Step 1: Specify the learning goal related to the gap in skills and knowledge

The Learning for Performance process begins by reviewing the human resources for health issues and performance problems/gaps, determining if these issues or problems/gaps require a learning intervention, and if so, specifying a learning goal that is related to a gap in skills and knowledge.

When a learning intervention is part of a response to human resources for health issues, human resources assessments may provide valuable information to guide the development of the learning intervention.

In the context of performance improvement, the result of a performance needs assessment¹ that has identified a performance problem is a key starting point.

Examining existing information about human resources or performance gaps will help insure that:

• A learning intervention (education/training, etc.) is the right solution.
• The learning intervention is tailored to the right level of health worker, in the right place and for the essential skills or competencies.
• Other interventions are also identified that are needed to make sure the learning intervention is successful.
• The learning intervention is designed to help learners transfer skills and knowledge to the job, resulting in improved job performance.

Process

Use Tool #1 Sources of Information Worksheet, Tool #2 (Optional) Human Resources for Health Context Worksheet and Tool #3 Performance Factors Worksheet to record information in this step.

1. Collect and review existing information about human resources for health issues and performance problems/gaps.
2. Describe the gap in performance (skills and knowledge gap) that a learning intervention can address. Information from a performance needs assessment or human resources assessment is especially useful. At this point it is important to:
• Clearly define the problem and identify its cause(s)
• Verify that the problem is related to job performance
• Verify that the problem can be addressed, at least in some part, through a learning intervention.
3. Write a goal or overall objective for the learning intervention. The goal of a learning intervention is a statement that clarifies, in broad terms, what the learner will be able to do after the learning intervention. For example:

Box 6: Sample gaps and goals
Lack of skills and knowledge causing a performance gap	Learning goal
75% of clinic-based health care workers do not know how to perform infection prevention practices to standard to reduce the risk of transmitting infections in health care facilities.	Goal for in-service training: Clinic-based health care workers will be able to perform appropriate infection prevention practices to standard to reduce the risk of transmitting infections in health care facilities.
100% of graduates of the nursing school do not know how to prevent HIV/AIDS infection or provide ART.	Goal for pre-service education: Nursing school graduates will be able to provide HIV/AIDS prevention and ART services according to the national HIV/AIDS service policies, standards and procedures guidelines.

4. Describe the interventions that are planned to address the other performance factors besides skills and knowledge. While training developers do not always have authority to address all performance gaps, it is important to raise missing performance factors with stakeholders or others who can make changes in these areas. This is critical to maximizing the success of learning interventions and ensuring that the trained health workers will have what they need to apply their new skills and knowledge on the job. Also, describe how you will coordinate with those who are responsible for the other interventions to close the performance gap and achieve desired performance.

Helpful Hints

• A performance needs assessment is a good starting point for determining how to develop a learning intervention. Further analysis of the learners, the work environment, the resources and requirements and the job tasks is also needed. Later steps in the Learning for Performance process address these points.
• Sometimes a comprehensive learning intervention can address several performance factors.

Box 7: A comprehensive performance and learning intervention
Private midwives in Ghana wanted to expand their services to adolescents, but they did not have experience or skills in working with clients in this age group. The Ghana Registered Midwives Association, working with IntraHealth International and the PRIME ll project, developed a self-directed learning program that targeted several performance factors to ensure the success of the learning intervention.2
Performance factor	Interventions
1. Clear job expectations	Self-learning materials based on Ghana's National Reproductive Health Service Policy and Standards and international standards in adolescent reproductive health counseling
2. Clear and immediate performance feedback	Faciltator visits and peer-review group sessions for performance feedback and learning from each other
3. Adequate physical environment, including proper tools, supplies and workspace.	Counseling materials (penile models, job aids, etc.) and family planning supplies provided to learners Learning activities that encouraged creative adolescent-friendly modifications to service sites (e.g., private space and separate entry for adolescent clients)
4. Motivation and incentives to perform as expected	(Private midwives were already motivated to expand their services, as noted above) Learning activities examined how health providers' personal values and attitudes toward adolescents can affect their behavior toward adolescents and therefore adolescents' interest in seeking health care from them
5. Skills and knowledge required to do the job	Printed self-study modules with readings, learning activities, self-assessments, role plays and exercises for learning partners covering skills and knowledge in adolescent reproductive health, counseling and education, family planning/emergency contraception/postabortion care and sexually transmitted infections/ HIV/AIDS services for adolescents

Tools

1. Sources of information worksheet -- /
2. Human Resources for Health Worksheet -- /
3. Performance Factors Worksheet -- /

1. Performance Needs Assessment and Human Resources for Health Assessments - A performance needs assessment is an activity to define the gap between desired health worker performance and actual performance, identify missing performance factors that are root causes of the gap, and select interventions to address the root causes. A human resources for health assessment is a large, macro-level activity to identify gaps in a country's capacity to plan, develop and support their health workforce so that health services can meet health needs.
2. Nelson D. Improving client-provider interaction and counseling. PRIME ll Results Review. Chapel Hill, NC, Intrah, 2002. Available Here