The second event of the Webinar Cycle 'The CVSP and the training of health technicians', held on August 20, had as its main objective to share the results of a research developed by the Joaquim Venâncio Polytechnic School of Health (EPSJV/Fiocruz), WHO Collaborating Center for Education of Health Technicians, in partnership with the Virtual Campus for Public Health of the Pan American Health Organization (VCPHPAHO/WHO)  with support from the Spanish Agency for International Cooperation for Development (AECID).

The event was attended by the VCPH coordinator, Gabriel Listovisky; the head of the AECID Health Area, Oriana Ramirez Rubio; VCPH international consultant Isabel Duré; the EPSJV/Fiocruz International Cooperation coordinator, Carlos Eduardo Batistella; and researchers Gabriel Muntaabski and Fernando Santoro. The general objective of the research was to contribute to the expansion and qualification of health technicians' access to the educational materials made available by the VCPH, by analyzing the profile and educational trajectories of health technicians who enroll in the campus' courses.

Several institutions, a single objective: to strengthen the training of health technicians

After Batistella opened the seminar, the floor was taken by Gabriel Listovsky, who also represented Benjamin Puertas, head of PAHO/WHO's Human Resources for Health Unit.

Listovsky began his speech by pointing out that the VCPH, which celebrated its 20th anniversary in 2023, has more than three million users and more than seven million enrolments in its courses, which reinforces its commitment to always seeking to improve its performance to increasingly meet the needs of those workers who maintain national health systems. “There is no health system without human resources. That's why I'm celebrating the cooperative work we've been doing with the Polytechnic School for almost a year now,” he emphasized, stressing the VCPH's commitment and interest in reaching out more effectively to health technicians in the Americas.

According to him, the VCPH has sought to work with prestigious institutions with the capacity to network and develop research activities that enable the VCPH to improve its training work and make decisions based on quality information. Listovsky thanked everyone involved in the study and stressed: “This is just the start of a journey that we will continue to build together. The survey results, which will be presented today, open the door for us to discuss and analyze the best way to continue working to meet the training needs of the health workers who come to the VCPH even better.” Finally, he thanked Aecid for its support, pointing out that the Spanish agency will continue to fund the second stage of the project.

In her speech, Oriana Ramirez Rubio praised the importance of the project and the cooperation context in which it was carried out. She pointed out that international development cooperation is one of the most important public policies in Spain, where it has been endorsed by the International Development Cooperation and International Solidarity Act of January 2023 and by the Sixth Cooperation Master Plan, approved this year, which defines Spanish cooperation from both a strategic and geographical perspective. In this sense, according to her, the regions of Sub-Saharan Africa, the Middle East, and Latin America, in which Aecid has training centers in several countries, are considered priorities. “I believe that Spain is an interesting actor, a strategic ally in the area of triangular cooperation and South-South cooperation, which favors cooperation between equals, between peers,” she explained, pointing out that, in the area of sectoral cooperation, Spain has been raising the banner of gender equality, the importance of the environment and climate change, but is also concerned with strengthening public health institutions, with a view to universal coverage and the right of access to health.

With regard to multilateral cooperation, she highlighted PAHO as a long-standing partner. According to her, in 2017, Spain created a very powerful cooperation fund, which has been renewed every year and which values training actions, especially in virtual form, which proved to be fundamental during the pandemic. “In this context, the partnership with the VCPH is fundamental to strengthening continuing training in the health area, especially for those in remote and underserved regions.”

Speaking on behalf of Anamaria Corbo, director of the EPSJV, Batistella spoke a little about the Polytechnic School, which had celebrated its 39th anniversary the day before the event and which for 20 years has been a PAHO/WHO Collaborating Center for the Education of Health Technicians, as well as being the Executive Secretariat of the International Network and the Ibero-American Network for the Education of Health Technicians and the CPLP Network of Health Technical Schools.

“Since its creation, the EPSJV has been committed to working in the areas of education, research, communication, and technological development to strengthen the training of health technicians. During the pandemic, it became even clearer to us how important it is for health systems to be strengthened and capable of responding quickly and effectively to health emergencies and this means increasingly improving the training of technicians in the sector who, despite being the basis of health systems, remain invisible,” he said, adding that reducing this invisibility is one of the objectives of the partnership with the VCPH.

The research and its results

Fernando Santoro began the presentation of the research, briefly explaining the methodology used to obtain and analyze the available data on health technicians enrolled in CVSP courses from 01/01/2018 to 12/31/2023. (access the PDF of the presentation made by Fernando Santoro and Gabriel Muntaabiski)

He explained that the first step in carrying out the research was to process the data contained in the CVSP database, which originates from the course registration form. “The issue of data processing was mainly due to the ‘occupation’ field on the registration form, which allows the user to fill it out freely,” he explained.

He explained that the users of the Virtual Campus are very diverse. There are people who do not work in a health institution but have training in the area. Of those who work in a health institution, there are those who have training in the area and those who do not. In addition, there are people who have training in the area, but are unemployed and, finally, there are those who do not have training in the area and do not work in health institutions, but are interested in health issues. According to Fernando, at the time of registration, users can choose an option from among the 19 higher education options or choose one of the 23 technical-level occupations, as shown in the table below, constructed from the occupations defined in ISCO-08, published by the International Labor Organization (ILO). However, they can also type in the “other” field the occupation of their choice, if they do not identify with any of the 23 options given. “This leads us to cases of police officers, cooks, or even dancers signing up for courses or cases in which the person does not identify their occupation and types anything just to complete the registration stage,” he exemplified.

The first step, therefore, was to work in this field to recover as many records as possible for analysis. “In December 2023, we were able to identify 340,088 (100%) technical-level users, of which 65,469 (19%) were recovered from the others column,” detailed Santoro.

With the data processed, the next step was to define what type of information would be relevant to the research. This was done by creating a dashboard, using the Power BI tool (see figure below), which can be accessed in real-time through the link: https://app.powerbi.com/view?r=eyJrIjoiNDEzYjFmOWMtZmJiNi00ODY5LWIzNGYtNWZlODRhMTgwZDU3IiwidCI6IjQwMDRiYTU1LTMxNDYtNGFiZi04NGNkLTk1ODUzZjYzYWE0OSJ9

According to the researcher, to create the dashboard it was necessary to define all the filters to be used for the analysis. “We chose to analyze four dimensions: subscribers (users), countries, professions (occupations), and courses. We also created two segmentations for quick filters. One with regard to the period of the survey, which we decided to divide into three: the pre-pandemic (2018 and 2019), the pandemic (2020 and 2021), and the post-pandemic (2022 and 2023),” he said, highlighting the fact that Power BI is a very interactive tool that allows for different analyses, based on the dimensions defined in the survey, according to the information required.

The next presentation was by Gabriel Muntaabski, who gave a small sample of the results of the investigation into the universe of technicians who use the Virtual Campus.

To begin with, he pointed out that the 340,088 technical users mentioned above generated 877,920 enrollments in VCPH courses, with an average of 2.48 enrollments per user. Another clarification is that the research is descriptive and shows trends: “In order to understand the relationships between this data, it is necessary to generate more information through qualitative research, information that will allow us to make increasingly informed decisions”.

The analysis showed that there has been a huge cumulative monthly increase, from January 2018 to December 2023, in the number of technical users on the VCPH, from 28,163 to 340,088. The number of registrations has also grown enormously and continues to do so.

This result tends to confirm that the VCPH was a powerful tool in training workers to deal with the situation during the pandemic. About the post-pandemic period, the analysis of the age of these users, which shows a predominance of people up to 41 years old and a large increase in younger users, also gives us clues as to how the VCPH courses have become a resource used by students in the field in their studies.

Regarding place of work, according to Muntaabski, there were no significant changes during the period studied. The largest percentage of users work in hospitals (42.5%), followed by health centers (25%). The research showed that, except for community agents, who work mainly in health centers, the main groups work in hospitals.

The researcher also presented data on the gender of the technicians who use the VCPH. “Following the trend in the health workforce, the vast majority of technicians at the VCPH are female (79.6%),” he said.

The figures for the occupation of these workers show that of the 23 professions presented earlier by Fernando Santoro, only eight account for 91.87% of the users studied, with 78.26% of the total belonging to the nursing group, including auxiliaries, assistants, mid-level and senior professionals. Of the technical users, community workers make the most use of the resources available at the VCPH. “As you can see, there is a high concentration of a few professions,” said Muntaabski.

Regarding the origin of users, of all the 35 countries in the Americas, eight - Mexico (42.79%), Colombia (30.2%), Ecuador (9.78%), Argentina (3.37%), Chile (3.01%) Peru (2.5%), El Salvador (1.77%) and Guatemala (0.98%) - represent 94.22% of the users studied. This, according to the researcher, points to the enormous possibility of growth in the other 27 countries in the region. “Because of the big population differences between these countries, we also chose to study the number of users per 100,000 inhabitants and so we can see that, among the three countries with the most users, Colombia showed large growth during the pandemic and continues to grow, surpassing Mexico, which was first in absolute number of users,” he added, highlighting the spectacular growth in users in El Salvador, a small country in population terms, in the post-pandemic period, especially because of courses on non-communicable diseases.

What courses do technicians take? Of the 407 courses offered by the VCPH in the post-pandemic, eight gathered 52.14% of users. 'Non-communicable diseases' (29.48%), 'responses to epidemics' (15.6%), and 'zoonoses, neglected diseases, tropical diseases and vector-borne diseases' (11.16%) are the topics that most attract users.

Concerning the skills that users seek to develop, the courses are classified into four categories: knowledge of new protocols and their use; acquisition of techniques or use of specific tools that enable them to work better in their careers; sensitization of teams on priority issues; and health management. As for the duration of the courses, the main choice for technical users of the virtual campus is between 8 and 24 hours.

Another important fact from the survey was the level of completion of the courses. Almost 70% of students passed and only around 5% failed. In addition, more than 98% of users rated the courses as highly relevant. “When we compare these results with those of other international surveys on virtual courses, which indicate a course completion rate of around 12% to 30%, we can say that this is an excellent result,” commented Muntaabski.

Finally, he summarized the main data from the survey, which recorded a large increase in the use of VCPH by technicians since the pandemic, the predominance of women and young people among these users, the concentration of origin in eight countries, the predominance of the nursing area, the preference for taking courses lasting less than 24 hours and on eight specific topics, the high pass rate and those related to the development of technical skills.

Finally, he highlighted the main recommendations resulting from the survey.

• Classification of occupations: continue the task of classifying the “other” field on the registration form for the entire universe of users.

• Data collection: it is important to discuss modifications to the enrollment system to reduce the “Other” category.

• Factors that positively affect demand for courses: initiate a process of qualitative and quantitative research in the eight main countries on the factors that positively affect (good practices) enrollment in VCPH courses.

• Baseline data to identify gaps: promote research on the quantity, quality and location of the health technician workforce in the Americas.

• Communication on the VCPH offer: Promote and/or participate in meeting spaces for health technicians in order to identify training demands and needs and publicize the VCPH offer. Disseminate the results of this survey to the member countries in order to generate a debate on improving access to the VCPH offer.

• Strategic alliances: Strengthen links with governments, academic institutions, organizations and technician training networks in the Americas to strengthen the previous point.

See the final research report in the RETS Library

VCPH: continuity of projects in the permanent search for improved work

Continuing the event, Isabel Duré gave a presentation on the VCPH and what is being done to ensure that the VCPH, which is PAHO/WHO's educational platform, increasingly fulfills its mission of “contributing to the development of the skills and competencies of health professionals, supporting the transformation of public health services and practices in the region of the Americas”.

Isabel began her presentation by highlighting the exponential growth that the VCPH has seen in regards to the number of users - doctors, nursing staff, health technicians and students in the field - who work in hospitals, first level care establishments and management. (access the PDF of Isabel Duré's presentation)

According to her, the major challenge that the VCPH is facing is what to do to reach those who have not yet been reached, especially workers currently in remote and underserved areas and health technicians and community workers. “We aim to strengthen the use of the VCPH in coordination with technical cooperation, to maintain and improve the quality and accessibility of our educational offer, and continually adapt the VCPH proposals to new global trends and international standards,” she said.

In this sense, according to Isabel, the 'AECID 2023-2024 Project - Human Resources for Health in Covid-19: Strengthening capacities to improve the response of health systems', is being fundamental. “The general objective of this project is to strengthen the resilience of health systems through the knowledge of health technicians working at the first level of care and improve their access to virtual education and in its first stage, as we saw in the previous presentations, it sought to characterize the profile and training paths of technical users of the VCPH,” she explained.

In the second stage of the project (2024-2025), the project's specific objectives will seek to recognize and characterize the groups of technical workers who work at the first level of care; identify the most effective pedagogical and technological strategies for this group of workers and improve communication to facilitate access to VCPH courses for this audience, in line with the recommendations made in the first stage, which has already been completed.

To this end, together with the EPSJV/Fiocruz team, a mapping of technicians working at the first level of care and in PHC networks will be carried out to identify their preferences and conditions of access to the training offered. In addition, the idea is to draw up a document with the most appropriate pedagogical and communication strategies to reach this group of workers. Finally, the intention is to present a proposal for a standardized register of all the occupations of health professionals registered with the VCPH.

According to Isabel, the continuation of the research will be able to answer several questions that still need to be answered: How are teams at the first level of care made up in different countries? Under what conditions do technicians undergo the desired training? What are the national legislations for the certification of workers, among many others that, according to her, could be answered through qualitative studies? “We expect that we will have more qualified information that will allow us to promote greater alignment of the VCPH's course offerings with the training needs of technicians in the region, including the creation of new courses; increasing the use of existing courses by technicians, with recommendations for use, and implement specific communication strategies to publicize the VCPH among these workers,” she concluded.

Research aims to show who are the health technicians working in PHC in Latin American countries

To present the project to map health technicians working in primary care in Latin American countries, Carlos Batistella, who is one of the study's coordinators, pointed out that there is a great diversity of technical health workers in the region and that, despite representing the majority of the health workforce in most countries, this group of workers remains invisible due to a lack of knowledge about who they are, what they do and where they work. (access Carlos Batistella's PDF presentation)

“We know that there are similarities and differences between the technicians in these countries which, if analyzed and promoted through articulated dissemination strategies among potential interlocutors in the field of international cooperation, could lead to a strengthening in favor of the development of these professional categories and, consequently, of PHC in national health systems,” he said.

“First of all, I would like to point out that, within the scope of the health technician training networks, we have been working with an expanded concept of this category, including all workers who carry out technical-scientific activities in the sector, from the simplest, which require a low level of training, such as assistants, to the most complex, carried out by higher-level technicians,” she recalled, adding that, in Brazil, the majority of technicians are black women from peripheral areas and from less favored social classes.

Regarding the mapping of technical workers who work in PHC in Latin America, he pointed out that it aims to contribute to regional cooperation and integration processes and that it involves analyzing the historical and political-institutional aspects that shape the organization of PHC in each country; identifying the professional categories, training, functions and practices, forms of work relations and the degree of institutionalization of these workers; describe the general characteristics of the work organization of PHC technicians in the different countries; identify the main norms that define the context in which they work and regulate the work and training of this group of workers; and also mobilize strategic research partners to strengthen their capacity for collaborative work and the production of shared knowledge, as well as to disseminate the products and results achieved.

For the qualitative and exploratory study, 18 Spanish and Portuguese-speaking countries with a history of partnership with the International Network for the Education of Health Technicians (RETS) were initially selected: Argentina, Belize, Bolivia, Chile, Colombia, Costa Rica, El Salvador, Ecuador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela. “The research will be carried out in three ways. The first involves a bibliographical review of articles, theses, and dissertations about the subject over the last ten years. Secondly, there will be a survey and analysis of documents on public policies and regulations governing the training and work of technicians in the countries. Finally, questionnaires and interviews will be conducted to provide information on the composition of teams, roles, professional profiles, access to and participation in training activities, and access to technology for health technicians,” explained the researcher.

Batistella emphasized that all the interviewees will be selected using the so-called “snowball” methodology, which involves the initial selection of some key informants in these countries, who will then refer new participants who can help us build a representative study universe. According to him, the key informants, or seeds, will be selected with the support of members of RETS and other networks with which the research already has a partnership; national advisors and consultants on Human Resources for Health from PAHO/WHO country offices; advisors and consultants from PAHO's sub-regional offices for South and Central America; coordinators of the VCPH country nodes; and regional cooperation and integration entities and organizations, such as the Andean Health Organization (ORAS-CONHU), the Amazon Cooperation Treaty Organization (OTCA) and the Executive Secretariat of the Central American Council of Ministers of Health (COMISCA).

Among the expected products are an electronic publication, in Portuguese and Spanish, with the research findings and an international seminar on the subject. “With this research, we hope to provide an overview of the professional categories - training, functions and practices, links and degrees of institutionalization - of the technical health personnel working in PHC in Latin American countries; the characterization of the organization of PHC work in the countries; and, in a complementary way, strengthen the capacity for collaboration between the members of RETS and its sub-networks,” he concluded.

Save the date: Ibero-American Meeting on Simulation-Based Education for Health Technician Training

The event ended with an invitation for everyone to take part in the Ibero-American Meeting on Simulation-Based Education for Training Health Technicians, which will take place on November 27, 28, and 29 in a virtual and immersive format, free of charge to all those interested in the subject and where they can be in direct contact with experts on the Topic and technicians from all backgrounds and various countries. “We hope to bring together more than 2,500 people who want to deepen their knowledge of this subject and exchange ideas with their peers,” said Gabriel Muntaabski.