WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Forty-ninth session Manila 14-18 September 1998
WPRlRC49/INF.DOC.l2
I September 1998 ORIGINAL: ENGLISH
Provisional agenda item 15
RAPID FOLLOW-UP STUDY ON WHO FELLOWSHIPS AND STUDY TOURS, WESTERN PACIFIC REGION, 1996-1997
BACKGROUND
Fellowships and study tours are key components of WHO's support for human resources for health. Fellowships enable health workers and health professionals to go overseas for training in subjects not provided in their home country. In exceptional circumstances a fellow may be supported
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by WHO to undertake training in his or her home country. Study tours provide opportunities for health personnel to visit a number of countries on short "fact-finding" missions. In contrast to the standard fellowship, study tour participants are usually middle or senior managers, there is no requirement for a selection process and no reference is made to the nominee's future service.
INTRODUCTION
The rapid follow-up study is used to monitor fellowships and study tours organized by the WHO Regional Office for the Western Pacific. This is the fifth rapid follow-up study in a series which began in 1991. The first four rapid follow-up studies covered the periods 1986-1989, 19901991,1992-1993 and 1994-1995.
WPRlRC49/INF.DOC.lZ pageZ
This rapid follow-up study has used infonnation taken from the Regional Office's central database and from a questionnaire (Annex) sent to all fellows (via the relevant WHO Representative) in May/June 1998. The questionnaire requested participants to comment on their employment status, to identify the extent to which they felt their original objectives had been met and to comment on the value of their programme to their home cOUntry. As of I September 1998, J IS replies had been received.
COMMENTS AND SUMMARY FINDINGS
Numbers The number of fellowships and study tours increased over the previous biennium. Study tours experienced a higher level of growth than fellowships and accounted for about JS% of all awards in 1996-1997. Fellowships were used by most countries in the Region while study tours were used mainly by eight countries (Table I).
Duration Study tours and fellowships of less than one month duration now account for 66% of all awards (Figure I). As current guidelines and administrative procedures were developed primarily for longer term awards, a shift to shorter term awards suggests the need for a reappraisal of programme processing, delivery, administration and evaluation. Appropriate selection processes, administrative procedures and the setting of achievable programme objectives are critically important when the cost per person month is higher and there is limited time for language study, cultural adjustment and programme refinements.
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Retention rates Retention rates appear to have improved over the previous biennium. While this study has not identified any significant improvement in the professional position of fellowship and study tour participants on their return, it is clear that these resources are not being lost from the health system
WPRlRC49IINF.DOCJl pagel
from which they were selected. Approximately 94% of fellows returned to the same employer and same position; while 5% returned to their home country in a related or better position (Figure 2).
Outcomes Almost 60% of respondents stated that their programme objectives were fully met. A further 29% stated that their objectives had been met to some extent (Figure 3). The evidence gathered in
this study suggests that the majority of fellows are actively using the experience and knowledge gained during the fellowship experience to contribute to health services development in their home
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country. More than 80% of fellows stated they were training and informing others, approximately 68% had introduced new methods and techniques into their work place and more than 30% of respondents used their training in further research work in their home institutions (Figure 4).
Constraints The most common reason cited for participants failing to fully achieve their fellowship objectives was insufficient time. This suggests that fellowship objectives may not be being critically examined in terms of the duration allowed or that budgets are determining duration rather than the programme's objectives. Inability of the host country to provide specific programme elements was the second most common reason for programme objectives not being fully met. An inappropriate choice of host country destination and language difficulties were also cited as impediments. There
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were also indications that more support was needed to determine a receiving institution's ability to deliver training which was relevant to the situation in the fellow's home country. These reasons are in contrast to an earlier study which identified frustration felt by some fellows that their services were not fully utilized on their return to their home institution.
PROFILE OF FELLOWSHIPS AND STUDY TOURS
Information on numbers of fellows, profession, duration of award, country of origin, destination and field of study were taken from the Regional Office database.)
Data are provisional. The database is currently being refined to improve the accuracy of the data and to support further analysis, for example on gender aspects offellowships.
WPR/RC49IINF.DOC.l2 page 4
Number of fellowships and study tours awarded There were 983 fellowships and 543 study tours awarded in the 1996-1997 biennium. This was an increase of 187 fellowships and 153 study tours over the previous biennium. Study tours continue to increase at a faster rate than fellowships and have more than doubled in number since 1992-1993 (Figure 5).
Fellowships and study tours by country of origin China accounted for the largest number of fellowships in the Region. The 129 fellows from China represented 13% of all fellowship awards. China (129), Viet Nam (94), Malaysia (91) and the Philippines (72) accounted for about 39% of all fellowships awarded in the biennium (Table I). China also accounted for the largest number of study tours. The 167 study tours from China represented 31 % of all study tour awards. Viet Nam (158) accounted for 29% of study tours. While fellowships are the preferred award for most countries in the Region, Cambodia, China Mongolia and Viet Nam used more study tours than fellowships.
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Fellowships by country of destination The majority (66%) of fellowships were undertaken in the Western Pacific Region. The second most popular destination was the Americas Region (20%). The remainder of fellowships were undertaken in other regions (Figure 6).
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Fellowships and study tours by duration of study Fellowships of less than six months duration accounted for the majority of awards. About 66% of all awards (fellowships and study tours) were for periods of less than one month (Figure I). There is an increasing trend towards shorter fellowships and study tours. China, Mongolia and
Viet Nam account for almost 50% of fellowships and study tours of less than one month. Other countries in the Region generally use more fellowships and study tours than Pacific island countries, However, Pacific island countries clearly demonstrate a preference for fewer, but longer, awards (Figure 7).
WPRlRC491INF.DOC.12 pageS
Average cost of fellowships aod study tours In 1996-1997 expenditure on fellowships and study tours totalled US$ II 297 000 (Table 2). Table 3 shows the estimated cost per person month of training for fellowships and study tours combined. An impact study of the fellowships programme which assesses the usefulness, impact and cost-effectiveness of awards of different duration is under consideration.
Field of study Public health sCiences continues to be the most popular field of study for fellowships,
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accounting for about 32% of all fellowships.
It is followed by postgraduate specialities, which
accounts for about 17% of fellowships. Compared with the previous biennium, there were increases in the numbers of fellowships in medicine, postgraduate specialities and environmental health. There were fewer fellowships compared with the previous biennium in diagnostic and laboratory sciences; nursing; education, communication and research; and public health sciences (Figure 8).
PROFILE OF PARTICIPANTS
Age More fellows in 1996-1997 came from the 40-49 year age range than from any other age range (Figure 9).
Profession Three health professions accounted for the majority of all fellowships awarded in 1996-1997 (Figure 10). Although the percentage of doctors has been falling gradually in favour of the nursing professions, medical doctors still account for 30% of fellowships compared with around 20% for nurses.
WPRlRC49IINF.DOC.l2 page 6
Table 1. Fellowship numbers by country and area, 1996·1997 (Western Pacific Region) Fellowships (total nos.) Nauru French Polynesia Tokelau Guam Brunei Darussalam Hong Kong Northem Mariana Islands Japan Niue American Samoa Tuvalu Macao Australia/New Zealand Marshall Islands Singapore Palau Cook Islands Micronesia Tonga Kiribati Papua New Guinea Cambodia Vanuatu Solomon Islands Fiji Samoa Lao People's Democratic ReQUblic Rellublic of Korea Mongolia Philippines Malaysia Viet Nam China Study tours (total nos.)
1 1 3 3 4 4 4 6 7
8 9 10 12 12 13 15 16 18 18 27 33 34 39 44 48 48 49 54 57 72
0 2 0 0 0 0 0 0 0 1 0 0
-
0 0 1 0 1 0 1 0
0 58 0
0 6 4 21 18 61 34
-
91 94 129 983
10 158 167 543
WPRlRC491INF.Docn page 7
Table 2. Cost of fellowships and study tours Fellowships (total nos.) American Samoa Australia Brunei Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong Japan Kiribati Lao People's Democratic Republic Macao Malaysia Marshall Islands Micronesia Mongolia Nauru New Zealand Niue Northern Mariana Islands Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam ICP Total Study Tour (total nos.) Fellowships and study tours Cost ($'0001
--
8 7 4 34 129 16 48 1 3 4 6 27 49 10 91 12 18 57 1 5 7 4 15 33 72
54 48 13 42 3 18 9
39 94 0 983
1 0 0 58 167 1 6 2 0 0 0 0 21 0 10 0 0 61 0 0 0 0 0 0 34 18 4 1 0 0 1 0 0 158 0 543
48 69 27 283 2989 171
491 17 46 112 76 213 250 57 576 79 267 531 2 41 34 102 83 290 657 891 482 198 289 36 245 42 224 1061 318 11297
WPRlRC49IINF.DOC.J2
pageS
Table 3. Estimated cost per month of fellowships and study tours, 1996·1997 (Western Pacific Region) Estimated cost per month In US $ 457 3136 9000 1199 2640 583 1252 n.a. 793 4000 1266 1283 1 412 n.a. 3254 1067 1 517 2751 n.a. n.a. 395 2125 1930 1464 5763 2846 732 1534 570 972 1655 538 682 2713
American Samoa Australia Brunei Darussalam Cambodia China Cook ISlands Fiji French Polynesia Guam Hong Kong Japan Kiribati Lao People's Democratic Republic Macao Malaysia Marshall Islands Micronesia Mongolia Nauru New Zealand Niue Northem Mariana Islands Palau Papua New Guinea Philippines Republic of Korea Samoa SingaQOre Solomon Islands Tokelau Tonga Tuvalu Vanuatu VietNam
-
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)
)
Figure 1. Fellowships and study tours by duration, 1996-1997 (Western Pacific Region)
.Stud y Tours <~ 1 month 29%
IIFello wships <~1 month 37%
CFello wships > 12 months 5%
CFello wships - 7 to 12 months 13%
.Fello wship s - 2 to 6 months 16%
~
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Figure 2. Fellowships and study tours by employment outcome, 1996·1997 (Western Pacific Region) Fellow returned to home country to a related or better po.ition Follow has not returned home 01 to • field a.sociated ";th fellow.hip
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5%
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Fellow returned to same employer and same position
94%
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Figure 3. Extent to which respondents felt their objectives had betn met (Western Pacific Region)
200 180 160 140 120 100 80 60 40 20 0 Fully Some Not Not responded to the question Explanafion (not enough fime) 3
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Figure 4. Use to which respondents put their fallowshlps or study tours (Western Pacific Region)
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Figure 5. Fellowships and study tours, numbers of participants, 1988·1989 to 1996·1997 (Western Pacific Region) lBOO~-------------------------------------------------------------------------------------------
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WPRlRC49/INF.DOC.l2 page 14
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Figure 7. Fellowships by duration, 1996-1997 (person months per country) (selected countries In the Western Pacific Region) 600
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Other Asia includes: Bnmei Dam.IJS.larn~ Hong Kong. China; Japan~ Macao; and Singapore. Other Pacifk: includes: AustraliaINew Zealand, Cook Islands, French Polynesia, Guam. Marman
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Figure 8. Fellowships by field of study, 1996-1997 (%) (Western Pacific Region)
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Figure 9. Fellowships by age, 1996-1997 (%) (Western Pacific Region)
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Figure 10. Fellowships by profession. 1990-1991 to 1996-1997 (%)
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50 45 40
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111990-1991 -1992-1993 [] 1994-1995 C1996-1997
20 15
5
o Doctor Nurse Pharmacist Other
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WPRlRC49IINF.DOC./2 page 19 ANNEX
1.
Official Name (Surname)
Title Address (for official communications) Other Names Date ofBinh
Il.
Qualifications Phone:
Fax:
Objectives of Study
Ill.
COUNTRY DATA
Countries/institutions visited Country Institution Stan Date End Date
WPRlRC49IINF.DOC.l2 page 20
Annex
IV.
VALUE OF YOUR FELLOWSHIP Has the fellowship been valuable (i)
1•
to you? (please explain)
(ii)
to your organization? (please explain)
(iii)
to your country ? (please explain)
--
2•
Is having being awarded a fellowship recognized as valuable by your organization. To what extent do you believe your fellowship training/skills are being used in your current position.
3.
How have you used your fellowship skills/expenence m your orgaruzatJon or elsewhere (I) (ii) (iii)
By informing /training others introducing new methods/techniques. establishing new services conducting research other (please specify)
(iv) (v)
--
WPRfRC49IINF.DOC./2 page 21
Annex
V.
FELLOWSHIP OUTCOMES
1.
To what extent were your fellowship objectives met? FULLY (please explain)
TO SOME EXTENT {QIease e~ain)
NOT MET (please explain)
WPRJRC49IINF.DOC./2 page 22
Annex
Employer at the time of fellowship being granted
Current Employer (if changed)
Position Position
Job Description Job Description
--
z.
Are you still in your home country
?
IY" 3•
I
No (pI,,,, 'p""')
Are you working for Government
IYes 4.
INo
--
Are you working in the same field
I 5.
y"
I
No (pi,,,, 'P',;fy)
Are you working in the same Institution
I
Yes
INo (please specify)
WPRlRC49IINF.DOC.l2 page 23
Annex
6.
Are you in the same Position
7•
Have you been promoted
8.
If you have been promoted, do you believe that your fellowship training contributed to your promotion or change in position.
VI.
DURA nON OF FELLOWSHIP How was the duration of your fellowship determined?
Set by the host institution
-I Yes
Self determined (please explain)
(iii) Determined by others (please specify) Was the duration sufficient to meet your objectives No (please explain)
WPRlRC49IINF.DOC.l2 page 24
VI I.
SELECTION PROCESS Were you involved in a formal selection process?
1.
I Yes
I
No (pI..,. "",I...)
2.
Did you have to meet set selection criteria?
I Yes
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VI I I •
REPORTING OBLIGATIONS Have you prepared any reports commenting on your fellowship programme 1.
Fellowship Tennination of Studies Report (example attached) No (please explain reasons for non completion. It would be appreciated if you would complete the attachment and forward to fellowships either with this questionnaire or under separate cover.)
2.
Utilization of Fellows Services Report (page 2 - example attached) No (please explain reasons for non completion. It would be appreciated if you would complete the attachment and forward to fellowships either with this Questionnaire or under separate cover.)
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