Education and Training;

In our previous discussions, we have discussed topics which included the need to restore the “can do” attitude among African health professionals, country ownership, the need for committed leadership of individuals that is needed to close the huge implementation gap at country level and the place of mentorship and role models in growing a new generation of accountable African techno-professionals. In this issue let’s continue the discussion on creating a new generation of accountable health professionals using Education and Training as a critical entry point for achieving this goal.

The education system including the national policies, training institutions and their managers can be compared to a factory for producing health professionals. By the time a product leaves a good factory, it should be fit for purpose. A good factory has in-built controls and quality assurance mechanisms to ensure that the final product is right. In the case of health professionals, the graduates should be able to provide skilled health care where it is needed in their communities and health systems. However, recent studies and commissions on health professionals’ education globally and in Africa have pointed out significant challenges and possible solutions. The GHWA Task Force on Scaling up Education and Training, The Sub-Saharan African Medical Schools Survey (SAMSS), the Commission on Education of Health Professionals for the 21^st Century and the Global Consensus for Social Accountability of Medical Schools all point out the need for major reforms. What are the challenges to be overcome?

First, there is an urgent need to synchronize the education systems and health systems to facilitate joint planning of curriculum, numbers and deployment so that the graduates of training institutions are fit for purpose and will be distributed and retained where they are needed. In many countries this essential intersectoral collaboration is nonexistent and in others, worse still the relations between the two sectors are plainly bad. The training of health professionals should be part and parcel of the National Development Plans which requires consensus from all stakeholders within and outside government. Second, partly as a result of misunderstanding of the meaning of Primary Health Care, there has been a tendency to neglect and under fund hospitals including teaching hospitals. As a result, many of the current teaching hospitals are performing very poorly; overcrowded, poorly equipped, dirty, inefficient and even corrupt! What type of product (health professional) will come out of such a factory (training institution)? Third, SAMSS established that there are huge shortages of teachers in the medical schools and the same must apply to Nursing, Pharmacy and Paramedical schools. The few teachers who are there are frustrated and not able to teach and train by the poor quality of the institutions in which they work. Fourth, Regulatory Bodies such as Professional Councils are also under funded and yet they are needed to assure quality of training. The importance of these institutions is becoming even more pertinent due to the rapid increase of the numbers of private training institutions. Professional Associations are also weak.

Let’s end on a hopeful note as there is evidence of forward movement. There are African countries that are moving very well in implementing health professionals’ education reforms that are linked to the health systems and MDGs. Examples include Ethiopia and Malawi. GHWA has already developed guidelines for country coordination. WHO is currently developing Global Guidelines on Transformative Medical and Nursing Education. The government of the USA has launched $130 million project; the Medical Education Partnership Initiative (MEPI) to improve Medical Education in 12 countries in sub Saharan Africa and there is a sister project on Nursing Education (NEPI). The government of Japan has committed to training 1000 new African health professionals and other donors too including African Development Bank, the World Bank, Norway, etc  have indicated interest. There are moves afoot to revitalize several African Health Workforce organizations for coordination, communication and sharing.

So then; if we have African health techno-professionals possessed of the “can do” attitude, who are mentors and role models and there is effective country ownership why should we not succeed? Can anyone tell us why not?