An overview of health workforce education and accreditation in Africa: implications for scaling-up capacity and quality

Abstract

Background For countries to achieve universal health coverage, they need to have well-functioning and resilient health systems. Achieving this requires a sufficient number of qualified health workers and this necessitates the importance of investments in producing and regulating health workers. It is projected that by 2030, Africa would need additional 6.1 million doctors, nurses, and midwives. However, based on the current trajectory, only 3.1 million would be trained and ready for service delivery. To reduce current shortages of the health workforce, Africa needs to educate and train 3.0 million additional health workers by 2030. This study was conducted to describe the distribution and ownership of the health training institutions, production of health workers, and the availability of accreditation mechanisms for training programmes in the WHO African Region. Methods A cross-sectional study was conducted using a standardized questionnaire from January 2018 to April 2019. All the 47 countries in the Region were invited to complete a structured questionnaire based on available secondary information from health sector reports, annual HRH reports, country health workforce profiles, and HRH observatories and registries. Results Data from 43 countries in the World Health Organization African Region in 2018 show that there were 4001 health training institutions with 410, 1469 and 2122 being medical, health sciences, and nursing and midwifery schools, respectively, and 2221, 1359 and 421 institutions owned by the public, private for-profit and private not-for-profit sectors, respectively. A total of 148 357 health workers were produced in Region with 40% (59, 829) being nurses and midwives, 19% (28, 604) other health workers, and 14% (20 470) physicians. Overall, 31 countries (79%) in the Region have an accreditation framework for the health training institutions and seven countries do not have any accreditation mechanism. Conclusion To achieve universal health coverage, matching of competencies with population needs, as well as increasing capacities for health worker production to align with demand (numbers and skill-mix) for improved service delivery should be prioritized, as this would improve the availability of skilled health workforce in the Region.

Are midwives ready to provide quality evidence-based care after pre-service training? Curricula assessment in four countries - Benin, Malawi, Tanzania, and Uganda

“…As we were unable to review curricula for both public and private institutions, we cannot say if standards differ between type of institution. A review done in the African region during 2018 revealed that two, nine, 84 and 71 nursing and midwifery institutions exist in Benin, Malawi, Tanzania and Uganda respectively but not sector details are provided for these countries [33]. Assessing curricula is one track followed to measure quality of pre-service education but does not capture key information on the quality of training provided, the educational content delivered in the classroom nor in clinical practice.…”

“…As we were unable to review curricula for both public and private institutions, we cannot say if standards differ between type of institution. A review done in the African region during 2018 revealed that two, nine, 84 and 71 nursing and midwifery institutions exist in Benin, Malawi, Tanzania and Uganda respectively but not sector details are provided for these countries [33].…”

“…There are also other important aspects that this study did not cover such as the regulation of training programmes, the assessment of training institutions and accreditation. However, a recent study highlighted the need for better global, regional and national alignment with professional regulation and practice as the current systems have hindered service delivery and progress towards achieving universal health coverage [33].…”

Are midwives ready to provide quality evidence-based care after pre-service training? Curricula assessment in four countries—Benin, Malawi, Tanzania, and Uganda

“…As we were unable to review curricula for both public and private institutions, we cannot say if standards differ between type of institution. A review done in the African region during 2018 revealed that two, nine, 84 and 71 nursing and midwifery institutions exist in Benin, Malawi, Tanzania and Uganda respectively but no sector details are provided for these countries [33].…”

“…There are also other important aspects that this study did not cover such as the regulation of training programmes, the assessment of training institutions and accreditation. However, a recent study highlighted the need for better global, regional and national alignment with professional regulation and practice as the current systems have hindered service delivery and progress towards achieving universal health coverage [33]. Midwife trainees and pre-service training educators perspectives on the curricula content, usefulness and implementation were not assessed in this review, and would be important views to further illuminate, enhance and elaborate on our review findings.…”