Cost analysis and provider preferences of low-dose, high-frequency approach to in-service training programs in Uganda

Journal Article
(Published February, 2019)
Willcox, M. (Author),
LeFevre, A. (Author),
Mwebaza, E. (Author),
Nabukeera. J. (Author),
Conecker, G. (Author),
Johnson, P. (Author)
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Many countries in sub-Saharan Africa still face significant challenges in maternal and child health where low numbers, uneven distribution, and training deficits of the health workforce impede quality care. Low-dose, high-frequency training (LDHF), an innovative approach to in-service training, focuses on competency, team-based repetitive learning and practice in the clinical setting. In Uganda, we conducted cost analyses of local organization LDHF training programs for Post-abortion care (PAC) and Pediatric HIV to assess cost drivers and cost efficiency and compare costs to traditional workshop based training.  A survey of trained providers was conducted to understand costs and incentives of participation as well as experience and training preferences.

In traditional training programs, costs to providers were nearly equal to incentives given. In LDHF training programs, financial incentives and costs to participate were not equal and varied by roles and programs; all district trainers’ incentives outweighed their costs of participation, trainee incentives were higher than costs of participation in the PAC training, but in the Pediatric HIV program, trainee incentives were lower than the costs of participation.  Local training programs differ widely in applying Low Dose, High Frequency principles to design and implementation thus leading to variation in costs and cost-efficiency. LDHF can be more cost-efficient than workshop based trainings if programs take advantage of the wider scope of trainees available for the facility-based trainings. Incentive differences between district trainers and trainees may influence participation and perception of training. The perspectives of providers participating in LDHF or traditional workshop training should be integrated when developing future programs for maximum uptake and participation for in-service training


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Willcox M, LeFevre A, Mwebaza E, Nabukeera J, Conecker G, Johnson P. Cost analysis and provider preferences of low-dose, high-frequency approach to in-service training programs in Uganda. J Glob Health. 2019;9(1):010416.