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A new training approach for vaccinators: cascade plus training.



Angela Kydd


Effective training of staff plays a major role in reaching and sustaining immunization goals. Training and updating health staff is the responsibility of all governments and immunization related organizations. The critical issue is finding the most efficient and effective way of providing initial and continuous training. Cascade training is thought to be one of the best methods. However, several researches showed that besides its advantages the classical cascade training approach has some disadvantages. A cascade training strategy is not an inappropriate choice, but the problems are initiated from inappropriate planning and implementation of it. Therefore, in order to have better trained health staff with high performance, rather than thinking of an alternative training strategy, the governments have to consider alternative ways of increasing the quality of the classical cascade training strategy. If the cascade training strategy is well planned, carried out by blending appropriate teaching techniques and is well monitored/supervised during the implementation phase it can be an effective strategy for training the health care staff and managers. In order to differentiate this understanding from the classical cascade approach, the authors propose the "Cascade-Plus Training" model, which is defined as "a well-planned and implemented cascade training strategy with an understanding of a holistic approach to the topic of training, which is practice oriented, flexible, delivered via multiple evidence based training-techniques, supported with effective supervision, monitoring, process evaluation and problem solving deliveries."


ÖZTEK, Z. and KYDD, A. 2022. A new training approach for vaccinators: cascade plus training. Turkish journal of public health [online], 20(1), pages 164-176. Available from:

Journal Article Type Article
Acceptance Date Apr 1, 2022
Online Publication Date Apr 1, 2022
Publication Date Apr 1, 2022
Deposit Date Mar 9, 2022
Publicly Available Date Mar 9, 2022
Journal Turkish journal of public health
Electronic ISSN 1304-1088
Publisher Cetus Publishing
Peer Reviewed Peer Reviewed
Volume 20
Issue 1
Pages 164-176
Keywords Vaccinators; Health service staff; Clinical training; Cascade training
Public URL


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