The strength of a healthcare system, in addition to physical infrastructure, depends on the skills, competencies, values and availability of its workforce. In sub Saharan Africa, there is a severe shortage and imbalance in its workforce that poses a major threat to achieving the Millennium Development Goals
. Due to this critical shortage, healthcare workers are overworked and healthcare gains are at risk of being reversed, especially with the burden of diagnosing and monitoring HIV/AIDS patients on antiretroviral therapy
. There is the need to build and maintain an appropriate healthcare workforce to staff the different components of the healthcare system.
The clinical laboratory workforce plays a vital role in healthcare service delivery and has been recognized as one of the six key components for healthcare systems strengthening that would impact and improve the well-being of the community
. Properly trained laboratory technologists are needed to obtain reliable results essential for service providers to accurately assess the status of a patient’s health, make accurate diagnoses, design treatment plans and monitor the effectiveness of a specific treatment, as well as for early detection, notification and response to disease outbreaks. Some of the shortages have been linked to a lack of retention strategy and a shortage of appropriate training institutions to build a competent and critical workforce. In some instances, training of healthcare professionals at institutions of higher education has failed to meet current healthcare demands due to a rigid curriculum that fails to evolve, static pedagogy and a lack of adaption to local needs
. In sub Saharan Africa, there is a shortage of healthcare professional training schools. For example, the number of degree-granting schools for medical and public healthcare professionals was estimated at 134 and 51, respectively, for a population of 868 million, while in North Africa and the Middle East there were 206 and 46 schools for medical and public healthcare professionals, respectively, for a population of 450 million
. In Ethiopia there is a shortage of qualified laboratory technologists among other healthcare workers. In the 2002/2003 Health and Health-related Indicators Report by the Planning and Programming Department of the Ministry of Health (MOH), only 249, 223 and 302 laboratory technologists graduated from five universities with medical laboratory training in 2001, 2002 and 2003, respectively. Additionally, maintaining the quality of laboratory education has become an important challenge in recent years given advances in technology.
The critical shortage of healthcare workers has been further revealed during the HIV/AIDS epidemic in sub Saharan Africa as countries tried to accelerate their response. There was already a shortage of skilled and properly trained healthcare workers, which affected the care and treatment of AIDS patients. Many of the healthcare workers themselves succumbed to AIDS
[5, 6]. Innovative ways were developed to address shortages of healthcare workers for HIV/AIDS care and treatment delivery services, including in-service training in which existing healthcare workers were trained in specialized skills and areas they lacked. This approach was short-term and involved using multiple implementing partners working with the government to train in-service healthcare workers as needed. Also, the task shifting strategy was emphasized in which a healthcare professional was trained to provide services in more than one specialized area, or the tasks of more highly trained healthcare professionals were shifted to less highly trained healthcare professionals
[7–10]. For example, in addition to providing care to AIDS patients, nurses were trained to prescribe and provide ART drugs to AIDS patients
[11–13]. For laboratory technologists, in-service training on advanced and complex tests for antiretroviral therapy (ART) monitoring resulted in disruption of the services they normally provided and in an increased task load because of the shortage of laboratory technologists. Because of a high staff turnover, in-service training became quite repetitive, costly and not sustainable.
Preservice education training has an important role in maintaining a steady supply of skilled and knowledgeable healthcare workers to ensure country ownership and sustainability. In the reauthorization of the US President’s Emergency Plan for AIDS Relief (PEPFAR) II, PEPFAR set a target, supported with funding, for training and retention of 140,000 new healthcare workers in recognition that maintaining an appropriate healthcare workforce is a critical component for country ownership, sustainability and overall healthcare system strengthening
. The curriculum for preservice education training for laboratory technologists in sub Saharan Africa, in most cases, is not standardized and is heavily skewed towards didactic training with little or no hands-on experience with the laboratory equipment used in the workplace. This is historically due to lack of financial resources to fund and support this equipment in a teaching setting as well as lack of expertise and training of the teaching staff.
The absence of hands-on experience is a major challenge facing preservice education because medical laboratory technology graduates only see this equipment for the first time at healthcare facilities on the first day they have been employed. This may further exacerbate equipment maintenance problems as the newly employed laboratory technologists, if not properly trained, often resort to trial and error with equipment at their new healthcare facility
. There is a critical need to build a strong and competent laboratory workforce to properly staff public health laboratories and to provide quality laboratory services. The Field Epidemiology Laboratory Training Program (FELTP) has largely focused on building skills and competency of in-service staff to meet short and medium term skill shortages
The goal of this research was to carry out a formative evaluation of the feasibility of strengthening preservice laboratory education in partnership with local universities to ensure a skilled and well trained laboratory workforce for overall healthcare system strengthening.