In response to its critical health worker shortages, the Ministry of Health (MoH) in Zambia plans to double the annual number of health training graduates in the next five years to increase the supply of health workers. This study sought to determine the feasibility and costs of doubling training institution output through an individual school assessment framework. Assessment teams consulted faculty, managers and staff in all of Zambia's 39 public and private health training institutions in 2008. The individual school assessments affirmed the MoH's ability to double the graduate output of Zambia's public health training institutions. Lack of infrastructure was determined as a key bottleneck in achieving this increase while meeting national training quality standards. The authors argue that an investment of US$ 58.8 million is required to meet infrastructure needs, and the number of teaching staff must increase by 111% over the next five years.
Human Resources
What does it mean to be a young orphan? Why and how are numbers burgeoning? Why are orphans socially excluded and how might education support their inclusion? This study investigates the lives of orphans in an area of Malawi, suggests why the numbers of orphans are exploding and indicates how the social unrest that may follow could be avoided. This small project conceives of education in the broadest possible sense to include what the orphans need to know to survive in the short term, to fruitfully participate in their surroundings in the medium term, and to prosper in the long term. It attempts to build a picture of their lives and aspirations, the particular perceptions of female orphans and also of their carers, organised in state registered, community level Orphan Care Groups (OCGs).
African truck drivers have long been implicated in the spread of HIV. They stop at towns along major routes to eat, sleep, sell goods and have sex. Intermediaries are often involved in negotiations between drivers and commercial sex workers (CSWs). Could these middlemen contribute to HIV prevention efforts?
While there is optimism surrounding Africa’s growth potential, the continent appears to be lagging behind in training the necessary people to match its economic growth, according to this article. Although the number of students enrolling for tertiary education has been growing, the numbers are still low. Only 6% of students in sub-Saharan Africa are enrolled in tertiary institutions. Educationists and economists have observed that if Africa is going to compete in the global economy, this needs to increase to 15%. Africa can overcome barriers to student enrollment by using e-Learning and correspondence to extend education to students who face time and space constraints. There are significant challenges to this, such as limited and high cost internet connectivity on the continent, intermittent power disruption, a lack of national and institutional policies, a scarcity of experienced human resources and a perception that distance education may not offer the same quality as face-to-face education.
This paper summarises the literature on e-learning in low- and middle-income countries (LMIC), and presents the spectrum of tools and strategies used. Using standard decision criteria, reviewers narrowed the article suggestions to a final 124 relevant articles. Of the relevant articles found, most referred to e-learning in Brazil (14 articles), India (14), Egypt (10) and South Africa (10). While e-learning has been used by a variety of health workers in LMICs, most (58%) reported on physician training, while 24% focused on nursing, pharmacy and dentistry training. Blended learning approaches were the most common methodology presented (49 articles) of which computer-assisted learning (CAL) comprised the majority (45 articles). Other approaches included simulations and the use of multimedia software (20 articles), web-based learning (14 articles), and eTutor/eMentor programmes (3 articles). The authors conclude that e-learning in medical education is a means to an end, rather than the end in itself. Utilising e-learning can result in greater educational opportunities for students while simultaneously enhancing faculty effectiveness and efficiency. However, this potential of e-learning assumes a certain level of institutional readiness in human and infrastructural resources that is not always present in LMICs.
In Tanzania, the authors of this study found that increasing numbers of universities are training many more health professionals to address the country’s extreme shortage of health care workers. In 2009 six universities admitted 756 medical students, but this is still many fewer than are needed based on population growth. Tanzania’s universities have the ability to support health professionals to build and maintain critical competencies by strengthening curricula and pre-service and internship training, and providing opportunities for continuing professional development, according to the study. For example, Muhimbili University of Health and Allied Sciences (MUHAS), the oldest health sciences academic institution in Tanzania, is partnering with the University of California San Francisco to transform MUHAS's educational environment through curricula revision and faculty development. However, enhancing the educational process involves a great deal of commitment from faculty across MUHAS and will only succeed if supported by long-term institutional reform. Sharing of early lessons learned by institutions undergoing educational reform will start to build a body of knowledge and experience to inform transformation of health professions education in Tanzania and elsewhere in Africa.
The Global Assessment of Functioning (GAF) is the standard method and an essential tool for representing a clinician’s judgment of a patient’s overall level of psychological, social and occupational functioning. It is probably the single most widely used method for assessing impairment among the patients with psychiatric illnesses. The authors of this study set out to assess the effects of one-hour training on application of the GAF by Psychiatric Clinical Officers’ in a Ugandan setting. They randomly selected five psychiatrists and five psychiatric clinical officers (PCOs) or assistant medical officers who hold a two-year diploma in clinical psychiatry to take part. Before receiving an hour of training on how to rate the GAF scale, they were asked to rate a video-recorded psychiatric interview, and they assessed the video again after training. The PCOs were then offered and asked to rate the video case interview again. Results showed that the interclass correlations (ICCs) between the psychiatrists and the PCOs before training in the past one year, at admission and current functioning were +0.48, +0.51 and +0.59 respectively. After training, the ICC coefficients were +0.60, +0.82 and +0.83. The findings of this study indicate that brief training given to PCOs improved the applications of their ratings of GAF scale to acceptable levels. There is need for formal training to this cadre of psychiatric practitioners in the use of the GAF.
Drawing on IntraHealth International's lessons learned in designing reproductive health and HIV/AIDS training and performance improvement programmes, this commentary discusses promising practices for strengthening human resources for health through more efficient and effective training and learning programmes that avoid the same old traps. These promising practices include the following: assessing performance gaps and opportunities before designing a training initiative; addressing performance factors other than skills and knowledge that health workers need to perform well; applying a ‘learning for performance’ approach; standardising curricula throughout a country; linking pre-service education, in-service training and professional associations; enhancing traditional education; strengthening human resources information systems to improve workforce planning, policies and management; and applying technology to meet training needs.
This report provides examples of professional and academic associations which work across three or more African countries, and which have some evidence of success. The author aims to identify the characteristics of these organisations which enable their success. Types of impact are varied, but are usually identified as strong membership, attendance at national or international meetings, awareness of the organisation in the wider sphere, dissemination and uptake of publications, and connection or influence on policy and policy-makers. The report particularly tries to draw out any impacts on governance in the wider public sphere, however, most of the indicators of success are input or output rather than outcome-focused, and do not identify broader social or policy change. The author emphasises the need for strongly committed individuals at the centre of the organisation, personal leadership, involvement of policy-makers and the quality of outputs. Independence and neutrality are seen as important values, allowing professional development free from politics.
Health facility supervisors are in a position to increase motivation, manage resources, facilitate communication, increase accountability and conduct outreach. This study evaluated the effectiveness of a training intervention for on-site, in-charge reproductive health supervisors in Kenya using an experimental design with pre- and post-test measures in 60 health facilities. Cost information and data from supervisors, providers, clients and facilities were collected. Regression models with the generalized estimating equation approach were used to test differences between study groups and over time, accounting for clustering and matching. Total accounting costs per person trained were calculated. The intervention resulted in significant improvements in quality of care at the supervisor, provider and client–provider interaction levels. Indicators of improvements in the facility environment and client satisfaction were not apparent. The costs of delivering the supervision training intervention totalled US$2113 per supervisor trained. In making decisions about whether to expand the intervention, the costs of this intervention should be compared with other interventions designed to improve quality.