determine if CHWs had access to computers
n=107 % through other means outside the work
Own a computer environment. Among the respondents, 74.8%
Yes 7 6.5 (n=80) did not use a computer at all, 18.7%
No 100 93.5 used computers less than once a week, while
Have access to a computer at your work that
3.7% and 2.8% used computers several times a
could be used for learning/training
Yes 13 12.1 week or daily, respectively.
No 94 87.9
How often do you use a computer Source of Internet access: The majority (69.2%) of
Every day 3 2.8 respondents did not have access to the Internet.
Several times per week 4 3.7 Another 19.6% reported having Internet access
Less than one time per week 20 18.7
through Internet cafés, while only 2.8%
I do not use a computer 80 74.8
accessed the Internet either at home or at work.
Access to Internet
At home/residence 2 1.9
At work 1 0.9
Internet café 21 19.6
Other 9 8.4
I do not access the Internet 74 69.2

4.3 Assessment of Training Needs at the Competency Domain Level

4.3.1 Competency Domain Areas

These are internationally accepted competency domains for requisite knowledge, skills, and attitudes for
public health practitioners (Figure 3).8 These competencies have been cross walked with the current job
descriptions of CHWs and determined to be appropriate for use in Nigeria.9 The domain areas have been
adapted to suit the practice expected of CHWs in Nigeria.
Figure 3: Competency domains for public health practitioners

Domain Description
Skills, such as ability to collect, collate and evaluate
Analytic/Assessment Skills monitoring and evaluation data, and the ability to
teach other staff, simple methods of data analysis.
Skills related to the development of plans to ensure
Program Planning Skills effective functioning of the PHC system based on
national standards.
Skills related to ability to convey standard
Communication Skills knowledge of basic health and social concerns in
ways that are familiar to clients and their families.
Skills related to successfully considering the
Cultural Competency Skills cultural background of the intended audience for
public health services, literature, and education.

8
Council on Linkages between Academia and Public Health Practice. Core Competencies for Public Health Professionals, 2010

9
The CHPRBN recommended the use of these competencies as a guidance framework for competency assessment of CHWs.
10
 Skills related to ensuring the initiation and
participation of the community and other health
workers in identifying major health problems of the
Community Dimension Skills
community and develop their capacity and access
to resources including health insurance, food,
quality care and health information.
Skills related to provision of integrated primary
health care services e.g. Nutrition, immunization,
Public Health Science Skills
basic antenatal & obstetric care, basic clinical
management of minor ailments etc.
Skills related to developing and managing a PH
Financial Planning and Management Skills facility, develop an annual workplan with approval
of the PHC coordinator etc.
Skills related to utilizing leadership characteristics,
serving as a public health role model, and
Leadership and Systems Thinking Skills establishing mentoring, peer advising, and other
professional development opportunities for the
other CHW cadres

4.3.2 Need Scores Based on Competency Domains

Respondents were asked to assess themselves along the lines of the competency domains on how
important it is for them to have the set of skills and how confident they are in their ability to demonstrate
the set of skills.

Analysis was carried out to determine the need score at both the domain and individual skill levels. The
domain areas assessed included analytical/assessment skills, program planning skills, communication skills,
cultural competency skills, community dimension skills, public health science skills, financial planning and
management skills, leadership and systems thinking skills, and computer and IT skills. The needs assessment
used two dimensions: 1) importance or relevance of the competency domain area; and 2) confidence in
each competency domain area. Each dimension was graded into three categories (not important, neutral,
important; and not confident, neutral, and confident). This allowed for the calculation of need scores,
determined by calculating the difference in the proportion of respondents who indicated the competency
domain was important and the proportion of respondents who indicated confidence in their ability to
perform the competency. For example, if 67.3% reported that community domain competencies were
important but only 38.3% indicated that they felt confident in this domain area, then the 29% of
respondents who felt the skill was important but did not indicate feeling confident would be in need of
some kind of training in that skill. The scores assumed that respondents who reported a “neutral”
confidence level were also in need of training.

11
Figure 4: Analysis of need scores by competency domain

Importance Confidence
(Means) (Means)
Not Not Need
Domain Area Important Neutral Important N Confident Neutral Confident N Score*
Community
0.9 31.8 67.3 107 11.2 50.5 38.3 107
Dimensions Skills 29.0%
Financial Planning and
1.9 42.1 56.1 107 13.1 57 29.9 107
Management Skills 26.2%
Analytic/Assessment
0 31.8 68.2 107 6.5 51.4 42.1 107
Skills 26.1%
Program Planning
0 43 57 107 14 53.3 32.7 107
Skills 24.3%
Leadership and
2.8 37.4 59.8 107 15.9 48.6 35.5 107
Systems Thinking Skills 24.3%

Communication Skills 0 26.2 73.8 107 0.9 46.7 52.3 107 21.5%
Public Health Science
1.9 20.6 77.6 107 3.7 40.2 56.1 107
Skills 21.5%
Cultural Competency
9.3 45.8 44.9 107 8.4 60.7 30.8 107
Skills 14.1%
*Proportion of study participants in need of training in the competency domain

From Figure 4 above, community dimensions skills had the highest need score (29%), indicating the
greatest gap between the levels of importance ascribed to the domain area and the existence of the
capacity among respondents. Financial planning and management skills and analytical/assessment skills
had need scores of 26.2% and 26.1%, respectively. Both program planning and leadership and systems
thinking skills had need scores of 24.3%. Communication and public health science skills both had 21.5%
need scores. Cultural competency skills had the lowest need score (14.1%) in the rankings. Figure 5 provides
a graphical representation of the need score ranking.

Figure 5: Competency domain ranking by need score

Cultural Competency 14.1%

Public Health Science 21.5%

Communication 21.5%

Leadership and Systems Thinking 24.3%

Need Scores
Program Planning 24.3%

Analytic/Assessment 26.1%

Financial Planning and Management 26.2%

Community Dimensions 29.0%

0.0% 10.0% 20.0% 30.0% 40.0%

12
4.3.3 Need Scores Based on Individual Skills within Broader Competency Domains
This analysis sought to explore need score differences across specific individual skills (matched to the
broader competency domains) that are relevant for CHWs to perform their role within the Nigerian context.
The skills are adequately mapped to fit into the broader competency domain areas. This level of detail is
required to further identify specific skills that would be requisite for re-licensure of CHWs. It would also help
to corroborate findings at the competency domain levels described earlier. Appendix 3 provides a detailed
analysis of need scores by individual skills across the competency domains and depicts sublevels of possible
prioritization within each competency domain. This can serve to further tailor the IST/CPD design.

Since there was more than one skill under each competency domain, the mean score of all the skills in a
competency domain was determined to get the representative score for each domain. Standard deviation
was also calculated to check deviation from the mean. 10 The values were expressed in percentages and the
need scores calculated. This was then used to generate the need score chart at the competency domain
level (Figure 6).

Based on the mean values calculated for skills in each competency domain, more than 55% of respondents
agreed that having skills in all competencies was important, while less than 15% said it was not important.

In all nine competency domains, respondents who indicated they were confident were less than 50%.
About 56% pointed out they were not confident with computer and information technology skills while the
other seven competency domains had fewer than 20% who said they were not confident with their skills in
those areas.

Figure 6: Assessment of individual skills within broader competency domains, aggregated by domain

How important is it to have the skills in this How confident are you in your ability to
domain demonstrate the skills in this domain
(Mean expressed In percentages) (Mean expressed In percentages) Need Standard
Score Deviation
Not Not
Neutral Confident N Neutral Important N
Confident Important
Domain
Cultural Competency
Skills 2.8 41.6 55.6 107 8.9 48.2 43.0 107 12.6 5.9

Communication Skills 2.2 36.6 61.3 107 8.1 48.4 43.4 107 17.9 2.9
Community
Dimensions Skills 4.1 32.7 63.2 107 11.2 47.6 41.1 107 22.1 2.7
Analytic/Assessment
Skills 3.2 38.5 58.3 107 18.3 47.0 34.7 107 23.6 5.5
Public Health Science
Skills 3.9 27.8 68.3 107 13.2 44.5 42.3 107 26.0 6.7
Leadership and
Systems Thinking
Skills 2.4 30.2 68.2 107 9.0 49.5 41.4 107 26.8 3.0
Financial Planning and
Management Skills 1.9 34.7 63.4 107 19.9 48.1 32.1 107 31.4 1.8
Program Planning
Skills 3.0 32.7 64.2 107 15.0 52.6 32.5 107 31.8 3.4
Computer/
Information
technology Skills 10.5 45.6 58.5 107 55.4 26.4 18.2 107 40.3 1.7

10
See Appendix 3.
13
Aggregating individual skills by competency domains and generating mean values for need scores, the skills
within the computer/information technology domain ranked highest in terms of need scores (40.3%) while
cultural competency skills averaged the lowest need score (12.6%). Program planning and financial planning
and management skills had average need scores of 31.8% and 31.4%, respectively. The ranking is also
depicted in Figure 7 below.

Figure 7: Aggregation of need scores for individual skills within competency domains

Mean of need scores by individual skills across domain areas

Computer/Information Technology Skills 40.3

Program Planning Skills 31.8
Financial Planning and Management Skills 31.4
Leadership and Systems Thinking Skills 26.8
Public Health Science Skills 26.0
Analytic/Assessment Skills 23.6
Community Dimensions Skills 22.1
Communication Skills 17.9
Cultural Competency Skills 12.6
0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0

4.3.4 Need Score Analysis by Competency Domain and CHW Cadre

The assessment sought to ascertain if there were any significant differences in need scores that could be
attributed to the respondent’s current job designation. For the analytical/assessment skills domain, the
CHEWs had a larger need score (14). The statistical significance of this finding will need to be further
explored, probably through another study that adopts a proportionate sample size allocation to each cadre.

Figure 8: Need scores by competency domain and CHW cadre

Others 1 Program planning

Others 0 Communication
Others 0 Cultural
Competency
CHO 1 CHO 4 CHO 0
CHEW 20 CHEW 15 CHEW 11
JCHEW 5 JCHEW 4 JCHEW 4

0 20 40 0 10 20 0 10 20

Community Others 0 Financial Planning & Mgt.

Others 0 Leadership & Thinking
Others 0
CHO 6 CHO 4
CHO 5
CHEW 19 CHEW 15 CHEW 17
JCHEW 7 JCHEW 7 JCHEW 5
0 10 20
0 10 20 0 10 20

Public Health Science Computer & IT Skills Others 1 Analytical/Assessment

Others 0 Others 0
CHO 3 CHO 7 CHO 5
CHEW 14 CHEW 19 CHEW 14
JCHEW 6 JCHEW 7
JCHEW 8
0 10 20 0 10 20
0 10 20

14
A similar observation is made for other competency domains with higher need scores demonstrated by the
CHEW cadre (Figure 8). This could be as a result of a sampling effect, as 56% of the study population were
CHEWs, and would require further interrogation using a sampling design that corrects for this. Note is made
that the proportion of CHEWS in the study might be a reflection of the proportion of experienced CHEWS
found within the public health sector. New graduates, or JCHEWS, are finding employment within the
private health sector as state and local governments have operated with embargoes on employment for
several years now.

4.3.5 Need Score Analysis by Competency Domain and CHW Years of Experience
The assessment tried to determine if there were any noted differences or trends in need scores for the
competency domains based on CHW years of experience (Figure 9).

Figure 9: Need scores by competency domain and CHW years of experience

Analytical/Assessment Program Planning Communication

>5yrs 17 >5yrs 14
>5yrs 16

1-5yrs 9 1-5yrs 6 1-5yrs 8

<1yr 2 <1yr 4 <1yr 1

0 10 20 0 10 20 0 5 10 15
Financial planning & Mgt. Leadership & thinking Community Dimension

>5yrs 14
>5yrs 15 >5yrs 15

1-5yrs 8
1-5yrs 9 1-5yrs 13

<1yr 4 <1yr 4 <1yr 3

0 10 20 0 5 10 15 0 10 20
Cultural Competency Public Health Science Computer& IT

>5yrs 7
>5yrs 13 >5yrs 12

1-5yrs 5
1-5yrs 7 1-5yrs 22

<1yr 3 <1yr 3 <1yr 1

0 5 10 0 5 10 15 0 10 20 30

15
Figure 9 seems to suggest that the need for training increases as the number of years of experience
increases. Those with fewer years from their initial training have a smaller need gap than those who have
been practicing for several years since their preservice training.

This is in keeping with the continuing changes and innovations to methods and approaches to service
delivery to which older CHWs would have not been exposed during their preservice training.

16
SECTION FIVE: RECOMMENDATIONS

Since this TNA was conducted in the southern part of the country, it is recommended that a similar
assessment with a proportionate sample size allocated to each type of CHW be extended to other parts of
the country to enable evidence-based formulation of IST/CPD curricula across all regions. In addition, the
assessment could include a few objective structured clinical exam (OSCE) stations to assess and validate
selected key competencies against the respondents’ self-reported level of confidence.

Based on the need scores derived from the community health worker survey at the competency domain
level, it is recommended that CHPRBN prioritize competency areas in its IST/CPD programs in the following
order of priority:

s/n Training needs Need scores

1 Computer and information technology skills 41%
2 Financial planning and management skills 28%
3 Public health science skills 27%
4 Program planning skills 26%
5 Analytical/assessment skills 25%
6 Community dimensions skills 23%
7 Leadership and systems thinking skills 22%
8 Communication skills 19%
9 Cultural competency skills 15%

It is recommended that trainings on computer and information technology skills be made more available
for all participants in the IST/CPD program. In line with the critical role that CHWs play as the front line of
the health system in Nigeria, it becomes imperative that there be sufficient investment in significantly
improving access of this cadre of the health workforce to information technology. This cannot be
overemphasized as evidence abounds on the critical role that IT now plays in the improvement of learning
and access to information.

The dearth of financial resources for the public health system demands that existing resources be managed
efficiently. CHWS also have a role to play in this important aspect of health. Their capacity to manage scarce
resources, if improved, will help attain greater efficiencies in the health system. The need score table
reinforces this fact going by the expressed need for improvement in this skill set.

As public health science evolves, CHWs need to be continually abreast of new technologies and service
delivery methods. Being third in ranking order, the public health science competency domain needs to be
given its due position in the design of future IST/CPD programs.

17
SECTION SIX: APPENDICES

Appendix 1: Training Needs Assessment Questionnaire

TRAINING NEEDS ASSESSMENT FOR COMMUNITY HEALTH WORKERS

GENERAL INFORMATION

Date of interview (dd/mm/yyyy) / /

Interviewer’s name

Facility name

State

LGA

Interview start time HH:MM

Interview completed Yes No

INFORMED CONSENT

Hello, my name is _______________________________________. I am working with INTRAHEALTH

INTERNATIONAL implementer of CapacityPlus project funded by USAID. We are conducting a training
needs assessment for community health workers in Nigeria. The information we collect will help the
Community Health Practitioners Registration Board of Nigeria to plan for in-service training needs for
community health workers in Nigeria.

I would like to ask you some questions about yourself. The questions usually take about 15 to 20 minutes.
All of the answers you give will be confidential and will not be shared with anyone other than members of
our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions
since your views are very important. If I ask you any question you don't want to answer, just let me know
and I will go on to the next question or you can stop the interview at any time.
In case you need more information about the survey, you are free to ask.

Respondent agrees to be interviewed Yes/No

Respondent does not agree to be interviewed End

Interviewee’s full name

Interviewee’s signature/thumbprint

18
 SECTION 1: GENERAL INFORMATION

READ TO THE CLIENT: I would like to ask you some questions about yourself. This will include questions about your
training, qualifications and some basic demographic data.

No Question Response Skips

1. Interviewer: Is the person you are

Male Female
interviewing a male or female?

2. Age (in completed years)

----------------------- Years

JCHEW

3. What is your current designation in this facility? CHEW

CHO

Other (specify):

4. Highest level of education q Certificate

q Diploma

q Higher diploma

q Other (specify):

5. For how many years have you practiced since q Less than 1 year
obtaining your highest qualification?
Tick as appropriate q 1-5 years

q Greater than 5 years

6. What type of training Institution did you attend q Public (govt. owned)
for your preservice training?
q Private (private or faith-based)

7. Is the institution located in an urban or rural q Rural

area?
q Urban

19
SECTION 2: ASSESSMENT AT DOMAIN LEVEL
For each skill area listed below, please indicate how important it is for you to have these skills and
how confident you are in your ability to perform these skills.

SKILL AREA IMPORTANCE CONFIDENCE

How important is it for you How confident are you in
to have these skills? your ability to perform these
skills?

1 = Not important 1 = Not confident

2 = Neutral 2 = Neutral

3 = Important 3 = Confident

Analytic/Assessment Skills: Skills, such as ability 1 2 3 1 2 3

to collect, collate, and evaluate monitoring and      
evaluation data, and the ability to teach other
staff simple methods of data analysis.
Program Planning Skills: Skills related to the 1 2 3 1 2 3
development of plans to ensure effective      
functioning of the PHC system based on national
standards.
Communication Skills: Skills related to ability to 1 2 3 1 2 3
convey standard knowledge of basic health and      
social concerns in ways that are familiar to clients
and their families.
Cultural Competency Skills: Skills related to 1 2 3 1 2 3
successfully considering the cultural background      
of the intended audience for public health
services, literature, and education.
Community Dimensions Skills: Skills related to 1 2 3 1 2 3
ensuring the initiation and participation of the      
community and other health workers in
identifying major health problems of the
community and developing their capacity and
access to resources including health insurance,
food, quality care, and health information.
Public Health Science Skills: Skills related to 1 2 3 1 2 3
provision of integrated primary health care      
services, e.g., nutrition, immunization, basic
antenatal and obstetric care, basic clinical
management of minor ailments, etc.
Financial Planning and Management Skills: 1 2 3 1 2 3
Skills related to developing and managing a PHC      
facility, developing an annual workplan with the
approval of the PHC coordinator, etc.
Leadership and Systems Thinking Skills: Skills 1 2 3 1 2 3
related to utilizing leadership characteristics,      
serving as a public health role model, and
establishing mentoring, peer advising, and other
professional development opportunities for the
other CHW cadres.

20
 SECTION 3: ASSESSMENT AT THE INDIVIDUAL SKILL LEVEL
For each individual skill listed below, please indicate how important it is for you to have these
skills and how confident you are in your ability to perform these skills.

SKILLS IMPORTANCE CONFIDENCE

How important is it for you to How confident are you in

have these skills? your ability to perform
these skills?

1 = Not important 1 = Not confident

2 = Neutral 2 = Neutral

3 = Important 3 = Confident

Analytic/Assessment Skills
Ability to assess the health status of 1 2 3 1 2 3
populations and their related determinants of      
health and illness (e.g., factors contributing to
health promotion and disease prevention,
availability and use of health services)
Ability to describe the characteristics of a 1 2 3 1 2 3
population-based health problem (e.g., equity,      
social determinants, environment)
Ability to collect, collate, and evaluate 1 2 3 1 2 3
monitoring and evaluation data for the      
national primary health care program for
appropriate health intervention
Ability to use methods and instruments for 1 2 3 1 2 3
collecting valid and reliable quantitative and      
qualitative data
Ability to keep accurate records of activities 1 2 3 1 2 3
and health problems as stipulated within the      
area of coverage and forward same to the LGA
Ability to teach trainees, community health 1 2 3 1 2 3
extension workers (CHEWs), clinic staff, and      
other students simple methods of data analysis
Ability to use information technology 1 2 3 1 2 3
(computers, mobile phones, Internet, etc.) to      
collect, store, and retrieve data
Program Planning Skills
Ability to prepare and coordinate schedule of 1 2 3 1 2 3
activities to tackle prioritized health problems      
Ability to ensure seamless delivery of care by 1 2 3 1 2 3
providing the main point of contact for service      
users and families
Ability to ensure fast and safe referral and 1 2 3 1 2 3
where to refer for a particular clinical or      
pathological case
Ability to ensure the maintenance of a constant 1 2 3 1 2 3
supply of drugs to the target population      
through forecasting, stock checks, and timely
requests
21
SKILLS IMPORTANCE CONFIDENCE

How important is it for you to How confident are you in

have these skills? your ability to perform
these skills?

1 = Not important 1 = Not confident

2 = Neutral 2 = Neutral

3 = Important 3 = Confident

Communication Skills

Ability to communicate and listen to clients 1 2 3 1 2 3

and families in basic English and/or local      
languages including the use of specialist
assistance where required (e.g., sign language)
Ability to convey standard knowledge of basic 1 2 3 1 2 3
health and social concerns in ways that are      
familiar to clients and their families
Ability to discuss the reasons and options for 1 2 3 1 2 3
change in culturally sensitive ways as regards      
health promotion and disease prevention
Cultural Competency Skills

Ability to use relevant languages and 1 2 3 1 2 3

respectful attitudes and demonstrate deep      
cultural knowledge in all aspects of work with
community members
Ability to respond to the needs of people in an 1 2 3 1 2 3
open manner that promotes equal      
opportunities and confidentiality and
encourages freedom of choice
Community Dimensions Skills

Ability to ensure the initiation and participation 1 2 3 1 2 3

of the community in carrying out initial      
community diagnosis and continuous health
needs assessment of the community
Ability to carry out community mobilization 1 2 3 1 2 3
     
Ability to help communities develop their 1 2 3 1 2 3
capacity to access resources including health      
insurance, food, quality care, and health
information
Financial Planning and Management Skills

Ability to develop an annual workplan with the 1 2 3 1 2 3

approval of the primary health care      
coordinator and ensure its proper
implementation
Ability to carry out day-to-day administration 1 2 3 1 2 3
of the primary care facility including financial      
and staff management

22
SKILLS IMPORTANCE CONFIDENCE

How important is it for you to How confident are you in

have these skills? your ability to perform
these skills?

1 = Not important 1 = Not confident

2 = Neutral 2 = Neutral

3 = Important 3 = Confident

Leadership and Systems Thinking Skills

Ability to supervise the activities of other staff 1 2 3 1 2 3

     
Ability to identify, direct, and conduct training 1 2 3 1 2 3
and continuing education for other members      
of the health team (village health workers,
CHEWs, traditional birth attendants, etc.)
Ability to initiate, direct, and work with 1 2 3 1 2 3
community and staff to plan solutions to      
identified health problems
Public Health Science Skills
Ability to provide services for prevention and 1 2 3 1 2 3
control of endemic diseases (e.g., malaria, HIV,      
TB, diarrheal diseases, worm infestations,
sexually transmitted infections [STIs],
malnutrition)
Ability to provide integrated and basic primary 1 2 3 1 2 3
health care services (e.g., first aid, blood      
pressure monitoring, nutrition monitoring,
health promotion, basic infection control and
disease prevention, water and sanitation, etc.)
Ability to provide effective immunization 1 2 3 1 2 3
services including management of the logistics      
and cold chain systems
Ability to provide basic maternal and child 1 2 3 1 2 3
health services (e.g., safe and qualitative      
antenatal care in pregnancy, delivery, postnatal
care, family planning)
Ability to provide HIV counseling and testing 1 2 3 1 2 3
and PMTCT-related services      
Ability to conduct basic TB screening and 1 2 3 1 2 3
diagnosis      
Ability to carry out rapid diagnostic tests for 1 2 3 1 2 3
malaria and provide appropriate treatment      
using artemisinin-based combination therapies
Ability to provide related services in 1 2 3 1 2 3
community management of acute malnutrition      
(e.g., malnutrition screening, diagnosis of
malnutrition, administration of plumpy nuts,
and referral of acute cases to secondary
facilities for stabilization)
Ability to provide integrated management of 1 2 3
23
SKILLS IMPORTANCE CONFIDENCE

How important is it for you to How confident are you in

have these skills? your ability to perform
these skills?

1 = Not important 1 = Not confident

2 = Neutral 2 = Neutral

3 = Important 3 = Confident

childhood illnesses according to national   

guidelines
Ability to conduct STI screening and provide 1 2 3 1 2 3
syndromic management of STIs      
Ability to screen for other noncommunicable 1 2 3 1 2 3
diseases (e.g., diabetes, hypertension) and      
provide early referrals and health promotion
advice
Computer/Information Technology Skills
Ability to operate a computer (basic functions) 1 2 3 1 2 3
     
Ability to use Microsoft Office applications 1 2 3 1 2 3
(e.g., Word, Excel, PowerPoint)      
Ability to navigate the Internet to conduct 1 2 3 1 2 3
searches and find relevant information      
Ability to create an e-mail address and utilize 1 2 3 1 2 3
an e-mail platform for communication      
COMPUTER OWNERSHIP AND USE
Do you own a computer? *YES *NO

Do you have access to a computer at your work that *YES *NO

could be used for learning/training?

How often do you use a computer? * Every day

* Several times per week
* Less than one time per week
* I do not use a computer

Where do you access the Internet? * At home/residence

* At work
* Internet café
* Other (SPECIFY): ...........................................
* I do not access the Internet

Thank you for your cooperation.

24
Appendix 2: Matrix of Competency Domains and Individual Skills

Competency Domain Individual Skills

Ability to assess the health status of populations and their related determinants of health
and illness (e.g., factors contributing to health promotion and disease prevention, availability
and use of health services)
Ability to describe the characteristics of a population-based health problem (e.g., equity,
social determinants, environment)
Ability to collect, collate, and evaluate monitoring and evaluation data for the national
primary health care program for appropriate health intervention
Analytic/Assessment
Ability to use methods and instruments for collecting valid and reliable quantitative and
Skills
qualitative data
Ability to keep accurate records of activities and health problems as stipulated within the
area of coverage and forward same to the LGA
Ability to teach trainees, community health extension workers (CHEWs), clinic staff, and other
students simple methods of data analysis
Ability to use information technology (computers, mobile phones, Internet, etc.) to collect,
store, and retrieve data

Ability to prepare and coordinate schedule of activities to tackle prioritized health problems
Ability to ensure seamless delivery of care by providing the main point of contact for service
users and families
Program Planning
Ability to ensure fast and safe referral and where to refer for a particular clinical or
Skills
pathological case
Ability to ensure the maintenance of a constant supply of drugs to the target population
through forecasting, stock checks, and timely requests

Ability to communicate and listen to clients and families in basic English and/or local
languages including the use of specialist assistance where required (e.g., sign language)
Ability to convey standard knowledge of basic health and social concerns in ways that are
Communication Skills
familiar to clients and their families
Ability to discuss the reasons and options for change in culturally sensitive ways as regards
health promotion and disease prevention

Ability to use relevant languages and respectful attitudes and demonstrate deep cultural
knowledge in all aspects of work with community members
Cultural Competency Ability to respond to the needs of people in an open manner that promotes equal
Skills opportunities and confidentiality and encourages freedom of choice

Ability to ensure the initiation and participation of the community in carrying out initial
community diagnosis and continuous health needs assessment of the community
Community
Ability to carry out community mobilization
Dimensions Skills
Ability to help communities develop their capacity to access resources including health
insurance, food, quality care, and health information

Ability to develop an annual workplan with the approval of the primary health care
Financial Planning and coordinator and ensure its proper implementation
Management Skills Ability to carry out day-to-day administration of the primary care facility including financial
and staff management

25
Competency Domain Individual Skills
Leadership and Ability to supervise the activities of other staff
Systems Thinking Skills
Ability to identify, direct, and conduct training and continuing education for other members
of the health team (village health workers, CHEWs, traditional birth attendants, etc.)
Ability to initiate, direct, and work with community and staff to plan solutions to identified
health problems.

Ability to provide services for prevention and control of endemic diseases (e.g., malaria, HIV,
TB, diarrheal diseases, worm infestations, sexually transmitted infections [STIs], malnutrition)
Ability to provide integrated and basic primary health care services (e.g., first aid, blood
pressure monitoring, nutrition monitoring, health promotion, basic infection control and
disease prevention, water and sanitation, etc.)
Ability to provide effective immunization services including management of the logistics and
cold chain systems
Ability to provide basic maternal and child health services (e.g., safe and qualitative antenatal
care in pregnancy, delivery, postnatal care, family planning)
Ability to provide HIV counseling, testing, and PMTCT-related services
Public Health Science Ability to conduct basic TB screening and diagnosis
Skills
Ability to carry out rapid diagnostic tests for malaria and provide appropriate treatment
using artemisinin-based combination therapies (ACTs)
Ability to provide related services in community management of acute malnutrition (e.g.,
malnutrition screening, diagnosis of malnutrition, administration of plumpy nuts, and referral
of acute cases to secondary facilities for stabilization)
Ability to provide integrated management of childhood illnesses according to national
guidelines
Ability to conduct STI screening and provide syndromic management of STIs

Ability to screen for other non-communicable diseases (e.g., diabetes, hypertension) and
provide early referrals and health promotion advice

Ability to operate a computer (basic functions)

Computer/
Ability to use Microsoft Office applications (e.g., Word, Excel, PowerPoint)
Information
Technology Skills Ability to navigate the Internet to conduct searches and find relevant information
Ability to create an e-mail address and utilize an e-mail platform for communication

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Appendix 3: Individual Skills Assessment Table

Importance Confidence
Need Score
Not Not
Neutral Important N Neutral Confident N
SKILL Important Confident

Analytic/Assessment Skills
Ability to assess the health status of populations and their
related determinants of health and illness (e.g., factors
4.7 48.6 46.7 107 11.2 56.1 32.7 107 14
contributing to health promotion and disease prevention,
availability and use of health services)

Ability to describe the characteristics of a population-based 1.9 40.2 57.9 107 24.3 51.4 24.3 107 33.6
health problem (e.g., equity, social determinants, environment)
Ability to collect, collate, and evaluate monitoring and
evaluation data for the national primary health care program 1.9 37.4 60.7 107 10.3 54.2 35.5 107 25.2
for appropriate health intervention

Ability to use methods and instruments for collecting valid and 2.8 32.7 64.5 107 19.6 48.6 31.8 107 32.7
reliable quantitative and qualitative data
Ability to keep accurate records of activities and health
problems as stipulated within the area of coverage and forward 3.7 26.2 70.1 107 11.2 46.7 42.1 107 28
same to the LGA
Ability to teach trainees, community health extension workers
(CHEWs), clinic staff, and other students simple methods of data 5.6 35.5 58.9 107 12.1 35.5 52.3 107 6.6
analysis

Ability to use information technology (computers, mobile 1.9 48.6 49.5 107 39.3 36.4 24.3 107 25.2
phones, Internet, etc.) to collect, store, and retrieve data
Program Planning Skills

Ability to prepare and coordinate schedule of activities to tackle 2.8 44.9 52.3 107 20.6 56.1 23.4 107 28.9
prioritized health problems

Ability to ensure seamless delivery of care by providing the 2.8 23.4 73.8 107 15.9 62.6 21.5 107 52.3
main point of contact for service users and families

Ability to ensure fast and safe referral and where to refer for a 3.7 38.3 57.9 107 8.4 40.2 51.4 107 6.5
particular clinical or pathological case

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 Importance Confidence
Need Score
Not Not
Neutral Important N Neutral Confident N
SKILL Important Confident
Ability to ensure the maintenance of a constant supply of drugs
to the target population through forecasting, stock checks, and 2.8 24.3 72.9 107 15 51.4 33.6 107 39.3
timely requests
Communication Skills
Ability to communicate and listen to clients and families in basic
English and/or local languages including the use of specialist 0.9 40.6 58.5 106 6.5 38.3 55.1 107 3.4
assistance where required (e.g., sign language)

Ability to convey standard knowledge of basic health and social 1.9 39.3 58.9 107 8.5 51.9 39.6 106 19.3
concerns in ways that are familiar to clients and their families
Ability to discuss the reasons and options for change in
culturally sensitive ways as regards health promotion and 3.7 29.9 66.4 107 9.3 55.1 35.5 107 30.9
disease prevention
Cultural Competency Skills
Ability to use relevant languages and respectful attitudes and
demonstrate deep cultural knowledge in all aspects of work 3.7 43.9 52.3 107 9.3 44.9 45.8 107 6.5
with community members
Ability to respond to the needs of people in an open manner
that promotes equal opportunities and confidentiality and 1.9 39.3 58.9 107 8.4 51.4 40.2 107 18.7
encourages freedom of choice
Community Dimensions Skills
Ability to ensure the initiation and participation of the
community in carrying out initial community diagnosis and 2.8 21.5 75.7 107 12.1 49.5 38.3 107 37.4
continuous health needs assessment of the community

4.7 38.3 57 107 4.7 43.9 51.4 107 5.6

Ability to carry out community mobilization
Ability to help communities develop their capacity to access
resources including health insurance, food, quality care, and 4.7 38.3 57 107 16.8 49.5 33.6 107 23.4
health information
Financial Planning and Management Skills
Ability to develop an annual workplan with the approval of the
primary health care coordinator and ensure its proper 1.9 35.8 62.3 106 27.4 44.3 28.3 106 34
implementation

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 Importance Confidence
Need Score
Not Not
Neutral Important N Neutral Confident N
SKILL Important Confident

Ability to carry out day-to-day administration of the primary 1.9 33.6 64.5 107 12.3 51.9 35.8 106 28.7
care facility including financial and staff management
Leadership and Systems Thinking Skills
Ability to supervise the activities of other staff 1.9 36.4 61.7 107 7.5 50.5 42.1 107 19.6
Ability to identify, direct and conduct training and continuing
education for other members of the health team (village health 34.6 65.4 107 12.1 51.4 36.4 107 29
workers, CHEWs, traditional birth attendants, etc.)

Ability to initiate, direct, and work with community and staff to 2.8 19.6 77.6 107 7.5 46.7 45.8 107 31.8
plan solutions to identified health problems
Public Health Science Skills
Ability to provide services for prevention and control of
endemic diseases (e.g., malaria, HIV, TB, diarrheal diseases,
3.7 15.9 80.4 107 7.5 46.7 45.8 107 34.6
worm infestations, sexually transmitted infections [STIs],
malnutrition)
Ability to provide integrated and basic primary health care
services (e.g., first aid, blood pressure monitoring, nutrition
4.7 15.9 79.4 107 3.7 39.3 57 107 22.4
monitoring, health promotion, basic infection control and
disease prevention, water and sanitation, etc.)

Ability to provide effective immunization services including 2.8 23.4 73.8 107 3.7 31.8 64.5 107 9.3
management of the logistics and cold chain systems
Ability to provide basic maternal and child health services (e.g.,
safe and qualitative antenatal care in pregnancy, delivery, 2.8 23.4 73.8 107 7.5 54.2 38.3 107 35.5
postnatal care, family planning)
Ability to provide HIV counseling, testing, and PMTCT-related
0.9 34.6 64.5 107 10.3 44.9 44.9 107 19.6
services
Ability to conduct basic TB screening and diagnosis 2.8 22.4 74.8 107 25.2 49.5 25.2 107 49.6
Ability to carry out rapid diagnostic tests for malaria and
provide appropriate treatment using artemisinin-based 3.7 33.6 62.6 107 6.5 38.3 55.1 107 7.5
combination therapies (ACTs)

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 Importance Confidence
Need Score
Not Not
Neutral Important N Neutral Confident N
SKILL Important Confident
Ability to provide related services in community management
of acute malnutrition (e.g., malnutrition screening, diagnosis of
3.7 29 67.3 107 18.7 44.9 36.4 107 30.9
malnutrition, administration of plumpy nuts, and referral of
acute cases to secondary facilities for stabilization)

Ability to provide integrated management of childhood 5.6 37.4 57 107 15 46.7 38.3 107 18.7
illnesses according to national guidelines
Ability to conduct STI screening and provide syndromic
3.7 38.3 57.9 107 30.8 43.9 25.2 107 32.7
management of STIs
Ability to screen for other non-communicable diseases (e.g.,
diabetes, hypertension) and provide early referrals and health 8.4 31.8 59.8 107 15.9 49.5 34.6 107 25.2
promotion advice
Computer/ Information Technology Skills
Ability to operate a computer (basic functions) 8.4 30.8 60.7 107 51.4 27.1 21.5 107 39.2
Ability to use Microsoft Office applications (e.g., Word, Excel,
9.3 36.4 54.2 107 59.8 22.4 17.8 107 36.4
PowerPoint)
Ability to navigate the Internet to conduct searches and find
12.1 27.1 60.7 107 54.2 31.8 14 107 46.7
relevant information
Ability to create an e-mail address and utilize an e-mail
12.1 87.9 107 56.1 24.3 19.6 107 -19.6
platform for communication

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