1. Besim Nuri Unité de Santé Internationale CHUM/Université de Montréal

2. The need for training in developing countries In Sub-Saharan Africa: Only 4% of medical schools (64 out of 1642) 21 countries had 1 medical school and 6 countries had none; Half of the African countries – no graduate program in public health 173 800 young doctors graduate each year in Europe versus 5100 in Africa Curricula misaligned with countries health problems; outdated pedagogical methods, excluding practical problem-solving skills; Few health leadership and management programs Major gaps in continuing education Human Resources for Health. Overcoming the crisis. Joint Learning Initiative, 2004

3. Proposed strategies - Joint Learning Initiative, 2004 Enhancing competencies by educating for appropriate skills Fostering leadership and entrepreneurship Training for continual learning

4. Training programs in cooperation projects – an engine for capacity building? Academic institutions (universities, schools, institutes, centers…) Health service organizations (health centers, hospitals, clinics, etc.) Sub-systems (PHC, HRH, MIS etc.)

5. Unité de Santé Internationale - UdeM 20 ans de partenariats pour la santé dans le monde Population and Health Program in Africa, 2003-2013, 11 million $ US, Gates Foundation Support to Health Management capacities in Haiti (PARC), 2006-2011, 15 million $C, CIDA Professional Development System in Albania, Phase 1 - 2007-2010, 2,7 milion SFr, Swiss Cooperation

6. Capacity building at academic level Graduate and post-graduate training programs Develop curriculum and content Professor/teachers/trainers Institutional challenges Teaching materials and access to information Financial resources to ensure sustainability

7. Training programs: why their impact is sometimes limited? Problems related with training needs assessment Traditional training courses and pedagogical methods Lack of support systems Enabling working conditions (salaries, motivation etc.)

8. Challenges of implementation Implementation of knowledge and skills: problems Training Program in Health Planning and Management in Albania, 2005- 2008 Frequent turn-over of directors and decision- makers Political influence versus merit-based appointments Autonomy of health services not yet implemented in practice Not all members of health teams are trained Culture of health sector organizations doesnt allow personal initiative

9. Leadership and Management in health systems http://www.who.int/management/strengthen/en/index.html

10. Systemic capacity building Ch.Potter and R. Brough, Health Policy and planning, 19(5), 2004

12. Strengthening Health Management Capacities in Haiti Conceptual framework of the project PARC (2006-2011) HUMAN CAPITAL PersonnalitY Qualities Basic éducation etc. Individual capabilities Knowledge and skills CAPACITY Personal (know-how) CAPACITY Organiz. CAPACITIY System Performance of people Performance of organizations Performance of the system Internal end external factors with an impact on HRH : - Governance - - skills and appropriate use of HRH - - availability of resources - Learning and continuing education NEEDS TO STRENGTHEN/BUILD/DEVELOP PERFORMANCE

13. Beneficiaries: project PARC, Haiti Individuals: managers and professionals attending training programs (graduate diploma and Masters) Central level decision- makers, mostly in the area of HRH Organizations: Academic Health services Health system (MoH, health departments, etc.)

14. PDS Project in Albania, 2007-2010 Schematic view Certification of health workforce Centre of Cont. Education Universities Schools Training org. Planning, organizing, implementing, financing Training programs Quality of health services and performance of health system Accreditation of programs

15. Summary of ideas… Training programs through cooperation project – an engine for capacity building: Personal capacities Capacities of academic institutions - sustainability Training can have an impact on health organizations capacities when combined with other interventions Support to build/improve structures and processes in order to enhance the impact of training/education programs