REPORT ON THE REGIONAL WORKSHOP ON DISTANCE LEARNING MATERIALS FOR SAFE BLOOD AND BLOOD PRODUCTS
Amman, Jordan, 20-24 March 1995
T
WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE EASTERN MEDITERRANEAN Alexandria, Egypt June 1995
This document is not issued to the general public and all rights are reserved by the World Health Organization (WHO). The document may not be reviewed, abstracted, quoted, reproduced or translated, in part or in whole, without the prior written permission of WHO. No part of this document may be stored in a retrieval system or transmitted in any form or by any means - electronic, mechanical or other without the prior written permission of WHO. e
The views expressed in documents by named authors are solely the responsibility of those authors.
1
INTRODUCTION COUNTRY REPORTS 2.1 Bahrain 2.2 Egypt 2.3 Islamic Republic of Iran 2.4 Iraq 2.5 Jordan 2.6 Morocco 2.7 Sultanate of Oman 2.8 Palestine 2.9 Kingdom of Saudi Arabia 2.10 Sudan 2.11 Syrian Arab Republic 2.12 Tunisia 2.13 Republic of Yemen 2.14 UNRWA
3
CURRENT TRAINING PROVISION 3.1 Training priorities 3.2 Constraints on training provision for blood transfusion service staff 3.3 Training and support needs of trainers
4
SUMMARlES O F PRESENTATIONS 4.1 Background to the WHO distance learning project 4.2 Introduction to Safe Blood and Blood Products 4.3 Identifying and meeting learners' needs 4.4 Establishing a structure for a national distance learning programme in blood safety 4.5 Establishing a learner support system 4.6 Al-Quds Open University 4.7 Programme coordination and management 4.8 Assessment and recognition 4.9 Monitoring and evaluation GROUP REPORTS 5.1 Building motivation 5.2 Potential problems for distance learners 5.3 Support requirements 5.4 Potcntial constraints
5
5.5 5.6 5.7
Methods of supporting learners Criteria for selection of programme personnel and participating centres Assessment and recognition
5.8
Monitoring and evaluation
6 7
ACTIONPLAN RECOMMENDATIONS
Annexes 1 2
Programme Participants
1
INTRODUCTION
A Regional Workshop on Distance Learning Materials for Safe Blood and Blood Products was held from 20 to 24 March 1995 in Amman, Jordan. The workshop was attended by fifteen participants from twelve Member States and Palestinian authority, six observers from Jordan, a representative of UNRWA and WHO staff and a temporary adviser from the Eastern Mediterranean Regional Office, Alexandria, Egypt, and WHO Headquarters, Geneva. The overall objective of the workshop was to assist national blood programmes to establish distance learning programmes in blood safety in order to strengthen and expand training provision for staff working in blood transfusion services and hospital blood banks. The specific objectives of the workshop were to:
1 Facilitate the effective use of the distance learning materials, Safe Blood and Blood Products, as a means of improving the quality and coverage of national training programmes in blood safety. 2 Provide orientation on the establishment and management of distance learning programmes at country level for senior blood transfusion service personnel identified as national focal points. 3 Identify support requirements and potential constraints on the establishment of distance learning programmes at country level.
4 Assist participants to develop a broad action plan and schedule for the establishment of national distance learning programmes in blood safety. The workshop was inaugurated by Dr H. Oueiss, Undersecretary, Ministry of Health, Jordan on behalf of His Excellency Dr Aref Bataineh, the Minister of Health, who welcomed participants and wished them both a successful meeting and a pleasant stay in Jordan. In his message, Dr Hussein A. Gezairy, Regional Director, WHO Eastern Mediterranean Region, extended his sincere thanks to the Government of Jordan for hosting the workshop and to His Excellency Dr Aref Bataineh for inaugurating the workshop. He said that the development of blood transfusion services in all countries of the Region and ensuring a supply of safe blood, blood components and blood products has always been of great concern to the WHO Regional Office for the Eastern Mediterranean. To support this development, a series of very successful inter-country workshops, covering different aspects of blood transfusion medicine, has been conducted in Amman, Jordan. These workshops have, in turn, stimulated participants to conduct national workshops and training courses in their own countries, using material and knowledge gained from their participation. Dr Gezairy emphasized that no development can be expected without taking into account the training of personnel. For this reason, the WHO Eastern Mediterranean Regional Office is giving priority to training personnel from blood transfusion services and supporting this by all possible means. One of the main regional achievements in the field of blood transfusion is the establishment of two regional training centres arid the ulher ill Tu~lis. These two cerllres have already for blood transfusion training, one in Arrllrra~~ contributed, and continue to contribute, to the development process. In this workshop, the Region is embarking on a ncw training approach using distnncc lcarning materials on safe blood and blood products, an initiative that the Eastern Mediterranean Regional Office has supported from the beginning. The distance education approach will be unfamiliar to many trainers and training institutions. It is not meant to replace other training methods, but rather to be used in conjunction with regular and in-service training programmes. This will contribute to the training of $aff responsible for blood safety and will thus help to ensure the provision of safe and adequate supplies of blood and blood products. Dr Gezairy observed that the interactive distance learning approach offers a number of additional advantages. It is more cost-effective, as training is undertaken by trainees while in the workplace, without disruption to services. An increased number of staff can be trained and slower learners have an opportunity to spread their study over a longer period.
Dr Gezairy commented that great hopes are placed on the outcomes of this workshop. He reminded participants that, using the distance learning package, they would be responsible for organizing and sustaining distance learning systems and becoming the trainers of trainers in their own countries. He looked forward to the outcomes of the application of this approach and its impact on the further development of blood transfusion services in countries of the Region. Following introductions by participants, the programme was discussed and adopted. The principal topics were introduced by the facilitators, but the workshop methodology focused on active discussion in group and plenary sessions. Section 4 contains summaries of the presentations, with group rcports in Scction 5.
2
COIJNTRY REPORTS
In the first workshop session, participants briefly described current training provision for blood transfusion service staff in their countries.
Bahrain Bahrain is a small country with a population of less than 500,000. There are two blood banks which work in close cooperation with each other. The Ministry of Health Central Blood Bank supplies blood to government and private hospitals throughout the country, while a small blood bank in the Bahrain Hospital serves military personnel and their dependants. There is no private blood bank. Donor education, motivation and recruitment are undertaken by the Red Crescent Society of Bahrain while a medical consultant, qualified nurse and laboratory technical staff are responsible for phlebotomy and donor care. No specialized training is available for n~ellicalduclu~sar~d&nor clinic staff. Medical laboratory technologists require a BSc degree or its equivalent and receive their training overseas. Laboratory technicians require an associate degree from the College of Health Sciences, followed by three months in-service training in the Central Blood Bank. Whilc training is generally good, particularly for
2.1
laboratory technicians, the training of trainers needs to be strengthened. 2.2 Egypt Egypt has 230 blood banks serving its population of 60 million people. In addition to the main blood bank, there are satellite centres and storagecentres which collectblood for processing in the satellite centres.There is one main blood bank in the private sector, and ten blood banks in private hospitals, all of which are regulated by the Ministry of Health. Private blood banks organize their own training programmes for their staff, all of whom are required to have specified qualifications.
In the government sector,blood collectionisundertakenby 400-500 medical doctors and nurse-phlebotomists who receive three months' training in donor recruitment and selection in the main centre. The 500-700 laboratory technical staff include medical doctors with post-graduate qualifications in clinical pathology and technicians who havecompleted a two-year diploma in bloodbanking in a technical training institution. Periodic refresher courses of between one to three weeks duration are provided by the Ministry of Health with support from WHO and commercial companies. While the overall quality of training is good, there is a need for the upgrading of laboratory technicians.
2 . 3 Islamic Republic of Iran The Blood Transfusion Service in the Islamic Republic of Iran is not operated by the Ministry of Health but is an independent, multi-sectorial national service. There are 62 blood centres at central and regional level, with apotentially largetrairdng need within the large number of hospital blood banks. There are no military or private blood banks. Q
There are 570 donor clinic staff, most of whom are high school graduates who have received three months training in phlebotomy and donor care from the Blood Transfusion Service. The 560 laboratory technical staff include medical laboratory technologists with a BSc degree and high school graduates who have received in-service training for a period of three months or two years. Overall, training is good.
2.4 Iraq Iraq has 18 central blood banks serving 1-3 annexed hospitals and five military blood banks, which are organized on a separate basis but where staff require the same qualifications. There are no private blood banks. There are around 250 laboratory technical staff whose role includes phlebotomy and donor care. The minimum entry requirementis two years training in a technical training institution, followed by one month's in-service training in the Blood Transfusion Service and a further month's refresher training every one or two years. More advanced and intensive training in subjects that are directly or indirectly related to blood transfusion is provided for science graduates and other selected members of staff. Training is adequate, but there is a need for updating and further training.
2.5 Jordan Of the 28 blood banks in Jordan, 18 operate under the Ministry of Health, with the National Blood Bank having two branches. They collaborate closely with the remaining blood banks in seven military hospitals, a university hospital, an Islamic hospital and the Red Crescent Society. There are no private blood banks. There are fewer than 100 donor clinic staff and around 250 laboratory technical staff. The National Blood Bank is a WHO Collaborating Centre which offers training on both a national and regional basis. Approximately 90% of blood transfusion service staff have a two-year diploma from a paramedical institutionor college, with medical laboratory technologistshaving completeda five-year degree programme in paramedical sciences. Medical staff require a post-graduatedegree in immunohaematology. Staff receive in-service training on entry to the blood transfusion service and two updating workshops are held each year, as required, on topics such as IIIV tcsting and thc rational usc of blood. Training is adcquatc, but there is
a need for more highly trained staff. 2.6 Morocco Blood transfusion services in Morocco are under the control of the Ministry of Health. The 45 blood banks, including a national centre and a regional centre, collect a total of 160,000 units per year. There are in the region of 500 donor clinic staff and 400 laboratory technical staff.
Blood collection is undertaken by medical doctors with post-graduate qualifications in haematology or biology and nurses who have completed two-year or four-year training courses at a Health Institute for Nursing. In-service training in the Blood Transfusion Centre is provided for a period of six months for doctors and three months for nurse-phlebotomists.Medical laboratory technologists complete a four-year degree course at the Medical Health Institute or technical college and laboratory technical staff undertake a three-year BSc programme in biology, followed by a period of three months specialized in-service training. Training is considered to be good.
2.7 Sultanate of Oman Blood transfusion services are operated by the Ministry of Health and comprise a central blood bank and nine satellite blood banks in regional hospitals. In addition, there are three small blood transfusion centres for the army, the police and theuniversity. There are no private blood banks. A National TaskForce has been established to coordinate blood transfusion services. Medical doctors appointed to blood transfusion services require a postgraduate qualification in blood transfusion medicine. Nurse-phlebotomists require a Diploma in Nursing from the Institute of Health Sciences School of Nursing and receive in-service training. Laboratory technicians complete a three-year Diploma in Medical Laboratory Technology at the Institute of Health Sciences, including a one-year job rotation scheme in which six weeks are spent in blood banking. Periodic updating is provided in short workshops that are organized as required. Overall, training is adequate but only 60%of laboratory technical staff are Omani and there is a need to increase the number of trained staff.
2.8
Palestine
The Palestinian National Authority has little responsibility for blood banks in the West Bank. In the Gaza Strip, about 30 laboratory technical staff are involved in the collection and processing of 20,000 units of blood. Laboratory technicians receive two years training in paramedical technology and medical laboratory technologists complete a four-year training programme outside the country or in West Bank University. Although training is adequate, there is a need for the updating and upgrading of staff.
2.9
Kingdom of Saudi Arabia
The Ministry of Health is responsible for 20 hospital-bascdblood banks and 35 bloodcentres in which blood
is collected. In addition, there are five university hospital blood banks and three in armed forces hospitals. There are no private blood banks. No organized training programmes are offered in blood banking. There are about 100 nurse-phlebotomists who receive three months in-service training. Most of the approximately 400 laboratory technical staff have been trained on an in-service basis by specialists, although an increasing number of university graduates in laboratory technology are being recruited and provided with three months in-service training. The majority of blood banking personnel are expatriates with a relevant degree or diploma, plus three years experience. The training of more national staff is therefore a priority.
2.10 Sudan Blood transfusion services in the Sudan are currentlybeing restructured to form a national blood transfusion service. The Ministry of Health is responsible for services, with the Sudan Red Crescent Society contributing to blood donor recruitment. In addition to the five main hospital blood banks, there are ten hospitals in which hlood collection and limited screening is undertaken: No commercial blood banks are permitted, but blood banks are operated in two private hospitals under the approval and supervision of the Ministry of Health. Donor clinics are staffed by medical doctors who are qualified as clinical pathologists and who have received in-service training. Donor recruitment staff are trained by the Sudan Red Crescent Society. There are fewer than 100laboratory technical staff who require a Diploma from the College of Medical Laboratory Technology, which includes one year's training in blood banking. Although the quality of basic training is good, there is no continuing education programme.
2.11 Syrian Arab Republic The National Blood Bank in Syria in operated by the Ministry of Defence, with 19 centres in military, university and Ministry of Health hospitals. There are no private blood centres or blood banks. A National Committee has been established by the Ministry of Health to coordinate the activities of all blood banks in the country. Blood collection is undertaken by medical doctors, who receive post-graduatetraining ina blood transfusion centre, and by registered nurses. There are approximately 200 laboratorytechnical staff who have completed a two-year Diploma course at the Medical Health Institute. No specialized training programme in blood banking is provided, although the Ministry of Health organizes periodic short courses. 'l'raining is considered to be adequate. 2.12 Tunisia Blood transfusion services are coordinated through the National Blood Transfusion Centre in Tunis and include two regional centres, 34 hospital blood banks, a military blood transfusion centre, the Red Crescent Centre and the Blood Donors' Association. There are no private blood banks. The National Committee for Blood Transfusion, headed by the Minister of Health, is responsible for advising on training activities.
The National Blood Transfusion Centre is a WHO Collaborating Centre and is one of only two institutions in the world to offer a structured Diploma course in Transfusion-Hemobiology for medical doctors and pharmacists, recognized by the universities. Laboratory technical staff require a diploma in laboratory
technology. A continuing education programme is provided for medical doctors, pharmacists, nurses and laboratory technicians through seminars and short courses held twice a year. While training for technical staff is good, there is a need to strengthen training for donor clinic staff.
2.13 Republic of Yemen Blood transfusion services are controlled by the Ministry of Health, with the central blood bank being located in the Central health Laboratory. There are 30 hospital blood banks, including military hospitals, and no private blood banks. There are about 50 donor clinic staff who receive periodic refresher training. The approximately 500 laboratory technical staff have either a BSc degree or a higher or intermediate Diploma in Medical Laboratory Technology. Short refresher courses are provided periodically for technical staff through the Ministry of Public Health. The training of technical staff is adequate, but training provided for donor clinic staff is considered to be poor.
2.14 UNRWA About 250 units of blood are collected each year in the 43-bedded UNRWA Qalqilla Hospital in the West Bank. There are three laboratory technicians with a diploma qualification, plus one helper, who have received in-service and on-the-job training from the Field Laboratory Superintendent and the Senior Laboratory Services Officer in UNRWA Headquarters. Although current training provision is good, the priority is to train more staff.
3
CURRENT TRAINING PROVISION
Pre-workshop questionnaireswere completed by participantsin which they identifiedthe following training priorities and constraints on the provision of training.
3.1
Training priorities Donor clinic staff Donor selection, counselling and deferral Phlebotomy and donor care Donor education, motivation, recruitment and retention Organization and management of donor clinics Quality assurance Interpretation of screening results Plasmapharesis, cytopharesis and autologous transfusion Laboratory technical stag Screening for HIV and other infectious agents Serology Quality assurance Safety Storage and transportation of blood Component preparation
3.2
Constraints on training provision for blood transfusion sewice staff (in order of priority) Difficult for staff to leave their posts to attend training courses Too many staff need training Shortage of funding Staff are spread out over a large geographical area Shortage of appropriate training facilities T
Shortage of suitably qualified and experienced trainers Inadequate training of trainers Insufficient time to provide adequate training
3.3 Training and support needs of trainers (in order of priority) Continuing education and updating Training materials Funding Training in teaching skills Training in training design, management, assessment and monitoring Technical support Support from relevant authorities Suitable laboratory facilities, equipment and reagents Incentives More time for training
4 4.1
SUMMARIES OF PRESENTATIONS Background to the WHO distance learning project Dr J. C. Emmanuel, Acting Chief, Blood Safety Unit, WHO Headquarters, Geneva
With the spread of the human immunodeficiency virus (HIV), the safety of blood and blood products has come under ever-greater scrutiny and there is growing acceptance of the need to improve the quality of all aspects of blood transfusion medicine. A series of guidelines has been produced to support the three-point strategy of the WHO Global Programme on AIDS (WHOIGPA) to safeguard national blood supplies by means of: the collection of blood from low-risk blood donors the screening of blood for transfusion-transmissibleinfection minimizing the unnecessary use of blood and blood products. The effectiveness of this strategy will partly depend on the knowledge and skills of blood transfusion service staff which, in turn, will be determined by the quality of the training they receive. Throughout the world, the qualifications and experience required for entry into blood banking have generally risen to a markedly higher level than even ten years ago. In many countries, however, there remain large numbers of staff who have received inadequate training in the past and urgently require updating and further training. In addition, the knowledge and skills required for safe and efficient practice are ever-changing, particularly with the growing risk of transmission of infectious agents such as HIV and Hepatitis C. As a result, there are considerable variations in the quality of training and, therefore, in service performance, both within and between countries. Within the short or medium term, it would be impossible for most developing countries to provide further training by conventional nieans [or all staPPw11orequirt: it. Few llavt: suficicril Iirlallcial lesuulces L o p~uvidc training on the required scale, suitable training facilities are often limited and there is a shortage of appropriately qualified and experienced trainers. Many of the staff most in need of training work in small hospital blood banks that are remote from training institutions and participation in conventional training courses requires them to leave their workplace, which places additional demands on other staff or requires the appointment of replacement staff. Recognizing the difficulties faced by many national blood programmes inexteqding and strengthening their training activities, WHOIGPA has developed a series of distance learning materials, Safe Blood and Blood Products, to complement existing training approaches. The objectives are: to use the learning materials to update trainers' knowledge to train an increased number of staff
to make training more cost-effective to provide uniformly high quality training to offer more flexibility in the pace at which staff work on the materials to reinforce the information provided and build on trainees' own skills and experience. The materials have been specificallydesigned for use by laboratory technical staff, nurse-phlebotomists and blood donor motivation and recruitment staff working in blood transfusion services and hospital blood banks. They can also be used by senior staff with responsibility for training and supervision to ensure their own knowledge is up to date. They will assist blood transfusion services to update and upgrade staff in a practical and cost-effective way and to make the best possible use of limited training resources. Since most of the theoretical knowledge and practical applications will be learned through individual study of the materials, the time and costs involved in teaching on a face-to-face basis will be considerably reduced. Extended absences from the workplace will not be required and individual staff will be able to work through the materials at their own pace. The materials were written by blood transfusion specialists with knowledge and experience of developing countries and were rigorously reviewed by many blood transfusion medicine experts throughout the world. They will be reviewed periodically to identify any revisions or updating that may be required and can be adapted to suit local needs. Their use within national distance learning programmes in blood safety will be subjected to ongoing monitoring and evaluation to ensure a process of continual improvement. 4.2
Introduction to Safe Blood and Blood Products Ms Jan Fordham, Open Learning Associates, UK
The publication of the learning materials, Safe Blood and Blood Products, by WHOIGPA is the first stage in a longer-term strategy which includes assisting countries in establishing national distance learning programmes in blood safety, evaluating the use of the materials within a global training strategy and
exploring the feasibility of a wider application of the distance learning approach in the training of blood transfusion service personnel. Distance learning was adopted as a means of supportingnational blood programmes in staff training because it offers a flexible and cost-effective means of overcoming common constraints to training provision that are found in all regions of the world. Conventionaleducation and training programmes tend to be institutioncentred rather than learner-centred because they require direct contact between teaching staff and students and the curriculum, timetable and pace of learning are controlledby the training institution rather than being determined by the needs of individual learners. This is a costly method of training that removes students from the work environment in which they need to apply the knowledge and skills that they are learning and tends to disadvantagethose working in small, remotecentres which can ill afford to release staff for extended periods of study. It requires access to specializedtraining facilities and to suitably qualified and experienced trainers who themselves have the opportunity to keep up to date with new developments. Distance learning is an alternative method of delivering education and training that attempts to overcome the barriers that makeit difficult for many people to attendconventional taught courses, such as geographical isolation and the demands of their work and family commitments. Tutors and students can be physically separated during the course of training because teaching takes place at a distance, largely through the medium of specially prepared or adapted learning materials. It is a learner-centred rather than institutioncentred approach in which a wide range of teachingllearning and support strategies are used to promote independent and individualizedlearning.This removes the necessity for regular, classroom-basedparticipation and offers individuals control over the time, place and pace of their learning to suit their own needs and circumstances and those of their employers. Now there are many open universities in the world that use the distance learning approach to offer undergraduate and postgraduate degree courses in subjects as diverse as nursing and accountancy, as well as a wide range of professional and vocational education programmes.
The distance learning approach that has been adopted by WHO to strengthen training in blood safety on a global scale offers a number of benefits to trainers and training institutions. Since most of the teaching will take place through the medium of learning materials that have been specifically designed for the purpose, training will not be dependent on access to establishedtraining facilities and larger numbers of staff can be trained within a relatively short time-frame. It will therefore be more cost-effective than conventional training courses since fewer trainers will be required and residential course attendance will be minimized. There will also be less disruptionto services or need for costly replacement staff cover as most of the study will take place in individual learners' own workplaces. Uniformly high quality teaching can be provided to all staff sincc thc materials have bccn written by international subject specialists and reviewed by experts in transfusion medicine from all regions of the world. This will promote improved performance through the standardizationof approaches and procedures. The materials can also be used as a resource in conventional training courses and as reference and revision material for traincrs and staff at all lcvcls. Distance learning also offers benefits for the individuals who participate in the programme. It provides increased accessto training,particularly for staff in small centres who might normally have little opportunity to follow a lengthy course of study. Individual control over the time, place and pace of learning enables study to be planned to fit in with work commitments and staff will not have to leave their families for prolonged periods of study on residential courses. The flexibility that is built into the materials accommodates variations in learners' knowledge, skills, experience and current work while providing them with an assurance of consistently high quality teaching. Since the materials are designed to promote the evaluation of current practice and the planning and implementation of improvements in the workplace, each individual can make a tangible contribution towards the achievement of higher standards in blood banking. The availabilityof the WHOIGPA distance learning materials on blood safety does not constitute a distance learning programme, however, but simply means that individuals have greater access to learning resources that they can study independently. They will need ongoing support as they work through the materials to ensure that they are able to study effectively and apply what they have learned in the context of their work. Much of the support they require can be provided at a distance by such means as correspondence and telephone counselling, but they will also need to participate in occasional group meetings, short courses and practical workshops, particularly to strengthen their practical skills. In addition, they will require individualized support at local level from a suitable person within their own workplace who can provide guidance and feedback to help minimize potential educational isolation and promote effective learning. Each country will therefore need to establish its own organizational infrastructure for the delivery of the learning materials, the provision of support services to individual learners and the development and management of the assessment process. The combined use of the learning materials with local expertise thus makes it possible to provide a comprehensive and in-depth training programme that would normally only be available in a specialized training institution without requiring learners to be physically present in a classroom or teaching laboratory for most of their study. The high quality of the learning materials should lead to an improved quality of service and help in the setting and maintenance of national standards, while the focus on practical applicationsin the individual's own work setting enables the programme of study to be tailored to meet local needs and circumstances. The primary audience for whom the distance learning materials have been developed are junior laboratory technical staff, nurse-plilebolonrisls donor recruitment staff working in a variety of settings, including national blood transfusion services, public health laboratories and small hospital blood banks. They are not designed for basic or advancedtraining, but for staff who have completed an initial training programme and already have some experience. Senior laboratory technologists with responsibility for training and supervision and staff in training institutions should also find them a comprehepsive resource that they can use to update their own knowledge and integrate into local training programmes. The materials have been prepared in modular form for self-directedlearning. There are five self-contained units, comprising:
I
I
Trainer's Guide Introductory Module: Guidelines and Principlesfor Safe Blood Transfusion Practice Module 1: Safe Blood Donation Module 2: Screening for H N and Other Infectious Agents Module 3: Blood Group Serology. They provide a comprehensive training package that contains all the information that would normally be provided by a tutor in a conventional training programme. Unlike textbooks, they are also designed to build on the professional exptxierlce of individual staff and encourage them to apply thcir lcarning in the course of their everyday work. The focus on individual reflection, critical evaluation, a constant search for improvement and a willingness to innovateis a fundamental component of the programme and will be a key test of its effectiveness. Each modulc contains thc following features in order to promote this process of active learning: a statement of the overall aim of the module and each section within it module objectives outlining what learners should be able to do when they have completed the module learning objectives outlining what they should be able to do after working through each section study plans to help them to identify their individual training priorities and organize their study * practice-based activities designed to help them relate their learning directly to their own experience and current work and to practise new skills self-assessment questions to assist them to check their own knowledge and understanding a summary of the key points covered in each section a progress check at the end of each section to help learners to evaluate their own progress and their ability to apply their learning in their own work an action plan to be prepared by each learner when they have reached the end of the module to help them to apply their new knowledge and skills in the context of their own work setting appendices containing reference material, checklists,examples of standard operating procedures, documentation and donor information offprints: selected extracts from the materials that can be reproduced and displayed in the workplace as an aid to everyday practice.
4.3
Identifying and meeting learners' needs Ms Jan Fordham, Open Learning Associates, UK
The starting point for the development of a national distance learning programme in blood safety will be the identification of training needs and priorities. A training need can be defined as any shortfall in employee performance, or potential performance, that can be remedied by appropriate training. Training needs are, in part, determined by the demands of the job, and the knowledge, understanding and skills that are required to perform it to an agreed standard. They are also determined by the demands of change within the organization,such as theintroduction of a new technique for screening blood or a move away from areliance on family and replacement blood donors to the recruitment of regular, voluntary, non-remunerated blood donors, as well as changes outside the organization, such as changes in national policy. The other side of the training need equation is the level of the staffs knowledge, understanding and skills and their willingness and ability to learn and adapt to change. While it is possible to identify overall training needs and priorities, it is also important to recognize that each individual will have slightly different training needs, depending on their general level of education, prior training, qualifications, experience, the type of centre in which they are employed and the nature of their current work. Factors such as their age and length of service will also help to define the training priorities that might be identified by their supervisors. f
A number of methods can be used to determine these needs, including: interviews and questionnaires to collect staff and managers' views on perceived problems, deficiencies in knowledge and skills and priority areas for updating and further training observation by trainers or other specialists
tests which can be used as diagnostic tools to identify specific areas of weakness and select the individuals who will benefit most from training records and reports which provide clues to problem areas job analysis and performance review to break jobs into segments that are manageable both for training and appraisal purposes discussions between managers and staff to build support for training and identify training priorities. The distance learning programme in blood safety has been designed to be flexible ancl responsive to the
specific needs of each member of staff, with each module focusing on the identification of their particular training priorities and the development of individual study plans. In building the programme at country level, it is i m p u ~ t a lu ~~ recugr~ise l U~at adull learners are a highly cliversifled group with widely differing preferences, needs, backgrounds and abilities and that their motivation and capacity to complete their studies successfully will be influenced by a variety of factors that must be taken into account in the planning and implementation process. 4.4
Establishing a structure for a national distance learning programme in blood safety Ms Jan Fordham, Open Learning Associates, UK
While the distance learning materialson blood safety already exist, the task that lies ahead is to build national distance learning programmes that use these learning resources effectively to expand training provision. Although produced for global use, the rigorous process of review and modification involving each WHO Region during the developmental process should mean that the materialsthemselves require little adaptation at country level. The design of the programmes in which they are to be used will, however, nccd to bc undertaken at country level in order to ensure that they are responsive to national needs and circumstances. Each country therefore needs to establish a simple and practical structure for the delivery of the materials, the provision nf support to staff during the course of their studies, assessment and recognition, and monitoring and evaluation. The most appropriate structure for each country's programme will depend nn its size, the structure of the national blood programme and the nature and location of existing training facilities. Whatever structure is developed, however, it will need to encompass the following roles, although in smaller countries some of them may be held by the same person.
Programme coordinator The overall coordination of the programme should be undertaken by a senior member of staff at national levels. In large countries, it may be also be necessary for coordinators to be appointed at state or provincial level. The programme coordination role includes the following functions: establishing and managing the programme training key programme personnel organizing the learner support system selecting participating centres developing and managing the assessment process coordinating programme monitoring and evaluation. Trainer or tutor The use of the distance learning approach reduces the amount of face-to-face contact required between trainers and individual learners, but it is important for those studying the materials to have ongoing contact with an experienced trainer who can provide teaching input as required and ensure that they have access to Q local support. The role of the trainer includes the following functions: orienting learners about the programme selecting local supporters or mentors to assist them in the course of their studies providing support at a distance through such means as correspondence, by telephone and in group meetings
organizing short courses or workshops for practical training and assessment monitoring learners' progress assessing their learning contributing to the monitoring and evaluation of the programme. Supporter or mentor in each learner's own workplace Staff studying the materials will need access to local support to help maintain their motivation and assist them to apply what they are learning in the context of their everyday work. Ideally, the supporter will be the individual's own supervisor.Where this is not possible, the function can beundertaken by anothcr scnior member of staff, such as a medical superintendent, who has a good understanding of their particular area of work. The role of the supporter involves: providing ongoing support and encouragement for individual learners in their own workplace monitoring their progress through regular meetings helping them to identify and deal with any problems relating to their studies assisting them in formulating and implementingthe action plans that are part of their work on each module of the learning materials supervising their practical work (where the supporter is qualified to do so) reporting on their progress to their manager and trainer. Models for the structure of a distance learning programme Essentially, there are three basic models for the structureof a national distancelearning programme in blood safety, each of which can be modified to suit a country's individual requirements.
Model 1 Model 1 is appropriate in small countries where there is a single centre for the collection, processing and distribution of blood supplies and where only a small number of staff require training. The programme coordinator is located in the same centre as the learners and should therefore also be able to perform the functions of trainer and supporter, providing direct support for all learners on a face-to-face basis, as required.
Coordinatorltrainerl supporter and learners
Model 2 Model 2 has a two-tier structure which is appropriate in larger countries where staff requiring training are located in a number of centres at national, regional and district level. Tne programme coordinator, based in the national centre, is responsible for the establishment and management of the programme and may also act as a trainer. It may be necessary to appoint additional trainers, depending on the number of staff to be trained, the size of the country and the geographical spread of learners. A network of supporters is established to provide individual guidance and support to learners in their own workplaces.
National centre 1
National coordinator and trainers
I
RegionaVdistrict centres 1
Learners and supporters
Model 3 Model 3 is appropriate in large countrieswith semi-autonomousblood transfusion services operating at state or provincial level. In addition to the national coordinator who has overall responsibilityfor the programme, an additional tier of provincial coordinators is established to manage the learner support system within their own areas. They may act as trainers although, as in Model 2, it may also be necessary to appoint additional trainers at provincial level. As in Models 1 and 2, supporters are identified in each regional or district centre to provide support to individual learners in their workplaces.
National coordinator
National centre
and trainers Provincial coordinator and trainers Learners and supporters
Statelprovincial centres Regionalldistrict centres
Whichever model is adopted, the primary responsibility for the programme should lie with the national blood transfusion service or the unit responsible for the national blood programme. The establishment of a Steering Committee at national level will assist in building awareness and support for the programme and in securing funding. Its role will normally involve advising on and approving the development and management of the programme, and monitoring progress and standards. The Steering Committee will benefit from a broad membership'that includes representatives of: the national blood transfusion service state or provincial blood transfusion services, where appropriate the Ministry of Health/National AIDS Control Programme and other appropriate Ministries, such as the Ministry of Defence * universities and technical training institutions involved in the basic training and continuing education of blood transfusion service personnel professional associations, such as an Institute of Medical Laboratory Technology non-governmental organizations, such as the national Red Crescent Society a distance learning institution. 4
In order to draw on the experience of programme personnel and ensure that the programme is meeting the needs of staff studying the materials, the Steering Committee should include national and provincial coordinators and may also include representatives of the trainers, learners and their supporters.
Model 4 indicates the way in which various institutions and agencies might interact at different levels to support the development of the programme. Model 4
NationaUprovincial BTS
institutions/medical
Participating centres: medical officers with BT experiencelsenior laboratory technicians
I Participating centres: staff requiring training
4.5
Establishing a learner support system Ms Jan Fordham, Open Learning Associates, UK
The WHOIGPA distance learning materials provide a comprehensivetraining package in blood safety and it is possible for highly-motivated and more experienced staff to study them independently. However, they were specifically designed for use within a structureddistance learning programme providing individudized guidance and support to promote effective learning and help maintain motivation. Staff who are studying at a distance will have a range of support needs. Some will be shared by people undertaking a conventional training course, but others will relate specifically to the distance learning approach which will be unfamiliar to most adult learners. Many people find they enjoy studying by distance learning because of the increased opportunities it provides for individual control over the learning process and the practical application of their learning to their everyday work. Others find it difficult and even stressful to study outside the classroom or teaching laboratory without the structure provided by a timetable and regular, face-to-face contact with their tutor and other students. Distance education institutions throughout the world have found that distance learners have a number of common needs that must be met by an appropriate system of learner support if they are to study effectively. Their experience makes it possible to anticipate potential problems and establish mechanisms toprevent or overcomethem, whilst also enhancing the quality or the learning experience for the individuals participating in the programme. Staff studying by distance learning are likely to require varying levels of support in the following areas. Preparing for study t making a realistic assessment of their own abilities and prospects, deciding what they want to achieve and making a commitment to the learning programme understanding how the programme works, what they will be expected to do and how to make the most effective use of their supporter and trainer
getting support from their manager and supervisor in areas such as the allocation of study time identifying a personal supporter and any other support or resources they may need to aid them in their study assessing their present level of knowledge, skills and experience and identifying areas on which they particularly need to concentrate making contact with others studying the same programme or with experience of distance learning. Studying the materials niakiug a study pla.11and inanaging their time overcoming practical barriers to learning, such as a shortage of time for study, and sorting out any conflicts between their work, study and home improving thcir study skills and lcarning how to study independently making the most of their supporter and learning from other people informally making sense of the materials and dealing with new or difficult concepts keeping going if their motivation flags and they begin to wonder whether the sacrifices are worthwhile. Applying theory to practice relating what they are learning to their prior experience and current work getting the support they need from their manager, supervisor and colleagues using local resources and setting up projects that enable them to practise what they have learned applying what they have learned from the activities in the modules to their everyday work developing and implementing realistic action plans. Coping with assessment learning to assess their own progress realistically and reflect on what and how they are learning understanding how they are to be assessed hy others and hy what standards dealing with apprehension about assessment making effective use of feedback on their progress deciding when they are ready to move on to the next module getting recognition for their new competence deciding what to do next in the light of how well they have done. Experience shows that the quality of support provided in these areas directly affects motivation and the effectiveness of individual learning. Poor support systems are reflected in demoralization, slow progress and high drop-out rates. A wide range of methods can be used to support distance learners, from correspondence to computer-based training, radio and television broadcasts and even tutorials by satellite. However, Safe Blood and Blood Products has been designed for use within a low-cost, low-technology system of learner support that is viable in any country, even where staff and financial resources may be limited, through ongoing contact with an approved trainer at national or provincial level and individualized support at local level. The role of the distance learning trainer differs from that of a conventional tutor because it involves little direct teaching or personal contact with learners. It is primarily a facilitation role in which a combinatioil of the following methods are used to communicate with learners: correspondencethrough individual or standardletters to build arelationship with learners, provide information, maintain regular contact and monitor progress telephone communication to provide tutorial support and deal with problems individual meetings with learners and supporters to review progress and resolve any difficulties Q relating to the learning materials group meetings with learners in the same locality to cover key topics practical workshops and short courses for supervized benchwork the promotion of peer support and study groups.
-
The involvement of a supporter or mentor in the workplace is a crucial element in the learner support system. Through everyday contact and regular progress meetings,the supporterplays animportant role in providing: information about how the programme works advice on how to work through the materials and complete the activities and action plans constructive feedback encouragement and support to help maintain motivation advocacy to remove obstacles to learning: for example, by negotiating study time and facilitating the implementation of action plans coaching by setting up learning situations that enhance the learner's progress guidance and counselling to help resolve any problems. 4.6
Al-Quds Open University Dr Ahmed Abou Sheikhah, President, Al-Quds Open University, Amman, Jordan
Al-Quds Open University (QOU) is a national distance education institution for higher education, training and research that was established in response to the needs of the Palestinian people in the occupied territories and the diaspora. Its philosophy stems from its commitment to the education of Arab individuals and the development of the Arab community in Palestine and more generally in the Arab World. Throughout the period of occupation, the educational system deteriorated, teachers were not qualified, schools were unfit and curricula unsuitable. The idea of an Open University for the Palestinian people began in the mid- 1970s with the objective of making opportunities for education, training and human resource development available to all. Following a feasibility study by UNESCO, a number of programmes were selected for development: agriculture, land and rural development, applied science and technology, computing, social and family development, management and entrepreneurship, and general education. In addition to the Bachelor Degree programme, a continuing education programme is also being implemented which enables students to join a course without registering for a degree. Some courses can even be tailored for certain sectors of the community. The University has adopted a highly flexible policy in relation to admission policies, the time and place of study and a wide range of study options and thus has the capacity to serve the needs of an unlimited number of students. Teaching began in 1991 and by 1995, 3900 students were enrolled, most in the education programme. There are 800 students from Gaza and the number is expected to increase to 2000 by 1996. A secondary education certificate is a minimum requirement for admission. Students may enrol at any time, no matter how many years have elapsed since they completed their secondary education. The largest group of students are aged 22-27 years, although a large percentage are over the age of 50 and a small number below the age of 20. Eight branches have beenestablished, including Jenin, Tulkarm, Ramallah, Bethlehem, A1 Jalil and Gaza. In 1994, a branch of the University was established in the United Arab Emirates in which 70 students of Arab and other nationalities have enrolled and it is hoped to open further branches in the Arab World. The location of the University in Amman is temporary and the headquarters will eventually be stationed in Jerusalem where planning and textbook production will take place. Fromthe beginning, the University has produced its own textbooks, television programmes and other audiovisual aids, all of whlch are designed to foster independent learning and self-evaluation. Considerdliun is currently being given to the development of laboratory kits. To date, 152 books have been produced in addition to 140 television programmes that reinforce the written material but are no substitute for it. The process of materials development begins with the preparation of a syllabus plan by a steering committee which specifies the number of hours of study and the objectives and content of the syllabus, as well as methods of teaching and assessment. The materials are written by teachers selected from amongst the most efficient and best qualified staff in their field and reviewed by juries of subject experts. The University has its own group of materials producers who specialize in instructional desigq, text preparation, layout and audio-visual production and all material is subjected to quality control procedures before being approved, reproduced and distributed. The preparation of a textbook takes 1-2 years.
Following enrolment, students receive the textbooks for their course and attend the University headquarters or one of the branches for lectures, seminars and meetings with their academic supervisors. Hours are flexible. In the United Arab Emirates, for example, female students attend classes for one week and male students attend the following week. Practical activitiesareundertakeninconjunctionwithotheruniversities. Courses have to be completed over a maximum of nine years. The assessment process is sophisticated and complex and includes self-evaluation,formative assignments that are marked by teachers and examinations. The University is a member of the Higher Council of Arab Universities and a member of the International Council for Distance Education and is thus recognized worldwide. Funding is provided by the Palestinian National Fund and other agencies, although financial limitations are currently constraining the expansion of the University's programmes. It is currently considering the establishment of two Master's degrees in environmental affairs and population affairs, a post-graduate diploma and a pnst-gradi~atediploma in education. It has not yet developed any programmes for the Ministry of Health but is keen to cooperate in any possible way. Dr Abou Sheikhah suggested the following possible areas of collaboration with WHO and national blood programmes in the field of blood safety. 1 The translation and production of an Arabic language edition of the distance learning materials. 2 Technical assistance to member statesin the development of national distancelearning programmes in blood safety.
3 Assistance in the training of programme personnel. 4 The validation of national distance learning programmes in blood safety and the award of a recognized qualification.
5 The production of Arabic audio-visual material and television broadcasts to complement the printed material. 6 Collaboration in the production of additional learning resources in the area of laboratory test procedures.
4.7
Programme coordination and management Ms Jan Fordham, Open Learning Associates, UK
As in any training course, effective programme coordination and management are essential to the success of a distance learning programme. This will include selecting centres to participate in the programme, providing support to both trainers and supporters, developing an efficient administration and recordkeeping system, organizing assessment and establishing procedures for monitoring and evaluation. 'lne support needs of traners will include: approval and support from the Ministry of Health, other relevant Ministries and their employers orientation on the distance learning programme and briefing on their roles and responsibilities skills, w11~1t: nwessmy training in teaching and cumr~~unicatiun the allocation of sufficient time for their work on the programme adequate supplies of the learning materials a budget for: 9 additional resource materials administration overheads and secretarial support stationery, postage and telephone travel and subsistence group meetings, practical workshops and short courses.
Since supporters are unlikely to have experience of distance learning, they will require appropriate orientation and support in order to maintain their own motivation and ensure that they provide effective support to learners. They will therefore require: approval and support from their manager for their role as a supporter and recognition of the time and resources required to perform the function effectively orientation and written guidelines on their roles and responsibilities information on the process of monitoring and reporting on learners' progress regular contact by post or telephone with the trainer or programme coordinator
-
contact with othcr supporters at periodic intervals
a budget to cover the costs of postage, telephone and other local programme expenses An efficient record keeping system is not only important for the efficient management of the programme
but will also provide the basis for monitoring and evaluation. It will need to cover the following areas.
1 1
1
Programme personnel coordinators, including the areas and centres for which each coordinator is responsible trainers, including the centres and learners for which each trainer is responsible. Participating centres type of institution: e.g. blood transfusion service, reference laboratory, training institution name of director number of staff requiring training or updating facilities and equipment available to support learners. Learners personal details, including prior training, qualifications,experience,job title and nature of current work name of their supporter and supervisor agreed training needs and priorities study plans and dates for agreed contacts correspondence and notes on meetings and telephone conversations, including agreed actions, planned and actual completion dates, and outcomes progress reports from their supporter/supervisor,copies of individual action plans and reports on implementation notes on their participation in group meetings, workshops and courses assessment data any problems experienced by individual learners and action taken to resolve them. Supporters personal details, including training, qualifications and experience, job title and nature of current work name of the learner for whom they are acting as supporter correspondence and notes on meetings and telephone conversations, including agreed actions, planned and actual completion dates, outcomes. Group meetings, workshops and shon courses date and place list of participants objectives programme resource persons evaluation and report.
2
I
3
iI
4
5
6
Problems and constraints common problems experienced by learners and supporters,including action taken to resolve them constraints and action taken to overcome them. Accounts central expenditure local expenditure. Assessment and recognition Ms Jan Fordham, Open Learning Associates, UK
7
4.8
Assessment is generally used to evaluate whether an individi~al has reached a specified standard and is therefore eligible for a qualification or some other form of recognition. However, although it is not possible to grade a learner's work without assessing it, it is feasible - and sometimes more appropriate - to assess without awarding a grade or marks. Formative assessment takes place during the learning process and is used to aid learners in their subsequent learning by: giving them feedback on their work and suggesting ways in which they could improve helping them to identify their own strengths and weaknesses and develop greater self-confidence helping them to prepare for formal examinations and giving them a measure of how successful their work is in relation to examination standards or other criteria providing a basis for communication between the trainer and learner and opportunities for further teaching providing them with stages and deadlines to help them structure the timing of their work helping them to maintain their motivation and commitment to their work. Summative assessment takes place after the learning programme has been completed and is used to assess what students have learned by: testing their knowledge, understanding and application assessing their competence to perform defined tasks to specified standards identifying continuing knowledge and skills deficits and further training needs. Assessment can be formative, summativeor acombinationof the two. No formal assessment processes have been built into the distance learning programme since each country must make its own decision about how to assess learners' progress and achievements and how to link this into existing assessment procedures and qualifications structures. However, the learning materials have been designed to provide a structure for assessment that will facilitate the development of national assessment schemes. Each module contains a number of broad learning objectives that are broken down into specific learning objectives for each section and that can be used as a framework for assessment. Learners' work on the activities and action plans that are built into each module also provide an opportunity for assessing their ability to apply what they have learned to their particular work situation. In addition, learners are encouragedto evaluate their own progress U11.uug11 a se1i:riesuf sdf-assessme~:lll questiolls auld progress checks as well as through the progress meetings
with their supporter that form part of their individual study plans. 4.9 Monitoring and evaluation Ms Jan Fordham, Open Learning Associates, UK
Monitoring and evaluation are an essential part of programme development,particularly in the early stages when the programme is likely to be established on a pilot basis and some replawng may be required before implementation on a wider scale. Procedures for monitoring and evaluation should be built into the programme during the planning stage and should include both quantitative and qualitative approaches. A variety of evaluation techniques can be used, including:
analysis of data from the assessment of learners reports from programme personnel reports from directors of participating centres records observation questionnaires interviews focus group discussions.
I ~
The following aspects may be included in the monitoring and evaluation of programme effectiveness. 1 The programme
the suitability of the structure established to introduce and support the programme the nature and extent of the supportprovided by relevant departments, institutionsand organizations the adequacy of the resources available for the establishment and maintenance of the programme the appropriateness of the terms of reference for the Steering Committee and the extent to which it has conformed with them. Programme personnel the appropriateness of the criteria set for the selection of coordinators, trainers and supporters the availability of a sufficient number of suitably qualified personnel the effectiveness of the orientation and support provided to them the amount of time required for different aspects of programme implementation the advantages and disadvantagesof the distance learning approach as perceived by the personnel involved in programme implementation constraints on programme implementation and the solutions identified.
3
Participating centres the number and location of centres participating in the programme, both those acting as study centres and those from which staff have been selected to undertake the course the appropriateness of the criteria set for their selection and the extent to which they were met the advantages and disadvantages of the distance learning approach as perceived by participating centres problems experienced by participating centres and the ways in which they were identified and resolved. Learners the number of learners admittedto the programme in relation to the total number requiring training the proportion of learners who successfully completed the programme to an acceptable standard the proportion of learners who dropped out of the programme and the reasons for attrition rates of successful completion and attrition compared with those in conventional courses at a similar level the time required for completion of individual modules and the programme as a whole an analysis of assessment results the impact of the programme on learners' performance in the workplace problems experienced by learners and the ways in which they were identifid and resolved learners' perceptions of the advantages and disadvantages of the distance learning approach, including the support provided and ways in which it could be improved. Cost-effectiveness Q the costs incurred in the implementation of the programme compared with the budget allocation the adequacy of the financial resources available the cost-effectiveness of the programme in relation to conventional training programmes.
4
5
6
Learning materials the adequacy of the supply of materials to permit entry for all candidates accepted on the programme the relevance and appropriateness of the materials in relation to identified training needs learners' ability to understand the materials and any topics on which they require a high level of support identified gaps where additional resource materials are required.
5
GROUP REPORTS
Throughout the workshop, presentations by the facilitators were followed by intensive group work and further discussion in plenary sessions that focused specifically on regional needs and circumstances. 'lhe following group reports summarize the participants' conclusions
5.1
Building motivation
Undertaking a course by distance learning often requires a higher level of motivation than conventional training because individual trainees have to take greater responsibility for organizing their own study. Factors that are likely to motivate staff to take part in the programme include: a commitment to continuous quality improvement in their work an awareness of their own training needs an opportunity for further training, particularly for those in peripheral centres who currently have limited access to training by conventional means an opportunity to gain a qualification that might strengthen their prospects of an additional allowance, salary illc~ease UI plvlllotio~l and improve their chances of career advancement over those not undertaking further training encouragement and support from their supervisors and colleagues * formal recognition of their involvement through thc allocation of timc for study the prospect of increased responsibility and job satisfaction as a result of the training. 5.2
Potential problems for distancc lcarncrs
Few blood transfusion staff are likely to have any prior experience of distance learning and some may find it difficult to adjust to a different approach to the teaching-learning process. It is important to be aware of potential problems that individuals may face in studying by distance learning so that appropriate strategies can be developed to prevent or overcome them. 1 Individual lack of awareness of their need for updating and improving their knowledge and skills Supervisors and other appropriatepersonnel will need to helpthem to understand why they will benefit from further training and encourage them to take part in the programme.
Variations in individual knowledge, skills and experience on entry to the programme 2 This can be addressed by the careful selection of trainees to ensure their capability to study by distance learning prngramme The use of individual study plans in the modules will enable the content and pace of learning to be tailored to individual training needs and abilities. Difficulty in studying the materials in the English language 3 In the pilot stages of the programme, trainees should be selected from those who are familiar with English. The translation of the learning materials into national languages should be given high priority to ensure their accessibility to all staff. 9 Lack of suitable facilities, equipment and reagents Participating centres should be carefully selected to ensure that they can offer an appropriatelevel of support in upgrading practical skills. Larger blood transfusion centres, universities andtechnical training institutions with suitable facilities should be used as study centres for short courses and practical workshops. Funding should be sought from national or international agencies to upgrade the facilities in other centres. Staff
4
shouldonly be taught how to perform screening tests that areusedinthecentrein whichthey work, although they should understand the principles of other tests. In order to make best use of scarce resources, practical training should be built into daily routine testing.
Shortage of suitable trainers and supporters 5 The careful selection of trainers and supporters is vital and orientation and training should be provided to enable them to fulfil their roles. Appropriate personnel from universities and training institutions may also be used within the learner support system. Reluctance to participate in the distance learning programme 6 Staff who are reluctant to participate in the distance learning programme will require a high level of encouragement and support from thcir supervisors. In somc countries, it may be appropriate to enact a
directive on the requirement for all staff to take part in periodic updating. 7 Time constraints The time required to complete the programme will to some extent depend on individuals' prior training and experience. The individual study plans in the modules should be used to plan a study programme that fits in with the trainee's work commitments and managers should formally allocate a regular period of time for study.
Isolation and luck of support during the course 8 The effectiveness of the programme will largely depend on the quality of the learner support system, but senior staff appointed as supporters are unlikely to have experience of acting as a mentor. Careful selection and training of stipprters will he essential and the trainer should maintain regular contact with supporters to identify any problems that may arise. Poor communication systems Methods of learner support that are appropriateto the communicationsinfrastructure should be selected and monitored carefully to ensure that staff working in remote centres are not disadvantaged because they have difficulty in contacting the trainer. Where telephone and mail links are unreliable, correspondence may be sent through suppliers who make deliveries to the hospital. Trainers may need to make more frequent visits to learners who cannot be contacted by other means. 9
5.3 Support requirements In reviewing the support required to establish a distance learning programme, the following areas were identified. 1 Approval andinstitutional support from Government,including the Ministries of Health, Defence, Education and Finance and relevant authorities such as the National AIDS Control Programme.
2 Financial support for: staff salaries or honoraria orientation and training the purchase, translation or reproduction of the distance learning materials and other resource materials administrative and secretarial support communication: postage, telephone, fax, telex, radio travel and subsistence meetings, short courses and workshops facilities, equipment and reagents.
3 Technical support in the areas of: distance learning assessment
technicaUcommunication media evaluation. 4 Human resources coordinators trainers supporters resource people * administrative support.
5 Support and commitment from directors, supervisors and colleagues of individual learners to: crcatc an environment that promotes effective learning provide encouragement and opportunities for evaluation, innovation and change. 6 Validation and accreditation of the distance learning programme by an appropriate, approved institution. 7 Resource materials adequate supplies of the distance learning materials in national languages policy guidelines and updates additional reference and resource materials.
The following potential sources of technical and financial support were identified: 1 Government, including Ministries of Health, Defence, Education and Finance.
2 WHOIGovernment joint programmes.
3 Education and training institutions: universities technical institutions distance learning institutions or departments. 4 Professional associations. 5 National non-governmental organizations, such as the Red Crescent Society and the National
Association of Blood Donors. 6 National service organizations, such as Rotary Club and Lions Club.
7 International non-governmental organizations, such as DANIDA, FINNIDA and UNDP.
8 Other national organizations, including commercial companies, where appropriate.
5.4
Potential constraints
Participants identified the following potential constraints to the development ot ettective national distance learning programmes in blood safety, together with possible strategies for avoiding or overcoming them. 1
Lack of governmental recognition orfinancial support and obstacles to programme implementation involvement of senior officials from relevant Ministries in the Steering Committee advocacy by WHO, professional associations, training institutions and influential people building awareness of the identified need to expand training and the potential benefits of distance learning demonstrating the effectiveness of the distance learning approach through a pilot project.
2
Difjiculty in communicating with the periphery establishment of an effective learner support system, including the selection of suitable supporters selection of appropriate methods of learner support using cost-effective communication channels provision of training and support for trainers and supporters to enhance their effectiveness testing out the effectiveness of different methods of learner support in a pilot project. Lack of cooperation and coordination between the Ministry of Health, other Ministries and other organizations invulving kcy p c ~ s o ~ uin l d the Steering Committee. Materials unavailable in national languages * using English language materials in pilot projcct with lcarncrs with good undcrstmding of English requesting WHO Representativesto urge WHO EMRO and HQ to undertake their translation into Arabic and French undertakingin-country translation, with assistancefrom appropriateinstitutions such as universities.
3
4
5.5
Methods of supporting learners In reviewing the various methods that can be used to support staff studying by distance learning, participants identified the following advantages and disadvantages.
I
I
1 Correspondence Correspondence is a simple, inexpensive method that can be used at any time, unlike face-to-face communication. It provides a permanent record of contact for future reference and can be kept confidential. However, it may be a time-consuming andtherefore expensive method, particularly where individual rather than standard letters are written, and is dependent on a reliable mail system. As a one-way form of communication, there is a possibility that some points may be misunderstood. Supplementary materials snch as npdates, policy documents and epidemiological data can also be distributed to trainees by post.
I
2 Telephone The telephone is a more effective means of interpersonal communication than correspondence, enabling two-way discussion and the sharing of ideas to take place. It is a quick method of communication that saves time, but is invariably expensive. It may not be a feasible method of contact if the telecommunications system is unreliable or some trainees do not have easy access to a telephone. Unless conversations are systematically documented. no record of the contact is available for future reference. 3 Individual meetings and tutorials Individual meetingsprovide an opportunity for in-depthdiscussion and the sharing of information andideas. They enable trainers to review learners' progress, give direct feedback and advice, and identify and resolve any problems that they may be experiencing. There is less likelihood of misunderstandings than where communication is dependent on correspondence. They are the most time-consuming method of learner support, however, and replacement staff cover may need to be arranged for trainers who are supporting a large number of trainees. They require careful planning and organization, particularly where travel to peripheral areas is needed, and may be expensive if accommodation and subsistence are required. 4 Group meetings and tutorials Group meetings provide an opportunity tor open discussion and Ule sharing of ideas, opinions and experience with the trainer and with other learners, although staff who lack self-confidence may be unwilling to participate actively in discussions. The interaction between learners is likely to help maintain their motivation by reducing any sense of isolation, enabling them to check their progress with each other and work together in identifying and resolving problems. Group meetingsdsu provide oppvrlunilies for further teaching, particularly where learners are experiencing common problems in understanding the materials or relating them to their own work situations. Like individual meetings, however, group meetings tend to be time-consuming and expensive and require considerable advance planning. They may not be feasible or cost-effective where learners are scattered over a wide geographical area.
Short courses and practical workshops Since the distance learning programme is designed to strengthen learners' technical skills, some form of practical tuition will be required to ensure their ability to apply what they have learned from their study of the materials. Short courses and practical workshops provide an opportunity for demonstrations, intensive tuition and the assessmentof knowledge and skills. They also provide information needed for the monitoring and evaluation of the programme. As with group meetings, practical courses are invariably expensive and need a high level of planning and support. Appropriate facilities and residential accommodation will generally be needed. Small centres may find it difficult to release staff, even for short periods, without 5
causing disruption to services. To reduce costs, bench training can be built into routine daily testing, with
learners observing and then performing the procedures under supervision. 6 Peer s ~ q p o rand i lnlral study groups
Peer support is an important informal means of support which helps distance learners to maintain motivation, reduce their isolation and increase their self-confidence.It is an inexpensive method of support that they can organize themselves. It can be maintained by post, telephone and in periodic meetings that can be used for the exchange of ideas and experience and for problem-solving, although some staff may work too far apart to enable them to meet except during courses organized as a fonnal part of the course. However, peer support groups may perpetuate incorrect information or bad practice and some staff may find it frustrating if they are at different levels from other trainees. 7 Local support in the workplace: the supporter Learners' individual supporters play a key role in providing guidance and support at every stage of the learning process -planning, during the course of study, assessment and the implementation of action plans. The personal interest and close contact they provide enables them to give regular feedback and immediate assistance if any problems arise. This should help to build a sense of safety and security on the part of individual learners, which helps to maintain their motivation and promote steady progress. Close and regular contact with the trainer should save time and costs because less support will be required from above.
The effectiveness of the support that they provide will, however, depend on their own motivation and ability and the quality of their relationship with the individual learner. It is essential to select suitable supporters who have adequate time for their role and to provide them with orientation and training. 5.6 Criteria for selection of programme personnel and participating centres The following criteria were agreed as requirements for the selection of personnel and centres participating in the distance learning programme. 1
Programme personnel
Coordinators Authorization to participate in the programme Formal recognition of their role in the programme Appropriate qualifications in blood transfusion Appropriate experience in blood transfusion An established reputation in the field of blood transfusion
Trainers x
Supporters x x Ideally Ideally
x x
x x x
x x
Influential Respected by peers in the blood transfusion field Committed to training and to the distance learning approach Highly motivated Management skills Senior position
x x x x X
x
x x X
*
x X
x x
x
x
Interpersonal communication skills Training skills and experience Sufficient time to devote to the programme Knowledge of national and local policies Flexibility and adaptability Positive attitude towards change Willingness to travel 2
X
X
X
Ideally X X X
x X X X X X
Ideally X X X
X X
X
Stztdy centres
commitment to support the distance learning programme appropriate facilitiesto conductpractical training, including equipment, reagents and administrative support adequate communication links, including transport, telephone and, if possible, fax senior staff able to act as trainers or resource people during practical training accessible to trainers and learners in the region. 3
Centres with learners undertaking the programme recognition of the need for training for nominated learners member of staff able and willing to act as a supporter commitment to the distance learning programme willingness to allocate time for study willingness to innovate and respond positively to realistic, appropriate proposals for change by learners as a result of their participation in the programme adequate facilities adequate mail and telephone links with the trainer and coordinator. Learners currently working in blood transfusion identified need for training unlikely to be transferred out of blood banking awareness of the need for training willingness to learn ability to learn adequate knowledge, skills and experience in blood transfusion motivated to study by distance learning ability to study independently ability to manage their time effectively adequate study skills familiarity with the English language or with the national language in which the materials are provided.
4
5.7 Assessment and recognition World Health Resolution WHA 28.72 of the Twenty-Eighl World Health Assembly statesthat Governments, through Ministries of Health, are responsible for ensuring the safety and adequacy of national blood supplies. The responsibility for regulating training, including assessment and certification processes, therefore ultimately rests with the Ministry of Health or the national body entrusted with responsibility for ensuring blood safety. 9 The decision about whether to award a certificate, a letter of satisfactory completion or other form of recognition to individuals who complete the programme must be made at national level. For individual learners, the benefits of certification are that it will demonstrate a recognition of their hard work and
commitmentto quality improvementand provide evidence that they have reached a standard of achievement comparable to that on a conventional training course. The prospect of gaining a certificate will be an important motivator since it may assist in career advancement. The benefit of certification for the programme is that it will demonstrate that it is arecognized, valid and high quality training programme. This may assist in securing funding and technical support. Participants discussed the aspects of the course that should be assessed and identified arange of assessment methodologies. These are shown below, together with an indication of the personnel or agencies that might be responsible for them.
Area of assessment Theoretical knowledge
Method Examination Test Multiple-choice questions
By whom
Ministry of Health University Institute of Health Blood Transfusion Service Blood Transfusion Service Trainers
Practical skills
Practical test Observation Coded samples Oral
Understanding
Trainers Blood Transfusion Service (endorsed by Ministry of Health)
Application to own work environment/ Oral transferable skills Inspection Observation Action plans Progress and extent of improvement Self-assessment Journal Portfolio Activities Action plans Progress reports Action plans Progress reports Questionnaire Self-assessment
Learners Supporters/supervisors Trainers
Problem-solving skills
Trainers Learners
5.8 Monitoring and evaluation Monitoring and evaluation should be built into the programme during the planning stages when detailed protocols should be developed. Participants identified the following components of the programme that need to be monitored and evaluated, suggesting a range of methodologies and allocation of responsibilities. Component Programme implementation of action plan pilot project: appropriate realistic time-frame cost-effectiveness need for replanning Method Reports from: trainers supporters directors of participating centres By whom
Coordinator Steering Committee WHO
cost-effectiveness need for replanning Coordinator
centres
Questionnaire Report/assessment Records Questionnaire Repodrecords
Steering Committee (involving trainers, etc.)
Trainers
Coordinator
Visits Meetings to review progress Centres Observation . Reportslrecords Questionnaires Questionnaire Interview Progress reportslrecords Self-assessment Questionnaire Interview Results of assessment Reports Questionnaire Audit Financial records Financial reports Coordinatorltrainers Directors of centres
Supporters
Coordinator Trainers
Learners
Learners Trainer Coordinator Coordinator
Materials
Cost
Coordinator Steering Committee Trainers Directors of centres Supporters, etc. Coordinator
Time
Reports from programme personnel
6
RECOMMENDATIONS
NATIONAL LEVEL Governments Governments of member states are requested to: 1 Give official recognition and authority for the establishment of a national distance learning programme in blood safety. 2 Provide ongoing moral and financial support for the programme. 9
3 Appoint the National Blood Transfusion Service as the appropriate authority with responsibility for overall coordination and management of the programme.
4 Identify suitable staff and, where necessary, appoint staff to assist in programme development.
Blood Transfusion Services National Blood Transfusion Services are requested to:
1 Develop a plan of action for the establishment and ongoing management of the national distance learning programme in blood safety. 2 Facilitate the establishment of a Steering Committee to advise on the promotion and management of the programme. 3 Coordinate and promote the programme.
4 Provide or facilitate the provision of suitable facilities for the implementation of the programme.
5 Identify suitable centres and personnel to participate in the programme. 6 Coordinate the monitoring, evaluation and replanning of the programme.
7 Act as the focal point for communication with other countries that have established distance learning programmes in blood safety.
Education and training institutions, in collaboration with Blood Transfusion Services Education and training institutions, in collaboration with Blood Transfusion Services, are requcstcd to: 1 Provide technical support and assistance to the distance learning programme in blood safety.
2 Support the practical training component of the distance learning programme by providing appropriately qualified resource people and access to facilities, including laboratories, library and residential accommodation. 3 Provide technical assistance and expertise in assessment and, where appropriate, facilitate certification and accreditation. 4 Facilitate the provision of financial support for the programme, where appropriate. 5 Give formal recognition to the programme, where appropriate.
Professional bodies Professional bodies, in collaboration with Blood Transfusion Services, are requested to:
1 Formally recognize the distance learning programme in blood safety. 2 Provide technical assistance and support in programme development, assessment, monitoring and evaluation.
3 Facilitate the provision of financial support for the programme. 4 Participate in the Steering Committee.
*
Non-governmental organizations National and international non-government organizations, such as national Red Crescent Societies, are requested to:
1 Provide advocacy and moral support for the establishment of the national distance learning programme in blood safety. 2 Participate in the Steering Committee, where requested.
3 Provide financial support for the establishment and maintenance of the programme. 4 Facilitate the provision of technical assistance in programme development, monitoring and evaluation.
Workshop participants Participants in the WHO Regional Office for the Eastern Mediterranean Regional Workshop on Distance Learning Materials for Blood Safety, Amman, Jordan, 20-24 March 1995, are requested to: 1 Provide advocacy for the establishment and support of a national distance learning programme in blood safety by reporting on the workshop to their superiors and initiating discussions with relevant organizations and institutions. 2 Assist in drawing up a plan of action for the establishment of the programme.
3 Where appointed as National Coordinator, coordinate and implement the plan of action in conjunction with the Blood Transfusion Service, or assist the National Coordinator. 4
Facilitate inter-country communication and networking through the production of a Regional
Newsletter. 5 Contrihute to a Regional Newsletter on a regular hasis
6 Share information and resource materials with other member states that have established national distance learning programmes in blood safety. 7 Provide regular feedback to WHO on the development of the distance learning programme, through the WHO Regional Office for the Eastern Mediterranean.
WHO Representatives WHO Representatives are requested to: 1 Provide advocacy in the establishment and maintenance of the national distance learning programme in blood safety.
2 Advise on and, where possible, facilitate the provision of technical and financial support. 3 Provide technical assistance in programme monitoring and evaluation.
KHGIONAL AND INTERNATIONAL LEVEL
WHO Regional Office for the Eastern Mediterranean (WHOIEMRO) WHOIEMRO is requested to: 9
1 Provide advocacy and continuing contact with national governmentsto promote recognition of the need for training in blood safety and the use of the WHOIGPA distance learning materials.
2 Circulate the workshop report to all member states. 3 Provide additional copies of the distance learning materials and the Trainer's Guide, where requested, to be charged to the Supplies and Equipment component of countries' budgets.
4 Assist member states in the translation of the distance learning materials into national languages, using inter-country allocations. 5 Ensure coordination with the WHO Regiorial Office for Africa in the trarislatiorl ar~d productiori
of a French edition of the distance learning materials. 6 Providc funds for pilot projects, to be agreed upon during the planning and revision of WIIOI
Government joint programmes.
7 Produce a manual on establishing national distance learning programmes in blood safety. 8 Provide additional information and resource materials on blood transfusion to support distance learning programmes in blood safety. 9 Provide financial support for training fellowships and further training through WHOIGovernment joint programmes.
10 Provide technical assistance and support in programme development, monitoring and evaluation through WHO/Governmentjoint programmes. 11 Provide feedback on evaluation reports from member states. 12 Respond positively to requests for further assistance resulting from evaluation, such as a followup workshop. 13 Facilitate the development of a standardized approach to the monitoring and evaluation of distance learning programmes in blood safety. 14 Facilitate the production and distribution of a Regional Newsletter on distance learning and blood safety.
-
15 In conjunction with WHO Headquarters, organize a follow-up workshop within two years. 16 Continue to promote the development of Blood Transfusion Services as separate, identifiable and sustainable programmes.
WHO Headquarters WHU Headquarters are requested to:
1 Provide advocacy to promote the development of national distance learning programmes in blood safety. 2 Provide sufficient free copies of the distance learning materials to enable member states to start pilot projects without delay.
* 3 Facilitate the translation and reproduction of required language versions of the distance learning materials.
4 Explore means of providing additional free copies or reducing the prices of the distance learning materials.
5 Provide technical assistance in the development of national distance learning programmes in blood safety.
6 Assist in the monitoring and evaluation of the implementation of action plans and programme development.
7 Provide feedback on evaluation reports from member states. 8 Resyu~lJ yusitively tu ~eyuesls fur fu'urtllcrassislarice resulting from evaluation, such as a follow-
up workshop.
9 Facilitate the development of a standardized approach to the monitoring and evaluation of national distance learning programmes. 10 In conjunction with WHOIEMRO, organize a follow-up workshop within two years. 11 Update, revise, and improve the distance learning materials, as required.
Other international non-governmental organizations and agencies Other international non-governmental organizations and agencies, including the International Federation of Red Cross and Red Crescent Societies Blood Programme, DANIDA, FINNIDA, JICA, Commonwealth of Learning, Overseas Development Administration, British Council, African Medical and Research Foundation, European Commission and Council of Europe are requested to: 1 Provide advocacy for the establishment of national distance learning programmes in blood safety.
2 Provide, or facilitate the provision of. financial support for the establishment and maintenance of national distance learning programmes in blood safety. 3 Provide, or facilitate the provision of, technical assistance and support for the establishment and maintenance of national distance learning programmes in blood safety. 4 Provide financial andfor technical support for the further development of distance learning materials in blood safety.
7
ACTION PLAN
At the conclusion of the workshop, participants agreed the steps that would need to he followed in establishing a national distance learning programme in blood safety, together with the technical support and resource requirements and possible sources of support. They then prepared a generic action plan and implementation schedule to provide a framework for the development of action plans at country level. This is shown on the following two pages.
ACTION PLAN Activity Date (quarters) 2/95
By whom
Support required
Resource
1 Report to Ministry of Health and other relevant Ministries on workshop and distance learning programme 2 Sensitization of relevant authorities through briefing meetings 3 Ministry of Health approval for the establishment of the distance learning programme and nomination of the national coordinator 4 Organization of a national meeting for interested parties and formation of Steering Committee -b
Workshop participant
2/95
Workshop participant
Official workshop report Advocacy
3/95
Government
3/95
Coordinator
Copies of workshop report and distance learning materials
Funds for m expenses fo representati interested a
5 Preparation of plan of action
3/95
BTS, in collaboration with workshop participant, Coordinator and Steering Committee Coordinator
6 Submission of progress report to WHOIEMRO
End 3/95
7 Approval of plan of action
4/95
Government
Activity
Date ( quarters)
By whom
Support required
Resource
8 Preparation of project proposal and budget for submission to donor agencies 9 National meeting to brief trainers, centres, supporters
4/95
Coordinator
4/95
Coordinator
Technical assistance
Funding
10 Implementation of pilot project
1/96 ongoing
Coordinator Trainers Supporters
Funding
11 Monitoring
4/95 ongoing
BTS, through: Coordinator Trainers Supporters BTS, through: Coordinator Trainers Supporters Steering Committee Coordinator
12 EvaJuation/review/replanning
3/96
13 Progress report to WHO/ EMRO
End of 2/96 & 4/96
ANNEX 1 WORKSHOP PROGRAMME Monday, 20 March 1995 08.00 - 09.00 09.00 - 09.15
Registration Opening session Address by H. E. Dr Aref Bataineh, the Minister of Health, Jordan Message from Dr Hussein A. Gezairy, Regional Director for the WHO Eastern Mediterranean Region Background to the WHO distance learning project Discussion of programme and workshop expectations Coffee break Review of regional and national training provision existing facilities and programmes unmet training needs constraints on expansion of training Lunch break Introduction to Safe Blood and Blood Yroducts the distance learning approach the distance learning materials Coffeebreak Identifying and meeting learners' needs training needs and priorities the characteristics of adult learners potential problems for distance learners
09.15 - 09.30
09.30 - 10.00 10.00 - 10.15 10.15 - 13.00
13.00 - 14.00 14.00 - 15.30
15.30-15.45 15.45 - 16.15
Tuesday, 21 March 1995 08.00 - 08.45 08.45
Group work (continued) Reports and discussion on group work
- 09.15
09.15 - 10.00
Establishing a national distance learning programme in blood safety building a structure support and resource requirements 9 potential sources of support potential constraints developing a strategy
10.00 - 10.15 10.15 - 12.15 12.15 - 13.00 13.00 - 13.15 13.15
Coffee break IndividuaVgroup work Reports and discussion on group work Coffee break Establishing a learner support systcm
- 14.00
learning at a distance: learners' support needs methods of supporting learners 14.00 - 15.00
Group work
Wednesday, 22 March 1995 08.00 - 09.00
Group work (continued) Al-Quds Open University: Dr Ahmed Abou Sheikhah Coffee break R e p r t s and discussion on group work
09.00 - 10.00 10.00 - 10.15 10.15 - 1 1 .CKI
11.00 - 12.00
Programme coordination and management supporting the trainers supporting the supporters administration and record-keeping criteria for the selection of: coordinators trainers participating centres individual learners supporters/mentors Group work Coffee break Reports and discussion on group work Assessment recognition and certification methods of assessment Group work
12.00 - 13.00 13.00 - 13.15 13.15 - 13.45 13.45 - 14.15
14.15 - 15.00
Thursday, 23 March 1995 08.00 - 08.45 08.45 - 09.15 09.15 - 10.15 10.15 - 10.30
Reports and discussion on group work Monitoring and evaluation Group work Coffee break
10.30- 1 1.30 11.30- 13.00
Reports and discussion on group work Action plans: group work developmentof outlineaction plan for the establishment of national distancelearning programmes identification of support and resource requirements preparation of workplan Coffee break Group work (continued) Discussion and adoption of action plan
13.00 - 13.15
13.15 - 14.15 14.15 - 15.30
Friday, 24 March 1995 08.00 - 10.30 10.30 - 10.45 10.45 - 1 1.00
Formulation and adoption of workshop recommendations Workshop evaluation Close of workshop
ANNEX 2 PARTICIPANTS BAHRAIN Miss Fakhriya Ali Akbar Darwish Medical Technologist Salmaniya Medical Centre Blood Bank Ministry of Health Government of Bahrain P. 0. Box 12 Manama Tel: 973 279522 Fax: 973 27963 1 EGYPT Dr Mohamed Wegdan A. Shoukry Director, Technical Supervision and Follow-up General Directorate of Blood Banks Ministry of Health Magles El Shaab Street Cairo Tel: 20 2 354546013541156 ISLAMIC REPUBLIC OF IRAN Dr Farhad Razjou Responsible Laboratory Specialist Blood Transfusion Centre 138 Ostad Nejatolahi Avenue P. 0. Box 11/1745 Teheran Tel: 98 21 89883316 Tlx: 2451 NBTS-IR IRAQ Dr Sabah B. A1 Qutub Director National Blood Transfusion Centre Ministry of Health Baghdad Tel: 964 1 416805114163999 JORDAN Dr Janiet Y. Merza
Director National Blood Bank P. 0. Box 10058
Amman Tel: 962 6 74912112
Fax: 962 6 749123
Dr Nidal M. Irshaid Deputy DirectorlImmunohaematologist National Blood Bank P. 0 . Box 10058 Amman Tel: 962 6 749122 Fax: 962 6 749123
Dr Basma Q. Khraisat National Blood Bank P. 0. Box 10058 Amman Tel: 962 6 749122
Fax: 962 6 749123
MOROCCO Dr Mouhssine El Alaoui Azzeddine Dircctor
Centre Regional de Transfusion Sanguine 472 Avenue Hassan I1 B. P. 180
Rabat Tel: 2127690217169231561690410 OMAN Dr Shahnaz A1 Baloushi Medical Officer Department of Blood Services Central Blood Bank Ministry of Health P. 0. Box 393 Muscat 113 Tel: 968 562480 Fax: 968 561503
Fax: 212 7 691561
PALESTINE Mr Hassan Deeb Hassan Suleiman Deputy Director El-Shifa Hospital Laboratory and Blood Bank Ministry of Health Palestinian National Authority Gaza Strip Tel: 972 7 8655201822131 Fax: 972 7 8224411869809 SAUDI ARABIA Mr Omran A1 Madani Assistant Director, Blood Banks Ministry of Health P. 0. Box 42702 Ri yad Tel: 966 1 4358038 Fax: 966 1 4350503
SUDAN Dr El Tahir Awad Gasim Khalil Director National Blood Transfusion Services National Health Laboratory Ministry of Health Khartoum Tel: 249 1175351
SYRIAN ARAB REPUBLIC Dr Maral Karageuzian Project of Developing Blood Distribution Ministry of Health P. 0. Box 1509 Damascus Tel: 963 11 4444505 TUNISIA
Professor Mohamed Kame1 Boukef Director National Blood Transfusion Centre
Ministry of Public Health 2 Rue Djebel Lakhdar Bab Saadoun 1006 Tunis Fax: 216 1 562957 Tel: 216 1 568903 YEMEN Mr Essam Salem Abdullah Head of Blood and Biochemistry Central Laboratory Taiz Governorate Ministry of Public Health Sana'a Tel: 967 2 231431/272388/272861/2/3
OTHER ORGANIZATIONS UNRWA Mr Ahmad Abdallah Ali Senior Laboratory Services Officer UHB Amman UNRWA Headquarters P. 0. Box 140157 Amman 11814 Tel: 962 6 826171 Fax: 962 6 864147
OBSERVERS Dr Waleed A. Qhawi National Blood Bank P. 0 . Box 10058 Amman Jordan Tel: 962 6 749122
Dr Ali A. Smadi Jordan University Hospital Amman Jordan Tel: 9626 845845-2318
Dr Hussein A1 Waheidi Red Crescent Hospital Amman Jordan Tel: 9626779131
Dr Nasir Batineh Ramtha Hospital Ramtha
Irbid Jordan Dr Nina El Natour National Blood Bank P.O. Box 10058 Amman Jordan Tel: 962 6 749122 Dr Kareem Elias National Blood Bank P. 0 . Box 10058 Amman Jordan Tel: 962 6 749122
WHO SECRETARIAT Country
Dr Omer Sulieman WHO Representative Amman Jordan Regional
Dr M. M. El Nageh Regional Adviser, Health Laboratory Services World Health Organization Eastern Mediterranean Regional Office P. 0. Box 1517 Alexandria 215 11 Esnt Fax: 20 3 4838916 Tel: 20 3 4830090 Dr J. C. Emmanuel Acting Chief Blood Safety Unit World Health Organization 20 Avenue Appia CH- 1211 Geneva 27 Switzerland Tel: 41 22 7914387 Fax: 41 22 7914165
I
Ms Jan Fordham Short Term Consultant Director Open Learning Associates 182 Albion Road London N 16 9JR UK TeVfax: 44 171 254 2834
Mrs G. Ismail Secretary World IIcalth Organization Eastern Mcditerrancan Regional Office
P. 0. Box 1517 Alexandria 2 1511 Egypt Tel: 20 3 4830090
Fax: 20 3 4838916
Mrs M. Adly Secretary World Health Organization Eastern Mediterranean Regional Office P. 0. Box 1517 Alexandria 2 1511 Egypt Tel: 20 3 4830090
Fax: 20 3 4838916