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Table 2 Problems identified with MLW training and proposed solutions

From: Curriculum and training needs of mid-level health workers in Africa: a situational review from Kenya, Nigeria, South Africa and Uganda

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
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