WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANT~
REGIONAL OFFICE FOR
THE WESTERN PACIFIC
BUREAU REGIONAL OU PACIFIQUE OCCIDENTAL
Eighteenth Session Taipei 13-19 September 1967 Provisional agenda item
WPR,lRc18/6 14 JUly 1967 ORIGINAL: ENGLISH
13
,1 INl'RODOOl'ION
APPRAISAL OF THE FEI.J:.aVSHIP PROORAMME IN THE WFSl'ERN PACIFIC REGION
The shortage of adequately trained personnel is a oommon problem in the Region and is the main cause for the inadequacy of health services particularly in the developing countries. For this reason the education and training of health personnel receives high priority in WHO's programme of work. one of the methods of helping governments train their health personnel is through fellowships. Experience has shown that the fellowship programme is an effective means of (a) promoting the international exch8nge of knowledge, (b) improving standards of teaching and training in health, medicine and related fields. (c) advancing research. (d) introducing new concepts. methods and techniques and (e) starting new activities and improving existing ones. thus strengthening the national health services. It is therefore no wonder that the Rockefeller Foundation. which has invested millions of dollars in fellowships, stated that "in retrospect. few 1 activities of the Foundation appear of more general and endearing value."
2
DEFINITION
In general, a fellowship is defined "as a method of assisting an appropriately qualified individual. within a definite period of time. to
acquire or exchange knowledge and skills. through st~. training or observation so as to fulfill a specified objective."2 /A WHO fellowship
...
~e Rockefeller Foundation. Annual Report 1953, New York
~ld lUth arg. techno Rep. Ser., 1960, 186. 5
t
WPR/RCI8/6 page 2 A WHO fellowship means the acceptance by WHO, on the recommendation of a government, of an individual who, given the opportunity to study abroad, will increasingly contribute towards furthering the objectives of his government and WHO. The application and award of a WHO fellowship is thus a joint tmdertaking betWeen WHO, the fellow and his government. WHO makes appropriate plans for study abroad, as well as the arrangements with cotmtries and places of study. It also provides the financial assistance foreseen for the fellowship. The fellow upon return to his home cotmtry places his services at the disposal of the national health administration. The government will, as specified on the fellowship application form, give" an assurance that it will make full use of the knowledge and experience gained by the fellow and that his absence abroad will not affect his status, seniority, salary, pension and similar rights.
<~--
3
TYPES OF FELLOWSHIPS
Fellowships may either be (a) normal or (b) special. A normal fellowship is an award for advanced study abroad made to an individual on the recommendation of his government to fit him for a specifio assignment on his return home. Special fellowships are those which either in their administration or their purpose do not follow the usual pattern of normal fellowships. This group includes participants in certain group educational activities, such as seminars, conferenoes, study tours, training courses and the like, sponsored by WHO. Generally they are of short duration. 4 OBJECTIVE OF FELLOWSHIPS
-. ,
The specific objective of any fellowship is to assist selected personnel to obtain first-hand knowledge and experience abroad which would be applicable in developing improved medical and health standards of their cotmtries. Fellowships enable qualified persons to: (a) (b) (c) attend courses or similar group training activities organized or assisted by WHO; attend other courses, especially those leading to a post-graduate certificate, degree or diploma; observe praotices and techniques with which they are not familiar, or to carry out research. /Awards may •••
f
WPR/RC18/6 page 3 Awards may also exoeptionally be made to: (a) students from oountries which laok faoilities for undergraduate study in health subjects to enable them to study abroad; nationals of a oountry to enable them to attend a oourse organized in their oountry by WHO or by another agenoy to train fellows from other oountries, on oondition that they do not reside in the city where the course is being held; persons without medioal or allied qualifioations to study publio health administration and related subjects; and persons to enable them to exchange with a person oocupying a oorresponding post in another country.
.
-
(b)
(0)
(d)
It is essential that the objective of the fellowship be well defined so that the use to which the fellow subsequently puts the knowledge acquired can be easily assessed. It is a major responsibility of governments to ensure that returned fellows can use the knowledge they have acquired abroad for the benefit of their countries.
5
ELIGIBn.1TY FOR FELLOWSHIPS
Normally, fellowships are granted only to persons: (a) who are, or who will be, engaged in medical and health work in their national health organization and whose applications are supported by their national health administration; for whom the national health administration is prepared to oertify that, i f a fellowship is granted, full use will be made of the fellow in the field covered by the fellowship; who have not less than two years' experience in the subjeot they wish to study; who have exhausted the opportunities available in their own countries for studying that subject; who submit subjects for study which are directly connected with the country's own health programmes; I(f)
(b)
(c) (d) (e)
•••
t
WPRjRcl8/6 page 4 (f) who undertake in writing to continue in, or place their services at the disposal of, their national health organization for at least three years immediately following their fellowship. Fellows who are to undergo basic professional training must, in addition to the three years mentioned above, give one further year of service for each year of study over three years; Who are in good health and are not over 55 years of age if the retiring age is 60 or above, nor over 50 if the retiring age is below 60; and who are able to speak, read and write a language which can be used for the proposed studies.
(g)
(h)
It is suggested that the national health administration should submit applications to a national selection committee which will interview applicants and select suitable candidates. The selection committee should be established by the national health administration in consultation with the appropriate WHO Regional Director. It is suggested that the committee be composed of a representative from the national health administration, the national body concerned with the education of medical and health personnel, the appropriate professional group if applicable and. in an advisory capacity and. without vote, from WHO. 6 PREPARATION OF THE FmLOWSHIPS PROGRAMME In preparing the fellowships programme, the Regional Director
-
(
considers: (a) the candidate's previous education. training and experience, the language in which he is able to study, and what he needs to study in preparation for a specific assignment on his return home;
(b) training facilities and vacancies; (c)
the desirability of the candidate studying in countries where conditions are closer to those of his own country, if appropriate training facilities are available; the attention to be paid to the public health and preventive medicine aspects of the subject of study, whenever applicable; the inclusion, when it can be arranged, of visits to the field at the end of the academic year, preferably
(d)
(e)
Ito an area •••
WPR/RC18/6 page 5 to an area where condi tiona are similar to those in the candidate's country of origin; (f) the necessity of avoiding travel to many countries and preferably making arrangements for long stays in few institutions rather than short stays in many; of avoiding arrangements for studies to commence during vacation periods; of excluding travel to distant countries for short visits and travel to attend congresses.
.
-
7 f-
REPORTS
--
WHO keeps in contact with the fellows during the period of study by personal contacts where possible and by correspondence. Fellows are required to submit monthly reports on their activities. They are also required to submit a final report at the end of their fellowship and two follow-up reports, one six months and the other two years after their return home.
8
ANALYSIS OF WHO FELLOWSHIPS AWARDED DURING THE PERIOD 1 JULY 1951 TO 30 JUNE 1966 AND 1 JULY 1966 TO 30 JUNE 1967
,--
As shown in Table 1 no less than 1414 fellowships have been awarded to countries and territories in the Region from 1 July 1951 to 30 June 1966. As far as the number of fellowships is concerned, it will be noticed that China (Taiwan) comes out first followed by the Philippines, Japan and Republic of Korea. Table 1 also indioates that malaria has the greatest number of fellowships (225) followed by public health administration (216). other communicable diseases (127). nursing (124) and medical sciences and clinical medicine (101).
9
EVALUATION OF FELLOWSHIPS AWARDED DURING 1961 - 1964
The need for a continuous appraisal of the fellowship programme is well recognized and has been brought to the attention of WHO on a number of occasions. For this reason a Study Group on Appraisal of FellOWShips, which considered various aspects of the problem. was convened in Geneva in July 1959. The Study Group reported that in making an appraisal of a fellowshiP. the following aspects are significant: (a) ~
the administration or operation of the fellowship; /(b) the •••
t
WPft/RC18/6 page 6 (b) (c) (d) (e) the educational opportunities provided for the fellow; the subsequent utilization of the fellow; the impact of the fellowship upon the fellow's own country and his own organization; and any other collateral results or by-products of the fellowship which did not form a specific part of the original purpose for which it was awarded.
The Study Group considered various criteria for appraisal during the pre-fellowshiP. fellowship and post-fellowship periods (see Annex). It also stated that the methods for obtaining the information on which to base appraisals may be through (a) written evidence obtained otherwise than from field visits and personal interviews, (b) personal interviews of fellows and other persons relevant to the inquiry and (c) field visits by selected persons. Each of the above methods has its advantages and limitations. Information in fellowship files although simple to obtain might be heterogeneous, incomplete, defective and the quality might vary from person to person and from country to country. On the other hand, interviews are more difficult and expensive but they permit more detailed evaluation and provide control for data obtained from the files. The Study Group recommended further study of the following topiCS: 1. 2. development of a series of case histories as a system of documentation; formulation of specific criteria for each stage of the fellowship process; evaluation of the fellow in his environment before and after his fellowship; placement of fellows; studies of fellowship successes or failures; and methodology - the development of new techniques and methods and standardization and further refinement of existing ones.
3. 4. 5. 6.
No less than four evaluations of WHO fellowships have been made in the Region. A point system assessment scheme based on two main /cr1terla •••
WPR/RC18/6 page 7 criteria namely (a) employment of the fellow after return from fellowship study and (b) contributions made during the two years since his return were used in the second, third and fourth evaluations. The data have been obtained from the follow-up reports required of fellows two years after the completion of their fellowships. Details of the point assessment scheme are as follows: FELLOWSHIP ASSESS~
SCHEME
(point System) Criteria Score
A.
Employment of fellow after return 1. 2. 3. 4. Appropriate to studies, with promotion or more responsibility: Score 50 Appropriate to studies, without promotion: Score 40 Related to studies, with promotion or more responsibility: Score 20 Related to studies, without promotion: Score 10 Unrelated to studies or not employed: Score 0
o to
50
,-
I
I ,
.
.
5. B.
Contribution made since return 1. 2. Informing others (conferences, articles, committees, etc) Training others (in-service and/or formal teaChing) Introducing :lew methods, improving or expanding existing services Establishing new services not previously available in the community or institution laboratory or administrative
5 10 10 10 10
3. 4.
5. Conducting research - field, clinic,
. .....
/6.
other •••
WPR!RCI8/6 page 8
Criteria
Soore
6.
other forms of leadership (mostly indirect contribution towards improvement and expansion of services, organization of training and research, developing public demand for health services) Maximum total score
5
100 Rating failed fairly successful successful very successful
Total score for the fellowship less than 50 50 to less than 70 70 to less than 90 90 and over
-,
A total of 221 fellowships awarded during the period 1950-1957 were appraised according to the above scheme. Results revealed that the mean accredited points by countries were over "55.0. The mean accredited points for the Region as a whole were 69.0 indicating that the fellowships programme was fairly successful. Evaluation of 239 fellowships awarded during the period 1955-1961, and utilizing the same criteria, indicated that fellowships from various countries and territories in the Region ranged from fairly to very successful, the lowest mean accredited points being 59.0 and the highest 97.5. The mean accredited points for the Region as a whole were 77 which proved tha:t in general the programme was successful. The present evaluation covers the period 1961.1964 and is based on 159 fellowships with complete follow-up reports. Analysis revealed that accredited points by countries ranged from 55.0 to 90.0. The mean accredited points for the Region were 73.0 indicating that on the whole the programme was successful. Table 3 indicates the distribution of fellows according to employment after return and contribution made since return. It will be noted that 60.5% were either given promotion or more responsibility and 38.9% were not given promotion but were employed in jobs appropriate to their studies. There was only one case in which a fellow was doing worle unrelated to his studies. The table further reveals that training others is the main contribution of fellows after their return. /Attention is •••
.....
,
WPR/RCl8/6 page 9 Attention is called to the fact that the number of fellowships used in the above eValuations was below the totals for the periods involved. This is due to the fact that the submission of the two-year follow-up records by the fellows is rather incomplete. To illustrate 6 during the period 1950-1957. 33% of the fellows did not submit their two-year follow-up forms. Of the fellowships awarded from 1955 to 19616 barely 50% submitted follow-up forms at the time the appraisal was made. Returns for the period 1961-1964 were even more disappointing since to-date only 23% of the fellows have sent in the required forms. The small sample thus puts doubt on the validity of the conclusion that the fellowships programme for the period 1961-1964 was successful.
10
GENERAL COMMENl'S
The increasing number of fellowships awarded in the Region brings into sharper focus problems which. if not resolved satisfactorilY6 can impair the whole fellowships programme. Frequent delay by governments in selection. early nomination and submission of full documentation on candidates remains one of the greatest problems. MAny instances have occurred over the past year where placement action had to be deferred pending receipt of required documents on candidates. A most serious factor affecting the awarding of fellowships is lack of language proficiency. Language tests are required for placement in many countries particularly Australia 6 United States of America 6 Net.q Zealand. United Kingdom. Canada and for formal courses in Singapore. Japan and the Philippines. The difficulty of arranging for candidates to take their language tests well ahead of time constantly occurs; and in several cases where the test has been delayed. fellowships have had to be deferred from one year to the next. The Regional Office's attention has been drawn to difficulties in arranging fellowship programmes in Europe as well as in the United States of America and Canada during the holiday months of July and August. To avoid this recurring problem. Member countries are urged to take careful note of this point in maldng proposals on fellows' itineraries. Another matter of great importance is the need for improved programme planning which would minimize applications for ad hoc fellowships. changes or conversion of fellowships. extension of awards. changes in itinerary or non-adherence to placement arrangements already made. SUch requests not only cause a dissipation of the limited funds of the Organization but also great inconvenience and stress on receiving countries. the institutions involved and the WHO regional offices concerned with the placement. The candidate himself is also very often disappointed and disillusioned if late programme requests cannot be met.
.
,.'"
,/With regard •••
• WPR/RC18/6 page 10 With regard to evaluation, the assistance of governments in ensuring the return of essential fellowship follow-up records is earnestly requested since a larger proportion of returns would increase the reliability of any evaluation to be done. In addition to the present scheme, it is planned to use other methods of evaluation, in particular. personal interviews and field visits in the near future.
..
.
• WPR/RC18/6 page 11
LIS!' OF SOOGESl'ED CRITERIA FOR FELLOWSHIP APPRAISAL
A.
Pre-fellowship period
1. 2.
Were the objectives of the fellowship clearly and specifically stated? Did the candidate conform to the objectives set forth? Was the fellow physically and mentally able. as well as psychologically ready, to undertake the programme of study outlined? Did the fellow have. before beginning the fellowship. the language capacity necessary to carry out the programme of study or observation? Has the process of selection been effective in obtaining applicants fulfilling the requirements of the fellowship programme? Have the quality and quantity of applicants for fellowships been maintained or improved?
3.
4.
5. B.
Fellowship period 1. Could the studies proposed be undertaken only abroad? Was the country of study and the locale wi thin that country suitable for the study outlined? Was the programme of studies and observations appropriate to the needs of the fellow? Was the fellow aoademically qualified for his fellowship studies and was he suitably prepared before taking up his fellowship? Was the period of study adequate for attaining the objective proposed? Was the academic or training record and the adjustment of the fellow unsatisfactory? Did the host institution provide a satisfactory fellowship experience? Were the administrative arrangements for the fellow satisfaotory?
2.
3.
4.
5. 6.
7.
/8.
Did the •••
WPR/RC18/6 Annex page 12 8. C. Did the fellow complete the educational programme or research for which the fellowship was awarded?
Post-fellowship period 1. 2. Did the fellow return to his own country? Is the fellow now employed in the field of his fellowship study? Were the pre-fellowship expectations and plans substantially fulfilled? Were there identifiable benefits to the host institution or country? Has the fellow contributed to improving existing services or activities? Has the fellow introduced new types of organizations, activities or methods? Has the fellow shared his education or training with others? Has the fellow carried out any research since returning home? What are the number and quality of scientific publications produced by the fellow? Has he obtained any professional honours or recognition? Has he exerted any appreciable influence on policy or legislation? .' Have there been any noticeable changes in his attitude as a result of his fellowship experience? Have there been any collateral results or by-products of the fellowship?
3. 4.
5.
6. 7. 8.
9. 10. 11. 12. 13.
., .,'
,.\
TABLE 1 - FEIJ.OWSHIPS AWARDED DURING THE PERIOD 1 JULY 1951 TO 30 JUNE 1966-
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- - 9 71 40 - - lB 7 1 9 1 2 18 Envlronmental health _ ' 1 - 25 - - - - 1 21 9 - 1 5 1 - 4 - 1 18 Nursing 3 - 2 - - - 13 3 5 - 6 3 - 3 - 1 11 - 2 14 Maternal and child health 1 - - 7 lA. '1 3 - - 4 13 7 5 - 2 - - 1 - 2 10 Mental health 2 - - 1 2l 1 4 - - 5 24 - - - - - - 1 - - 16 Health education 2 - - 6 - - - 1 1 3 5 - - " 1 1 2 - 7 9 6 Nutrition 1 - - 1 - - 2 - - - 102 - - - 2 - 1 1 - - - - - 2 - - 6 Healt.'t statistics 1 - - 1 5 - 1 -- Dental health 1 - - - 2 - - - - 16 1 1 - - 2 - - - - - 4 Other health services 2 - - - 13 - 3 - - - 71 7 - - 2 - - 2 - - 9 Malaria - 8 6 3 7 - - - - 2 1 - 1. 52 5 - - - I 4 58 Itieponematosa : .. 1 - - - 1 4 - - - - 19 - 1 - - - 3 2 2 Tuberculosia 4 - - 3 21 2 4 1 - 2 4 9 1 - 1 1 - 1 - 4 9 Leprosy 1 - - - 2 - - - - - - 12 - - - - 2 - - - 2 2 Virus diaeasa 1 - - 2 - - - - - 3 2 - - 1 - - - - - -5 commumcanle 9 eases - - 2 33 1 1 - - 3 14 21 1 - 4 - - - . 2 20 1 1 3 ~tt~~~:ria- 4 - 7 - 6 - 1 - 11 4 13 1 . " I anll 1 1 - - 2- - - " 3- - 1 - - 1 . - " - - " Radiation medicine PubUc health- adrninisllatio
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4 1 4 7 1
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- 8 3 -2 3 1 1 2
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- 1 3 1 - 3 11 4 46 1
- 1 1 - 1 - - 3 1 - - - 5 - - 1 1 - - 36 - - 1 - - - 1 -1 · - - · 2 - 5 21 4 1
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81 47
18 33 34
69 225 . ----35
71 23
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171 101 19
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· 68 43
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262 6
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43 ~ 160 71
3 07 21
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29
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211 206
24 --
17
1414
~ 0'1
-Group training awards. individual fellowships financed from Inter-reglonal and Headquarters' allotments and special fellowships administered on behalf of the organizations are excluded.
WPR/RC18/6 page 14
TABLE 2 - NUMBER OF FELLOWSHIPS AWARDED, 1 JULy 1966 - 30 JUNE 1967
I. HlllAI1rH mGANIZATION AND SERVICES Public health administration Nursing Environmental health Maternal and child health Health education Dental health Rehabilitation Mental health Occupational health Nutrition Health statistics Drug control II.
28 25 23 16
31
12
8 9 7 3 8
3 173
CCMMUNICABLE DISEASES SERVEES Malaria Laboratory Tubercul.osis Other communicable diseases Leprosy
36
8
10 3
2 59 4 6 2
III.
MEDICAL EDUCATIQlf, CLINICAL AND BASIC MEDICAL SCIENCES Basic medical sciences Radiology Other medical and surgical specialities Undergraduate medical assistants studies Clinical medicine
4 4 20
TOTAL
•••••••••••••••••••••••
252
,.
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-
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.'
-
ACCREDITED POnn'S BY COUN.rnY OR TERRITORY ACCORDING TO ASSESEHEm' ITEM WPRO 1961-1964 CONTRIBUTION EMPLOYMENT ApproEstablish- Conductpriate Related Related Unrelated ing reInforming Training Improving ing new w/o pro- w/pro- w/o pro- or unothers services services search motion motion motion employed others -40 30 30 120 15 30 220 110 130 270 400 105 10 20 20 40 10 10 40 5 20 20 40 40 10 40 10 10 40 5 20 30 70 30 50 80 100 160 60 160 70 200 20 10 10 30 20 50 80 90 30 320 50 50 30 50 50 120
\
lNo. of', Country fe11owships or territory assessed _."._-- ... -_.-.4 Australia China 29 4 1 2 4 1 Hong Kong 10 Korea 19 8 Laos Malaysia 11 New Zealand 6 Papua New Guinea 7 Ryukyus 4 Sabah 15 4 Sarawak Singapore 13 Tonga 6 1 TTPI 8 Viet-Nam Western 2 Samoa o t a 11 Mean 159
---.--50 900 200
Appropriate w/promotion
100 150 700 400 150 150 250 100 550 50 300 50 50 250 50 4800 30.18
-
350
-
80 80 160 120 280 200 120 40 2 440 15·35
-
-
-
-
-
-
-
-
-
-
-
40 355 60 2 195 3].0 10 55 120 305 5 70 5 640 10 30 1480 480 10 30 760 20 520
-
88.2 75·7 77·5 55.0 60.0 76.2 70.0 64.0 77.8 60.0 69.0 66.6 85.0 82.5 65.0 73.7 74.2 76.6 90.0 63.7
35 15 30 10 1~5
20
20
-
70 40 120 40 120 50 10 50 10 1 280 8.050
60 40 60 40 80 50 10 10 10 1 090 6.855
30 40 20
50 50 20
-
50 10 10 20 50 20 10 30
30 5 25 15 40 20 10 10 5
595 330 975 295 965 460 90 510
-
10 485 3.050
10 570 3.585
620 3.899
135 67.5
I
380 D-1645 73.2 ~.~ (1)~ 2.389 73.24 1-'0 \.111-'
- ----
~
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WPR,!RC18/6 page 16
•
TABLE 4 - DISTRIBUrION OF 159 FELLCMS ACCORDmG TO 11MPLOlMENT mER RETURN AND CONrRIBUl'ION MADE SINCE RETURN 1961 - 1964* ~
L 60.5
A.
l!MPLOYMEN.r OF
Ji'ELL(M
AFTER RETURN
1. Appropriate to studies with promotion or more responsibility 2.
96 62
Appropriate to studies without promotion responsibility
38.9
3. Related to studies with promotion or no
4. Unrelated to studies or not employed B. CONrRIBtJrION MADE SINCE RETURN 1. Informing others 2. '1!raining others 3· Introducing new methods, improving or expanding existing services
1
0.6
97 128 109 51 62 76
60.6 80.0
68.1 35.6
;1
4. Establishing new services not previously 5· Conducting research - field, cliniC, laboratory, administrative
available in the community or institution
38.8 47.5
6. other forms of leadership
- - - - - - - - - - - -------------
----------
.•...
*iiaSed on data obtained from follaw-up reports submitted two years after returning home.