WHO Regional Office for Africa Reality and challenges of Health Professional Education for strengthening of Portuguese speaking African countries health systems Akpa R. Gbary, Regional Adviser, Human Resources for Health, WHO/AFRO 11TH WORLD CONGRESS ON PUBLIC HEALTH AND 8TH BRAZILIAN CONGRESS ON COLLECTIVE HEALTH, RIOCENTRO CONVENTION CENTRE, 21-25 AUGUST 2006 WHO Regional Office for Africa

Introduction Health systems in PALOPs in development Human resources for health (HRH) as one of their main components HRH Strategic Plan 2002-2006 developed in 2001, but not implemented Need to continue the reflection for action

Objectives of the presentation Give a brief overview of health systems in PALOPs Review the overall situation of health workers in PALOPs Review the status of education, training and skills development in PALOPs Highlight the constraints and challenges facing education, training and skills development in PALOPs Propose some prospects for action

Health systems in PALOPs Population: over 42 million Variety of socio-economic situations Angola and Mozambique Guinea-Bissau Health budgets: 4 to 8% of national health budgets Organization of health system: central, intermediate and peripheral levels Heavy hospital-centered organization in most countries

Health systems in PALOPs (2): disease burden Double burden Communicable diseases Non communicable diseases Situation of complex emergencies Floods (Mozambique) Re-emerging diseases (Cholera, Ebola fever): Guinee Bissau, Angola Clear epidemiological transition in Cape Verde Negative impact on health indicators

Health systems in PALOPs (3): some health indicators Name of the country Infant mortality (p. 1000) Under 5 mortality (p. 1000) Maternal mortality (p. 100,000) Skilled birth attendance (%) Guinea-Bissau 203.8 125.8 1,100 35 Mozambique 158.2 106.9 1,000 48 Angola 259.7 153.8 1,700 45

Situation of HRH in Africa

Situation of HRH in PALOPs Lack of HRH policies and plans except for Cape Verde and Mozambique High migration to OECD countries (Portugal +++) High dependency on foreign countries for training of specialized HRH Ageing specialized HRH without replacement Huge imbalances of HRH distribution

Education and training of HRH in PALOPs Nursing schools In all five countries Several health cadres trained Faculty of Medicine: 3 countries Physicians Pharmacists Specialized physicians (Angola and Mozambique) Promising practices in Cape Verde

Education and training of HRH in PALOPs (2) Private higher education institutions Universidade Jean Piaget (Private, Cape Verde): training of specialized nurses at B.Sc level Faculty of Medicine in Beira (Mozambique) 4 medical institutes in Angola Two higher level institutes of health sciences in Mozambique Two regional training centres Centro Regional de Desenvolvimento Sanitario (CRDS, Mozambique) Instituto Superior de Enfermagem (ISE, Angola)

Education and training of HRH in PALOPs: constraints Insufficient capacities of production of HRH Mismatch between training curricula and health systems needs Weak culture of institutional and curricula evaluation Quality of training threatened by mushrooming of private institutions Weak stewardship role of countries

Education and training of HRH in PALOPs: constraints (2) Insufficient physical facilities and infrastructures Limited and/or obsolete equipment Inadequate numbers and quality of tutors and lecturers Insufficient training materials in Portuguese Weak collaboration between PALOPs countries

Education and training of HRH in PALOPs: challenges In what ways could the training in health sciences training institutions better prepare the trainees for the difficult situations prevailing in the field? How could quality and improvement in HRH be ensured owing to changing ownership of health sciences training institutions? How best could health sciences training institutions adapt to government reforms? How could PALOPs scale up training of trainers?

Education and training of HRH in PALOPs: challenges (2) How could collaboration and utilization of scarce resources be optimized between and within PALOPS? How could PALOPs increase mobilization of resources for education and training? How could PALOPs streamline establishment of health sciences training institutions? How could national and international partners be fully involved in and support scaling up of education and training?

Education and training of HRH in PALOPs: some prospects for action Match the educational capacities and health challenges and needs Develop and implement joint inter-country projects/programmes in HRH development and education of health workers Mobilize resources for education of HRH in the health sector (GAVI, GFATM) and beyond (HIPC, MTEF, PRSP, budgetary support) Evaluate health sciences training institutions regularly and undertake reforms of curricula

Education and training of HRH in PALOPs: some prospects for action (2) Countries to improve their regulatory role with regard to establishment of private health sciences training schools Come up with innovative ways such as distance education to scale up training of trainers Maintain advocacy with development partners for massive investments in production of health workers in PALOPs

Conclusion Fragile health systems in PALOPs HRH crisis as one of the greatest challenges for health systems Offer of training to be enhanced for health system strengthening Conditions of success Collaborative efforts Comprehensive approaches Sustainability of efforts

THANK YOU OBRIGADO GRACIAS WHO/AFRO Division of Health Systems & Services Development