1
|
Amde WK, Marchal B, Sanders D, Lehmann U. Determinants of effective organisational capacity training: lessons from a training programme on health workforce development with participants from three African countries. BMC Public Health 2019; 19:1557. [PMID: 31771556 PMCID: PMC6878696 DOI: 10.1186/s12889-019-7883-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health systems in sub-Saharan Africa face multifaceted capacity challenges to fulfil their mandates of service provision and governance of their resources. Four academic institutions in Africa implemented a World Health Organisation-funded collaborative project encompassing training, curriculum development, and partnership to strengthen national leadership and training capacity for health workforce development. This paper looks into the training component of the project, a blended Masters programme in public health that sought to improve the capacity of personnel involved in teaching or management/development of human resources for health. The paper aims to explore factors influencing contribution of training to organisational capacity development. METHODS We chose a case study design. Semi-structured interviews were held with 18 trainees that were enrolled in the training programme, and who were affiliated to health ministries or public health training institutions. We gathered additional data through document reviews, observation, and interviews with 14 key informants associated with the programme and/or working in the collaborating institutions. The evidence gathered were analysed thematically. RESULTS Thirteen of the 18 training participants stayed in the target institutions and contributed to improved capacity of their institutions in the fields of management, policy, planning, research, training, or curriculum development. Five left for private and international agencies due to dissatisfaction with payment, work conditions, or career prospect. Factors that were associated with the training, trainees, and the institutional and broader context, determine contribution of training to organisational capacity development. These include relevance of newly acquired knowledge and skills set of trainees to the role/position they assume in the organisation; recognition of trainees by employing organisations in terms of promotion or assignment of challenging tasks; and motivation and retention of trained staff. CONCLUSION Training, even if relevant and applicable, makes no more than a 'latent' contribution, one which is activated and realised through alignment of clusters of interacting contextual and relational factors related to the target institutions and trained personnel. While not predictable, implementers need to focus more deliberately on the likely interaction and best possible alignments between training relevance, student selection for potential to contribute, recognition and career advancement potential.
Collapse
Affiliation(s)
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Uta Lehmann
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
2
|
Zweigenthal VEM, Pick WM, London L. Career Paths of Public Health Medicine Specialists in South Africa. Front Public Health 2019; 7:261. [PMID: 31572703 PMCID: PMC6751254 DOI: 10.3389/fpubh.2019.00261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022] Open
Abstract
Public health (PH) skills are core to building responsive and appropriate health systems, and PH personnel including medical specialists are embedded in many countries' health systems. In South Africa, the medical specialty in PH, Public Health Medicine (PHM), has existed for over 40 years. Four years of accredited training plus success in a single national exit exam allows specialist registration with the Health Professions Council of South Africa (HPCSA). However, there are few posts designated specifically for PHM specialists in SA's health system. In view of uncertain roles, this research was designed to determine specialists' career paths, their work, job satisfaction, and perspectives on the future of the specialty. We combined three databases to generate the study population and invited all specialists to participate in an online or hard-copy survey. We found that in 2010, PHM was a small specialty of less 200 physicians. Of the 151 contactable, eligible physicians, 55.6% completed the questionnaire. Participants represented an aging group (median age = 49) of specialists and recent graduates were increasingly women. They largely worked in academic institutions (as managers, teachers, and researchers) and in the public sector health system; were motivated by a sense of social justice and their training was formative, exposing them to work settings which they later entered; were largely highly satisfied at work, but many worked in non-specialist positions. Indeed, one fifth had not registered with the HPCSA as specialists. They were concerned about the specialty's poor visibility and identity, but did not see other PH professionals as a threat. They believed that the specialty should refine its competencies, demonstrate its value and advocate for service positions at all levels of the public sector health service. PHM has a contribution to make—reorienting services to protect communities, preventing ill health, analyzing disease burdens locally, identifying innovations in a resource-constrained health service, largely preoccupied with curative care services.
Collapse
Affiliation(s)
| | - William M Pick
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Leslie London
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
3
|
Rennie T, Nangombe V, Mangombe T, Kibuule D, Hunter CJ. Health workforce planning in Namibia: assessing a pilot workforce survey of pharmacists. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:565-574. [DOI: 10.1111/ijpp.12547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 05/02/2019] [Indexed: 11/30/2022]
Abstract
Abstract
Background
Southern Africa lacks resources necessary to combat presenting health challenges. This crisis will likely be remedied through the in-country training of healthcare professionals, for example, in Namibia. Monitoring the workforce will be essential to inform planning in health services and training. A national pilot workforce survey in Namibia using a multi-modal sampling approach aimed to test methodology for describing the pharmacy workforce and quantifying preferences towards further training.
Methods
The survey tool included questions relating to socio-demographics, professional and practice aspects. A conjoint analysis approach was utilised to quantify preferences around study programme, modality of study and cost.
Key findings
Respondents (N = 135; ~20% response) represented a diverse range of individuals in various pharmacy sectors in Namibia. The majority of respondents reported female gender, private sector working, studying outside Namibia and societal group membership. Societal membership and pharmacy ownership – indicators of professional engagement – were associated with higher age; ownership was also associated with study outside Namibia and practice in community pharmacy. Regarding further study preferences, respondents placed more importance on study programme and modality over cost with the most preferred scenario being a 2-year full-time Masters programme in pharmaceutical industry/regulation by distance learning at the highest cost bracket.
Conclusions
This national survey sampled the population of pharmacists in Namibia exploring the composition of the profession and preferences towards training. Further work will validate the findings and provide ongoing monitoring of the pharmacy workforce that can be expanded to other professional groups over a larger geographical area.
Collapse
Affiliation(s)
- Timothy Rennie
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Vulika Nangombe
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Tafadzwa Mangombe
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Christian J Hunter
- School of Medicine, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| |
Collapse
|
4
|
Zamani-Alavijeh F, Araban M, Harandy TF, Bastami F, Almasian M. Sources of Health care providers' Self-efficacy to deliver Health Education: a qualitative study. BMC MEDICAL EDUCATION 2019; 19:16. [PMID: 30626364 PMCID: PMC6327583 DOI: 10.1186/s12909-018-1448-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/28/2018] [Indexed: 05/23/2023]
Abstract
BACKGROUND The self-efficacy of educators plays a crucial role in their professional competence and subsequent provision of care. The present study aims to explain the main sources contributing to the development of self-efficacy beliefs among healthcare providers in delivering health education. METHODS This qualitative study was conducted from 2015 to 2016 in various settings of Isfahan such as hospitals, doctor's offices, and healthcare centers. Twenty three health educators with an average of 10-year work experience in healthcare participated in the study. Data were collected using semi-structured in-depth individual interviews and were analyzed through conventional content analysis. Prolonged engagement with the participants, maximum variation in the participants' characteristics, sampling, and member check were among the factors enriching the research. RESULTS The six main categories extracted during data analysis included: 1) Quantity and quality of their experience; 2) Encountering unexpected events; 3) Client trust; 4) Self-concept; 5) Professional knowledge and skill; 6) Vicarious experiences. CONCLUSIONS The study results show two new findings, including "encountering unexpected events" and "client trust", affecting professional self-efficacy beliefs among healthcare providers in the delivery of health education. The other main findings were extremely similar to Bandura's theory. These results can be used as a basis in planning and implementing health development educational models for human resources.
Collapse
Affiliation(s)
- Fereshteh Zamani-Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Araban
- Social Determinants of Health Research Centre, Department of Health Education and Promotion, Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Tayebeh Fasihi Harandy
- Social Determinants of Health Research Centre, Alborz University of Medical Sciences, Karaj, Iran
| | - Fatemeh Bastami
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Almasian
- Department of the English Language, Faculty of Medicine, Lorestan University of Medical Sciences, Lorestan, Iran
| |
Collapse
|
5
|
Eissa M, Patel AA, Farag S, Babiker NH, Al-Shahrani MS, Al-Nahari AM, Al Sahmaa AM, Al-Shraim M. Awareness and Attitude of University Students About Screening and Testing for Hemoglobinopathies: Case Study of the Aseer Region, Saudi Arabia. Hemoglobin 2019; 42:264-268. [PMID: 30821195 DOI: 10.1080/03630269.2018.1541802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Hemoglobinopathies can disturb a patient's life style leading to community problems. Premarital screening is an important tool to control and minimize hemoglobinopathies. This study aimed to assess and improve the awareness and attitude of King Khalid University (KKU) [Abha, Kingdom of Saudi Arabia (KSA)] students in the Aseer Region, regarding hemoglobinopathies and the National Premarital Screening Programme (NPMS) in addition to screening for hemoglobin (Hb) variants of students who agreed to participate. This study was an interventional educational prospective study of electronic-lectures (e-lectures) that addressed some important issues of hemoglobinopathies and premarital screening. Six hundred and eleven students were interviewed during the academic year 2017/2018, using closed-ended questionnaires that distributed before and after intervention. Blood samples were taken from 114 students who agreed to check their Hb type by the D-10 Hemoglobin Testing System. The results revealed significant changes in knowledge and attitude of students toward hemoglobinopathies and premarital counseling after intervention. These results reflected the need for easily accessible and continuous health education programs for students to increase their awareness and attitude toward hemoglobinopathies. Laboratory results for 114 students revealed seven cases with microcytic hypochromic anemia (6.1%); they were all females. Blood screening for Hb variants revealed another two females (1.75%) with sickle cell trait (Hb AS). Electronic-health (E-health) is an efficient tool for improving the awareness and attitude of the community toward hemoglobinopathies. Screening blood tests for detection of hemoglobinopathies should be provided to young adults at an earlier stage (before marriage) to decrease the incidence of hereditary diseases in the community.
Collapse
Affiliation(s)
- Mohamed Eissa
- a Pathology Department, College of Medicine , King Khalid University , Abha , Kingdom of Saudi Arabia.,b Clinical Pathology Department, Faculty of Medicine , Zagazig University , Zagazig , Egypt
| | - Ayyub A Patel
- c Clinical Biochemistry Department, College of Medicine , King Khalid University , Abha , Kingdom of Saudi Arabia
| | - Shehata Farag
- d High Institute of Public Health, Alexandria University , Alexandria , Egypt.,e Community and Family Medicine Department, College of Medicine , King Khalid University , Abha , Kindom of Saudi Arabia
| | - Nashwa H Babiker
- f Clinical Laboratory Science Department, College of Applied Medical Science , Abha , Kingdom of Saudi Arabia
| | - Malak S Al-Shahrani
- f Clinical Laboratory Science Department, College of Applied Medical Science , Abha , Kingdom of Saudi Arabia
| | - Albatool M Al-Nahari
- f Clinical Laboratory Science Department, College of Applied Medical Science , Abha , Kingdom of Saudi Arabia
| | - Ali M Al Sahmaa
- g Laboratory and Blood Bank Department , Aseer Central Hospital , Abha , Kingdom of Saudi Arabia
| | - Mubarak Al-Shraim
- b Clinical Pathology Department, Faculty of Medicine , Zagazig University , Zagazig , Egypt
| |
Collapse
|
6
|
Sridharan S, Bondy M, Nakaima A, Heller RF. The potential of an online educational platform to contribute to achieving sustainable development goals: a mixed-methods evaluation of the Peoples-uni online platform. Health Res Policy Syst 2018; 16:106. [PMID: 30419943 PMCID: PMC6233379 DOI: 10.1186/s12961-018-0381-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper reports on an online platform, People's Open Access Education Initiative (Peoples-uni), as a means of enhancing access to master's level public health education for health professionals. Peoples-uni seeks to improve population health in low- and middle-income countries by building public health capacity through e-learning at very low cost. We report here an evaluation of the Peoples-uni programme, conducted within the context of Sustainable Development Goal 4, which seeks to "ensure inclusive and quality education for all and promote lifelong learning" by 2030. The evaluation seeks to address the following three questions: (1) Did Peoples-uni meet its intended goals? (2) What were the different types of impacts that students experienced? (3) What suggestions for future changes in Peoples-uni did students recommend? METHODS A mixed methods evaluation consisted of two parts, namely an online survey and a telephone interview. A total of 119 master's level graduates were invited to participate; responses were obtained from 71 of those invited, giving a response rate of 60%. Respondents were spread across 31 countries. Interviews were conducted with 18 respondents. RESULTS There was strong evidence that Peoples-uni had achieved its stated goals. Potential impacts on students included knowledge to enhance practice and appreciation of context, enhanced research capacity through knowledge of public health, critical thinking and evidence-based programming, and empowerment of students about the potential of education as a means of improving their lives. Accreditation through future partnerships with local universities was recommended by students. CONCLUSIONS Peoples-uni has been able to deliver a credible public health master's level educational programme, with positive impacts on the students who graduated. Challenges are to find a way to accredit the programme to ensure its sustainability and to see how to take full advantage of the current, and future, graduates to turn this from an education programme into a capacity-building programme with real impact.
Collapse
Affiliation(s)
- Sanjeev Sridharan
- The Evaluation Centre for Complex Health Interventions, St. Michael’s Hospital and University of Toronto, Toronto, Canada
| | - Madeleine Bondy
- The Evaluation Centre for Complex Health Interventions, St. Michael’s Hospital and University of Toronto, Toronto, Canada
| | - April Nakaima
- The Evaluation Centre for Complex Health Interventions, St. Michael’s Hospital and University of Toronto, Toronto, Canada
| | - Richard F. Heller
- People’s Open Access Education Initiative (Peoples-uni), Manchester, United Kingdom
| |
Collapse
|
7
|
Hiatt RA, Engmann NJ, Ahmed M, Amarsi Y, Macharia WM, Macfarlane SB, Ngugi AK, Rabbani F, Walraven G, Armstrong RW. Population Health Science: A Core Element of Health Science Education in Sub-Saharan Africa. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:462-467. [PMID: 27508343 PMCID: PMC5367502 DOI: 10.1097/acm.0000000000001320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Sub-Saharan Africa suffers an inordinate burden of disease and does not have the numbers of suitably trained health care workers to address this challenge. New concepts in health sciences education are needed to offer alternatives to current training approaches.A perspective of integrated training in population health for undergraduate medical and nursing education is advanced, rather than continuing to take separate approaches for clinical and public health education. Population health science educates students in the social and environmental origins of disease, thus complementing disease-specific training and providing opportunities for learners to take the perspective of the community as a critical part of their education.Many of the recent initiatives in health science education in sub-Saharan Africa are reviewed, and two case studies of innovative change in undergraduate medical education are presented that begin to incorporate such population health thinking. The focus is on East Africa, one of the most rapidly growing economies in sub-Saharan Africa where opportunities for change in health science education are opening. The authors conclude that a focus on population health is a timely and effective way for enhancing training of health care professionals to reduce the burden of disease in sub-Saharan Africa.
Collapse
Affiliation(s)
- Robert A. Hiatt
- R.A. Hiatt is professor and chair, Department of Epidemiology and Biostatistics, University of California, San Francisco, and director of population sciences and associate director, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Natalie J. Engmann
- N.J. Engmann is a doctoral student, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Mushtaq Ahmed
- M. Ahmed is professor and associate dean of medical education, Aga Khan University, Faculty of Health Sciences–East Africa, Dar es Salaam, Tanzania
| | - Yasmin Amarsi
- Y. Amarsi is professor and dean, School of Nursing and Midwifery, Aga Khan University, Faculty of Health Sciences–East Africa, Nairobi, Kenya
| | - William M. Macharia
- W.M. Macharia is professor and chair, Department of Paediatrics and Child Health, Aga Khan University, Faculty of Health Sciences–East Africa, Nairobi, Kenya
| | - Sarah B. Macfarlane
- S.B. Macfarlane is professor, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, and visiting professor, Aga Khan University, Faculty of Health Sciences–East Africa, Nairobi, Kenya
| | - Anthony K. Ngugi
- A.K. Ngugi is assistant professor, Aga Khan University, Faculty of Health Sciences–East Africa, Nairobi, Kenya
| | - Fauziah Rabbani
- F. Rabbani is professor and chair, Department of Community Health Sciences, Aga Khan University–Karachi, Pakistan
| | - Gijs Walraven
- G. Walraven is honorary professor, Department of Community Health Sciences, Aga Khan University–Karachi, Pakistan, and director for health, Aga Khan Development Network, Geneva, Switzerland
| | - Robert W. Armstrong
- R.W. Armstrong is professor and dean of the medical college, Aga Khan University, Faculty of Health Sciences–East Africa, Nairobi, Kenya
| |
Collapse
|
8
|
Dlungwane T, Voce A, Searle R, Stevens F. Master of Public Health programmes in South Africa: issues and challenges. Public Health Rev 2017; 38:5. [PMID: 29450077 PMCID: PMC5810082 DOI: 10.1186/s40985-017-0052-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The demand for highly skilled public health personnel in low- and middle-income countries has been recognised globally. In South Africa, the need to train more public health professionals has been acknowledged. The Human Resource for Health (HRH) Strategy for South Africa includes the establishment of public health units at district and provincial levels. Programmes such as Master of Public Health (MPH) programmes are viewed as essential contributors in equipping health practitioners with adequate public health skills to meet the demands of the health care system. All MPH programmes have been instituted independently; there is no systematic information or comparison of programmes and requirements across institutions. This study aims to establish a baseline on MPH programmes in South Africa in terms of programme characteristics, curriculum, teaching workforce and graduate output. METHODS A mixed method design was implemented. A document analysis and cross-sectional descriptive survey, comprising both quantitative and qualitative data collection, by means of questionnaires, of all MPH programmes active in 2014 was conducted. The MPH programme coordinators of the 10 active programmes were invited to participate in the study via email. Numeric data were summarized in frequency distribution tables. Non-numeric data was captured, collated into one file and thematically analysed. RESULTS A total of eight MPH programmes responded to the questionnaire. Most programmes are affiliated to medical schools and provide a wide range of specialisations. The MPH programmes are run by individual universities and tend to have their own quality assurance, validation and assessment procedures with minimal external scrutiny. National core competencies for MPH programmes have not been determined. All programmes are battling to provide an appropriate supply of well-trained public health professionals as a result of drop-out, low throughput and delayed time to completion. CONCLUSION The MPH programmes have consistently graduated MPH candidates, although the numbers differ by institution. The increasing number of enrolments coupled by insufficient teaching personnel and low graduate output are key challenges impacting on the production of public health professionals. Collaboration amongst the MPH programmes, standardization, quality assurance and benchmarking needs considerable attention.
Collapse
Affiliation(s)
- Thembelihle Dlungwane
- College of Health Sciences, School of Nursing and Public Health, Howard College Campus, University of KwaZulu-Natal, Glenwood, Durban, South Africa
| | - Anna Voce
- College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Ruth Searle
- College of Humanities, School of Education, University of KwaZulu-Natal, Durban, South Africa
| | - Fred Stevens
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
9
|
Quaglio G, Dario C, Karapiperis T, Delponte L, Mccormack S, Tomson G, Micheletti G, Bonnardot L, Putoto G, Zanaboni P. Information and communications technologies in low and middle-income countries: Survey results on economic development and health. HEALTH POLICY AND TECHNOLOGY 2016. [DOI: 10.1016/j.hlpt.2016.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
10
|
Campbell OMR, Calvert C, Testa A, Strehlow M, Benova L, Keyes E, Donnay F, Macleod D, Gabrysch S, Rong L, Ronsmans C, Sadruddin S, Koblinsky M, Bailey P. The scale, scope, coverage, and capability of childbirth care. Lancet 2016; 388:2193-2208. [PMID: 27642023 DOI: 10.1016/s0140-6736(16)31528-8] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/23/2016] [Accepted: 06/17/2016] [Indexed: 12/15/2022]
Abstract
All women should have access to high quality maternity services-but what do we know about the health care available to and used by women? With a focus on low-income and middle-income countries, we present data that policy makers and planners can use to evaluate whether maternal health services are functioning to meet needs of women nationally, and potentially subnationally. We describe configurations of intrapartum care systems, and focus in particular on where, and with whom, deliveries take place. The necessity of ascertaining actual facility capability and providers' skills is highlighted, as is the paucity of information on maternity waiting homes and transport as mechanisms to link women to care. Furthermore, we stress the importance of assessment of routine provision of care (not just emergency care), and contextualise this importance within geographic circumstances (eg, in sparsely-populated regions vs dense urban areas). Although no single model-of-care fits all contexts, we discuss implications of the models we observe, and consider changes that might improve services and accelerate response to future challenges. Areas that need attention include minimisation of overintervention while responding to the changing disease burden. Conceptualisation, systematic measurement, and effective tackling of coverage and configuration challenges to implement high quality, respectful maternal health-care services are key to ensure that every woman can give birth without risk to her life, or that of her baby.
Collapse
Affiliation(s)
| | - Clara Calvert
- London School of Hygiene & Tropical Medicine, London, UK
| | - Adrienne Testa
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Lenka Benova
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - France Donnay
- Tulane University School of Public Health, New Orleans, LA, USA
| | - David Macleod
- London School of Hygiene & Tropical Medicine, London, UK
| | - Sabine Gabrysch
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Luo Rong
- National Center for Women and Children Health, Chinese Disease Prevention Control Center, Beijing, China
| | - Carine Ronsmans
- London School of Hygiene & Tropical Medicine, London, UK; West China School of Public Health, Sichuan University, Chengdu, China
| | | | - Marge Koblinsky
- USAID, Office of Health, Infectious Diseases and Nutrition, Maternal and Child Health, Washington, DC, USA
| | | |
Collapse
|
11
|
Thomson DR, Semakula M, Hirschhorn LR, Murray M, Ndahindwa V, Manzi A, Mukabutera A, Karema C, Condo J, Hedt-Gauthier B. Applied statistical training to strengthen analysis and health research capacity in Rwanda. Health Res Policy Syst 2016; 14:73. [PMID: 27681517 PMCID: PMC5041513 DOI: 10.1186/s12961-016-0144-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 09/07/2016] [Indexed: 11/22/2022] Open
Abstract
Background To guide efficient investment of limited health resources in sub-Saharan Africa, local researchers need to be involved in, and guide, health system and policy research. While extensive survey and census data are available to health researchers and program officers in resource-limited countries, local involvement and leadership in research is limited due to inadequate experience, lack of dedicated research time and weak interagency connections, among other challenges. Many research-strengthening initiatives host prolonged fellowships out-of-country, yet their approaches have not been evaluated for effectiveness in involvement and development of local leadership in research. Methods We developed, implemented and evaluated a multi-month, deliverable-driven, survey analysis training based in Rwanda to strengthen skills of five local research leaders, 15 statisticians, and a PhD candidate. Research leaders applied with a specific research question relevant to country challenges and committed to leading an analysis to publication. Statisticians with prerequisite statistical training and experience with a statistical software applied to participate in class-based trainings and complete an assigned analysis. Both statisticians and research leaders were provided ongoing in-country mentoring for analysis and manuscript writing. Results Participants reported a high level of skill, knowledge and collaborator development from class-based trainings and out-of-class mentorship that were sustained 1 year later. Five of six manuscripts were authored by multi-institution teams and submitted to international peer-reviewed scientific journals, and three-quarters of the participants mentored others in survey data analysis or conducted an additional survey analysis in the year following the training. Conclusions Our model was effective in utilizing existing survey data and strengthening skills among full-time working professionals without disrupting ongoing work commitments and using few resources. Critical to our success were a transparent, robust application process and time limited training supplemented by ongoing, in-country mentoring toward manuscript deliverables that were led by Rwanda’s health research leaders.
Collapse
Affiliation(s)
- Dana R Thomson
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America.
| | | | - Lisa R Hirschhorn
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America.,Ariadne Labs, Boston, MA, United States of America
| | - Megan Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Vedaste Ndahindwa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Anatole Manzi
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,Partners in Health-Rwanda, Rwinkwavu, Rwanda
| | - Assumpta Mukabutera
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Corine Karema
- Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda.,Quality and Equity Healthcare, Kigali, Rwanda.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Jeanine Condo
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Bethany Hedt-Gauthier
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America.,Partners in Health-Rwanda, Rwinkwavu, Rwanda
| |
Collapse
|
12
|
Rabbani F, Shipton L, White F, Nuwayhid I, London L, Ghaffar A, Ha BTT, Tomson G, Rimal R, Islam A, Takian A, Wong S, Zaidi S, Khan K, Karmaliani R, Abbasi IN, Abbas F. Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations? BMC Public Health 2016; 16:941. [PMID: 27604901 PMCID: PMC5015344 DOI: 10.1186/s12889-016-3616-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges. MAIN TEXT The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs). CONCLUSION SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries.
Collapse
Affiliation(s)
- Fauziah Rabbani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Leah Shipton
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Franklin White
- Pacific Health & Development Sciences Inc., Victoria, Canada
| | - Iman Nuwayhid
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Leslie London
- Division Public Health Medicine, School of Public Health and Family Medicine University of Cape Town, Cape Town, South Africa
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | - Bui Thi Thu Ha
- Hanoi School of Public Health, Giang Vo, Ba Dinh, Hanoi, Vietnam
| | - Göran Tomson
- Depts LIME & PHS, Karolinska Institutet Stockholm, Stockholm, Sweden
| | - Rajiv Rimal
- Department of Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, USA
| | - Anwar Islam
- School of Health Policy and Management, York University, Toronto, Ontario Canada
| | - Amirhossein Takian
- Department of Global Health & Sustainable Development, School of Public Health-Tehran University of Medical Sciences, Tehran, Iran
| | - Samuel Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Shehla Zaidi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Kausar Khan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rozina Karmaliani
- School of Nursing & Midwifery and Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Imran Naeem Abbasi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Farhat Abbas
- Medical College, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
13
|
Public health nutrition capacity: assuring the quality of workforce preparation for scaling up nutrition programmes. Public Health Nutr 2016; 19:2090-100. [PMID: 26857753 DOI: 10.1017/s136898001500378x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To describe why and how capacity-building systems for scaling up nutrition programmes should be constructed in low- and middle-income countries (LMIC). DESIGN Position paper with task force recommendations based on literature review and joint experience of global nutrition programmes, public health nutrition (PHN) workforce size, organization, and pre-service and in-service training. SETTING The review is global but the recommendations are made for LMIC scaling up multisectoral nutrition programmes. SUBJECTS The multitude of PHN workers, be they in the health, agriculture, education, social welfare, or water and sanitation sector, as well as the community workers who ensure outreach and coverage of nutrition-specific and -sensitive interventions. RESULTS Overnutrition and undernutrition problems affect at least half of the global population, especially those in LMIC. Programme guidance exists for undernutrition and overnutrition, and priority for scaling up multisectoral programmes for tackling undernutrition in LMIC is growing. Guidance on how to organize and scale up such programmes is scarce however, and estimates of existing PHN workforce numbers - although poor - suggest they are also inadequate. Pre-service nutrition training for a PHN workforce is mostly clinical and/or food science oriented and in-service nutrition training is largely restricted to infant and young child nutrition. CONCLUSIONS Unless increased priority and funding is given to building capacity for scaling up nutrition programmes in LMIC, maternal and child undernutrition rates are likely to remain high and nutrition-related non-communicable diseases to escalate. A hybrid distance learning model for PHN workforce managers' in-service training is urgently needed in LMIC.
Collapse
|
14
|
Amde WK, Sanders D, Lehmann U. Building capacity to develop an African teaching platform on health workforce development: a collaborative initiative of universities from four sub Saharan countries. HUMAN RESOURCES FOR HEALTH 2014; 12:31. [PMID: 24886267 PMCID: PMC4049409 DOI: 10.1186/1478-4491-12-31] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 05/13/2014] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Health systems in many low-income countries remain fragile, and the record of human resource planning and management in Ministries of Health very uneven. Public health training institutions face the dual challenge of building human resources capacity in ministries and health services while alleviating and improving their own capacity constraints. This paper reports on an initiative aimed at addressing this dual challenge through the development and implementation of a joint Masters in Public Health (MPH) programme with a focus on health workforce development by four academic institutions from East and Southern Africa and the building of a joint teaching platform. METHODS Data were obtained through interviews and group discussions with stakeholders, direct and participant observations, and reviews of publications and project documents. Data were analysed using thematic analysis. CASE DESCRIPTION The institutions developed and collaboratively implemented a 'Masters Degree programme with a focus on health workforce development'. It was geared towards strengthening the leadership capacity of Health ministries to develop expertise in health human resources (HRH) planning and management, and simultaneously build capacity of faculty in curriculum development and innovative educational practices to teach health workforce development. The initiative was configured to facilitate sharing of experience and resources. DISCUSSION The implementation of this initiative has been complex, straddling multiple and changing contexts, actors and agendas. Some of these are common to postgraduate programmes with working learners, while others are unique to this particular partnership, such as weak institutional capacity to champion and embed new programmes and approaches to teaching. CONCLUSIONS The partnership, despite significant inherent challenges, has potential for providing real opportunities for building the field and community of practice, and strengthening the staff and organizational capacity of participant institutions. Key learning points of the paper are:• the need for long-term strategies and engagement;• the need for more investment and attention to developing the capacity of academic institutions;• the need to invest specifically in educational/teaching expertise for innovative approaches to teaching and capacity development more broadly; and• the importance of increasing access and support for students who are working adults in public health institutions throughout Africa.
Collapse
Affiliation(s)
- Woldekidan Kifle Amde
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville 7535, South Africa
| | - David Sanders
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville 7535, South Africa
| | - Uta Lehmann
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville 7535, South Africa
| |
Collapse
|
15
|
Shrimpton R, Hughes R, Recine E, Mason JB, Sanders D, Marks GC, Margetts B. Nutrition capacity development: a practice framework. Public Health Nutr 2014; 17:682-8. [PMID: 23651529 PMCID: PMC10282465 DOI: 10.1017/s1368980013001213] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 03/16/2013] [Accepted: 03/20/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To outline a framework and a process for assessing the needs for capacity development to achieve nutrition objectives, particularly those targeting maternal and child undernutrition. DESIGN Commentary and conceptual framework. SETTING Low- and middle-income countries. Result A global movement to invest in a package of essential nutrition interventions to reduce maternal and child undernutrition in low- and middle-income countries is building momentum. Capacity to act in nutrition is known to be minimal in most low- and middle-income countries, and there is a need for conceptual clarity about capacity development as a strategic construct and the processes required to realise the ability to achieve population nutrition and health objectives. The framework for nutrition capacity development proposed recognises capacity to be determined by a range of factors across at least four levels, including system, organisational, workforce and community levels. This framework provides a scaffolding to guide systematic assessment of capacity development needs which serves to inform strategic planning for capacity development. CONCLUSIONS Capacity development is a critical prerequisite for achieving nutrition and health objectives, but is currently constrained by ambiguous and superficial conceptualisations of what capacity development involves and how it can be realised. The current paper provides a framework to assist this conceptualisation, encourage debate and ongoing refinement, and progress capacity development efforts.
Collapse
Affiliation(s)
- Roger Shrimpton
- Department of Global Community Health and Behavioural Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Roger Hughes
- Health Professional Education, School of Health Sciences, Bond University, Gold Coast, Queensland, Australia
| | - Elisabetta Recine
- Departamento de Nutrição, Observatório de Políticas de Segurança Alimentar e Nutrição, Universidade de Brasília, Brasília, Brazil
| | - John B Mason
- Department of Global Community Health and Behavioural Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - David Sanders
- School of Public Health, University of the Western Cape, Bellville, Republic of South Africa
| | - Geoffrey C Marks
- Nutrition Unit, School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - Barrie Margetts
- Public Health Nutrition, Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
16
|
Chastonay P, Moretti R, Zesiger V, Cremaschini M, Bailey R, Pariyo G, Kabengele EM. Health workforce development: a needs assessment study in French speaking African countries. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2013; 18:265-77. [PMID: 22453358 DOI: 10.1007/s10459-012-9369-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 03/14/2012] [Indexed: 05/22/2023]
Abstract
In 2006, WHO alerted the world to a global health workforce crisis, demonstrated through critical shortages of health workers, primarily in Sub-Saharan Africa (WHO in World Health Report, 2006). The objective of our study was to assess, in a participative way, the educational needs for public health and health workforce development among potential trainees and training institutions in nine French-speaking African countries. A needs assessment was conducted in the target countries according to four approaches: (1) Review at national level of health challenges. (2) Semi-directed interviews with heads of relevant training institutions. (3) Focus group discussions with key-informants. (4) A questionnaire-based study targeting health professionals identified as potential trainees. A needs assessment showed important public health challenges in the field of health workforce development among the target countries (e.g. unequal HRH distribution in the country, ageing of HRH, lack of adequate training). It also showed a demand for education and training institutions that are able to offer a training programme in health workforce development, and identified training objectives and core competencies useful to potential employers and future trainees (e.g. leadership, planning/evaluation, management, research skill). In combining various approaches our study was able to show a general demand for health managers who are able to plan, develop and manage a nation's health workforce. It also identified specific competencies that should be developed through an education and training program in public health with a focus on health workforce development.
Collapse
Affiliation(s)
- Philippe Chastonay
- Institute of Social and Preventive Medicine, Faculty of Medicine, University of Geneva, Centre Médical Universitaire, Rue Michel Servet 1, 1211, Geneva 4, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
17
|
Chang AY, Ghose S, Littman-Quinn R, Anolik RB, Kyer A, Mazhani L, Seymour AK, Kovarik CL. Use of mobile learning by resident physicians in Botswana. Telemed J E Health 2011; 18:11-3. [PMID: 22171597 DOI: 10.1089/tmj.2011.0050] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
With the growth of mobile health in recent years, learning through the use of mobile devices (mobile learning [mLearning]) has gained recognition as a potential method for increasing healthcare providers' access to medical information and resources in resource-limited settings. In partnership with the University of Botswana School of Medicine (SOM), we have been exploring the role of smartphone-based mLearning with resident (physicians in specialty training) education. The SOM, which admitted its first class of medical students and residents in 2009, is committed to providing high-level on-site educational resources for resident physicians, even when practicing in remote locations. Seven residents were trained to use an Android-based myTouch 3G smartphone equipped with data-enabled subscriber identity module (SIM) cards and built-in camera. Phones contained locally loaded point-of-care and drug information applications, a telemedicine application that allows for the submission of cases to local mentors, and e-mail/Web access. Surveys were administered at 4 weeks and 8 weeks following distribution of phones. We found that smartphones loaded with point-of-care tools are effectively utilized by resident physicians in resource-limited settings, both for accessing point-of-care medical information at the bedside and engaging in self-directed learning at home.
Collapse
Affiliation(s)
- Aileen Y Chang
- Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Khandelwal S, Huffman MD, Shah S, Kishore S, Siegel K. Non-Communicable, Chronic Disease Training and Education Needs in
India. Glob Heart 2011; 6:195-9. [DOI: 10.1016/j.gheart.2011.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
19
|
Plugge E, Cole D. Oxford graduates' perceptions of a global health master's degree: a case study. HUMAN RESOURCES FOR HEALTH 2011; 9:26. [PMID: 22018521 PMCID: PMC3213151 DOI: 10.1186/1478-4491-9-26] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 10/21/2011] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Low and middle-income countries suffer an ongoing deficit of trained public health workers, yet optimizing postgraduate education to best address these training needs remains a challenge. Much international public health education literature has focused on global capacity building and/or the description of innovative programmes, but less on quality and appropriateness. CASE DESCRIPTION The MSc in Global Health Science at the University of Oxford is a relatively new, full-time one year master's degree in international public health. The programme is intended for individuals with significant evidence of commitment to health in low and middle income countries. The intake is small, with only about 25 students each year, but they are from diverse professional and geographical backgrounds. Given the diversity of their backgrounds, we wanted to determine the extent to which student background influenced their perceptions of the quality of their learning experience and their learning outcomes. We conducted virtual or face-to-face semi-structured individual interviews with students who had graduated from the course at least one year previously. Of the 2005 to 2007 intake years, 52 of 63 graduates (83%) were interviewed. We used thematic analysis to analyze the data, then linked results to student characteristics. DISCUSSION The findings from the evaluation suggested that all MSc GHS graduates who spoke with us, irrespective of background, appreciated the curriculum structure drawing on the strengths of a small, diverse student group, and the contribution the programme had made to their breadth of understanding and their careers. This evaluation also demonstrated the feasibility of an educational evaluation conducted several years after programme completion and when graduates were 'in the field'. This is important in ensuring international public health programmes are relevant to the day-to-day work of public health practitioners and researchers in low and middle-income countries. CONCLUSIONS Feedback from students, when they had either resumed their positions 'in the field' or pursued further training, was useful in identifying valuable and positive aspects of the programme and also in identifying areas for further action and development by the programme's management and by individual teaching staff.
Collapse
Affiliation(s)
- Emma Plugge
- Department of Public Health, University of Oxford, Old Road Campus, Old Road, Oxford OX3 7LF, Oxfordshire, United Kingdom of Great Britain and Northern Ireland
| | - Donald Cole
- Department of Public Health Sciences, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
20
|
Laabes EP, Desai R, Zawedde SM, Glew RH. How much longer will Africa have to depend on western nations for support of its capacity-building efforts for biomedical research? Trop Med Int Health 2011; 16:258-62. [PMID: 21371216 DOI: 10.1111/j.1365-3156.2010.02709.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Advances in biomedical research techniques have resulted in the conquest of many diseases and the improvement in the health and well-being of populations, yet sub-Saharan Africa continues to lag behind western nations in terms of research infrastructure and capacity. The increasing numbers of links and collaborations between western institutions of higher learning and teaching hospitals and universities in sub-Saharan Africa have undoubtedly promoted scholarly research activity on the continent. However, most of the research agenda is, understandably, dominated by western collaborators who provide the much needed funding. Given the recent exposure by events on Wall Street of the frailties of western economies, Africa urgently needs to look inwards in its quest to train biomedical researchers of repute and to secure funding for its capacity-building needs.
Collapse
|
21
|
Nartker AJ, Stevens L, Shumays A, Kalowela M, Kisimbo D, Potter K. Increasing health worker capacity through distance learning: a comprehensive review of programmes in Tanzania. HUMAN RESOURCES FOR HEALTH 2010; 8:30. [PMID: 21194417 PMCID: PMC3023774 DOI: 10.1186/1478-4491-8-30] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 12/31/2010] [Indexed: 05/10/2023]
Abstract
BACKGROUND Tanzania, like many developing countries, faces a crisis in human resources for health. The government has looked for ways to increase the number and skills of health workers, including using distance learning in their training. In 2008, the authors reviewed and assessed the country's current distance learning programmes for health care workers, as well as those in countries with similar human resource challenges, to determine the feasibility of distance learning to meet the need of an increased and more skilled health workforce. METHODS Data were collected from 25 distance learning programmes at health training institutions, universities, and non-governmental organizations throughout the country from May to August 2008. Methods included internet research; desk review; telephone, email and mail-in surveys; on-site observations; interviews with programme managers, instructors, students, information technology specialists, preceptors, health care workers and Ministry of Health and Social Welfare representatives; and a focus group with national HIV/AIDS care and treatment organizations. RESULTS Challenges include lack of guidelines for administrators, instructors and preceptors of distance learning programmes regarding roles and responsibilities; absence of competencies for clinical components of curricula; and technological constraints such as lack of access to computers and to the internet. Insufficient funding resulted in personnel shortages, lack of appropriate training for personnel, and lack of materials for students.Nonetheless, current and prospective students expressed overwhelming enthusiasm for scale-up of distance learning because of the unique financial and social benefits offered by these programs. Participants were retained as employees in their health care facilities, and remained in their communities and supported their families while advancing their careers. Space in health training institutions was freed up for new students entering in-residence pre-service training. CONCLUSIONS A blended print-based distance learning model is most feasible at the national level due to current resource and infrastructure constraints. With an increase in staffing; improvement of infrastructure, coordination and curricula; and decentralization to the zonal or district level, distance learning can be an effective method to increase both the skills and the numbers of qualified health care workers capable of meeting the health care needs of the Tanzanian population.
Collapse
Affiliation(s)
- Anya J Nartker
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, USA
| | - Liz Stevens
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, USA
| | - Alyson Shumays
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, USA
| | - Martin Kalowela
- International Training and Education Center for Health, Dar es Salaam, Tanzania
| | - Daniel Kisimbo
- Ministry of Health and Social Welfare, Centre for Distance Education, Morogoro, Tanzania
| | - Katy Potter
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, USA
| |
Collapse
|
22
|
Zolfo M, Iglesias D, Kiyan C, Echevarria J, Fucay L, Llacsahuanga E, de Waard I, Suàrez V, Llaque W, Lynen L. Mobile learning for HIV/AIDS healthcare worker training in resource-limited settings. AIDS Res Ther 2010; 7:35. [PMID: 20825677 PMCID: PMC2942790 DOI: 10.1186/1742-6405-7-35] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 09/08/2010] [Indexed: 11/12/2022] Open
Abstract
Background We present an innovative approach to healthcare worker (HCW) training using mobile phones as a personal learning environment. Twenty physicians used individual Smartphones (Nokia N95 and iPhone), each equipped with a portable solar charger. Doctors worked in urban and peri-urban HIV/AIDS clinics in Peru, where almost 70% of the nation's HIV patients in need are on treatment. A set of 3D learning scenarios simulating interactive clinical cases was developed and adapted to the Smartphones for a continuing medical education program lasting 3 months. A mobile educational platform supporting learning events tracked participant learning progress. A discussion forum accessible via mobile connected participants to a group of HIV specialists available for back-up of the medical information. Learning outcomes were verified through mobile quizzes using multiple choice questions at the end of each module. Methods In December 2009, a mid-term evaluation was conducted, targeting both technical feasibility and user satisfaction. It also highlighted user perception of the program and the technical challenges encountered using mobile devices for lifelong learning. Results With a response rate of 90% (18/20 questionnaires returned), the overall satisfaction of using mobile tools was generally greater for the iPhone. Access to Skype and Facebook, screen/keyboard size, and image quality were cited as more troublesome for the Nokia N95 compared to the iPhone. Conclusions Training, supervision and clinical mentoring of health workers are the cornerstone of the scaling up process of HIV/AIDS care in resource-limited settings (RLSs). Educational modules on mobile phones can give flexibility to HCWs for accessing learning content anywhere. However lack of softwares interoperability and the high investment cost for the Smartphones' purchase could represent a limitation to the wide spread use of such kind mLearning programs in RLSs.
Collapse
|
23
|
Straume K, Shaw DMP. Effective physician retention strategies in Norway's northernmost county. Bull World Health Organ 2010; 88:390-4. [PMID: 20461137 DOI: 10.2471/blt.09.072686] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 02/22/2010] [Accepted: 02/25/2010] [Indexed: 11/27/2022] Open
Abstract
PROBLEM Retaining physicians in remote settings can be challenging owing to the heavy workload and harsh environmental conditions and to the lack of opportunities for professional development. In Norway, poor physician distribution between urban and rural areas has been persistent, particularly in the north, where in 1997 a total of 28% of the primary care physician positions were vacant. APPROACH Several corrective measures have been tried over the years. One was the establishment of a medical school in the northern city of Tromsø, which proved effective but did not avert new crises. A 1998 survey among primary care physicians signalled the need for new interventions conducive to professional development in rural areas. The existing medical internship and in-service training model for general practice were systematically adopted as tools for retaining physicians. LOCAL SETTING In Finnmark - Norway's northernmost and most sparsely-populated county - medical practice is challenging, especially at the primary care level. In 1997, a 38% shortage of general practitioners (30 positions) threatened primary care safety. RELEVANT CHANGES Almost twice as many medical interns as expected now take their first fully licensed job in the north of Norway. The post-training retention of primary care physicians after 5 years currently stands at 65%. LESSONS LEARNT Postgraduate medical training can be conducted in remote areas in a manner that ensures professional development, counteracts professional isolation, and allows trainees and their families to grow roots in rural communities. Rural practice satisfies modern principles of adult learning (problem-based and attached to real-life situations) and offers excellent training conditions.
Collapse
Affiliation(s)
- Karin Straume
- Department of Health and Social Affairs, Governor of Finnmark County, Vardoeveien 46, Vadsoe, N-9800, Norway.
| | | |
Collapse
|