Training of Trainers (ToT)

This SME-tier course prepares ADHA's strongest alumni to become trainers and assessors who build digital-health capability at scale across Africa. Over four weeks and ten contact hours, you move from knowing digital health to teaching and judging it. You will design blended, offline-first, competency-based learning units; facilitate adult learners through psychological safety and active practice on real systems rather than lecturing; write rubrics and OSCE-style performance stations; and calibrate with fellow assessors so your "competent" means the same as theirs. You will also run an offline-first cohort end to end, from recruitment and scheduling through transitions, support, and completion tracking, then apply change-management tactics so trained skills outlast the workshop.

Grounded in African low-resource realities, from unreliable power and bandwidth to the gender digital gap, it is for top ADHA alumni who will facilitate and assess digital-health cohorts, and it models the pedagogy you will go on to deliver.

Course glossary

• Andragogy — the theory and practice of teaching adults, who are experienced, autonomous, problem-centred, and internally motivated.
• Facilitation — guiding learners to build competence through active practice and dialogue rather than transmitting content as a lecturer.
• Psychological safety — the shared belief that a learner can ask, admit confusion, or fail a practice attempt without being shamed.
• Blended learning — digital content for knowledge and standardization paired with facilitated sessions for skills, assessment, and the social commitment that sustains completion (Ch3 §3.5.1).
• Offline-first — content and activities that download once and function fully without a live connection, syncing when available; the African design default (e.g., Extension Essentials).
• Backward design — designing from the intended can-do outcome to the assessment to the content, so teaching and testing align.
• Modular unit (microlearning) — a short, self-contained learning chunk compatible with service-delivery schedules.
• Practice environment (sandbox) — a training instance of the real system (DHIS2 demo, OpenMRS reference app) where learners practise without risk to live data.
• Tiered cascade — a training structure matching depth to role across frontline, supervisory, and national-technical tiers (Ch3 §3.5.2).
• Signal loss (fidelity loss) — dilution or distortion of content as it passes through successive cascade handoffs.
• Digital champion / super-user — a respected facility peer developed into a standing internal source of help and adoption support.
• Informatics cadre — professionalized data roles with defined posts and career paths that give a system its backbone.
• Demonstrate–practise–coach ("I do, we do, you do") — the core skills-teaching cycle: model, perform together, then learners do it alone while coached.
• Wait time — the deliberate ~five-second silence after a question that gives adults time to process and respond.
• Scaffolding — structured support and tiered tasks that let learners of different abilities progress together.
• Cohort lifecycle — the arc from recruitment and readiness through scheduling, delivery, dual-period transition, support, and completion.
• Dual period — the transition when staff run paper and digital systems in parallel; must be short and dated (Ch3 §3.7.1).
• Competency-based assessment — judging what a learner can demonstrably do on the real system, not attendance or recall (Ch3 §3.5.1).
• Performance station (OSCE-style) — a realistic task the learner performs while the assessor scores observable steps against a rubric.
• Analytic rubric — an assessment tool breaking a task into observable criteria with concrete competent / not-yet descriptors.
• Validity — the degree to which an assessment actually measures the competency it claims to measure.
• Calibration — the deliberate alignment of assessors so their independent judgements converge on one standard.
• Inter-rater reliability — the degree to which independent assessors scoring the same performance agree.
• Anchor example — an agreed reference performance defining what a given rubric level looks like in practice.
• Rational resistance — opposition grounded in legitimate concerns (workflow burden, past failed tools, status anxiety, surveillance), not ignorance (Ch3 §3.7.1).
• Value equation — the user's weighing of a system's costs against its perceived value; adoption fails when demands exceed value to the user (NASSS).
• New mindset — a culture treating data as a clinical instrument, arguing decisions from evidence, and learning new tools as ordinary professionalism (Ch3 §3.7.2).
• Institutionalization — embedding competence in curricula, policy, and careers so it compounds rather than decays (Ch3 §3.6).
• Continuing Professional Development (CPD) — the requirement and mechanism by which professionals maintain and update competence, including digital competence.
• Donor cliff — the funding discontinuity when donor financing recedes, a recurring cause of tools that "arrived, broke, and vanished" and a rational basis for worker scepticism.

Frequently asked questions

Q: I'm an excellent clinician and DHIS2 user. Isn't that enough to be a good trainer? A: It is necessary but not sufficient. Teaching adults is a distinct craft — designing practice, building psychological safety, facilitating rather than lecturing, and judging demonstrated competence fairly. The most common failure of a new subject-matter expert is to lecture what they know instead of building what the learner can do. This course exists to add the facilitation and assessment craft to your existing expertise.

Q: My health post has no reliable power or internet. How can I run digital training there? A: Plan offline-first, the African default. Pre-load content and a practice sandbox onto devices while you have bandwidth, charge a power bank or confirm power, print your rubric and facilitator guide, and prepare a fallback for every connected activity. The mark of a professional trainer is that learning continues when power and signal fail — which, across rural African facilities, they regularly do. Ethiopia's Extension Essentials program is the book's proof that offline-first in-service training works at scale.

Q: What is the difference between a knowledge check and a competency assessment, and do I need both? A: A knowledge check (Q/A or quiz) efficiently confirms the underlying knowledge a skill depends on and works offline at scale, but it cannot certify a skill. A competency assessment — typically an OSCE-style performance station scored on a rubric — proves the learner can actually perform the task on the real system. Use knowledge checks to gate readiness to practise, and performance stations to certify competence. The book is explicit that certification must be tied to "demonstrated competency, not attendance."

Q: Two of us assessed the same learner and disagreed on pass/fail. What does that mean and how do we fix it? A: It means your assessment is not yet reliable — the learner's result depends on which assessor they drew, which is a fairness failure. The fix is calibration: run a calibration session on shared anchor and borderline examples, score independently, then discuss the rubric (not the person) until you converge. Repeat periodically, because standards drift, and document your inter-rater agreement so the credential can be trusted.

Q: My learners resist the new system. How do I overcome their resistance? A: First, reframe it: resistance is usually rational — it protects clinical time, reflects past tools that failed, and responds to surveillance and status anxiety. Don't try to communicate it away with more posters. Work the value side: involve users in workflow mapping, keep the dual paper-and-digital period short and dated, deploy champions and responsive support, sequence the rollout for early visible wins, and have a respected clinical leader (not IT) front the change. Adoption fails when the system's demands exceed its perceived value to the user.

Q: How do I make sure the skills survive after I leave? A: Institutionalize them. Cultivate a digital champion in every facility so help remains on-site; certify credibly so achievement is recognised and can attach to CPD and career progression; channel talented learners toward the informatics cadre; and advocate that workers get working tools and see their data actually used. The book's rule is that "workshop-based training decays; institutionalized competence compounds" — your legacy is the habit and the structure you leave, not the certificate ceremony.

Q: How do I handle a cohort with very mixed digital ability and a gender mix? A: For mixed ability, use scaffolding and tiered tasks — a core task everyone must complete plus an extension for fast finishers (who can then coach others). For the gender mix, act deliberately on the documented gender digital gap: make sure shared devices actually reach the women rather than being monopolized, schedule and locate sessions around caregiving loads, pair learners to share confidence, and make female champions visible models. The book warns that ignoring this "institutionalizes a ceiling" on a predominantly female frontline workforce.

Q: Where do I, as a ToT graduate, fit in the bigger national training picture? A: You are usually a middle tier of a cascade — trained by master trainers, training those below you. That makes you a fidelity-keeper (use standardized guides and calibrated rubrics so "competent" means the same everywhere), a champion-spotter (cultivate facility super-users so capability persists), and a cadre-scout (channel aptitude toward the professional informatics pathway). The cascade gives reach, champions give persistence, and the cadre gives the system a backbone — you contribute to all three.