Rapport de l'évaluation externe du projet recherche en santé du Centre Régional pour le Développement et la Santé (CREDESA)

Annexes inclusLe Centre Régional pour le Développement et la Santé (CREDESA) - ex Projet de Développement Sanitaire de Pahou (PDSP) a été créé en 1983 au Sud-Est du Bénin avec pour mission : - Promouvoir les soins de santé primaires (SSP) avec une approche pluridisciplinaire et multisectoriel par le biais d'une recherche opérationnelle orientée ·vers les besoins de la communauté; - Assurer avec les communautés des prestations de services rationalisés et la formation des agents de santé communautaire et du personnel de santé à tous les niveaux; Pour répondre à cette mission, le CREDESA a planifié ses activités selon les étapes suivantes : - Etablissement et renforcement de la capacité institutionnelle du CREDESA et de la Faculté des Sciences de la Santé en matière de recherche par le développement des ressources humaines; - Formation des secouristes et des accoucheuses traditionnelles; - Formation d'agents de santé, tels que les médecins, sages-femmes et infirmiers et assistants sociaux. Dans la mise en oeuvre de ce plan dont la troisième phase s'achève en Juin 1996, le CREDESA bénéficie depuis 1990 d'un appui du CRDI. Cet appui a permis la disponibilité de ressources humaines pluridisciplinaires compétentes pour élaborer et mettre en oeuvre des projets de recherche sur les problèmes prioritaires de la zone couverte par le projet, l'organisation des services du district et la formation d'agents de santé et d'agents de santé communautaire. L'exploitation des résultats de recherche et la formation devraient perm.ettre d'asseoir à moyen terme, un système de soins rationalisés et accessibles dans toute la zone de Ouidah. Quelques indicateurs de santé montrent l'impact positif sur la santé des communautés notamment la mortalité infantile qui est très en-dessous de la moyenne nationale. Il s'agit aujourd'hui pour le CREDESA qui vient de franchir un pas de plus dans la reconnaissance internationale en étrennant une troisième distinction internationale (UNICEF), de continuer les activités de service, de formation et de recherche pour d'unè part, suivre ces indicateurs de performance, la qualité de vie des communautés vivant dans ces zones organisées et d'autre part d'organiser le système-recours, en l'occurrence l'hôpital de référence pour son utilisation rationnelle par les populations de la zone. Les populations que nous avons rencontrées y croient fermement et attendent un soutien conséquent de leurs efforts. Mais si le projet connaît de nombreux succès dans ses divers domaines d'intervention, il est important de noter qu'il traîne quelques insuffisances qu'il convient de combler rapidement. En outre, le projet traverse en ce moment une période difficile qui n'est pas sans influence sur la performance et qui a pour origine essentielle : - une restructuration certes nécessaire, mais dont l'application ne va pas sans quelques difficultés heureusement surmontables, - la fin des financements de la part des bailleurs de 'fonds (CRDI, ACDI); ce qui n'est pas sans créer une atmosphère d'inquiétude

E-learning in medical education in resource constrained low- and middle-income countries

Background In the face of severe faculty shortages in resource-constrained countries, medical schools look to e-learning for improved access to medical education. This paper summarizes the literature on e-learning in low- and middle-income countries (LMIC), and presents the spectrum of tools and strategies used. Methods Researchers reviewed literature using terms related to e-learning and pre-service education of health professionals in LMIC. Search terms were connected using the Boolean Operators “AND” and “OR” to capture all relevant article suggestions. Using standard decision criteria, reviewers narrowed the article suggestions to a final 124 relevant articles. Results 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, the majority (58%) reported on physician training, while 24% focused on nursing, pharmacy and dentistry training. Although reasons for investing in e-learning varied, expanded access to education was at the core of e-learning implementation which included providing supplementary tools to support faculty in their teaching, expanding the pool of faculty by connecting to partner and/or community teaching sites, and sharing of digital resources for use by students. E-learning in medical education takes many forms. 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 programs (3 articles). Of the 69 articles that evaluated the effectiveness of e-learning tools, 35 studies compared outcomes between e-learning and other approaches, while 34 studies qualitatively analyzed student and faculty attitudes toward e-learning modalities. Conclusions E-learning in medical education is a means to an end, rather than the end in itself. Utilizing 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. Institutional readiness for e-learning adoption ensures the alignment of new tools to the educational and economic context

A survey of Sub-Saharan African medical schools

<p>Abstract</p> <p>Background</p> <p>Sub-Saharan Africa suffers a disproportionate share of the world's burden of disease while having some of the world's greatest health care workforce shortages. Doctors are an important component of any high functioning health care system. However, efforts to strengthen the doctor workforce in the region have been limited by a small number of medical schools with limited enrolments, international migration of graduates, poor geographic distribution of doctors, and insufficient data on medical schools. The goal of the Sub-Saharan African Medical Schools Study (SAMSS) is to increase the level of understanding and expand the baseline data on medical schools in the region.</p> <p>Methods</p> <p>The SAMSS survey is a descriptive survey study of Sub-Saharan African medical schools. The survey instrument included quantitative and qualitative questions focused on institutional characteristics, student profiles, curricula, post-graduate medical education, teaching staff, resources, barriers to capacity expansion, educational innovations, and external relationships with government and non-governmental organizations. Surveys were sent via e-mail to medical school deans or officials designated by the dean. Analysis is both descriptive and multivariable.</p> <p>Results</p> <p>Surveys were distributed to 146 medical schools in 40 of 48 Sub-Saharan African countries. One hundred and five responses were received (72% response rate). An additional 23 schools were identified after the close of the survey period. Fifty-eight respondents have been founded since 1990, including 22 private schools. Enrolments for medical schools range from 2 to 1800 and graduates range from 4 to 384. Seventy-three percent of respondents (n = 64) increased first year enrolments in the past five years. On average, 26% of respondents' graduates were reported to migrate out of the country within five years of graduation (n = 68). The most significant reported barriers to increasing the number of graduates, and improving quality, related to infrastructure and faculty limitations, respectively. Significant correlations were seen between schools implementing increased faculty salaries and bonuses, and lower percentage loss of faculty over the previous five years (<it>P </it>= 0.018); strengthened institutional research tools (<it>P </it>= 0.00015) and funded faculty research time (<it>P </it>= 0.045) and greater faculty involvement in research; and country compulsory service requirements (<it>P </it>= 0.039), a moderate number (1-5) of post-graduate medical education programs (<it>P </it>= 0.016) and francophone schools (<it>P </it>= 0.016) and greater rural general practice after graduation.</p> <p>Conclusions</p> <p>The results of the SAMSS survey increases the level of data and understanding of medical schools in Sub-Saharan Africa. This data serves as a baseline for future research, policies and investment in the health care workforce in the region which will be necessary for improving health.</p

Medical schools in sub-Saharan Africa

Small numbers of graduates from few medical schools, and emigration of graduates to other countries, contribute to low physician presence in sub-Saharan Africa. The Sub-Saharan African Medical School Study examined the challenges, innovations, and emerging trends in medical education in the region. We identified 168 medical schools; of the 146 surveyed, 105 (72%) responded. Findings from the study showed that countries are prioritising medical education scale-up as part of health-system strengthening, and we identified many innovations in premedical preparation, teambased education, and creative use of scarce research support. The study also drew attention to ubiquitous faculty shortages in basic and clinical sciences, weak physical infrastructure, and little use of external accreditation. Patterns recorded include the growth of private medical schools, community-based education, and international partnerships, and the benefit of research for faculty development. Ten recommendations provide guidance for efforts to strengthen medical education in sub-Saharan Africa.The Bill & Melinda Gates Foundation.http://www.thelancet.com/journals/lancet