Abt Associates Inc. n 4800 Montgomery Lane, Suite 600
Bethesda, Maryland 20814 n Tel: 301/913-0500 n Fax: 301/652-3916
In collaboration with:
Development Associates, Inc. n Harvard School of Public Health n
Howard University International Affairs Center n University Research Co., LLC
 Funded by:
 U.S. Agency for International Development
Technical Report No. 57
Jordan Training
Results Evaluation
January 15, 2001
Prepared by:
Shirl M. Smith, M.A.
PHR Training Officer
Howard University
Lonna T. Milburn, Ph.D.
PHR/Jordan Resident Advisor
Abt Associates Inc.
Jamal Abu-Saif, M.D.
PHR Counterpart for Training
Ministry of Health, Jordan
Manal Shahrouri, B.A.
Training Coordinator, PHR/Jordan
Abt Associates
Janet Edmond, M.P.H.
Program Officer
Development Associates
Anthony Mensah, B.Sc.
ANE Project Assistant
University Research Corporation
Joanne Jorissen, B.A.
ANE Project Assistant
Abt Associates Inc.
Mission
The Partnerships for Health Reform (PHR) Project seeks to improve people’s health in low- and
middle-income countries by supporting health sector reforms that ensure equitable access to efficient,
sustainable, quality health care services. In partnership with local stakeholders, PHR promotes an
integrated approach to health reform and builds capacity in the following key areas:
> better informed and more participatory policy processes in health sector reform;
> more equitable and sustainable health financing systems;
> improved incentives within health systems to encourage agents to use and deliver efficient and
quality health services; and
> enhanced organization and management of health care systems and institutions to support
specific health sector reforms.
PHR advances knowledge and methodologies to develop, implement, and monitor health reforms
and their impact, and promotes the exchange of information on critical health reform issues.
January 15, 2001
For additional copies of this report, contact the PHR Resource Center at PHR-InfoCenter@abtassoc.com or visit our
website at www.phrproject.com.
Contract No.: HRN-C-00-95-00024
Project No.: 936-5974.13
Submitted to: USAID/Amman
and: Karen Cavanaugh, COTR
Policy and Sector Reform Division
Office of Health and Nutrition
Center for Population, Health and Nutrition
Bureau for Global Programs, Field Support and Research
United States Agency for International Development
The opinions stated in this document are solely those of the authors and do not necessarily reflect the views of
USAID.
Recommended Citation
Smith, M.A., Shirl, Lonna T. Milburn, Ph.D., Jamal Abu-Saif, M.D., Manal Shahrouri, Janet Edmond, M.P.H., Anthony Mensah, and Joanne Jorissen.
January, 2001. Jordan Training Results Evaluation. Technical Report No. 57. Bethesda, MD: Partnerships for Health Reform Project, Abt Associates
Inc.
Abstract
As part of Partnerships for Health Reform Project (PHR) health sector reform activities in
Jordan, extensive training and capacity-building programs were completed for Ministry of Health
counterparts and staff, as well as various other key professional staff in the health sector. These
training activities included customized courses, study tours to examine other national health systems,
workshops, and on-the-job training. This report examines the results of these training activities, as
well as the strengths, limitations, and potential future strategies for building staff capacity to initiate
and manage health sector reform initiatives in Jordan, such as Decentralization, Hospital Autonomy,
National Health Accounts, and Applied Research/Evidence-Based Decision-Making.

Table of Contents iii
Table of Contents
Acronyms.....................................................................................................................................v
Acknowledgments ......................................................................................................................vii
Executive Summary.....................................................................................................................ix
1. Structure of PHR/Jordan Training Portfolio............................................................................1
2. Objectives and Methodology of the PHR Training Results Evaluation .....................................3
2.1 Objectives.....................................................................................................................3
2.2 Methodology ................................................................................................................3
3. Findings...............................................................................................................................5
3.1 View of Training Outcomes and Results Across the Project .............................................5
3.1.1 Counterpart Observations and Feedback..................................................................5
3.1.2 Summary of Feedback from the MOH Education and Training Directorate ................6
3.1.3 Summary of Feedback from PHR Technical Advisors..............................................7
3.2 Assessment of Training Activities Conducted Under the PHR Hospital Autonomy
Component ...........................................................................................................................8
3.2.1 Benefits from PHR-Sponsored Training..................................................................8
3.2.2 Progress Towards Results.....................................................................................11
3.2.3 Observable Performance Improvements.................................................................12
3.2.3.1 Participant Observations ........................................................................12
3.2.3.2 Supervisor Observations ........................................................................12
3.2.3.3 Organizational-Level Improvements.......................................................13
3.2.4 Innovations and Trends........................................................................................13
3.2.5 Contributions to Policy Changes...........................................................................14
3.2.6 Systems Changes.................................................................................................14
3.2.7 Achievement of PHR Training Indicators for the Hospital Autonomy Component....14
3.3 Assessment of Training Activities Conducted Under the National Health Accounts
Component .........................................................................................................................16
3.3.1 Benefits from PHR-Sponsored Training................................................................16
3.3.2 Progress Towards Results.....................................................................................17
3.3.3 Observable Performance Improvements.................................................................17
3.3.3.1 Participant Observations ........................................................................17
3.3.3.2 Supervisor Observations ........................................................................17
3.3.3.3 Organizational-Level Improvements.......................................................17
3.3.4 Policy and Systems Changes.................................................................................18
3.3.5 Progress Towards PHR Training Indicators for the NHA Component......................18
iv Table of Contents
3.4 Assessment of Training Activities Conducted Under the Applied Research Component...19
3.4.1 Benefits from PHR-Sponsored Training................................................................19
3.4.2 Observable Performance Improvements.................................................................21
3.4.2.1 Participant Observations ........................................................................21
3.4.2.2 Supervisor Observations ........................................................................21
3.4.2.3 Organizational-Level Improvements.......................................................22
3.4.3 Policy and Systems Changes.................................................................................22
3.4.4 Progress Towards PHR Training Indicators for the Applied Research Component....23
3.5 Foundation Building Training......................................................................................24
3.5.1 Benefits from PHR-sponsored Training.................................................................24
3.5.2 Performance Improvements..................................................................................25
3.5.2.1 Participant-level Improvements..............................................................25
3.5.2.2 Organizational-Level Improvements.......................................................25
3.5.2.3 Policy and Systems Changes ..................................................................25
4. Conclusions and Recommendations.....................................................................................27
4.1 Overall Assessment of PHR Training Component in Jordan...........................................27
4.2 Recommendations.......................................................................................................27
4.2.1 General Respondent Recommendations.................................................................27
4.2.2 Other Recommendations ......................................................................................28
4.2.3 PHR Recommendations.......................................................................................28
Annex A: Number of Participants Trained by Organization ..........................................................31
Annex B: Chronological History of PHR Training Activities, 1998–2000......................................41
Acronyms v
Acronyms
ANE Asia/Near East
APHA American Public Health Association
CAP Country Activity Plan
EPI Expanded Programme on Immunisation
JD Jordanian Dinar
JUH Jordan University Hospital
KSAs Knowledge, Skills, and Attitudes
MOH Ministry of Health
MPPMS Managing Procurement of Pharmaceuticals and Medical Supplies
NHA National Health Accounts
PHCI Primary Health Care Initiatives (USAID)
PHR Partnerships for Health Reform Project (USAID)
RMS Royal Medical Services
SO3 Strategic Objective 3 (USAID)
USAID United States Agency for International Development

Acknowledgments vii
Acknowledgments
The authors would like to thank all of the respondents who agreed to be a part of this Training
Results evaluation. Their candid feedback was instrumental to the success of this evaluation. In
addition, the authors would like to give a special acknowledgement to Dr. Salwa Bitar Qtiet, for her
guidance and support of this evaluation exercise, and to Partnerships for Health Reform Project
(PHR)/Jordan Chief of Party Dr. Dwayne Banks, for his commitment and dedication in supporting all
of the capacity-building and performance improvement activities undertaken by the project. A
special note of appreciation is also extended to PHR Lead Counterpart and Head of the Ministry of
Health (MOH) Planning Directorate, Dr. Taher Abu-Samen; PHR Program Manager, Dr. Hani Brosk;
PHR Counterpart for Applied Research, Dr. Taissir Fardous; PHR Counterparts for Hospital
Autonomy, Dr. Ayyob As-Sayideh, and Dr. Abdelrazzaq Shafei; and the Head of the MOH Education
and Training Directorate, Dr. Osama El-Samawi. PHR would also like to acknowledge all of the
tremendous support provided by Dr. Shugran, Director of Princess Raya Hospital; Dr. Sultan,
Director of El Kerak Hospital; Dr. Zuheir Teif, Director of Al Bashir Hospital;and Dr. Salim
Malkawi, Director of Al Ramtha Hospital.

Executive Summary ix
Executive Summary
From 1998-2000, the Partnerships for Health Reform Project (PHR)/Jordan training program
completed a series of skill-building and capacity-enhancing activities designed to strengthen Ministry
of Health (MOH) counterparts and staff in various areas of health sector reform. The primary
audience for these activities included staff from the MOH, Royal Medical Service, Jordan University
Hospital, and other key partner organizations in Jordan’s health reform sector. A total of 355
Jordanian participants were trained as a result of the PHR/Jordan training program.
Training activities included study tours to the United States and Tunisia, a series of customized
health and management courses, workshops, and on-the-job informal training opportunities. Training
topics ranged from applied health research to hospital autonomy to general management and
accounting principals.
In August 2000, as the training program was coming to a close, a diverse team of evaluators
conducted an assessment of results from the one-year set of activities. The objectives of the
evaluation were to: document short-term training results and outcomes; assess the “lessons learned”
from program implementation of the training component; and develop a clear picture of future
training needs and outcomes. Through in-depth interviews with a subset of training participants, the
PHR evaluation team learned that the majority of participants cited improved performance due to
skills gained as a positive outcome of the training program. In general, counterparts and key staff
gained a deeper understanding of health reform issues, and in the case of hospital autonomy,
counterparts implemented training course materials in daily job performance.
In addition, the health worker motivation activity resulted in a high degree of visibility for the
Education and Training Directorate within the MOH, as the department helped to shape a new policy
for linking training and employee performance within the MOH system.
Findings from this evaluation indicate that the PHR/Jordan training program completed the
majority of its objectives outlined in the training plan. These training activities did not completely
close the gap in training needs among MOH and professional staff. Interviews with key MOH staff
revealed that staff need to have competency-based training programs in order to fully meet the
expectations and requirements of health sector reform challenges in Jordan today.
Based on the results of this training program evaluation, PHR has assembled a set of
recommendations for future program activities, building upon the results in this report.
Select recommendations for future training goals include:
> Implement integrated training approaches from the start of the project and tie these
programs to overall project objectives;
> Focus training programs specifically toward improving job performance;
> Continue the capacity-building process at hospitals already trained in hospital
autonomy skills; and
> Improve the process for follow-up and supervision between the MOH counterparts
x Executive Summary
and individuals receiving PHR-sponsored training.
In addition, PHR recommends that the MOH Education and Training Directorate engage in a
partnership with the Planning Directorate to assume responsibility for national health training
activities at the central and local levels, involving primary, secondary, and tertiary levels of care.
Together these departments could help to coordinate with donors, develop a sector-wide plan for
skills development, and manage resources more effectively.
1. Structure of PHR/Jordan Training Portfolio 1
1. Structure of PHR/Jordan Training
Portfolio
The Partnerships for Health Reform Project (PHR)/Jordan training portfolio was structured to
support the achievement of objectives and intermediate results as identified in its Country Activity
Plan (CAP) for 1999-2001. All of the activities undertaken were in direct support of United States
Agency for International Development (USAID)/Amman’s third Strategic Objective (SO3),
“Improve access to quality reproductive health care services.” In 1999, PHR conducted a training
needs assessment, the results of which were documented in the PHR publication, “PHR Training
Plan1
,” for the purpose of identifying the sets of skills that would strengthen the capacity of the
Ministry of Health (MOH), Royal Medical Services (RMS), Jordan University Hospital (JUH), and
other key partner organizations to lead broad-based reforms in the health sector. The resulting
training plan defined the series of activities that PHR would conduct to support SO3, with emphasis
on the roles and responsibilities held by PHR counterparts, hospital directors, and senior officials
from the Palace, the MOH, the RMS, JUH, Princess Raya, El Kerak, Al Ramtha and Al Bashir
Hospitals, Jordan University, and Jordan University for Science and Technology in achieving
measurable performance improvements, as well as policy and systems changes on behalf of their
respective institutions.
From 1998-2000, PHR succeeded in training a total of a total of 355 participants from the public
and academic sectors. (See Annex A for participant profiles and Annex B for a list of training
activities for Jordanians.) Looking at a cross-section of participants who were surveyed for this
evaluation, 49 percent of these participants held bachelors degrees; 2 percent had doctorate degrees;
20 percent had degrees in medicine; and 14 percent held masters level degrees at the time of the
training. A detailed breakdown of these representative participant profiles appears in Table 1.
This report will begin with a description of the approach used to evaluate the PHR/Jordan
training program, followed by the presentation of general findings and findings specific to PHR’s
major program components. The report closes with conclusions and recommendations that will
hopefully contribute to the development of future efforts aimed at health systems strengthening.
 
1Smith, Shirl. (July) 1999. Jordan: PHR Training Plan. Bethesda, Maryland: Partnerships for Health Reform,
Abt Associates Inc.
2 1. Structure of PHR/Jordan Training Portfolio
Table 1: Representative Participant Profiles by Education and Current Position
Number of
Participants
Level of Education Current Job Work Location Previous
Experience
Course
M.D.
Ph.D.
Masters
High Degree
Bachelors
Associate Degree
High School
Not Specified
Doctor
Director
Project Manager
Pharmacist
Planning Officer
Consultant/ Researcher/
Assistant
Student
Administrator/ Clerk
Nurse
Biostatistician
Auditor/ Accountant
Not Specified
Al Bashir Hospital
Al Ramtha Hospital
Princess Raya Hospital
Karak Hospital
MOH
Jordan University Hospital
Royal Medical Services
Audit Bureau
PHR
PHC
Not Specified
Research
None
Other Related Work
Experience
Related Coursework
Not Specified
Accounting and
Data Interpretation
5 3 1 1 1 1 2 1 2 1 1 1 5
Applied Health
Research
15 6 4 5 1 3 1 1 2 1 2 2 1 1 1 8 2 1 1 2 1 7 7
English Course 66 15 1 8 32 2 3 5 14 3 3 2 9 1 9 17 2 6 2 8 38 10 1 1 6 1 43 6 16
EPI Training 9 1 1 4 3 1 1 2 3 1 1 2 3 2 2 7 1 1
Financial
Management
8 7 1 1 1 3 3 6 2 6 1 1
General Accounting 6 6 1 1 4 6 5 1
General
Management
32 6 4 15 7 4 2 1 12 8 5 5 13 7 7 22 9 1
Medical Records 10 1 6 1 2 1 7 2 2 3 5 9 1
SPSS 4 1 1 1 1 1 1 1 1 2 1 1 4
TOTAL 155 31 3 22 1 76 2 13 7 21 9 6 5 3 20 2 33 28 1 17 10 10 21 16 58 24 6 4 3 4 1 8 2 10
8
1 25 19
Notes:
Number of individuals who participated in two or more courses: 8
Real number of participants: 144
2. Objectives and Methodology of the PHR Training Results Evaluation 3
2. Objectives and Methodology of the PHR
Training Results Evaluation
2.1 Objectives
The objectives of the PHR Training Results evaluation were:
1. To capture and document short-term training results and outcomes from PHR-sponsored
training investments undertaken as part of the 1999-2000 PHR/Jordan Training Plan.
2. To evaluate experiences with program implementation as a basis for strengthening the
design of future capacity-building initiatives in Jordan.
3. To establish a clear picture of training outcomes accomplished by the PHR project and its
main partner institutions, for the purpose of facilitating the design of training activities by
USAID/Amman and its country counterparts under the new follow-on project for health
sector reform and health systems strengthening in Jordan.
2.2 Methodology
The structure of the PHR Training Results evaluation framework bears a direct correlation to the
layout of the PHR/Jordan 1999-2000 Training Plan. This results evaluation is centered on the
following research questions:
1. How have PHR trainees applied new knowledge, skills, and attitudes (KSAs) acquired from
PHR-sponsored customized courses in Jordan, third country training (focusing on study
tours and course enrollments in other countries), and US-based short-term training?
2. What specific performance improvements came about as an outcome of this application in
the work place, including participant-level improvements, organizational performance
improvements, and short-term policy or systems changes?
3. To what extent did PHR achieve the performance indicators stated in the 1999-2000
PHR/Jordan Training Plan, given the sets of training activities that were accomplished under
the Hospital Autonomy, National Health Accounts (NHA), Applied Research, and
Foundation Building Training components over a 12-month period?
In order to answer these questions, data were gathered on the following three levels (see Table
2):
> Input Level, referring to the actual training activity/event;
> Process Level, which refers to the individual participant’s application of new KSAs
and improved performance; and finally,
> Impact level, which refers to the broad impact of training interventions on
4 2. Objectives and Methodology of the PHR Training Results Evaluation
organizations, the health system, and clients.
Table 2: Levels of Evaluation
Input Level a) Assessment of Training Event
b) Assessment of Training Provider
c) Assessment of Management/Administrative Support
d) Acquisition of KSAs
Process Level a) Application of KSAs
b) Performance Improvement
Impact Level a) Organizational Change
b) Health System Change
c) Client/End-User Satisfaction
In consultation with the PHR Counterpart for Training at the MOH, the PHR/Jordan team
randomly selected three participants for each course evaluated under the Hospital Autonomy, NHA,
Applied Research, and Foundation Building Training components. In the actual implementation of
the evaluation exercise, PHR achieved a 79 percent response rate. A total of 41 participants and six
supervisors were interviewed.
Two survey forms were designed to collect the training results data. The first, entitled
“Participant Interview Form,” was administered to the sample of trainees who attended the training
courses assessed for this evaluation exercise. A second “Supervisor Evaluation Form” was developed
for the purpose of recording supervisor observations about changes in employee performance, before
and after the training received, in addition to providing a second tier of information about specific
organizational changes that came about as a result of the training. The PHR evaluation team utilized
the following methodology to administer the participant and supervisor surveys:
1. Standard written introductions were developed for each form to avoid skewed interpretation
of survey;
2. PHR evaluators provided a standard oral introduction at the beginning of each encounter,
including an orientation as to how the evaluation would be completed; and
3. Participants were encouraged to ask questions if something was unclear or not understood.
3. Findings 5
3. Findings
3.1 View of Training Outcomes and Results Across the Project
3.1.1 Counterpart Observations and Feedback
Nearly all PHR counterparts stated that they had derived numerous tangible benefits from PHR￾funded training activities across the board. It was noted that the opportunities to work with PHR
resident advisors and consultants helped the counterparts gain more confidence in the areas of report
writing and preparing presentations. In addition, it was cited that on-the-job training, as a form of
capacity building throughout the life of the project, was especially valuable as a learning vehicle.
Most PHR counterparts felt that they now understood the meaning of reform, as well as the
importance of partnerships with other sectors.
It was felt that the timing of programs became an important issue, given that opportunities to
apply new skills and knowledge were not immediately available upon their return to the workplace. In
several instances, counterparts expressed concern about the participant selection process as a whole.
The final selection of MOH participants is determined by the Minister of Health. As a result, a small
number of PHR-funded participants did not apply their new skills to the context of PHR’s ongoing
technical assistance to the MOH and other partner institutions. Because of this trend, it will be more
difficult to quantify or measure the impact of these training investments over the long term. Overall,
the counterparts observed that they now work very well as a team, and that PHR’s capacity-building
initiatives have made a difference in the way they are performing in their current positions. In the
future, the counterparts felt they would benefit by having training programs that are specifically
geared to enhancing their roles as technical managers on a donor-funded project.
In evaluating PHR’s effectiveness in addressing the performance gaps that were encountered in
the MOH, PHR’s lead counterpart stated that PHR’s training investments were focused, but did not
close the gap across the whole organization. PHR successfully forged an impact in some areas,
primarily through its work with the counterparts and the staff of Al Ramtha, Al Bashir, El Kerak, and
Princess Raya Hospitals. Changes in performance were readily observable in each of these hospital
facilities.
To improve the design and implementation of capacity-building programs in the future, all of the
counterparts stressed the importance of competency-based training as a way to close performance
gaps at the organizational and employee levels. Such an approach would transcend PHR’s original
focus on foundation skills training, which was geared to provide a broader introduction to health
reform concepts. As an extension of this sentiment, the counterparts requested involvement in
project-initiated applied research studies from the outset, having direct responsibility for data
interpretation and analysis.
A recommendation for planning the training component of the successor project was to develop
an integrated training plan collaboratively at the beginning of the project cycle, instead of mid-way
into the project. The need to sustain the capacity built so far to support health systems reforms within
the MOH system and among each of the Ministry’s partner institutions was also seen as a priority.
Suggested support measures included:
6 3. Findings
> Ensure that trained MOH staff continue in positions of leadership on current and
future health reform initiatives;
> Continue to build a critical mass of individuals who can provide leadership on health
systems and policy reforms;
> Better integrate training supported by PHR into PHR-initiated technical assistance
activities and other donor-funded health reform projects;
> Provide support to trained staff on other health sector reform-related projects and
activities; and
> Continue building more capacity by utilizing trained staff and counterparts to train
new cadres.
3.1.2 Summary of Feedback from the MOH Education and Training Directorate
The MOH Education and Training Directorate has been a strong supporter of the PHR training
portfolio over the past two years. The Head of the Directorate contributed to the design of the PHR
training plan in 1999, and has monitored the progress of trainees working at the central and hospital
levels. From the standpoint of this directorate, PHR has been effective in addressing the performance
gaps that were encountered in the MOH organizational structure. Training results have been
attributed to high levels of interest among middle- and high-level managers to collaborate with the
PHR project. Staff associated their participation in PHR training with increased management
authority and autonomy in the workplace; essentially, the more staff are trained, the more they can
feel confident in effecting management decisions.
The quality of PHR’s training courses was viewed as satisfactory overall. With practice, trained
staff will be in a position to implement what they learned. As a way of harnessing the capacity that
has been established, the Education and Training Directorate would like to see how the MOH, PHR,
and Primary Health Care Initiatives (PHCI)2
can combine resources. Under PHCI, for example, the
MOH is helping to design a course for nurses, in addition to designing a database system for the
purpose of tracking staff participation in training courses and tying their performance to accreditation.
Ideally, the successor project to PHR would also be open to meeting the needs of the MOH beyond
the current parameters of applied research, NHA, and hospital autonomy. The MOH Education and
Training Directorate would like to see more emphasis placed on building capacity in health
economics at the masters level; at this stage, the Ministry is lacking cadres with this specific
background.
Looking at PHR’s Hospital Autonomy component, the Head of the Education and Training
Directorate observed a need for staff training to be accompanied by supporting systems changes
which allow staff to have more authority to make decisions. Staff should be given opportunities to
prove themselves as individuals who can take the right decisions; this will allow the MOH to have
more confidence in their leadership and decision-making abilities.
It was also observed that PHR’s Health Worker Motivation component has brought a new range
of responsibility to the Education and Training Directorate as a department unto itself within the
MOH organizational structure. As an outcome of taking part in the PHR workshops and policy
forums on health worker motivation, the Education and Training Directorate has forged a higher
 
2
 The Primary Health Care Initiatives project is USAID/Jordan’s flagship bilateral health project.
3. Findings 7
degree of visibility and presence in helping to shape a new policy for rationalizing the link between
training and employee performance in the MOH system.
3.1.3 Summary of Feedback from PHR Technical Advisors
PHR/Jordan Resident Advisor Dwayne Banks cited the immense progress that PHR counterparts
had made over a two-year period. At the outset of training plan implementation, the counterparts
progressed from a baseline of limited capacity and understanding of concepts related to health sector
reform, to the point of providing technical direction and input into policy formulation and systems
improvements at the hospital, governorate, and directorate levels. Citing the example of the PHR
counterparts in charge of hospital autonomy and NHA, results have been most readily observable
under conditions where the participants’ range of authority and responsibility for a specific reform
could be increased incrementally over time. Dr. Banks noted that the counterparts for hospital
autonomy are now implementing reforms independently, using a PHR-developed technical and
regulatory framework for hospital decentralization.
Dr. Lonna Milburn, PHR/Jordan Resident Advisor for Training and Applied Research, noted
PHR’s success in implementing all components of the PHR/Jordan training plan within a one year
period. Given the brevity of this timeframe, she felt that it would be difficult to observe intermediate
results from PHR’s training investments at this stage. Looking back at the series of customized
courses, workshops, and study tour activities implemented to date, Dr. Milburn outlined the extent of
the participants’ progress in undertaking specific action-steps as a result of PHR training and
technical assistance. (See Table 3.)
Table 3: Impact of PHR Training Programs by Component
Component Status of Action-Steps Taken
Applied Research PHR started the applied research training portfolio in October
1999. As an outcome of concentrated research forums, in￾country workshops, and supervised applied and operational
research studies, 100% of the participants trained took part in
the development and presentation of policy recommendations
for a) the creation of a national agenda for health policy
research and b) the introduction of targeted performance
improvements at Al Bashir and Al Ramtha Hospitals.
Hospital Autonomy Upon completing customized skills training in computer
applications, general management, and medical records, staff
at El Kerak and Princess Raya pilot hospitals have successfully
restructured systems for accounting, personnel management,
and medical records.
National Health Accounts The NHA team has completed their final report in collaboration
with A.K. Nandakumar and Manjiri Bhalwakar. The team took
steps to create a supportive policy environment for the
institutionalization of NHA by tying it to the research-to-policy
link that was explored during the PHR Applied Research Forum
in July 2000.
The following is a detailed look, for each of these components, at the benefits, progress towards
results, observable performance improvements, and policy and systems changes that have resulted so
far from PHR training activities.
8 3. Findings
3.2 Assessment of Training Activities Conducted Under the PHR Hospital Autonomy
Component
PHR CAP Result 2.4: Improved hospital performance and efficiency through delegation or
decentralization of select responsibilities
PHR Training Indicator: Practical concepts assessed and used in the Jordan context
Courses Evaluated: Financial Management
General Management
Medical Records
Managing Procurement of Pharmaceuticals and Medical Supplies (MPPMS)
Hospital Autonomy Study Tour to Tunisia
3.2.1 Benefits from PHR-Sponsored Training
Course Benefits Received from
Training
New Skills Acquired Skills Application in the
Workplace
Financial
Management
Added skills in financial
management concepts.
How to design tables to
simplify work procedures.
The ability to prepare an
independent budget.
Designing tables to simplify
accounting procedures in the hospital
(especially related to expenditures);
preparing the hospital budget;
performing financial analyses.
General
Management
Understanding of modern
concepts of General
Management; more organized;
change in attitude.
More knowledge and skills in
general management of health
systems.
Use of concepts in health sector
management; increased
knowledge in principles of
management.
Management and planning.
Communication skills;
thinking and application
methods.
Increased confidence in
making decisions.
Tools for enhancing
productivity.
Using computers for data entry;
applying new management skills on
the job; short term planning.
Reorganizing department; sharing
activities and opinions; planning.
Better use of staff; expanded use of
teams in the hospital setting.
3. Findings 9
Course Benefits Received from
Training
New Skills Acquired Skills Application in the
Workplace
Medical
Records
Increased knowledge of medical
record concepts; learning about
the experiences of other
hospitals; computer skills.
Understanding the relationship
between the medical record
systems in other organizations
and our hospital.
Understanding the problems
encountered in other medical
records centers; working to
solve these problems along with
other colleagues and managers.
Learning about the standards of
the medical research operating
system, and how technology
and quality of work contribute to
productivity.
Computer skills; planning;
skills in problem solving;
information sharing.
Communication skills, used to
persuade decision-makers to
improve the medical records
department by applying
modern techniques.
Sharing computer skills with
colleagues.
Planning and organizing
responsibilities for staff.
Problem-solving.
Increasing efficiency in using the
computer for data entry, filing, and
statistical analysis.
Participating in the decision-making
process.
Managing
Procurement of
Pharma￾ceuticals and
Medical
Supplies
Seeing the experience of other
countries (12 countries
represented at course).
Learning procedures for buying
pharmaceuticals, preparing
tenders and contracts, choosing
suppliers, writing proposals, and
writing specifications for drugs.
Analyzing the performance
suppliers as part of the selection
criteria.
Learning how to deal with
insurance and shipment from
country of origin; bulk
purchasing and VEN (Vital,
Essential, and Non-Vital Drugs)
analysis.
Learning about treatment
protocols and essential drug
lists, based on experiences of
other countries. Seeing
importance of establishing
treatment modalities and
protocols as a way to achieve
cost savings. Made presentation
at MOH to share these
recommendations.
Skills for drug purchasing at
the hospital level after
decentralization. (Drugs are
currently procured from the
MOH’s central medical
stores.)
Skills in tendering,
purchasing, and contracting
with suppliers. In South
Africa, visited a medical store
that supplies small hospitals.
Training assistant to use new skills in
order to be prepared for the future.
Using negotiation method for direct
purchases. Purchasing drugs at the
lowest cost/best value. Leveraging
between suppliers to get lowest
price. Negotiating and obtaining
quotations by phone. Tendering is in
the future.
10 3. Findings
Course Benefits Received from
Training
New Skills Acquired Skills Application in the
Workplace
Hospital
Autonomy
Study Tour to
Tunisia
Seeing how the hospital board
of trustees takes decisions
through the director of the
hospital. This approach helped
the administration to deal more
effectively without needing to
conduct detailed studies.
Seeing the Tunisia MOH’s
referral system, capable of
tracking the status and
diagnosis of patients.
The opportunity to observe the
concept of delegation in
practice. In Tunisia, staff rely
less on the central Ministry
because responsibility is
formally delegated to the
governorates.
Observing staffing practices in
the absence of a civil service
commission. Hospital directors
have the autonomy to develop
and advertise job assignments,
and to make hiring and firing
decisions.
Seeing the experience of
hospitals before decentralization
and how these hospitals and
medical services improved after
decentralization.
The opportunity to exchange
experiences with staff at the
MOH headquarters and Raitha
Hospital. Representatives of
the Tunisia MOH departments
of personnel, finance, and
maintenance all encouraged us
to go forward with
decentralization.
Seeing hospital staff manage
their own budget.
Hearing Tunisian staff compare
the benefits of decentralization
before and after (i.e., more
efficiency, more time spent with
physicians and technical staff).
The importance of keeping
patients informed about the
different changes in the hospital,
and encouraging
consumer buy-in/participation.
Upon returning to Jordan,
study tour materials were
shared and reviewed in
conjunction with hospital staff
by department (nursing,
administration, personnel,
etc.).
Learned how to solve any
problem in the hospital, and
how to structure a staff
organizational chart and use
it as a management tool.
Exploring ways of using this study
tour to make changes in the
administration of the hospital. It is not
possible to implement everything in
light of current MOH rules and
regulations. We are looking at
possible applications, such as criteria
for selecting hospital directors.
Plotting the hospital’s new
organizational chart.
Giving everyone in hospital exact and
specific duties. Staff have ownership
about the hospital’s new
organizational chart. It clearly
delineates the way in which staff
perform specific functions in the
hospital. The Nursing section is now
more efficient. The hospital director
and nursing staff meet once a month.
Nurses are encouraged to work with
confidence. Problems are much
fewer now. Each [hospital] unit is
now equipped to solve its own
problems. The hospital autonomy
working group has also prepared a
booklet to inform hospital staff about
their job responsibilities.
Lessons learned from the study tour
were shared with the hospital
working groups; at the same time,
staff have yet to fully apply this
system because decentralization
hasn't been given by the MOH. The
MOH has given authority in some
ways only, for example, the authority
to spend up to 1000 JD without going
to the MOH for permission, or the
authority to decide how to hire and
take control of the hospital. We did
not have this authority before.
3. Findings 11
3.2.2 Progress Towards Results
Under the Hospital Autonomy component, PHR’s customized training and study tour
investments built a vision for how decentralization could operate and its potential benefits. However,
the majority of the participants interviewed cited MOH rules and regulations as key constraints to
their ability to apply new knowledge and skills in the workplace, combined with limited management
authority to effect decisions that would impact the introduction of specific changes in job
performance. In the case of the respondents who received skills training in procurement practices, for
example, difficulties were cited in applying all of the skills acquired from the course. In this instance,
the pace of higher level regulatory reforms in hospital drug purchasing practices had not yet coincided
with skills development in tendering and international bidding procedures. At the time of this
evaluation, hospital pharmacists were confined to purchasing drugs within the range of 200 Jordanian
dinar (JD), whereas 500 to 1,000 JD are required to execute a tender for the purchase of drug supplies
and medical equipment.
As Jordan is about to become a member of the World Trade Organization in 2001, respondents
based in the pilot hospital pharmacy departments were optimistic that further policy changes would
support their ability to develop tenders at the hospital level. The Minister also recently approved a
policy change that will allow each pilot hospital to spend up to 1,000 JD per month for drug
purchases. (The previous budget ceiling used to be 200 JD per month.)
In the area of medical records, the shortage of trained personnel, along with MOH rules and
regulations, was cited as a barrier to skills application. Another barrier was a shortage of computers
at each pilot hospital. Respondents felt that it would be possible to overcome these constraints by
hiring more personnel and by increasing the number of computers in the medical records departments
of El Kerak and Princess Raya Hospitals.
Respondents based in the pilot hospital accounting departments felt that it would be important to
continue to decentralize hospital management functions. This would give hospitals greater
management authority to implement skills acquired from the customized accounting courses.
Reforms in MOH rules and regulations surrounding financial management functions would help to
create a more supportive policy environment in which to apply these new skills.
Constraints cited in the application of skills from the general management course included:
limited computer knowledge; timidity to converse in English; MOH regulations; and limited
management authority. Solutions to these constraints were cited as within range of the respondents’
ability to impact specific changes in their respective work environments, namely, through increased
delegation of authority, cooperation with senior managers at the hospital level to adopt new rules and
regulations, and building a base of support for new ideas through continued information-sharing with
colleagues.
Respondents attending the hospital autonomy study tour in Tunisia observed that the rules and
regulations in Jordan are highly centralized. Continued dialogue and policy communication with
high-level decision-makers at the central ministry and parliamentary levels were viewed as tenable
solutions to create a more supportive policy environment for hospital decentralization. The challenge
of building staff confidence, ownership, and awareness of the concept of decentralization itself was
also a constraint to applying lessons learned from the Tunisia study tour. To overcome this,
management by participation was used as an approach to obtain staff buy-in around the concept. This
approach involved having staff directly participate in the design of hospital-level policies surrounding
personnel management, administration, purchasing, supply management, and financial management.
12 3. Findings
From the standpoint of ensuring that training investments are tied more closely to the pace of
policy and systems reforms occurring at the central and hospital levels, it was recommended that
trainees in each of the pilot hospitals be encouraged to follow up on a more consistent basis with the
MOH counterparts for hospital autonomy. This exchange of information and experience would serve
to enhance planning next steps for future capacity-building interventions, in addition to creating a
more supportive environment for trainees to apply new skills and knowledge.
3.2.3 Observable Performance Improvements
3.2.3.1 Participant Observations
All respondents noted significant improvements in their own performance at work. Twenty
percent of all respondents reported higher levels of confidence and productivity upon returning to the
workplace. Other positive benefits included: having a more realistic job outlook; improved
communication skills; and the ability to do more work in less time, without requiring the assistance of
other departments in the hospital. As a result of acquiring new skills, 33 percent of all respondents
interviewed under the Hospital Autonomy component have initiated performance improvements
within the parameters of their current management authority. Examples included: developing
requests for proposals for local vendors in line with a 200 JD per month budget; developing a plan to
improve the medical records department; sharing new ideas and knowledge with hospital staff;
designing protocols for medical records; and using computers to simplify hospital accounting and
financial management procedures.
The exposure to different country experiences also instilled a greater level of confidence on
behalf of the middle-level managers who are responsible for guiding the introduction of systems and
policy reforms within the central ministry and the two pilot hospitals. Differences in the way these
officials approached their positions stemmed from a stronger understanding of decentralization as an
organizational concept and the ability to implement it more than in the past.
3.2.3.2 Supervisor Observations
The directors of El Kerak and Princess Raya pilot hospitals also noted changes in performance
among hospital staff who participated in hospital autonomy-related training courses. Notable
changes included: a change in attitude; a better understanding of individual job responsibilities;
greater initiative; stronger skills in problem-solving without direct supervisory involvement; and
increased staff motivation, involvement, and ownership in the day-to-day functions of the hospital.
With its new computerized system, the medical records department is now more self-contained at
Princess Raya Hospital. El Kerak Hospital’s new pharmacy inventory tracking system also provides
an accurate picture on the number and types of drugs dispensed, thereby eliminating previous
problems with oversupply and expiry. All drug purchases are now effectively planned in accordance
with need.
Both pilot hospital directors cited a higher comfort level in going before senior, high-ranking
MOH officials and advocating for hospital reforms. Skills in advocacy and policy communication
have fostered the ability to lobby with greater confidence on how the MOH can improve the hospital
system within the confines of the new rules and regulations that are being developed. These skills
have enabled the directors to change the way the MOH views the importance of hospital
decentralization, resulting in greater efficiency, greater benefits for each hospital’s client base, and
greater cost-savings in the long term.
3. Findings 13
3.2.3.3 Organizational-Level Improvements
While it may be too soon to document medium-term training results across the board, 100
percent of all respondents observed short-term improvements in organizational performance at the
two pilot hospitals and Al Bashir Hospital as an outcome of new skills and attitudes being applied in
the workplace. Improvements included:
> Use of new procedures for filing, work planning, and scheduling;
> Discussions between the heads of the medical records departments and staff to
improve coordination;
> Team-based approaches to management and problem-solving;
> Changes in employee attitudes towards work;
> Improved relationships between the hospital directors and employees, resulting in
improved performance and productivity;
> Stronger collaboration between MOH decision-makers and hospital-level staff on
systems changes needed for reform;
> Increased authority for decision-making among middle-level managers;
> Reduced patient waiting times for medical records;
> Shortened time for repairing equipment and processing medications;
> Greater patient/client satisfaction; and,
> Initiative among trained staff to provide on-the-job training to co-workers.
Al Bashir Hospital reported a tangible performance improvement in its medical records
department. Staff participation in the customized medical records course, along with the placement of
a new PHR computer in the medical records registries for the inpatient and outpatient departments,
have cut down on records duplication. As a result of these measures, standards and protocols for
quality control have improved.
3.2.4 Innovations and Trends
A direct outcome from the study tour visit to Tunisia was the initiative on behalf of both pilot
hospitals to develop new organizational charts. These charts were jointly developed through a
process of mutual exchange between the hospital autonomy working groups of Princess Raya and El
Kerak Hospitals, in collaboration with the MOH Planning Directorate. Under the old organizational
chart, both hospitals had an Administrative Assistant and a Professional Assistant to supervise
administrative and clinical functions. Under the new staffing configuration, functions have been
further compartmentalized through the addition of Supply and Pharmacy Assistant positions. A new
hospital board, intended to function like a steering committee, was also placed at the top of the
organizational hierarchy to retain the highest administrative rank in the hospital, followed by the
hospital director and main department heads. To enhance each hospital’s effectiveness in the areas of
client satisfaction and community outreach, each hospital also added a Professional Medical
Committee; the members of this committee include the main staff of the hospital and will ultimately
be joined by two community representatives.
Another important innovation resulting from the process of ongoing capacity building under the
Hospital Autonomy component, is the leadership initiative undertaken by the MOH Planning and
Education and Training Directorates to develop and implement customized training in administration,
14 3. Findings
delegation, and financial management skills for pilot hospital staff. The PHR Counterparts for
Hospital Autonomy, in collaboration with the Education and Training Directorate and senior
department heads from the MOH Directorates of Administration and Financial Management,
designed and led two month-long training programs to strengthen skills in delegation and budgeting.
As a result of this competency-based training, both hospitals will be equipped to prepare their first
autonomous budgets for presentation to the Minister of Health.
Lastly, the directors of each pilot hospital have participated in high-level forums to share lessons
learned from the decentralization process with hospital directors in other governorates.
3.2.5 Contributions to Policy Changes
Approximately 61 percent of the respondents interviewed stated that they were able to make a
contribution to policy changes at the hospital and/or central levels. Examples included:
1. Making suggestions for consideration by decision-makers;
2. Securing high-level support and permission to work on hospital autonomy priorities, which
have led to changes that support hospital-level goals and objectives for reform;
3. Overcoming the MOH bureaucracy;
4. Developing policies for dealing with patients and staff;
5. Working with a new system of authority and delegation, plus a system for monitoring and
evaluation and a new organizational chart for the hospitals; and
6. Creating a plan to raise employee awareness about new policies, procedures, and
responsibilities related to hospital autonomy.
The remaining 39 percent felt that they were not able to make a direct contribution due to the
lack of authority associated with their current position. Respondents in this category felt that they
could reasonably influence the process of policy change by way of offering suggestions or ideas to
their superiors. Beyond this, each felt limited in terms of his or her own ability to make a significant
impact on the development of a specific policy change.
3.2.6 Systems Changes
While it is still early to determine if long-standing systems changes have occurred in each pilot
hospital, it is evident that skills training has contributed to observable operational changes, including:
1. A decrease in the number of steps required to deliver services to patients, and more efficient
service delivery, due to the fact that hospital staff have a stronger awareness of exact duties;
2. Increased community participation and ownership in the services of the hospital; and
3. New policies and procedures to deal with pharmaceutical procurement, personnel, and
medical records.
3.2.7 Achievement of PHR Training Indicators for the Hospital Autonomy
Component
The above evaluation results demonstrate that the PHR training indicator for the Hospital
Autonomy component, “Practical concepts assessed and used in the Jordan context,” has been
achieved. Practical applications for hospital autonomy have resulted from a combination of training
inputs, including customized courses, exposure to the experience of another country in the Asia/Near
3. Findings 15
East (ANE) region, and an off-the-shelf course on procurement. This training has directly impacted
the pace of reform at Princess Raya and El Kerak Hospitals, in addition to strengthening the
performance of senior- and middle-level managers who have a direct role in the implementation of
management and regulatory reforms.
16 3. Findings
3.3 Assessment of Training Activities Conducted Under the National Health
Accounts Component
PHR CAP Result 1.1: Establish National Health Accounts as a policy tool on a sustainable basis
PHR Training Indicators: 1. Capacity to analyze NHA data increased; 2. Steps for organization of NHA system
completed at national level; 3. NHA institutionalized in the MOH
SPSS Computer Skills
Epi-Info Computer Skills
Accounting and Interpretation of Data
Courses Evaluated:
NHA Regional Workshops
3.3.1 Benefits from PHR-Sponsored Training
Course Benefits Received
from Training
New Skills Acquired Skills Application in the
Workplace
SPSS
Computer Skills
Learning the software for
statistical analysis.
Data entry; processing and
analyzing data in a
statistical way.
No opportunities reported.
EPI-Info
Computer Skills
Learning and using the
software application for
tracking and analyzing
epidemiological data and
trends.
Research skills;
interpretation of data.
Collecting data; tabulating data; report￾writing; disseminating research results.
Accounting and
Interpretation of
Data
Better understanding of
NHA concepts; computer
applications; increased
productivity and motivation.
Data analysis. Participated in writing NHA technical
reports; analyzed NHA data to identify
issues and policy recommendations.
NHA Regional
Workshops
Learning what is required
of public institutions
regarding NHA data
collection and reporting.
Understanding the
mechanics of NHA.
Learning the experience of
other countries with NHA..
Learning how to classify
expenditures, including
sources and uses, and
provider expenditures; how
to reallocate resources for
primary health care.
Understanding the
importance of
institutionalizing NHA,
especially how to convince
policy makers and how to
look at results and explore
policy options.
How to prepare reports.
How to be more active in
discussions.
Having a broader vision of
financing systems across
sectors, especially in looking
at expenditures, savings,
and reallocation.
How to collect and validate
data and ensure data
transparency.
Currently applying NHA in the RMS
health and financial management
information systems; computerized
financial data system in line with NHA
reporting requirements, and are
performing a computerized study on
how the system is working. Based on
the results, will have all financial
departments at the RMS collecting data
on NHA by adding NHA data sets to
current systems.
Contributed to NHA final report by way
of data collection, analysis, and
interpretation of data.
It is difficult to apply what was learned
due to changes within the MOH; the
time for implementing NHA has not
been sufficient.
3. Findings 17
3.3.2 Progress Towards Results
Respondents interviewed under the NHA component unanimously agreed that NHA was a
valuable tool for improving resource allocation and evidence-based decision-making. At the same
time, all respondents encountered constraints in applying new skills in the workplace. The most
prevalent constraint cited was time management. Several respondents found it difficult to juggle the
responsibilities for NHA data collection and analysis with their current job workloads, because of the
time investment required. Limited supervisory support and incentives were also mentioned as
obstacles, combined with the lack of a computer in one instance and the need for more counterparts
with backgrounds in finance and accounting. The majority of the respondents interviewed held the
view that greater cohesiveness among the institutional partners would be key to ensuring the future
success of NHA, along with a shared commitment to move the policy process forward. A unification
of the MOH, JUH, and RMS financial systems was suggested as a measure to institutionalize NHA,
along with the creation of a national, multi-sectoral steering committee that would involve other
ministries and health committees of the higher and lower parliament.
The course inputs under the NHA component provided a mixed range of benefits for the
respondents interviewed. Training in Epi-Info was viewed as helpful, but not directly relevant to one
respondent’s role on the NHA team. Reasons for this were primarily attributed to a gap surrounding
the customization of this course to NHA applications. The majority of the respondents gained more
direct benefits from the customized skills training in SPSS and in accounting and interpretation of
data, along with the process of deriving practical skills and concepts from the first NHA workshop in
Jordan and the three ANE regional NHA workshops.
3.3.3 Observable Performance Improvements
3.3.3.1 Participant Observations
Fifty percent of the respondents in this category felt that their job performance improved as a
result of the training received. Improvements included: better communication skills; increased
exposure to working with officials in the public, semi-public, and private sectors; skills in data
analysis and interpretation and improved confidence. The remaining 50 percent stated that they did
not see any improvements in their own individual performance at work, because the opportunity to
fully apply these skills is contingent upon the start-up of related donor-funded activities. These
activities include undertaking a cost study for primary health care centers under PHCI and
implementation of a World Bank loan designed to improve the financial management systems of the
RMS. In the face of these future initiatives, this group of respondents did not observe any changes in
their job performance.
3.3.3.2 Supervisor Observations
At the supervisory level, skill-building in NHA was seen to have a positive impact, as it
established a critical mass of individuals who can apply NHA as a tool for policy decision-making.
An interest was expressed in expanding this capacity through additional technical assistance on the
ground.
3.3.3.3 Organizational-Level Improvements
Given the early stages of NHA implementation, respondents cited a limited number of
performance improvements at the organizational level. The Planning Department within the RMS, for
example, is well positioned to support institutionalization of NHA now that each team member
understands its benefits and applications. In addition, the RMS financial data system has been
changed to be consistent with NHA datasets.
18 3. Findings
3.3.4 Policy and Systems Changes
It is still too early to determine if training in NHA has contributed to a longer-term policy or
systems change. All respondents felt that they were able to make a positive contribution to the
process of policy and systems change in their respective organizations, including: re-configuring
agency management information systems to collect NHA data; writing reports; leveraging the support
of high-level decision-makers in multiple sectors; and using more proactive and participatory
approaches to meeting and workshop planning.
3.3.5 Progress Towards PHR Training Indicators for the NHA Component
In comparing the baseline data on the level of skills that the NHA team manifested at the
beginning of the training process, it is evident that the first training indicator, “Capacity to analyze
NHA data increased,” was fulfilled. There has been tangible progress towards the remaining two
training indicators, but not fulfillment (“Steps for the organization of NHA system completed at
national level; NHA institutionalized in the MOH”).
3. Findings 19
3.4 Assessment of Training Activities Conducted Under the Applied Research
Component
PHR CAP Result 1.1: Capacity of the MOH and other Jordanian institutions to take leadership in policy
development and implementation of health sector reforms strengthened
PHR Training Indicators: 1. Research agenda formulated; 2. Leadership capacity for research strengthened in the MOH
Courses Evaluated: Applied Research
Patient Flow Analysis
PHR Scholars and Mentors Program
American Public Health Association (APHA) Conference
Linking Research to Policy/US Study Tour
3.4.1 Benefits from PHR-Sponsored Training
Course Benefits Received
from Training
New Skills Acquired Skills Application in the Workplace
Applied
Research
New skills and research
techniques tied to the
Health Worker Motivation
and 360 Degree studies; a
hands-on instructional
approach allowed actual
implementation of lessons
learned.
Learning to undertake
research studies in steps; time
management and
organizational skills.
Developing skills in using the
Data Show computer software.
Developed three proposals, the first of
which was funded by WHO.
Applied Data Show techniques in training
presentations made to MOH staff in four
governorates.
Patient Flow
Analysis
Communication skills; skills
in data collection, coding,
and analysis.
Applying number coding to
patient flow analysis data.
The importance of timing in
relation to patient flow
analysis.
Introduction of significant organizational
changes at Al Bashir Hospital as a result
of implementing data findings.
PHR Scholars
and Mentors
Program
Gaining experience in
theory and practice of
applied research.
The opportunity to gain
real research experience
for the first time.
Data collection. Qualitative
analysis (by learning to do
coding).
Presentation skills; skills in
policy communication to
support interactions with high￾level decision-makers.
Designed a study on health worker
development activities, focusing on the
perspectives of nurses at Al Bashir and
Jordan University Hospitals.
Communicated study research findings to
the director of Al Bashir Hospital; study to
be published by the Jordan Dental
Association Journal.
Designed a pilot study on job satisfaction
for Al Bashir Hospital; formulated a
research framework, survey instrument,
and study sample. Presented findings at
closing workshop for PHR scholars,
involving representatives from the MOH,
academic, and private sectors.
20 3. Findings
Course Benefits Received
from Training
New Skills Acquired Skills Application in the Workplace
APHA
Conference
Chance to meet different
people and look at
problems in different ways.
At APHA, found that many
of the problems were also
prevalent in Jordan, i.e.
smoking, cancers, chronic
diseases, and health care
delivery in under-served
communities.
How to deal with problems on
all levels, i.e., within the private
sector, government sector,
not-for-profit organizations,
and local communities.
Working with local groups in Ramtha; now
taking steps to establish committees in the
hospital to improve the relationship
between hospital personnel and the local
community, so that the community has a
more active role in the health process.
Promoting the idea of health
economy/healthy community.
Linking
Research to
Policy/US
Study Tour
Opportunities for
networking; practical
orientation of the tour.
Learning how information
systems are used to
support research; how
research is designed and
prioritized based on
criteria.
Gaining insights on how to
fund not-for-profits.
The opportunity for
Jordanian decision-makers
from the academic and
government sectors to
come together for the first
time.
Seeing the US manages its
health system and uses
research to tackle
problems and come up
with real data/results.
Understanding the
importance of monitoring
and evaluation as a tool for
coming up with evidence￾based recommendations.
Learning about
mechanisms for
appropriating money for
scientific research.
Working with Prince Firas
to help influence the
creation of a
Research/Public Health
Unit in Amman.
Communication skills; learning
to communicate research
results; how to perform applied
research studies; how to fund
research.
How to utilize research
findings.
Procedures and methods for
research dissemination.
How to determine research
priorities.
Undertaking research (at the university
level) and generating findings.
Shared study tour results with high-level
decision-makers in the academic and
government sectors.
Convinced department heads of the
importance of evidence-based research,
and integrated research-based
methodologies into the design of curricula.
Focusing on gaining high-level buy-in to
make use of the research being
undertaken.
Sixty percent of the respondents interviewed under the Applied Research component stated that
they had encountered constraints in applying what they learned in the workplace. The main
constraint cited was the prevalence of limited supervisory and peer support to participate in studies or
to implement actual research results. Other constraints included: the lack of effort to integrate those
scholars and ministry staff trained in applied research methods into the day-to-day policy formulation
and decision-making activities of the MOH; difficulties in obtaining baseline data; challenges with
sampling due to the fact that respondents were not familiar with research concepts at the hospital
3. Findings 21
level, and thereby reluctant to participate in research studies; and limited support from high-level
decision-makers to act on research findings. Strategies proposed for resolving these constraints
included raising the awareness of the new Minister of Health; having PHR work more closely with
internal MOH structures to create a base of support; more wide-spread policy communication and
advocacy; and orienting the public to the importance of research.
The remaining 40 percent of the respondents interviewed did not experience constraints in
applying new skills and knowledge in their respective work environments. In these instances, the
conditions for successful application were attributed to the strong political will that the Palace, the
MOH, and collaborating academic institutions have been able to forge in support of both creating a
national research center in Jordan and strengthening ways of utilizing research findings in a policy
environment. Respondents involved in this high-level policy dialogue reported stronger short-term
results in the application of new skills, given the ability to draw on the base of support that had been
created prior to and during the research study tour visit to the US. The opportunity for officials to
come together for the first time from the high government, the MOH, RMS, and university sectors
was repeatedly acknowledged as a tangible and sustainable benefit from this study tour experience.
3.4.2 Observable Performance Improvements
3.4.2.1 Participant Observations
Ninety percent of the respondents in this category felt that their job performance improved as a
result of the training received. Improvements included: a stronger comfort level in writing proposals;
better skills in decision-making and establishing research priorities; increased productivity; and
higher levels of confidence and initiative in undertaking research studies. A success cited at Al
Ramtha and Al Bashir Hospitals was the ability to use survey data as an effective tool for problem
solving and improving staff motivation.
The remaining respondents felt that it was still too early to observe specific improvements in
their own individual performance at work. These respondents reported progress towards introduction
of specific performance improvements in the workplace as a result of the training received, but
changes were not apparent at this stage.
3.4.2.2 Supervisor Observations
Supervisors at Al Bashir and Al Ramtha Hospitals observed significant changes in the way that
trained staff approached their jobs before and after receiving PHR-funded training. The opportunities
to participate in the Patient Flow Analysis, 360 Degree, and Health Worker Motivation studies caused
staff to change their attitudes about their job functions. For example, nurses now are completing
independent studies on nursing satisfaction, in addition to producing reports without direct
supervision.
As a result of the Patient Flow Analysis and Health Worker Motivation studies, Al Bashir
Hospital identified bottlenecks in the outpatient, emergency, pediatrics, and ophthalmology
departments and performed structural changes in how these departments were organized. The
reorganization of the emergency department was considered an important success; this unit was
divided into three parts as a way of better streamlining the delivery of services to patients. Patients
are now examined in a pre-screening area. Depending on the severity of their cases, they are moved
to a newly created triage section, sent home, or referred to the outpatient department of the hospital.
These changes have brought about significant reductions in patient waiting times and eliminated
recurrent problems with overcrowding. As a result of these changes, staff are more confident and
“people are thanking them instead of complaining.” At Al Ramtha Hospital, trained staff display
22 3. Findings
greater initiative and a willingness to solve problems independently. Staff are also participating in the
creation of a new committee for motivation at the hospital. Before the Patient Flow Analysis and
Health Worker Motivation studies were carried out at Al Bashir Hospital, staff were operating in the
absence of set standards for performance. This environment was characterized by frequent mistakes
in diagnosis and filing, and long patient waiting time. Supervisors embraced the attributes of applied
research methodologies as a whole, citing the fact that these research studies helped to generate
plausible solutions without requiring a lot of money.
Within the PHR Scholars Program, mentors observed changes in the way that scholars
approached the process of data analysis and interpretation over time. As a result of receiving
competency-based training in applied research methodologies, the PHR Scholars have gained
concrete practical experience in conducting research and presenting research findings. Valuable
inputs to this capacity-building process included the skills training in SPSS to support data analysis.
3.4.2.3 Organizational-Level Improvements
Improvements at Al Bashir and Al Ramtha Hospitals were cited most frequently during the
participant and supervisor interviews. Apart from aforementioned changes in staff initiative, other
changes included: greater respect and cooperation between employees as a whole; improving the
paper trail as a way of ensuring that issues are followed up in a timely manner; and encouraging staff
to either come early or report to work on time. An extension of this sentiment was that the use of
research results also facilitated the decision-making process in each hospital facility.
Organizational changes or performance improvements stemming from the research study tour
were less apparent at the time of this evaluation. Respondents in this category felt that they were able
to make headway in establishing a foundation for continued policy dialogue on the creation of a
national agenda for health policy research. At the university level, one respondent emphasized the
need to continue to focus their efforts towards advocacy and to gain the buy-in of senior faculty and
department heads on the importance of applied research. Another important direction to be pursued
was the need to direct greater attention towards the utilization of research data that is currently
available in Jordan.
3.4.3 Policy and Systems Changes
Policy and systems changes resulting from PHR training in applied research were most apparent
at the hospital level, through the creation of a motivation committee to improve staff performance, as
well as steps taken to prepare an educational guidebook for patients and health workers on the
services of Al Ramtha Hospital.
Respondents involved in supporting the development of a national research agenda felt that they
were able to impact the course of policy dialogue, either directly or indirectly. Steps included making
presentations to the Minister of Health on the importance of research as a tool for evidence-based
decision-making, emphasizing the time- and money-saving features of this process. One respondent
observed that it could take time to introduce such changes in a traditional culture. An institutional
shift in the utilization of research at the MOH has been an expanded role on behalf of the Information
Management Directorate to track all research being undertaken.
3. Findings 23
3.4.4 Progress Towards PHR Training Indicators for the Applied Research
Component
After one full year of training investments in applied research, the respondents interviewed have
made progress towards the creation of a national research agenda. PHR fulfilled its target of
strengthening leadership capacity for applied research within the MOH, as manifested through the
training of key staff in the Planning, Food Safety, and Information Management Directorates. This
capacity has also clearly moved into the hospital and university sectors, by way of concentrated skills
development in applied research methodologies, as well as laying a foundation for the cross￾fertilization of this expertise within the hospital, university, and higher government sectors.
24 3. Findings
3.5 Foundation Building Training
PHR CAP Result 1.1: Capacity of the MOH and other Jordanian institutions to take leadership in
policy development and implementation of health sector reforms strengthened
PHR Training Indicators: 1. Research agenda formulated; 2. Leadership capacity strengthened in the MOH
English language training courses for counterparts and project-specific participants
Computer skills training courses (Windows Applications) for counterparts and project￾specific participants
Harvard University, School of Public Health Course on Managing Health Care in Developing
Countries
Boston University, School of Public Health Course on Financing Health Care in Developing
Countries
University of Connecticut, Institute for Public Service International Course on Training
Design and Management
World Bank Flagship Course on Health Sector Reform, Washington, DC
Courses Provided:
World Bank Flagship Course/Economic Development Institute, Lebanon
3.5.1 Benefits from PHR-sponsored Training
Course
Evaluated
Benefits Received
from Training
New Skills Acquired Skills Application in the
Workplace
World Bank
Flagship Course,
Washington, DC
Enhanced knowledge of
health sector reform;
learned about the concept
of health sector reform in
terms of its pluses and
negatives, and possible
application in hospital
settings.
How to improve project
management skills;
understanding of different
country experiences.
Applying to current work with PHCI; have
better skills in facilitating training courses
and designing case studies. Working in
the trenches has brought about a change
in vision.
Foundation building training in health sector reform concepts and applications, computer skills,
project management, and English language skills was a lynchpin to PHR’s strategy for strengthening
leadership and management skills among senior- and middle-level managers. One respondent was
interviewed under this category, for the purpose of determining the extent to which new skills,
knowledge, and attitudes have has influenced the process of reform as undertaken by middle
managers within PHR’s main partner organizations. The one respondent in this category cited an
inability to fully apply new skills in the workplace, primarily due to a change in position shortly after
the training occurred. In the respondent’s current capacity on PHCI, it is likely that future
opportunities will arise, especially as the MOH and USAID look at ways of harnessing all the
expertise and performance improvements that have evolved through MOH-, PHR-, and PHCI￾supported training investments.
3. Findings 25
3.5.2 Performance Improvements
3.5.2.1 Participant-level Improvements
The respondent did not observe any immediate changes in performance, since the acquired skills
have yet to be fully applied in the workplace. It is expected that opportunities for application will
increase as PHR, PHCI, and the MOH Planning and Education and Training Directorates take steps to
establish a base for coordination in the planning and monitoring of future training investments. The
respondent observed short-term benefits from the training received, as manifested through a new
range of responsibilities in her current position. These benefits included: the ability to conduct
meetings with the heads of different general directorates and governorates; the ability to look at
problems related to resource allocation and budget management at the governorate level; and working
with governorates to make decisions and identify options. Better communication skills and increased
confidence were noted as changes in the respondent’s performance as a result of the training.
3.5.2.2 Organizational-Level Improvements
Observable organizational improvements were noted primarily in the respondent’s work in the
MOH Education and Training Directorate. The respondent brought greater accuracy to the process
of student selection at the university level, in addition to working with colleges and paramedical
programs to develop long-range plans. These changes were approved by the Minister of Health.
3.5.2.3 Policy and Systems Changes
Limited decision-making authority at the level of a middle manager was articulated as an
obstacle in the respondent’s ability to effect policy or systems changes independently. The continued
development and presentation of ideas to supervisors, combined with the ability to change strategies
that directly contribute to policy or systems changes were identified as ways to influence the change
process. Examples of the respondent’s ability to impact systems and policy reforms as part of her
previous position in the MOH Education and Training Directorate included: revising curriculum and
degree requirements for nursing and changing the requirements for training paramedicals in Jordan.

4. Conclusions and Recommendations 27
4. Conclusions and Recommendations
4.1 Overall Assessment of PHR Training Component in Jordan
The findings from this evaluation indicate that the PHR Project achieved the majority of its
objectives under the 1999-2000 PHR Training Plan for Jordan. The majority of the participants
interviewed are applying new skills toward the achievement of reforms in the areas of hospital
autonomy, applied research, NHA, and training. Nearly 100 percent of the time, any barriers to
application were directly correlated to limited management authority among middle-level cadres, or
the perception of having an external or indirect relationship to those who were well positioned to
affect change at the systems and policy levels. Innovations were observed in cases where respondents
worked within their range of authority and available resources to implement reforms, combined with
direct support from their supervisors and senior decision-makers within their organizations.
4.2 Recommendations
4.2.1 General Respondent Recommendations
There was a 100 percent response rate in the identification of recommendations to PHR and
USAID/Amman, pointing to feedback on the quality of the training received and suggestions for
improvement in the future. These respondent recommendations are listed as follows:
1. Conduct more training for private sector institutions, not only for the MOH, JUH, or RMS;
2. Expand the lead-time for planning training activities in the future;
3. Place more emphasis on competency-based training tied to enhancing job performance and
the ability to undertake specific health system and policy reforms, now that a foundation has
been put into place;
4. Ensure that customized courses are structured to include participants with similar
backgrounds and disciplines;
5. Take steps to ensure that local training providers develop curricula which directly supports
the achievement of training objectives and/or provides a conceptual framework that ties new
skills with direct application in the workplace;
6. Continue with the capacity-building process at Princess Raya, El Kerak, Al Ramtha, and Al
Bashir Hospitals, as a way of expanding the skill base that now exists in each institution;
7. Provide more training in qualitative data analysis and interpretation;
8. Provide additional support in applying skills in patient flow analysis, 360 degree analysis,
and studies of health worker motivation in the surgery department of Al Bashir Hospital;
9. Take further steps to widen the critical mass of employees within the MOH who have skills
to support hospital decentralization, especially in the areas of health care financing and
management;
28 4. Conclusions and Recommendations
10. Provide more training to support the creation of a harmonized medical records system at El
Kerak Hospital;
11. Specific emphasis on budget skills training for staff at El Kerak and Princess Raya
Hospitals;
12. Offer more courses in English conversation, as opposed to skills training in grammar;
13. Extend the PHR project for two or three more years, after which time the results from PHR￾sponsored training will be more evident;
14. Require selected trainees to have a briefing with MOH staff before they leave for third
country or US training venues;
15. Provide more opportunities to see examples of hospital autonomy in other countries, ideally
in the ANE region;
16. Improve the linkage for follow-up and supervision between the MOH counterparts for
hospital counterparts and participants who received PHR-sponsored training either locally or
in third countries; and
17. Provide more skills training for counterparts, through courses that are specific to the topics
of decentralization and project management.
4.2.2 Other Recommendations
1. Develop a “Medline” at Jordan University, containing abstracts on the body of research that
has been developed. This will provide access to a greater number of resources in addition to
formalizing the way research products are catalogued and accessed;
2. Continue the path of encouraging scientific research in the public and private sectors;
3. Assist with the completion of a study on the effectiveness of recruiting temporary staff in the
event of patient flow increases occurring in different departments at Al Bashir Hospital;
4. Encourage donors, including USAID, to help in providing seed money for the creation of the
national research unit in Jordan; and
5. Focus on institutionalizing NHA through the creation of an independent institution with
clear rules and regulations, and systems for financial management and administration.
4.2.3 PHR Recommendations
In line with the above feedback, PHR recommends the provision of ongoing training support, for
the purpose of strengthening the creation of a critical mass of individuals who can lead the process of
health sector reform in Jordan. Ideally, the recipients of training under the life of the current PHR
project will be tapped more aggressively to provide direction and technical input into the design of
future competency-based training. Now that a broad-based capacity has been established, it will be
critical to continue to evaluate the performance gaps that exist within each partner organization and to
ensure that training will be structured to meet those gaps. PHR also recommends that more emphasis
and importance be placed on pre-defined conditions of training, so that selected trainees are better
positioned to make tangible and meaningful contributions to the process of health sector reform in
Jordan.
Lastly, as PHR draws to a close, it would also be timely and appropriate to have the MOH
Education and Training and Planning Directorates assume direct responsibility for working with the
donor community to develop a multi-sectoral training plan to support continued skills development at
the central, hospital, and primary health care center levels. Such a partnership will encourage a more
4. Conclusions and Recommendations 29
optimal utilization of resources, in addition to fostering clearly defined roles and systems for tracking
trainee progress and gauging performance as an outcome of the training received.

Annex A: Number of Participants Trained by Organization 31
Annex A: Number of Participants Trained by
Organization
32 Annex A: Number of Participants Trained by Organization
Number of Participants Trained from the Ministry of Health (Non-Duplicated Numbers)
Customized Courses Study Tours Workshops Conferences
In-country Out-country In-country Out-country In￾country
Out-country In￾country
Out-country
Type of Activity
Directorates
M F M F M F M F M F M F M F M F
Directorate of Planning 1 1 5 1
Directorate of Education and
Training
1 1 1 1
Directorate of Finance 1 1 2 1 1 1
Central Directorate 11 2 1 1
Directorate of Food Hygiene 1 1
Primary Health Care General
Directorate
1 1
Internal Monitoring Directorate 1 1 2
Information Center 1 1
Research and Studies
Directorate
2 3 1
General Directorate for Health
Insurance
2 1 2 1 2 2
Directorate for Curative
Services
1 1 1
General Directorate for
Administrative Affairs
1 2 2
Directorate of Purchasing 1 1 2
Directorate of Supplies 1 1
Directorate of Services and
Transportation
1 2
Directorate of Development 1
Legal Affairs Directorate 1
Directorate of Patient Affairs 1
Ma’an Health Directorate 2
Balqa Health Directorate 3
Tafieleh Health Directorate 1
Madba Health Directorate 2
Ajlon Health Directorate 2
Mafraq Health Directorate 2
Annex A: Number of Participants Trained by Organization 33
Number of Participants Trained from the Ministry of Health, Cont’d. (Non-Duplicated Numbers)
Customized Courses Study Tours Workshops Conferences
In-country Out-country In-country Out-country In￾country
Out-country In￾country
Out-country
Type of Activity
 Directorates
M F M F M F M F M F M F M F M F
Jerash Health Directorate 1
Zarqa health Directorate 2
Irbid Health Directorate 31 10 2 5 1
Al Karak Health Directorate 17 17 1 2 2 1 1
North Jordan Valley Health
Directorate
1
Al-Rawaished Health
Directorate
1
Al Bashir Hospital 15 10 1 2 3 1 2 1
Al Ramtha Hospital 18 2 2 1 1
Totals 89 45 7 0 0 0 19 1 59 11 4 0 6 1 4 1
Totals 134 7 0 20 70 4 7 5
Totals 141 20 74 12
Ministry of Health Trainees
Total of the non-duplicated numbers of female trainees = 60
Total of the non-duplicated numbers of male trainees = 187
Total of the non-duplicated numbers of trainees = 247
34 Annex A: Number of Participants Trained by Organization
Number of Participants Trained from Other Organizations (Non-Duplicated Numbers)
Customized Courses Study Tours Workshops Conferences
In-country Out-country In-country Out-country In-country Out-country In-country Out-country
Type of Activity
Organizations M F M F M F M F M F M F M F M F
Royal Palace 1
Academics 3 2 2 4 2 8 8 7
Private Sector 2 1 4
Royal Medical Services 3 2 2 2 1
Jordan University Hospital 1 1 1 1
Audit Bureau 1 1
World Health Organization 2 2
PHCI 2 1
Jordan Hashemiate Fund 1
USAID 1 1 1 1
Diabetes Center 1
World Bank 1 2 3
Civil Service 1 1
Arab Bank 3
Social Security Corporation 2
Ministry Social Development 1
General Budgeting Department 1
Ministry of Panning 1
Ministry of Health, Morocco 1 1
Jordan Petroleum Refinery 2
National Health Insurance Company 2
The Arab Niser Insurance Company 1
Annex A: Number of Participants Trained by Organization 35
Number of Participants Trained from Other Organizations, Cont’d. (Non-Duplicated Numbers)
Customized Courses Study Tours Workshops Conferences
In-country Out-country In-country Out-country In-country Out-country In-country Out-country
Type of Activity
Organizations M F M F M F M F M F M F M F M F
Ministry of Finance 1
Totals 9 2 0 0 0 0 5 4 28 13 3 0 33 12 0 0
Totals 11 0 0 9 41 3 45 0
Totals 11 9 44 44
Other Organization Trainees
Total of the non-duplicated numbers of female trainees = 31
Total of the non-duplicated numbers of male trainees = 78
Total of the non-duplicated numbers of trainees = 108
Summary
Total of the non-duplicated numbers of trainees from the Ministry of Health and the other organizations
Total number of female trainees from Ministry of Health and the other organizations = 91
Total number of male trainees from the Ministry of Health and the other organizations = 265
Total number of trainees from the Ministry of Health and the other organizations = 355
36 Annex A: Number of Participants Trained by Organization
Number of Participants Trained from the Ministry of Health (Duplicated Numbers)
Customized Courses Study Tours Workshops Conferences
In-country Out-country In-country Out-country In-country Out-country In￾country
Out-country
Type of Activity
 Directorates
M F M F M F M F M F M F M F M F
Directorate of Planning 46 5 8 55 4 4 18
Directorate for Education and Training 2 1 2 1
Directorate of Finance 4 3 1 2 6 1 3
Central Directorate 10 1 4 1
Directorate of Food Hygiene 2 1 1 1
Primary Health Care General Directorate 1 1
Internal Monitoring Directorate 2 1 2 1
Information Center 2 1 3 3
Research and Studies Directorate 2 1 3 2
General Directorate for Health Insurance 2 2 2 1 1 3 1
Directorate for Curative Services 2 1 4
General Directorate for Administrative Affairs 2 1 1 3 1
Directorate of Purchasing 1 1 4 2
Directorate of Supplies 2 1 1 1 2
Directorate of Services and Transportation 1 4 2
Legal Affairs Directorate
Directorate of Patient Affairs 1
Directorate of Development 1
Ma’an Health Directorate 2
Balqa Health Directorate 4
Tafieleh Health Directorate 1
Madba Health Directorate 2
Ajlon Health Directorate 2
Annex A: Number of Participants Trained by Organization 37
Number of Participants Trained from the Ministry of Health, Cont’d. (Duplicated Numbers)
Customized Courses Study Tours Workshops Conferences
In-country Out-country In-country Out-country In-country Out-country In￾country
Out-country
Type of Activity
 Directorates
M F M F M F M F M F M F M F M F
Mafraq Health Directorate 1
Jerash Health Directorate 1
Irbid Health Directorate 74 17 2 2 49 11 1 1 1
Al Karak Health Directorate 57 36 2 1 57 18 1 2 1
Zarqa Health Directorate 3
North Jordan Valley Health Directorate 1
Al- Rawaished 1
Al Bashir Hospital 9 5 1 18 6 1 4 4
Al Ramtha Hospital 22 2 6 6 1
Totals 222 72 14 2 0 0 20 1 241 46 7 0 59 10 4 1
Totals 294 16 0 21 287 7 69 5
Totals 310 21 294 74
Totals of the duplicated numbers of trainees from the Ministry of Health
Total number of female trainees = 132
Total number of male trainees = 567
Total number of female and male trainees from the Ministry of Health = 699
38 Annex A: Number of Participants Trained by Organization
Number of Participants Trained from Other Organizations (Duplicated Numbers)
Customized Courses Study Tours Workshops Conferences
In-country Out-country In-country Out-country In-country Out-country In-country Out-country
Type of Activity
Organizations M F M F M F M F M F M F M F M F
Royal Palace 1 1
Academics 11 6 3 4 5 5 22 12
Private Sector 2 4 1
Royal Medical Services 3 2 6 2 9 1
Jordan University Hospital 3 1 4 1 3 1
Audit Bureau 3 1 1
World Health Organization 1 3
PHCI 1 1 3
Jordan Hashemite Fund 1
USAID 3 7 2 1
Diabetes Center 1 1
World Bank 1 1 1
Civil Service 1 1
Arab Bank 1
Social Security Corporation 2 1
Ministry of Social Development 1
General Budgeting Department 1 1
Ministry of Planning 1 1
Annex A: Number of Participants Trained by Organization 39
Number of Participants Trained from Other Organizations, Cont’d. (Duplicated Numbers)
Customized Courses Study Tours Workshops Conferences
In-country Out-country In-country Out-country In-country Out-country In-country Out-country
Type of Activity
Organizations M F M F M F M F M F M F M F M F
Ministry of Health, Morocco 1 1
Jordan Petroleum Refinery 2
National Health Insurance Company 2
The Arab Niser Insurance Company 1
Ministry of Finance 2
Totals 22 6 0 0 0 0 7 4 30 17 3 0 57 21 0 0
Totals 28 0 0 11 47 3 78 0
Totals 28 11 50 78
Totals of the duplicated numbers of trainees from the other organizations
Total number of female trainees = 48
Total number of male trainees = 119
Total number of female and male trainees from the Ministry of Health = 167
Summary
Totals of the duplicated numbers of trainees from the MOH and the other organizations
Total number of female trainees from the Ministry of Health and the other organizations = 180
Total number of male trainees from the Ministry of Health and the other organizations = 686
Total number of trainees from the Ministry of Health and the other organizations = 866

Annex B: Chronological History of PHR Training Activities, 1998-2000 41
Annex B: Chronological History of PHR
Training Activities, 1998–2000
Study Tours
Tunisia Study Tour 16-22 January 1999
(NHA)
Tunisia Study Tour 21-29 January 2000
(Hospital Autonomy)
Health Policy Study Tour–Washington DC 20-29 February 2000
(Applied Research)
Conferences
World Bank Conference–Health Sector Reform–Washington DC 20 October-17 November 1999
(Applied Research)
American Public Association Research Conference–Chicago 7-11 November 1999
(Applied Research)
First Arab Conference on Health Care Management–Lebanon 3-13 April 2000
(Applied Research)
National Health Accounts Dissemination Conference–Amman April 2000
(NHA)
Applied Research Dissemination Conference–Amman 19-21 June 2000
(Applied Research )
National Policy Research Form Conference–Amman 31 July 2000
(Applied Research )
Workshops
National Health Accounts Workshop–Amman 25-28 May 1998
(NHA)
Hospital Autonomy Workshop–Amman 4 October 1998
(Hospital Autonomy)
Insuring the Uninsured on Jordan -Amman 23-24 November 1998
(Universal Coverage)
Hospital Costing Workshop-Cairo 28 January-5 February 1999
(Hospital Autonomy)
NHA Regional Workshop–Lebanon June 1999
(NHA)
World Health Organization Workshop–Syria October 1999
(Applied Research)
42 Annex B: Chronological History of PHR Training Activities, 1998-2000
360 Degree Assessment Workshop–Amman 24 October 1999
(Applied Research)
Patient Flow Analysis Workshop–Amman; 22 November 1999
debriefing of APHA and the World Bank conferences
(Applied Research)
Hospital Autonomy Workshop–Amman April 1999
(Hospital Autonomy)
Hospital Autonomy Workshop–Amman 27 July 1999
(Hospital Autonomy)
Debriefing of South Africa Course (MPPMS)–Amman 16 September 1999
(Hospital Autonomy)
Hospital Autonomy Workshop–Amman 12 October 1999
(Hospital Autonomy)
Hospital Autonomy Workshop–Amman, and 17 February 2000
Tunisia Study Tour Debriefing
(Hospital Autonomy)
Research Study Tour Debriefing 11 April 2000
(Applied Research)
National Health Accounts Regional–Amman May 2000
(NHA)
Hospital Autonomy Workshop–Amman 8 May 2000
(Hospital Autonomy)
Hospital Autonomy Workshop–Amman 18 July 2000
(Hospital Autonomy)
Courses
Management and Financing of Health Programs July- September,1998
in Developing Countries–Harvard
(Capacity [Foundation] Building)
Health Care and Policy–Boston September- December 1998
(Capacity [Foundation] Building)
Hospital Managerial and Financial Management–Amman September 1998
(Capacity [Foundation] Building)
English Language Skills–Amman July 98-April 2000
(Capacity [Foundation] Building)
General Computer Skills–Amman June 98-May 2000
(Capacity [Foundation] Building)
Procurement Management–Beirut June 1999
(Hospital Autonomy)
Managing the Procurement of Pharmaceuticals–South Africa August-September 1999
(Hospital Autonomy)
Computer Skills in SPSS January-February 2000
(NHA)
Computer Skills in Epi-info February-April 2000
(NHA)
Medical Records April 2000
(Hospital Autonomy)
Applied Research Course December 1999-May 2000
Annex B: Chronological History of PHR Training Activities, 1998-2000 43
(Applied Research)
General Management February-April 2000
(Hospital Autonomy)
Financial Management February-June 2000
(Hospital Autonomy)
Accounting and Interpretation of Data March-April 2000
(NHA)
Training Design and Management–US July 2000
(Training Capacity Building)