|
nif:isString
|
-
We developed an ad-hoc method inspired by methodologies previously used elsewhere [3] [4] [5] [6]. The assessment was carried out in two successive stages: (1) a standardized questionnaire administered to all staff in regional, prefectural and provincial surveillance teams, and (2) a series of interviews and field visits for direct observation and opinion gathering. A standardized electronic questionnaire was developed by WHO and sent by email to the staff of all ORS and CPE in the country. The distribution of questionnaires and reception of responses were centralized by the National Epidemiological Surveillance Service (SSE) within the DELM, located in the capital Rabat. The responses were compiled in an electronic database that was subject to quality control and cleaning. Answers to open questions, such as descriptions of courses taken, were verified and standardized. Respondents were contacted individually for clarifications where necessary. The questions covered the following areas: general characteristics of personnel; training received (anytime in the past) in epidemiology, in public health, in statistics and other subjects; institutions that had provided each training; country of training; importance attached to a list of 33 tasks/activities linked to epidemiological surveillance; level of competence by task; training needs felt; and training modalities preferred. The list of 33 tasks (Table 1) was developed on the basis of the curriculum and the evaluation results of various field epidemiology training courses in which WHO has participated. The level of competence was self-assessed by the survey participants, using the list of tasks. First, the participants were asked to rank (on a scale of 1 to 9) each task, according to its importance in the exercise of their surveillance duties. Second, the same 33 tasks were presented again and participants were asked to assess their own level of competence to perform each of them, also on a scale of 1 to 9. This scale was visually presented in three progressive stages: “weak” (values 1–3), “medium” (values 4–6), and “strong” (values 7–9).
Table data removed from full text. Table identifier and caption: 10.1371/journal.pone.0101594.t001 List of 33 tasks surveyed (original text in French), and their grouping in 10 domains. Because both parameters were measured with the same scale and by the same person, the calculation of the difference between the two figures provided a direct measurement of the gap between the importance attached to a given function and the perceived level of competence for that same function. The magnitude of this gap helped identify where a lack of competence was felt as a priority. The analysis consisted of quantitative description of data, stratifying by area of expertise, basic qualification (degree or diploma giving a professional status pertinent to the job), type of structure (ORS or CPE), and by administrative divisions (region and province/prefecture). Mapping (not shown in this manuscript) was used to present the geographical distribution of certain characteristics. Responses to the 33 tasks related to surveillance were synthesized for analysis by grouping them into 10 domains, as shown in Table 1 and Figures 1, 2 and 3.
Figure data removed from full text. Figure identifier and caption: 10.1371/journal.pone.0101594.g001 Importance attributed to surveillance tasks (grouped in 10 domains), by basic qualification, Morocco 2011. Figure data removed from full text. Figure identifier and caption: 10.1371/journal.pone.0101594.g002 Level of self-estimated competence in each area, by basic qualification, Morocco 2011. Figure data removed from full text. Figure identifier and caption: 10.1371/journal.pone.0101594.g003 Competence gap (self-rated), by basic qualification.Gap between the importance given to surveillance tasks (grouped in 10 broad areas) and the self- estimated competence (rated by each participant using a scale of 1 to 9), by basic qualification categories. Data analysis was performed with EpiInfo 3.5.4 and Stata 10 software.
Interviews and field visits were organized with the objectives of (1) gathering information and opinions of key players on broader issues such as motivators and barriers, and on training needs from the local perspective; and (2) directly observing and discussing the methods and tools used for the surveillance activities. At central level, the interviewees included relevant officials of the Ministry of Health's directorates which are involved in public health surveillance and the health information system, as well as epidemiology training providers. In each region visited we interviewed the Regional Health Director as well as the technical personnel conducting surveillance tasks at the ORS and at least at one CPE. For the field visits we selected five regions with different performance levels (appraised by the DELM on the basis of recent experience), in order to obtain representative results, especially regarding the inter-region variability. The visits and interviews were prepared on the basis of the results of the questionnaire, the review of documents and tools used for public health surveillance in Morocco, and the results of other consultations carried out in the past 10 years on related issues. Interviews were conducted in person and documented verbatim. A semi-structured interview guide included questions pertaining to interviewees' expectations regarding the output of the surveillance system, their working experience with the surveillance units that had revealed capacity gaps, their beliefs about the nature of existing barriers, and their beliefs about training modalities that would be most effective. Probing questions were used where necessary to seek comprehensive data. Qualitative data from the interviews and field observations were analyzed manually with a qualitative thematic approach, without coding or quantitative transformation, looking for deeper meaning in the individual expressions and observations. Salient ideas stemming from different sources were triangulated to identify areas of convergence. The convergent ideas were initially documented by type of source in the study report. In this manuscript they are further consolidated, and presented in 3 distinct theme categories (Training Needs, Training Modalities, and Other Issues Concerning Human Resources).
|
![[This page as RDF]](http://data.gesis.org/somesci/static/rdf-icon.gif){kind=icon}