title: Blended Training for Frontline Health Functionaries: Is this the Way Ahead?
abstract: BACKGROUND
  To test the change in the knowledge of the study participants following a Blended Training and Learning Approach (BTLA). Secondly, the paper also tries to discuss the use of this method over the classical classroom based trainings. Frontline health functionaries are the backbone of almost all health goals. It is therefore essential to ensure proper training of this cadre of workers for optimum service delivery. The present paper tries to discuss the use of an effective new training pedagogy over the classical classroom based trainings.
  
  
  METHODS
  A cross-sectional study was conducted from August 2013 to April 2014 in all districts in the state of Odisha. The study participants comprised of two groups. Group 1: Integrated Child Development Services supervisors, Child Development Project Officers received training on reduction of stunting. Group 2: Nutrition Counselors and Auxiliary Nurses and Midwifes received training on management of severe acute malnutrition (SAM). Selection of participants was done following complete enumeration technique. The training effectiveness was measured using paired t-test. Out of approximately 2400 participants identified across the state of Odisha, 2350 participants provided consent to participate in the study.
  
  
  RESULTS
  The change in knowledge was determined by using paired t-test. The results of the paired t-test for the training on reduction of stunting were significant, P < 0.001, indicates that there was a significant increase in the score from (mean = 11.4; standard deviation [SD] = 2.34) to the post-test (mean = 13.8; SD = 2.34). The mean increase was 2.4 with 95% confidence interval [CI] for the difference between means of 11.4 and 13.8. Similar test was conducted to evaluate the training on SAM. The results of the paired t-test were significant, P < 0.001, indicates that there was a significant increase in the score from (mean = 14.7; SD = 2.8) to the post-test (mean = 15.8; SD = 2.3). The mean increase was 1.12 with 95% CI for the difference between means of mean = 14.7 to mean = 15.8. There are different approaches that can be adapted during any training ranging from the traditional form of classroom teaching to the new technologically advanced forms of training such as e-learning. Understanding the merits and demerits, there was the felt need to try a newer approach of training. Thus, the method of BTLA was tried in the study and was proved to be effective.
  
  
  CONCLUSIONS
  The newly tried and tested pedagogy of training would provide the necessary evidence for future policy decisions.
authors.affiliation: India Institute of Public Health, Bhubaneswar, Odisha, India.
authors.forename: Nayan
authors.initials: N
authors.lastname: Chakravarty
authors.affiliation: India Institute of Public Health, Bhubaneswar, Odisha, India.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Nallala
authors.affiliation: India Institute of Public Health, Bhubaneswar, Odisha, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Mahapatra
authors.affiliation: Directorate Health and Family Welfare, Bhubaneswar, Odisha, India.
authors.forename: Prajna
authors.initials: P
authors.lastname: Chaudhury
authors.affiliation: Directorate Health and Family Welfare, Bhubaneswar, Odisha, India.
authors.forename: Farida
authors.initials: F
authors.lastname: Sultana
authors.affiliation: United Nations Children's Fund, Bhubaneswar, Odisha, India.
authors.forename: Sourav
authors.initials: S
authors.lastname: Bhattacharjee
keywords: Blended training; frontline functionaries; severe acute malnutrition; stunting