Human Resource Care Worker

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ETHIOPIAN FOOD, MEDICINE AND HEALTHCARE

ADMINISTRATION AND CONTROL AUTHORITY

Continuing Professional Development (CPD)

Guideline for Health Professionals in Ethiopia

March, 2013

Addis Ababa

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Table of contents

Glossary 3 Acronyms 4 Forward 6 Introduction 7 Purpose of the Guideline 8 Scope of the Guideline 8 Chapter One: Standards of CPD for Health Professionals in Ethiopia 9 Chapter Two: Continuing Professional Development Course Accreditation 12 Chapter Three: Credit Point Requirement and Allocation 16 Chapter Four: Accreditation of CPD Providers 18 Chapter Five: Roles and Responsibilities of Stakeholders in CPD Accreditation 22 Chapter Six: Monitoring and evaluation of CPD Accreditation 26 Annexes 30 3

Glossary

1. “Continuing Professional Development (CPD)” is defined as a range of learning activities through which health professionals maintain and develop throughout their career to ensure that they retain their capacity to practice safely, effectively and legally within their evolving scope of practice.

2. “Accreditation” is a type of quality assurance process, under which potential CPD providers and courses are evaluated by an Accreditor to determine if applicable standards are met.

3. “Continuing education unit (CEU)” is a unit which indicates the value attached to a learning activity for CPD

4. “Accreditor” refers to any mandated body by EFMHACA including professional association to pre-accredit CPD providers and courses for later approval by EFMHACA

5. “CPD Providers” are public or private institutions including Universities, Health Science colleges, Professional Associations and other training institutions who meet the criteria and have been accredited by FMHACA or its designated accreditor to present learning activities for Continuing Professional Development 6. “Health professional” means a health care worker involved in the preventive, curative, promotional or rehabilitative health care services licensed by FMHACA or regional health regulatory bodies.

7. “Professional association” is a group of people in a learned occupation who are entrusted with maintaining control or oversight of the legitimate practice of the occupation

8. ‘’Enduring Materials’’ are independent CPD learning materials in which the health professional learns through electronic media like CD-ROM, materials downloaded from internet, satellite broadcasts, etc

9. ‘’Live Activities’’ are CPD activities that take place in a face to face interaction between the learner and facilitator.

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Acronyms

CEU – Continuing Education Unit

CPD – Continuing Professional Development

EFMHACA – Ethiopian Food, Medicine and Healthcare Administration & Control Authority

EMA- Ethiopian Medical Association

EPA- Ethiopian Pharmaceutical Association

ENA- Ethiopian Nurses association

EPHA- Ethiopian Public Health Association

EMLA- Ethiopian Medical Laboratory Association

FMHACA – Food, Medicine and Healthcare Administration & Control Authority FMOH – Federal Ministry of Health

HRD – Human Resource Development

HRH – Human Resource for Health

HSDP – Health Sector Development Plan

IST – In-Service Training

NGO – Non Governmental Organization

PA – Professional Association

RHBs - Regional Health Bureaus

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Acknowledgment

The Ethiopian Food, Medicine, Healthcare Administration and Control Authority (FMHACA) would like to acknowledge the following individuals and organizations for actively participating in the development of this National CPD Accreditation Guideline.

Dr. Solomon Worku (Jhpiego)

Dr. Fitsum Girma (FMOH/Jhpiego)

Mr. Nigussie Debero (EPA)

Mrs. Rahima Shikur (FMOH)

Dr. Tola Tolesa (EMA)

Mrs. Tsehay Shimelis (ENA)

Mr. Asaye birhanu (EMLA)

Mr. Tesfa Demelew (EPHA)

Dr. Hamza Adus (I-TECH)

Mr. Dereje Shimels (Tulane Univesity)

Dr. Bizunesh Tesfaye (Intra Health)

Dr. Samuel Mengistu (jhpiego)

Mr. Mesafint Abeje (FMHACA)

Mrs. Mastewal Kerebih (FMHACA)

Mrs. Abrehet Gidey (FMHACA)

Mrs. Yenenesh kassaye (FMHACA)

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Forward

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Introduction

Health professionals must maintain, update and enhance their knowledge, skills and attitude in order to adequately deliver quality health care. This is particularly important due to a changing disease pattern in which diseases that had been eradicated are now reemerging, as well as an increase of non-communicable diseases. There is a need for CPD in order to maintain professional competence in an environment of numerous challenges, rapid organizational changes, information technology, increasing public expectations and demand for quality and greater accountability. The Federal Ministry of Health (FMOH) of Ethiopia is committed to ensure the quality and standards of health services in the Country. One of the five strategic areas on which human resource development (HRD) should focus as identified by the health policy of Ethiopia is developing appropriate continuing education for all categories of workers in the health sector. Besides, ensuring that health science education and training is responsive to the health needs of the nation is one of the strategic objectives of the national Human Resource for Health (HRH) strategy. Moreover, initiating and strengthening continuing education including in-service training is an essential objective of the HRD component of the fourth Health Sector Development Plan (HSDP IV). Currently, CPD activities in Ethiopia are fragmented as there are no standardization, regulation and accreditation mechanisms. Besides, CPD activities have never been linked to re-licensure of health professionals. Hence, the Ethiopian Food, Medicine, Health Care Administration and Control Authority (EFMHACA), the legally mandated agency to license and re-license federally regulated health professionals, believes that CPD should be systematically organized, tied to relicensing system and occur in concerted with other developments in health care system so as to improve the quality of health services.

The Ethiopian Food, Medicine, Health Care Administration and Control Authority firmly believes that there needs to be a CPD system to help maintain and enhance professional competence and ensure quality health services in the country. Therefore, 8

in order to set up a CPD system in the country whereby CPD is standardized, accredited and tied to re-licensure, EFMHACA has prepared this guideline with the technical support of HRD Directorate of FMOH, development partners, professional associations and training institutes. This guideline will be followed by an implementation plan which outlines a phased approach in undertaking the activities for the establishment of the CPD system.

Purpose of the Guideline

With the ultimate aim of improving the health status of Ethiopians through the delivery of quality health services by competent health professionals, this guideline helps to establish a CPD system in the country through outlining the process of accreditation of CPD courses and CPD providers and linking CPD with re-licensure. The objective of this guideline is to provide guidance:

The standards of CPD

The overall CPD accreditation of courses and providers

Course credit designation

Responsibilities of major stakeholder on the implementation

Documentation and monitoring, and evaluation of CPD process Scope of the Guideline

This guideline will govern all health professionals who are licensed by EFMHACA and regional health regulatory bodies.

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Chapter One: Standards of CPD for Health Professionals in Ethiopia

A. Features of CPD

Continuing Professional Development (CPD) refers to all activities health professionals undertake formally so as to maintain, update and develop their knowledge, skills and attitudes in response to the health service needs of the public.

Continuing Professional Development denotes to the period of education and training of health professionals commencing after completion of basic or post graduate health professional training.

Continuing Professional Development is a broad concept referring to the continuing development of the multi-faceted competencies inherent in health services covering wider domains of professionalism needed for high quality professional performance. It aims to maintain and develop competencies of individual health professionals essential for meeting the changing needs of patients and the health service system and responding to the new challenges of scientific development.

Continuing Professional Development must serve the purpose of enhancing the professional development (what is relevant to current practice and the profession) of health professionals.

Continuing Professional Development should occur when 1) there is a clear need 2) learning is based on the identified need 3) there is follow up to reinforce the learning is accomplished.

The content of CPD courses 1) should be tailored to fill gaps in knowledge, skills and attitudes 2) need to be diversified depending on each category of health professionals nature of practice 3) may include theoretical knowledge and skills in the area of professionals’ practice, team building and leadership, communication, professional ethics, teaching, research and administration 10

B. Continuing Professional Development Principles

Continuing Professional Development should be recognized as an integral part of health professionals’ practice reflected in budgets, resource allocations and time planning. Continuing Professional Development activities ought to be appropriately managed and resourced.

Health professionals should have protected time and opportunities to participate in CPD activities.

Continuing Professional Development activities have to be provided in settings and circumstances that are conducive to effective learning. Physical facilities, skills training equipment and work schedule should be evaluated and updated regularly for their appropriateness in providing adequate context and conditions for CPD.

Systems have to be established to document recognized CPD activities in a systematic and transparent way. Documentation of CPD must be used as a learning tool as well as providing feedback on relevance and quality for planning of CPD.

There must be a system for recognition of CPD providers and the individual CPD activities.

The provider of CPD activities must meet agreed educational quality requirements.

C. Modalities of CPD Courses Delivery

The CPD course should encompass integrated practical and theoretical components in order to enhance quality of health services. It can be given in the form of self-paced learning, live and/or blended programs. In self-paced programs, the learner works on his/her own pace without interacting directly with a facilitator whereas in live programs group of learners need interact with a facilitator for example, group based training. Blended sessions are mix of both self-directed and group based learning.

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Continuing Professional Development should take advantage of variety of learning modalities including courses, lectures, seminars, participation in conferences, research project and study visits.

Continuing Professional Development can be delivered through information technology and distance learning. Variety of media such as: a) Print material b) Enduring material (non-live CPD activity - videotape, monograph, or CD Rom c) Distance learning using technology such as: Audio-conference, Videoconference and Internet webcast

Relevant use of information and communication technology can function as an integrated part of CPD process.

D. Continuing Professional Development Need Assessment

Two approaches will be used for CPD need assessment: top-down and bottom- up approaches.

In top down approach, FMOH, FMHACA and Pas will recommend relevant CPD activities for health professionals based on new scientific development, revised national guidelines and changes in health services delivery.

In bottom up approach, health professionals will identify their own individual learning needs based on their performance appraisal and ability to accomplish annual plans. Then the identified CPD needs shall be revised and approved by the immediate supervisor. The immediate supervisor will send compiled needs in the unit/directorate to the responsible unit or directorate in the facility or organization. Eventually, compiled CPD needs will be present at the facility, Woreda and regional level.

Regional Health Bureaus and FMOH will collaborate with CPD providers for the provision of CPD courses and activities for the health professionals based on the CPD needs identified using the above two approaches. 12

Continuing Professional Development providers must seek information from the target health professional audience, professional association, training institutions, regulatory bodies and FMOH as the basis for planning CPD activities. E. Continuing Professional Development Monitoring and Evaluation

Continuing Professional Development process, provider and courses should be monitored.

Carefully planned and targeted feedback from participants of CPD must be systematically sought, analyzed and acted upon and the information made available to stakeholders.

Continuing Professional Development course evaluation should involve experts in subject matter and curriculum. It should also address the context of the learning process (include the organization and resources as well as learning environment), the structure and specific components of CPD (include program description and intended outcome) and learning outcomes. Chapter Two: Continuing Professional Development Course Accreditation

Guidelines and Criteria for Accreditors

FMHACA may delegate the function of accrediting service providers and activities to Accreditors with the mutual agreement with the Accreditor. FMHACA may find it practical to assign profession specific accreditors.

Accreditors are institutions appointed by FMHACA on the basis that they meet the criteria set out. The role of the Accreditor is to review and pre-accredit applications for the provision of CPD activities and send the pre-accredited documents to FMHACA for approval; to monitor these activities; and to revise continuing education units (CEUs) allocated where the provider failed to comply with the rules and regulations of the CPD guidelines. 13

Potential Accreditors should apply to FMHACA to function as an Accreditor. Accreditors who fulfill the criteria set below shall be appointed by FMHACA (CPD Committee) to function for 5 years.

Professional associations, tertiary institutions involved in health sciences education and other training institutions shall be considered as potential accreditors. However, priority shall be given to professional associations if all the potential accreditors compete for accreditation status.

The appropriate infrastructure and human capacity need to be set up by an Accreditor to facilitate proper administration of records. This infrastructure includes access to the internet and fax services and dedicated administrative support.

The Accreditor should establish a designated panel composed of at least five relevant professionals to perform its pre-accreditation responsibility. A record of all applications received, as well as their outcomes and a record of the minutes of all panel meetings is to be kept for at least five years.

In the case of contentious or problematic applications where the designated committee cannot reach a decision (or in the case of an appeal by the provider), such an application, with supporting documentation, should be referred to FMHACA CPD Committee.

In the presence of conflict of interest, the application for course/provider approval shall be referred to an independent Accreditor for review.

The FMHACA CPD Committee may randomly conduct quality assurance checks of Accreditors. Accreditor status may be reviewed and/or revoked after such quality check(s) or should any critical incident be brought to FMHACA’s attention. 14

Accreditation of CPD Course

It refers to the process through which FMHACA or its delegated Accreditors ensure that CPD activities meet acceptable standards of education (set in this guideline and FMOH IST Implementation Guide) that help maintain the standards of health care. Process of accreditation of CPD courses

To obtain accreditation for a CPD course:

1. The course accreditor shall be contacted for guidance on applying for accreditation of the CPD course.

2. When the CPD course is ready for review and accreditation, FMHACA accreditation form (Annex A) shall be filled in and returned with all relevant documentation to the course accreditor. The application should be submitted at least three months before the anticipated date of implementation of the CPD course.

3. The person receiving the application form at the accreditor office shall: i. Check the form and attached documents for completeness ii. Assign Application Number and a Professional Category to the application after reviewing it adhering with the review guide principle (see table below). The number will serve as a means of tracking progress in the review process. In reviewing the application, the course accreditor will check:

The purpose for the proposed CPD course

If the course fits the proposed target audience

If the course is based on perceived and objective CPD needs or results of assessment of training needs

The educational methods selected permit the realization of the learning objectives

Arrangements to evaluate the course with regards to content, process and outcome

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The CPD provider shall declare absence of commercial interest by presenting the signed agreement between the sponsoring organization and the provider.

The appropriateness of credit point designation

The venue indicated for conducting the CPD activity should be physically adequate to meet the CPD course’s stated objectives.

The course must have non-promotional commercial sponsorship Upon demand for expert review, the accreditor may request such review from an expert who shall not be author or presenter of the program, not employee of the provider or in any way would be in conflict of interest. 4. The course accreditor will forward the pre- accredited course with all the required documents to FMHACA for approval.

5. Upon receipt of the application, FMHACA approves the course against criteria listed in the table under CPD course accreditation process. 6. Then, FMHACA assigns a registration number to the activity which will be used in all announcements and certificates to be issued to participants. Publicity of CPD course

Continuing Professional Development courses must be publicized accurately with sufficient information provided to allow a potential participant to attend. Information Awarding Credits for CPD course

The amount of time a health professional takes to complete the course satisfying the purpose and/or learning objectives should be well estimated.

Credit hour designation should be determined based on the estimated or reasonable amount of time spend for learning to occur. 16

provided should include: Name of the CPD provider, CPD title; Course director and relevant qualifications; Course objectives; Description of the course content; Method of CPD delivery; Venue, date, time (for live programs); CPD accreditation statement (type, No. of credits assigned); Fee.

Chapter Three: Credit Point Requirement and Allocation All courses so designated for, or awarded, credit will be subject to review by the course accreditor during the accreditation process as verification of fulfillment of the accreditation requirements. Credits points can be claimed and earned for all kinds of courses attended either locally or abroad via internet or live as long as the courses are relevant to the health professional work context.

Recognizing credit points for re-licensure

Credit points for a CPD course shall be obtained only if the course received is accredited by a Course Accreditor and approved by FMHACA

For CPD courses or activities received from abroad, credit points shall be considered as reported if the courses or activities have designated credit points. However, if courses do not have assigned points, the course duration can be used to estimate the equivalent credit points as seen in the table below.

Credit points should only be claimed if the activity or the course is relevant to the applicants practice

Professionals in all health science fields are required to earn at least 30 (CEU) per year and 150 CEU per five years to get a re-licensure. List of activities that qualify CPD and their respective CEUs allocated are shown in table 1 below.

Professional associations may come up with their recommendations on credit point’s requirements for their respective profession. 17

The maximum credit point that can be earned from a single CPD course shall not exceed 15 CEUs.

Credit points should be earned from a particular course only once within a licensure period.

CPD credit points collected during one budget year cannot be transferred to another year.

A trainer shall not be awarded credits for delivering the same course more than once.

Professionals attending courses leading to a degree may not be obliged to fulfill the credit points requirement for that year.

Table 1: CPD Activities and their respective allocated CEUs Category I activity Credit Credit (CEU)

In-service training (group based) 1 CEU per 1 contact hour Workshop 0.5 CEU per 1 hour of attendance

e-learning (enduring materials, on-line etc) 1 CEU per 1 hour of engagement Scientific Conference 0.25 CEU per 1 hour of attendance Review a research article for journal 3 CEU per article reviewed Publish a research article in a peer reviewed journal Principal author

Co-author

20 CEU per article

10 CEU per article

Chapters in a book/training module in area of specialization: 1st (or single) author

2nd author (and beyond)

10 CEU per chapter or module

5 CEU per chapter or module

Writing a book in area of specialization All the required CEUs per annum Presentations in conference

Oral presentation

Poster presentation

10 CEU per presentation

5 CEU per presentation

Delivering training/workshop 2 CEU per 1 hour session Guest lecture (applies to non-routine tasks) 2 CEU per 1 hour session Panelist 1 CEU per 1hr of engagement

Assessing masters or doctoral thesis 5 CEU Per Thesis Note: A maximum of 6 hours shall be considered for a day CPD activity 18

Chapter Four: Accreditation of CPD Providers

Institutions and organizations that possess the expertise in conducting CPD activities at a national level can be recognized as CPD Providers. They are eligible to plan conferences, courses, symposia, seminars and other educational Activities for CPD. An institutional recommendation is based upon meeting the standards required for the licensure program, as indicated by successful performance on all required assessments by FMHACA.

Content Validation

The CPD activity must be based on evidence that is accepted within the discipline of health sciences.

Course accreditors are responsible for validating the content of CPD activities that they provide.

Authors

The provider must submit evidence of the expertise by training or experience of the program author

The author must offer an unbiased, factual and evidence-based program for participants to determine the most appropriate course of action for their practice setting

The author for each program must be competent in the subject matter and experienced and/or trained in the methods of the program delivery 19

Instructional Materials for Participants

The provider must offer educational materials for each CPD activity that will enhance participants' understanding of the content and foster applications to professional practice.

All the instructional materials offered must be of satisfactory technical quality, current in content, and designed to enhance the participants’ understanding of the topic.

The provider is encouraged to provide material adapted to the needs of the participants. This material may include the following elements, among others: Slides (Power Point); Bibliographical list; Text of complementary readings suggested by the author; Text summarizing the training, etc.

Reference: A full reference list must be provided in all instructional materials; Providers are responsible for verifying reference sources. For Enduring Material

The provider must communicate the following information to participants so that they are aware of this information prior to starting the educational activity: 1. Principal faculty and their credentials

2. Medium or combination of media used

3. Method of participation in the learning process 4. Estimated time to complete the educational activity (same as number of designated credit hours)

5. Dates of original release and most recent review or update

For CPD activities including those in which the learner participates electronically

(e.g., via Internet, CD-ROM, satellite broadcasts), all required information must be transmitted to the learner prior to the learner beginning the CPD

Providers that produce enduring materials must review each enduring material if indicated by new scientific developments.

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Internet CPD

Live or enduring material activities that are provided via the Internet are considered to be Internet CPD. Internet CPD must comply with all CPD Essential Areas and Elements. However, there are special requirements for Internet CPD because of the nature of the activities:

Activity Location: the accredited providers may not place their CPD activities on a website owned or controlled by a commercial interest. Links to Product Websites: With clear notification that the learner is leaving the educational website, links from the website of an the accredited provider to pharmaceutical and device manufacturers product websites are permitted before or after the educational content of a CPD activity, but shall not be embedded in the educational content of a CPD activity.

Transmission of information: For CPD activities in which the learner participates electronically (e.g., via Internet, CD-ROM), all required information must be transmitted to the learner prior to the learner beginning the activity. Hardware/Software Requirements: The accredited provider must indicate, at the start of each Internet CPD activity, the hardware and software required for the learner to participate.

Provider Contact Information: The accredited provider must have a mechanism in place for the learner to be able to contact the provider if there are questions about the Internet CPD activity.

Policy on Privacy and Confidentiality: The accredited provider must have, adhere to, and inform the learner about its policy on privacy and confidentiality that relates to the CPD activities it provides on the Internet.

Copyright: The accredited provider must be able to document that it owns the copyright for, or has received permissions for use of, or is otherwise permitted to use copyrighted materials within a CPD activity on the Internet.

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Process of CPD provider Accreditation

1. Potential CPD provider shall present a course to be eligible for application. 2. Application shall be made 3 months prior to the start of the course by the CPD provider.

3. Letter of application shall be sent to an accreditor designated by EFMHACA for review and pre-accreditation.

4. The accreditor shall review the application and relevant accreditation documents to pre-accredit the provider

5. The accreditor forwards the application and pre-accreditation documents to EFMHACA for approval

6. EFMHACA shall review the pre-accreditation document for approval. 7. EFMHACA shall register and certify the provider. Renewal of Accreditation - criteria and documentation Accreditation will be renewed on the basis of evidence that the CPD provider is continuing to meet the requirements of Accreditation. A CPD provider seeking to renew its Accreditation must provide an updated version of the documentation 2 months prior to license expiry date.

Renewal of Accreditation - Visits to the provider and Report to the Accreditation office

The Renewal of Accreditation Inspection will usually take the same form as the initial Accreditation visit; however, the accreditation office reserves the right to undertake an extended review. Accreditation visit for renewal can be done by the accreditor if the submitted documentation for renewal is not satisfactory. It is expected that renewed Accreditation will normally be granted for a period of 5 years. 22

If a CPD provider fails to meet the requirements (see Annex E), the status will be subject to reconsideration by the accreditor. The Accreditor also reserves the right to visit any of its accredited CPD providers at any time in the light of evidence from an institution’s Annual Course Review, from its Annual Report or if there is a substantiated reason for doing so.

Chapter Five: Roles and Responsibilities of Stakeholders in CPD Accreditation

1. Food, Medicine and Healthcare Administration & Control Authority

(FMHACA)

I. The Authority will establish a CPD Accreditation Committee composed of at least seven members from professional associations, HRD Directorate of FMOH, teaching/training Institutions and other relevant stakeholders. The committee will develop its own rules of procedure and chaired by FMHACA. The roles and responsibilities of the committee shall be as follows.

It develops implementation guidelines and manuals for a uniform system of CPD that will accommodate the diversity of health professions.

Appoints new accreditors or reappoints the existing accreditors every five years

Give CPD provider accreditation status based on the set criteria whenever accreditors apply for CPD provision

Approve CPD courses and CPD providers pre-accredited by Accreditors.

Ensures that high standards are set and maintained for Accreditors and Accredited CPD Providers.

Investigates

Contact this candidate