1. Introduction
Today tuberculosis is still one of the leading causes of deaths in adults in most developing countries. To fight
against tuberculosis as public health problem, it is as important as ever to develop human resources.
More than thirty years have passed since the international training courses on tuberculosis control started in 1963
in the Research Institute of Tuberculosis(RIT), Japan Anti-Tuberculosis Association.
In these 30 years more than 1000 participants, doctors and laboratory technicians from 68 countries were trained. Now many of those course graduates are actively contributing to tuberculosis control in their own countries and internationally. Here we summarize the history, content and role of the training courses,and attempt of its evaluation.
2. Background and Conditions for the Initiation of the Course
In the end of 1962, one Medical Officer, a technical advisor to Overseas Technical Corporation Agency (current Japan International Corporation Agency) explored RIT*s interest to conduct TB training courses for medical doctors in South East Asian countries as part of Colombo Plan (Japanese Government initiative for development of South East Asian countries after World WarII).
However, foremost important factor for RIT to enable to initiate the course was that Directors and the staff had already appreciated the impact of training to the control programme. Since its foundation in 1939, RIT had been conducting national training courses on tuberculosis for health staff; medical doctors,public health nurses, X-ray technicians and laboratory technicians from all over the country. Especially the medical doctors trained in RIT seemed to have contributed to develop successful nation wide tuberculosis programme.
The first course was unique in a way course organization including all materials for national training courses for medical doctors were translated and conducted. As a result, main emphasis was placed on anatomy, pathology, bacteriologyand clinical aspects of diagnosis and treatment. Dr Mahler, then Directorof TB Programme, WHO/HQ observed the first course and recommended to emphasize more on statistics and epidemiology, which was realized in the following years. Since 1967 the course has been co-sponsored with WHO so that some lecturers could be provided by WHO including its own staff. More than 40 consultants participated for 30 years.
As important part of course, field visit has been continued with eager support of branches of Japan Anti-Tuberculosis Association in each Prefecture.
3.Training Courses
Over the period of 30 years course contents have been and are being changed. according to the change of epidemiological situation such as emergence of AIDS and the development of the standard regimen such as short course chemotherapy and the new policy of Directly Observed Treatment, Short Course (DOTS). As emphasis was placed in basic and clinical aspectsin the beginning, Group Training Course in Tuberculosis Treatment/ Group Training Course of Chest Surgery had been conducted from 1965 to 1974. It was replaced with Group Training Course in Bacteriology since bacteriological diagnosis had become more important in national TB programme. Group Training Course in National Tuberculosis Programme Management (previously called Advanced Group Training in Tuberculosis Control) has been added to update the knowledge and to equip the skill of course graduates who are most lynational TB programme managers.
(1) Group Training Course in Tuberculosis Control
- Starting year: 1963.
- Duration: 4 months.
- Participants: Doctors who are engaged in tuberculosis control in developing countries. The number of participants per course: about 20
- Objectives
By the end of the training course, the participants are expected to be able to:- acquire the basic knowledge and epidemiological, sociological, and managerial skills for tuberculosis control,
- make a proposal of better national tuberculosis control programme to their own countries through evaluation of the on-going national programmes.
- Contents:
- Lectures on (i) Basics for TB such as bacteriology, immunology, statistics, and epidemiology, (ii) Diagnosis and treatment such as x-ray diagnosis and chemotherapy, (iii) Management of TB control programme suchas WHO policy in TB control, sociological aspects and evaluation, (iv) Related subjects such as leprosy and primary health care.
- Workshop/seminar on the problems and improvement of national TB programmes in participants* countries.
- Studytour to local governments, hospitals, public health centres and branches of Japan Anti-Tuberculosis Association and other Asian countries such as the Republic Korea and Viet Nam.
(2) Group Training Course in National Tuberculosis Programme Management
- Starting year: 1973.
- Duration: 6weeks.
- Participants: Leaders in tuberculosis control at national level. The number of participants per course: about 15.
- Objectives:
By the end of the training course, the participants are expected to be able to:- assess the epidemiological status of tuberculosis and its time trend,
- incorporate new knowledge and technology of tuberculosis control intotheir own national programmes,
- evaluate the on-going national tuberculosis programmes in their own countries,
- prepare a management plan for thenational control programme based on the findings as identified by evaluation.
- Contents:
- Additional lectures on (I) statistics and epidemiology,(ii) Diagnosis and treatment such as chemotherapy, (iii) Management of TBcontrol programme such as WHO policy in TB control, and evaluation.
- Workshop/seminar on the problems and improvement of national TB programmes in participants*countries, primary health care and integration of health services.
- Studytour to local governments, hospitals and public health centres in Japan. As feed back from participants indicated, recently more time has been given to discussion and workshop to encourage active participation to discussactual problems in depth.
(3) Group Training Course in Tuberculosis Control Laboratory Services
- Starting year: 1975.
- Duration: 4 months.
- Participants: Doctors and laboratory technicians who are engaged in laboratory work in developing countries. The number of participants: about 8.
- Objectives:
By the end of the training course, the participants are expected to be able to:- understand the importance of bacteriological examination in tuberculosis control such as case finding and evaluation of treatment,
- understand the way to isolate culture and to stain of Mycobacteria,
- conduct the sensitivity test for anti-tuberculosis drugs and
- manage and evaluateTB laboratory system.
- Contents:
- Lectures on basic knowledge on TB control programme such as epidemiology, chemotherapy and case finding andon bacteriology of TB
- Practice on direct smear examination, culture examination and identification test.
- Practice and workshop on TB laboratory management.
- Study tour to research institutes, pharmaceutical firms, and health centres in Japan.
(4) Individual Training Courses upon ad hoc request
There were 99 medical doctors and laboratory technicians from 19 countries to receive individual training. Upon the request of each participant, programmes were tailored.4. Evaluation
(1) Short term Immediate evaluation has been attempted using questionnaires for lectures and practices during the course. Free discussion with participants and course director and facilitators has been held in the end of the course. Both information are used for improvementof the content for the course of the year after. One year after the course,a questionnaire is sent to each ex-participant to describe the status of the implementation of action plan which is prepared during the course.
(2) Long term The accumulated number of participants (more than 1000) for longperiod of 30 years itself may mean that the courses have been well accepted by participants. According to the results of questionnaires among course graduates conducted in 1989 and 1990, 85% of course graduates remained in the service of national TB programmes in their own countries. One typical example of good impact of training is that a clinician had become to understand well epidemiology and control programme. In 28 out of 68 countries, course graduates held the top positions of director of national TB programme or national TB centre. Some have become key persons in TB control including Drs M. Shrestha and V. Yamamoto, former Ministers of Health in Nepal and Peru respectively and Dr Arata Kochi, Director of WHO Global Tuberculosis Programme.
5. Follow-Up Activities
In order to communicate with and encourage exchange of information between RIT and course graduates, News Letters of Research Institute of Tuberculosis have been published twice a year since 1989. Articles include the latest news on activities of RIT, reports from course graduates on their work and research activities and letters from lecturers for the course.
Other efforts are to visit the course graduate severy 3-4 years and have individual interviews and hold meetings and small seminars as necessary. So far we visited 5 countries in Asia. Followings are activities of RIT requested during the visit by course graduates asfollow-up activities;- Strengthening of linkage between course graduates and RIT through regular In addition, in any international meetings and conferences such as IUATLD meeting, reunion meetings are held.
- Distribution of up-to-date information to course graduates from RIT.
- Support from RIT in research activities.
- Regular visit of staff members of RIT to course graduates.
- Holding Regional seminars with neighbouring countries.
With the above activities we would like to strengthen our network with course graduatesand promote global tuberculosis control programme.