Cascade on-the-job training: an innovative approach to increase competencies amongst primary care personnel in use of the WHO PEN protocols in Moldova

Abstract

Introduction Noncommunicable diseases (NCDs) pose global health challenge and are the main cause of premature mortality in Moldova. Primary health care (PHC) centers hold the key to the prevention and management of NCDs. The WHO Package of Essential Noncommunicable (PEN) disease interventions was adapted to the local context and then rolled out at PHC level. The Healthy Life Project supported training of PHC staff in PEN 1 and 2 across 2020-2024. In 2025 a last round of training was targeted to 15 districts where the level of coverage, especially of medical assistants (MAs) of Family Doctors (FD), was below an agreed minimum, acceptable (30%). Aim of the study To assess the perceptions of PHC personnel that experienced the new training approach for PEN 1 and 2. Material and methods The new training was conducted by local trainers (FDs and MAs) in their own districts, at the staff’s workplace, in a flexible manner, without affecting clinical activity. The quality of the teaching process was monitored by national trainers through on-line and onsite visits. In the last round, 746 personnel were trained, including 129 family doctors (FDs) and 617 MAs. The perceptions of the staff trained were assessed based on a standardized data collection tool. The evaluation form was completed by 558 participants, of which 442 were MAs and 116 FDs. The forms were filled in digitally through Google Forms (using links and QR codes), and the collected data was processed and analyzed. Results The findings highlighted a very high level of satisfaction with all the educational dimensions evaluated: 85% of participants mentioned the achievement of the program objectives, 82.6% - the fulfillment of personal expectations, 83.6% - the efficiency of the training. In the analysis of the specific thematic responses, a significant focus on diabetes mellitus is noted. Subthemes such as diabetes treatment and diabetic foot management were frequently associated with the need to strengthen practical skills. Another aspect of interest was effective communication and motivational interviewing, relevant to the doctor-patient relationship. Cardiovascular risk assessment and the promotion of a healthy lifestyle were perceived as fundamental elements of prevention and integrated care. Conclusion Cascade districts training provided by local trainers contributes to the creation of a district-level network that provides support for the subsequent implementation of PEN. The use of PEN tools was perceived as one of the most useful and applicable components of the training. The practical and interactive nature of the training, the applied activities, teamwork and case studies were extremely useful for consolidating knowledge.