Nursing students in Liberia receive skills to care for people with HIV and TB
For the first time in many decades, nursing students in Liberia are receiving the fundamental skills needed to competently care for people suffering from HIV, TB, malaria and other diseases that kill thousands every year in Western Africa.
Sound elemental? It is, but in nearly 60 countries in the developing world, aspiring nurses, midwives, physicians and other members of the health care team have lacked the schools, teachers, supplies and clinical experiences needed to prepare them for their essential roles as health care providers.
War, political unrest, poverty and poorly organized systems of higher education have led to deplorable conditions for educating health care providers. The World Health Report in 2006 pointed out that the Millennium Development Goals cannot be met without an adequate health workforce. Today there is a global human resources in health crisis of unprecedented magnitude. Governments in African countries like Liberia are only now beginning to build the infrastructure, prepare their teachers and obtain the resources needed to meet internationally recognized education standards.
Global investments in reforming health education systems are essential to prepare the next generation of health providers with the knowledge, skills, attitudes and leadership qualities required to transform health care in the developing world. Better classrooms, more realistic skills labs and hospitals equipped to contribute to clinical education are critical to building competent, sustainable health care systems. And they are fundamental to ensuring the maturation of developing nations into self-reliant, independent providers of competent health care.
The realization of the importance of health professional preparation is building. The World Health Organization (WHO) is working with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and other partners on an effort for transformative scale-up of medical, nursing and midwifery education. This initiative recognizes the critical role health professional education plays in addressing health needs and poverty. As Dr. Margaret Chan, the Director-General of WHO, recently stated in her opening speech for the transformative scale-up meeting in December, “Powerful interventions and the money to purchase them will not improve health outcomes in the absence of robust, and equitable, systems for delivery. Health systems cannot deliver quality health services in the absence of sufficient numbers of appropriately trained, motivated and remunerated health care staff.”
A recent article in The Lancet, “Education of Health Professionals for the 21st Century,” also emphasizes the impact health professional education has on health outcomes. According to the report, health professional education needs to develop providers who are able to “mobilise knowledge and to engage in critical reasoning and ethical conduct so that they are competent to participate in patient and population-centered health systems.” A well-educated health workforce is critical to assure comprehensive services that “advance opportunity for health equity between countries.”
All of this recent attention to the importance of health professional education was underscored by the concluding statement of the second global forum on Human Resources for Health Conference, issued in January of this year: “All people, everywhere, shall have access to a skilled, motivated and supported health worker within a robust health system.”
Quality education of the health care workforce-for both professional and allied health workers-is critical for independent functioning health systems. The well-educated nurse, midwife and clinician are part of the strategic mix of providers, including community health workers, who help ensure access to strong, competent, skills-based care.
Without a workforce that is of sufficient quality, quantity and relevance, countries will not be able to reach the Millennium Development Goals nor achieve independence. An excellent example of education supporting independence is the progress of midwifery education in Afghanistan.
Under a comprehensive U.S. Agency for International Development (USAID)-funded project, REACH, Jhpiego provided the technical leadership in the development of a national midwifery education program that launched 27 midwifery schools in 29 provinces in six years-a nearly four-fold increase since 2002-and graduated more than 2,000 skilled midwives. A program evaluation in 2009 found that not only did the midwifery program deliver critical services to women, but “substantial health system strengthening” was achieved by Ministry of Public Health staff at central and provincial levels. A succeeding program, built on these accomplishments, continues today to produce new midwives and train community health workers in lifesaving interventions for women.
Another excellent example is the innovative work of Walter Sisulu University in South Africa. In order to retain physicians in the rural area of Transkei (one of the poorest and most under-resourced of the region), the university established a medical school utilizing available local resources. Their community-based medical education includes innovative admissions criteria, community involvement in recruitment, a community-based curriculum using problem-based learning and a first-term educational strategy to address secondary education inequities.
More than 25 years later, Walter Sisulu continues to prepare graduates who are significantly more likely to remain in country, to make appropriate clinical decisions and continue in the profession. Five years after graduation, 71 percent of graduates are working in the rural areas, 20 percent are in postgraduate training programs in urban centers and only 4.9 percent had emigrated from the country compared to a national rate of at least 33 percent.
In Mozambique, the Ministry of Health conducted a task analysis survey of 1,295 individuals to rationalize and streamline production of health care workers, especially nurses. The ministry, working with technical assistance from Jhpiego through the Centers for Disease Control and Prevention, used the survey findings to evaluate six different cadres. Based on the findings, the ministry consolidated two separate educational programs for midwifery and nursing into one for each career path, which will enable them to develop relevant health professionals faster.
For more than 36 years, in 68 countries and more than 100 education programs, Jhpiego has been working with donor support, primarily from USAID, to improve health worker education. After all this time, it is heartening to see the global tide turn toward recognizing the value in longer-term investments in health worker education.
Peter Johnson, a Certified Nurse Midwife, Educational Psychologist and Fellow of the American College of Nurse Midwives, and Julia Bluestone, a Certified Nurse Midwife, are global learning educators for Jhpiego, an international health non-profit affiliated with Johns Hopkins University.