Table 2.
Problems identified with MLW training and proposed solutions
| Nigeria | Uganda | Kenya | South Africa |
|---|---|---|---|
| Problems identified | |||
| • Inadequate numbers trained for volume of work | • Mainly manage common complaints, but not trained to manage emergencies – obstetric, surgical, some paediatric and medical • Lack of avenues for further training or CPD • MLWs dissatisfied with working conditions • Lack of ethical and professional behaviour: indiscipline and unwillingness to learn on part of students |
• Gaps in training and specialisation • Trainers need upgrading in skills and methods of teaching • Minimal support for specialisation of MLWs or career progression |
• Insufficient funding for trainers so fewer than required • Early days – the first cohort of 23 ClinAs qualified in 2010 followed by 93 in 2011, and are just getting established. • Hesitation on part of health science faculties to be involved |
| Solutions proposed | |||
| ▪ More emphasis on practical and curative aspects of work such as suturing wounds and surgical skills ▪ Improved training and supervision of primary care programs such as child health ▪ Upgrading training facilities ▪ Training of MLWs should take place at designated institutions and accreditation by National Board for Technical Education |
▪ Standards suggested for improving teaching of MLWs such as better staff- student ratios; training on how to develop teaching plans and learning outcomes; how to motivate students; how to encourage professional behaviour. ▪ Review curriculum to impart more competencies and skills to MLWs |
▪ Assessment by Clinical Officers Council before CO sent on internship ▪ Review curriculum ▪ Liaise with universities, Directorate of Personnel Management, professional associations to create clear career path e.g. BSc in Clinical Medicine, and in specialities ▪ CPD programs through accredited providers, associations etc. ▪ Government policy should change to focus on quality not just numbers trained |
• Increased funding for better staff-student ratio • Higher level political commitment in support of ClinA training |