WHO Regional Office for Africa

1. 11TH WORLD CONGRESS ON PUBLIC HEALTH AND 8TH BRAZILIAN CONGRESS ON COLLECTIVE HEALTH, RIOCENTRO CONVENTION CENTRE, 21-25 AUGUST 2006 Reality and challenges of Health Professional Education for strengthening of Portuguese speaking African countries health systemsAkpa R. Gbary, Regional Adviser, Human Resources for Health, WHO/AFRO WHO Regional Office for Africa

2. 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

3. 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 in PALOPs • Propose some prospects for action

4. Health systems in PALOPs • Population: over 42 million • Variety of socio-economic situations • Angola and Mozambique • Guinea-Bissau • Health budgets: 4 to 14% of national health budgets • Organization of health system: central, intermediate and peripheral levels • Heavy hospital-centered organization in most countries

5. 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

6. Health systems in PALOPs (3): some health indicators

7. Situation of HRH in Africa

8. 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

9. 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

10. 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)

11. 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

12. 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

13. 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?

14. 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?

15. 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

16. 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

17. 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

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