Training is where nonprofit programs usually begin. At Noora Health, a training of trainers workshop (ToT) is central to launching the Care Companion Program (CCP) — it’s where healthcare workers don’t just learn what to do, but build the confidence, skills, and motivation to teach caregivers in ways that stick.
Since the COVID-19 pandemic, organizations and governments have increasingly favored online, asynchronous, and blended training formats. Yet little guidance exists on how to choose the right approach for a given context.
We wanted to understand how online vs. in-person healthcare worker trainings compare in practice and to identify the conditions in which each format works best. So, in May 2024, we ran a structured comparison across four districts in Indonesia. All 875 participants completed a 2-hour virtual onboarding and one week of self-paced learning beforehand.
Then, we split the group into two:
- Online live training via Zoom in Pamekasan and Grobogan
- In-person training in Kota Kediri and Ponorogo
Online vs in-person healthcare worker training: What the data showed
Over eight months, we used a mixed-methods approach to track outcomes across four areas: learning and retention, learner experience, cost, and implementation. This included quantitative attendance and completion data, as well as qualitative interviews with healthcare workers, facilitators, and government stakeholders.
Across these four areas, three clear patterns emerged:
1. In-person training enabled deeper learning
Offline training consistently led to stronger engagement, clearer comprehension, and more hands-on demonstrations, especially for skill-based components like facilitation and tool use. Participants reported better retention and application of knowledge, supported by direct interaction and fewer distractions.
Facilitators also found offline sessions easier to lead, with smoother communication and more responsive participants. As one facilitator from Pamekasan noted, “Offline training makes it easier to retain information and interact with other participants. Meeting face-to-face allows us to absorb more information.”
By contrast, online facilitation required greater preparation and coordination, from managing digital tools to troubleshooting connectivity. While features like breakout rooms and quizzes supported interaction, communication often felt more one-directional, with fewer opportunities for spontaneous engagement.
2. Online training reduced costs by more than 65% and was more scalable
The cost-efficiency came primarily from eliminating travel, accommodation, and tool printing expenses. It also made it possible for healthcare workers in remote areas to participate, with minimal disruption to their clinical responsibilities.
For participants in leadership or academic roles, online formats were practical and time-efficient, especially in urban areas with strong digital infrastructure. Government stakeholders similarly viewed online training as more scalable, given its flexibility, repeatability, and cost efficiency. On the operational side, it also meant content could be updated and rolled out faster as health guidelines changed.
3. Post-training support matters more than modality of training
Surprisingly, we found that the format mattered less than we expected. The bigger driver of whether — and how often — healthcare workers delivered the program was the quality of support that followed after the training.
For the CCP, this support is led by district coordinators and field officers on our team, who work closely with healthcare workers after training to clarify doubts, reinforce quality standards, and support implementation at facilities.
Across all four districts, sustained engagement from our team was critical to maintaining implementation momentum. In online-trained districts, this often required significantly more effort, particularly where participants had limited prior exposure or faced connectivity challenges. In offline-trained districts, participants came in with stronger initial comprehension, but continued supervision remained essential everywhere.
Core principles for designing healthcare worker trainings at scale
From the study, we identified practical approaches that improve training effectiveness, consistency, and reach across large health systems.
1. Choose the modality based on purpose, not convenience
While online delivery significantly reduces costs, the goal is not to move everything online. Instead, cost efficiency should be used strategically, prioritising in-person training where it adds the most value and using online formats to expand reach and reduce disruption.
For example, offline training is most effective for foundational rollouts and skill-building, where engagement, practice, and confidence are critical. Online formats work better for structured, repeatable content, especially in settings with strong digital infrastructure. Therefore, adopting a blended approach — using each format where it performs best — offers the most effective path to scale.
2. Make online training more interactive by design
Online training works best when it is intentionally designed for participation. This includes building in structured interactions such as breakout rooms, live polls, and quizzes, and clearly communicating learning objectives and follow-up expectations.
It also requires more deliberate preparation. Online delivery often fails because of device issues, unclear contingencies, and inconsistent participation environments, making pre-session run-throughs and facilitator alignment critical.
Post-training reinforcement is also important, particularly for online cohorts. Refresher sessions, peer forums, and other forms of continued engagement can help ensure that the end of training is not the end of learning.
3. Treat implementation as part of training
Training outcomes depend heavily on what happens after the session ends. Participants, especially those trained online, benefit from clearer articulation of post-training responsibilities, along with early and consistent support. Supervision, mentorship, and timely follow-up are critical to sustaining momentum and ensuring that participants confidently move from learning to doing.
4. Customize monitoring and support to local realities
We found that program implementation varied across districts based on factors such as geography, prior exposure to the CCP, the number of facilities in a particular geography, and supervision timing. That’s why support needs to be flexible and context-led:
- Adjust supervision intensity for larger or lower-performing facilities, where teams may need more frequent follow-ups
- Deploy teams early in new rollouts since early supervision is strongly linked to stronger healthcare worker activity and better adherence to program delivery
- Set expectations that match local reality, based on infrastructure, connectivity, staffing, and prior program exposure
- Use digital dashboards to track trainer activity, session delivery, and quality in real time, so issues are spotted early, not months later
At the heart of all this is a simple truth: training isn’t a one-time event; it’s the start of a system. When we invest in the right mix of learning formats, practical rehearsal, and early follow-up, we don’t just transfer knowledge, we build confidence and momentum.
As we continue scaling the CCP, we’ll keep using online tools to expand reach, in-person spaces to strengthen facilitation, and blended models to bring the best of both together. Because when training is designed with intention, programs become more consistent, more engaging, and ultimately more useful for families where it matters most.
Note: Gulsheen Kaur contributed to this work during her tenure at Noora Health India Private Limited.
This article was made possible by editorial support from Shreya Adhikari and Tanaya Jagtiani, and design support from Rohina Thapar – thank you!
Anand Kumar
Board Member, YosAid Innovation Foundation
Gulsheen Kaur
Manager, Learning and Sharing, YosAid Innovation Foundation
Lara Rizka
Manager, Learning and Sharing, Yayasan Noora Health Indonesia
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