Table 2 Studies undertaken under a context of health workforce development in sub-Sahara Africa
Countries | Authors’ name | Who undertook the Workforce development intervention? How long the intervention lasted? | In which context the intervention was undertaken? | What was achieved by the intervention?a |
|---|---|---|---|---|
Mali | Sidibé et al. 2019 | The Government of Mali undertook a decentralization of training schools in rural regions | This decentralization reform attempted to improve accessibility of care | • Revision of curricula to include rural health topics; • Expansion of training schools in rural regions; in 2017, 115 to 120 training schools existed in rural Mali; • Increased in number of graduates; from 259 to 340 annually for midwives and from 261 per year in 2013 to a thousand per year in 2017 for obstetric nurses; • 92% of graduates (mainly midwives) remained in the rural regions after their trainings |
Dormael et al. 2008 | The NGO “Santé-Sud” and the Rural Doctors Association decided to set up an orientation course for recently established rural doctors | • Data suggest that community doctors face unforeseen situations for which they feel ill prepared, leading sometimes to early dropout (poor retention); • An orientation course on rural practice was developed for newly established rural doctors from 2003 to 2005 with the assumption that training meeting rural practitioners' needs would strengthen young doctors' technical competences and self-confidence, and consequently contribute to retention | • An orientation course on rural practice for newly established rural doctors from 2003 to 2005 contributed to a positive impact on their preparedness for rural practice and increased retention in rural areas, with 50% still in rural practice after 4 years; • In 2007, 99 rural doctors were serving in over 13% of Mali's rural community health centres | |
Coulibaly et al. 2007 | • The NGO “Santé-Sud” encouraged young doctors, facing unemployment, to settle in rural areas by providing them with installation kits (medicines, equipment, etc.), solar panels, a motorcycle, and a prerequisite training; • A regular follow-up is also organized as well as the support the professional association to help them fight against professional isolation: Regional and national meetings, continuing education, reciprocal visits, etc. | • Healthcare system and decentralization reforms in 1999; • The healthcare system reform of the 1999 resulted in the rise to new actors, the Town Halls, responsible for the Community Health Centres (CSCom). It is in this context (of reform of the health care system and decentralization) that rural medicine has developed in Mali; • Confronted with the banning of recruitment in urban areas, because of the healthcare system and decentralization reforms, many young doctors took up initiatives to settle in rural areas | • In 2005, 74% of young doctors supported by the ONG Santé-Sud were practising at CSCom level; • 11% of them had a contract with other types of associations (11%) or choose to practice in private practice (15%); • Data showed a relative stability of rural doctors: by 2005, 45% had been practising for more than 5 years, and 25% planned to practice for more than 10 years; • Many of those who left the profession became district chiefs, in charge among others to support CSCom | |
Ghana | Amalba et al. 2016a, 2016b, 2019 | • International reforms in medical education (2007); • In response to the international changes in medical education, The University for Development studies (UDS), School of Medicine and Health Sciences introduced a Problem-Based Learning and Community-Based Education and Service (PBL/COBES) methodology in its medical training curricula, in replacement of the traditional medical training curricula | • The programme occurred in a context where the Ghanaian government was offering a 20–30% salary top-up and a staff vehicle hire purchase scheme for health staff working in rural areas | • 74% of students from PBL/COBES track indicated that their medical school curriculum adequately prepared them for rural practice as compared to those from the traditional track (35%); • Significant proportions of program’s graduates from the towns (61%) and cities (68%) indicated that the PBL/COBES programme influenced them to practice in rural area; •••••••••44% of the students indicated that PBL/COBES have had an influence on their choice of career specialty |
South Africa | Gumede et al. 2021 | • The Umthombo Youth Development Foundation (UYDF) undertook the intervention based on evidence from Australia and Canada; • The programme commenced in January 1999 in provinces of KwaZulu-Natal and the Eastern Cape, areas which lacked good health and education services, and where unemployment was high | • The UYDF addressed the shortage of healthcare workers in the provinces of KwaZulu-Natal and the Eastern Cape, by identifying young people who were eligible for scholarships in health sciences; • The programme commenced with four students and by the end of 2017 had produced 336 graduates and was supporting 251 students with an annual pass rate of over 90% | |
Schalkwyk et al. 2018 | • In the 1990s, the Faculty of Medicine and Health Sciences at Stellenbosch University initiated Community-based Education as a strategy to train students appropriately for delivering primary health care services to South African communities | • By 2015, 80 primary healthcare sites were covered by the short clinical rotations programme | ||
Mapukata et al. 2017 | • The Faculty of Health Sciences at the University of Witwatersrand was the launch of the Graduate Entry Medical Programme in 2003 as a 4-year training programme that complemented the existing traditional approach to medical training, with both streams being combined in the clinical years • Within that, the integrated primary care (IPC) block, which is a compulsory 6-week placement in a range of primary health care settings, was launched in 2006 as one of the initiatives that would strengthen the university’s and students’ commitment to rural and underserved communities | |||
Uganda | Kizito et al. 2017 | • In 2010, Five Ugandans medical universities formed a consortium, Medical Education for Equitable Services to All Ugandans (MESAU), in order to address challenges in health professions education • These universities are: Makerere University College of Health Sciences, Mbarara University of Science and Technology, Gulu University, Kampala International University and Busitema University • This 5-year programme was established with funding from the US Government through the Medical Education Partnership Initiative (MEPI) and technical support from Johns Hopkins University | • The MESAU institutions included Community-Based Education, Research and Service (COBERS) in their health professions curricula; • Before COBERS, 44% students indicated that they intended to work in rural areas as compared to 48% after the COBERS placement • Before the COBERS placement, the factors that were associated with students considering to work in a rural area were: extra allowance (OR = 0.2; 95% CI 0.1–0.6), and availability of social amenities (OR = 0.2; 95% CI 0.1–0.7). After their COBERS placement, the factors were: access to long distance courses (OR = 2.0; 95% CI 1.0–3.7) and being posted to a facility in a rural area (OR = 15.0; 95% CI 6.5–35.5); • Before the COBERS placement the factors that influenced how long students thought they would be willing to work in a rural environment were: reliable electricity (IRR = 0.6; 95% CI 0.3–1.0) and Internet (IRR = 1.5; 95% CI 1.0–2.3), high salary (IRR = 0.4; 95% CI 0.3–0.7), and having skills to practice in rural settings (IRR = 2.0; 95% CI 1.3–3.1). Reliable electricity (IRR = 0.5; 95% CI 0.3–0.8) and long distance courses (IRR = 2.1; 95% CI 1.4–3.1) were significant motivators after having undergone the COBERS placement | |
Atuyambe et al. 2016 | • MESAU is the first nation-wide consortium approach to addressing medical education in Uganda with the overall aim of standardizing medical education and developing the partner institutions as centres of excellence for medical education, research and service that ad dress local and national needs to improve health in Uganda; • One of MESAU’s objectives is to improve the quality and relevance of medical education in order to produce health workers with the competencies and motivation to deliver locally relevant services; • Each of the MESAU institutions has implemented CBE as an integral part of their respective curricula for varying lengths of time since 1989 | |||
Kaye et al. 2010 | • The Makerere University Faculty of Medicine changed the traditional training of medicine and nursing students to a problem-based learning (PBL) curriculum in 2003; • The first of the nursing and medicine PBL graduates completed their studies in 2007 and 2008, respectively; • A comprehensive evaluation of the PBL curriculum aimed to assess the influence of graduates’ training on their choice of workplace | |||
DR Congo | Strasser et al. 2021 | • With PEPFAR funding through the United States Health Resources and Services Agency (HRSA), in 2017, ICAP was awarded the Resilient and Responsive Health Systems (RRHS) | • The first 2 years of the RRHS project built on extensive HRH capacity-building and infrastructure improvements for student nurses and midwives through the HRSA-funded Nursing Education Partnership Initiative and Global Nursing Capacity Building Programme | |
Malawi | Kelly et al. 2015 | • In 2004, the Malawi Ministry of Health (MOH) and the Christian Health Association of Malawi (CHAM) began a 6-year Emergency Human Resource Programme (EHRP) to address the critical health worker shortage; • The Global AIDS Interfaith Alliance (GAIA), a non-profit organization, also attempted to address the nursing shortage in Malawi • GAIA offers preservice scholarships for nurses who need assistance with college fees and who demonstrate a commitment to work in the public health system after graduation; • The scholarship program supports nursing students who are predominantly orphans or from lower socio-economic backgrounds | • The program has been operating in Malawi in collaboration with the MOH, CHAM, and the training institutions since 2005 and has awarded more than 400 scholarships to nursing students at the technician, diploma, bachelor’s, and master’s level; • The MOH also deploys 40% of nurse graduates to CHAM facilities while the other 60% are deployed to MOH facilities |