Non-physician clinicians in 47 sub-Saharan African countries

Many countries have health-care providers who are not trained as physicians but who take on many of the diagnostic and clinical functions of medical doctors. We identified non-physician clinicians (NPCs) in 25 of 47 countries in sub-Saharan Africa, although their roles varied widely between countries. In nine countries, numbers of NPCs equalled or exceeded numbers of physicians. In general NPCs were trained with less cost than were physicians, and for only 3–4 years after secondary school. All NPCs did basic diagnosis and medical treatment, but some were trained in specialty activities such as caesarean section, ophthalmology, and anaesthesia. Many NPCs were recruited from rural and poor areas, and worked in these same regions. Low training costs, reduced training duration, and success in rural placements suggest that NPCs could have substantial roles in the scale-up of health workforces in sub-Saharan African countries, including for the planned expansion of HIV/AIDS prevention and treatment programmes

Medical diaspora: an underused entity in low- and middle-income countries’ health system development

Background At present, over 215 million people live outside their countries of birth, many of which are referred to as diaspora—those that live in host countries but maintain strong sentimental and material links with their countries of origin, their homelands. The critical shortage of Human Resources for Health (HRH) in many developing countries remains a barrier to attaining their health system goals. Usage of medical diaspora can be one way to meet this need. A growing number of policy-makers have come to acknowledge that medical diaspora can play a vital role in the development of their homeland’s health workforce capacity. To date, no inventory of low- and middle-income countries (LMIC) medical diaspora organizations has been done. This paper intends to develop an inventory that is as complete as possible, of the names of the LMIC medical diaspora organizations in the United States of America, the United Kingdom, Canada, and Australia and addresses their interests and roles in building the health system of their country of origin. Methods The researchers utilized six steps for their research methodology: (1) development of rationale for choosing the four destination countries (the United States of America, the United Kingdom, Canada, and Australia); (2) identification of low- and middle-income countries (LMIC); (3) web search for the name of LMIC medical diaspora organization in the United States of America, the United Kingdom, Canada, and Australia through the search engines of PubMed, Scopus, Google, Google Scholar, and LexisNexis; (4) development of inclusion and exclusion criteria and creation of a medical diaspora organizations’ inventory list (Table 1) and corresponding maps (Figures 1, 2, and 3). Using decision criteria, reviewers narrowed the number to a final 89 organizations; (5) synthesis of information to collect the general as well as the unique roles the medical diaspora organizations play in building health systems; and (6) developing inventory of respective LMIC governments’ diaspora offices (Table 2) to identify units/departments that facilitate diaspora’s work. Result In total, the authors found 89 medical diaspora organizations in 4 main countries: in the United States of America 60, in the United Kingdom 24, in Australia 3, and in Canada 2. These medical diaspora organizations tend to have three focuses: providing healthcare services, training, and when needed humanitarian aid to their home country; creating a social or professional network of migrant physicians (i.e., simply to bring together people with an ethnic and professional commonality) and; supplying improved and culturally sensitive healthcare to the migrant population within the host country. Sixty-eight LMIC countries have established a diaspora office within their government office. It is also equally important to note that many policy-makers may lack knowledge of models for medical diaspora engagement or of valuable lessons learned by other governments about working with diaspora. Conclusions The medical diaspora remains an underutilized resource in both health systems policy formulation and program implementation

Future directions of Doctor of Public Health education in the United States: a qualitative study

Background: The Doctor of Public Health (DrPH) degree is an advanced and terminal professional degree that prepares the future workforce to engage in public health research, teaching, practice, and leadership. The purpose of the present research was to discuss the desirable future direction and optimal education strategies for the DrPH degree in the United States. Methods: A total of 28 Council on Education for Public Health (CEPH)-accredited DrPH programs in the United States was identified through the Association of Schools and Programs of Public Health (ASPPH) Academic Program Finder. Then, a qualitative analysis was conducted to obtain perspectives from a total of 20 DrPH program directors through in-depth interviews. Results: A DrPH program should be recognized as equal but different from an MPH or a PhD program and strengthen the curriculum of methodology and leadership education. It is important that a DrPH program establishes specific partnerships with other entities and provide funding for students. In addition, rather than being standardized nationwide, there is value in each DrPH program maintaining its unique character and enabling students to be open to all career pathways. Conclusions: The future of DrPH programs in the twenty-first century should aim at effective interdisciplinary public health approaches that draw from the best of both academic and applied sectors. A DrPH program is expected to provide academic, applied public health, and leadership training for students to pursue careers in either academia or the public/private sector, because public health is an applied social science that bridges the gap between research and practice

Analysis of CEPH-accredited DrPH programs in the United States: A mixed-methods study

Interest has been growing in regard to increasing the public health workforce and standardizing training to ensure there are competent professionals to support rebuilding and reinforcing the public health infrastructure of the United States. The need for public health leaders was recognized as early as the hookworm control campaign during 1909–1914 when it became apparent that prevention of disease should be distinct from clinical medicine and should be conducted by professionally trained, dedicated full-time public health practitioners. In recent years, research on the public health workforce and on standardizing health workforce education has significantly expanded. A key element of such a workforce is public health leadership, and DrPH programs are the means to provide effective public health education for these future health professionals. The purpose of this paper is to analyze the general trend of DrPH programs from past to present and analyze the common themes and variations of 28 Council on Education for Public Health (CEPH)-accredited DrPH programs in the United States. This research utilized a mixed-methods approach, investigating DrPH education at each school or program to improve our understanding of the current status of DrPH programs

The modeling assessment of World Vision’s Water, Sanitation, and Hygiene Program in Southern Africa countries, Malawi, Mozambique, and Zambia: analyses using Lives Saved Tool

Background: Since 2010, the humanitarian aid organization World Vision has implemented a community-based water, sanitation, and hygiene (WASH) program in 76 area development programs (ADPs) for a total target population of 2,831,535 in three Southern Africa countries: Malawi, Mozambique, and Zambia. Methods: This study was conducted using the Lives Saved Tool (LiST) to analyze the isolated impact of World Vision WASH interventions on child morbidity and mortality during the four-year implementation period from 2010 to 2014. The combined effects of WASH interventions – improved water source, home water connection, improved sanitation, handwashing with soap, hygienic disposal of children’s stools – were analyzed through LiST. Results: It showed that 917 to 929 children under five years of age were saved from death caused by diarrhea, pneumonia, meningitis, or measles between 2010 and 2014. WASH interventions led to a 131% mean increase in the percentage of under-five lives saved, alongside a 4.47% mean decrease in under-five mortality rates across the three countries. In addition, 809,552 cases of diarrhea among 541,935 children under the age of five were prevented. Conclusions: LiST acted as an effective tool for conducting the quantitative modeling assessment of the program retrospectively at a subnational level. World Vision WASH interventions in Malawi, Mozambique, and Zambia successfully saved children’s lives, and various approaches to WASH for the future program are necessary to reach the goal of preventing all three cases of diarrhea per child each year by 2020

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

Can the deployment of community health workers for the delivery of HIV services represent an effective and sustainable response to health workforce shortages? Results of a multicountry study

In countries severely affected by HIV/AIDS, shortages of health workers present a major obstacle to scaling up HIV services. Adopting a task shifting approach for the deployment of community health workers (CHWs) represents one strategy for rapid expansion of the health workforce. This study aimed to evaluate the contribution of CHWs with a focus on identifying the critical elements of an enabling environment that can ensure they provide quality services in a manner that is sustainable. The method of work included a collection of primary data in five countries: Brazil, Ethiopia, Malawi, Namibia, and Uganda. The findings show that delegation of specific tasks to cadres of CHWs with limited training can increase access to HIV services, particularly in rural areas and among underserved communities, and can improve the quality of care for HIV. There is also evidence that CHWs can make a significant contribution to the delivery of a wide range of other health services. The findings also show that certain conditions must be observed if CHWs are to contribute to well-functioning and sustainable service delivery. These conditions involve adequate systems integration with significant attention to: political will and commitment; collaborative planning; definition of scope of practice; selection and educational requirements; registration, licensure and certification; recruitment and deployment; adequate and sustainable remuneration; mentoring and supervision including referral system; career path and continuous education; performance evaluation; supply of equipment and commodities. The study concludes that, where there is the necessary support, the potential contribution of CHWs can be optimized and represents a valuable addition to the urgent expansion of human resources for health, and to universal coverage of HIV services

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

The Medical Education Partnership Initiative (MEPI): Innovations and Lessons for Health Professions Training and Research in Africa

MEPI was a $130 million competitively awarded grant by President's Emergency Plan for AIDS Relief (PEPFAR) and National Institutes of Health (NIH) to 13 Medical Schools in 12 Sub-Saharan African countries and a Coordinating Centre (CC). Implementation was led by Principal investigators (PIs) from the grantee institutions supported by Health Resources and Services Administration (HRSA), NIH and the CC from September, 2010 to August, 2015. The goals were to increase the capacity of the awardees to produce more and better doctors, strengthen locally relevant research, promote retention of the graduates within their countries and ensure sustainability. MEPI ignited excitement and stimulated a broad range of improvements in the grantee schools and countries. Through in-country consortium arrangements African PIs expanded the programme from the 13 grantees to over 60 medical schools in Africa, creating vibrant South–South and South–North partnerships in medical education, and research. Grantees revised curricular to competency based models, created medical education units to upgrade the quality of education and established research support centres to promote institutional and collaborative research. MEPI stimulated the establishment of ten new schools, doubling of the students’ intake, in some schools, a three-fold increase in post graduate student numbers, and faculty expansion and retention. Sustainability of the MEPI innovations was assured by enlisting the support of universities and ministries of education and health in the countries thus enabling integration of the new programs into the regular national budgets. The vibrant MEPI annual symposia are now the largest medical education events in Africa attracting global participation. These symposia and innovations will be carried forward by the successor of MEPI, the African Forum for Research and Education in Health (AFREhealth). AFREhealth promises to be more inclusive and transformative bringing together other health professionals including nurses, pharmacists, and dentists.<p

Medical schools in sub-Saharan Africa

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/85361/1/MedicalSchoolsinSubSaharaAfrica.pd