Table 2 Problems identified with MLW training and proposed solutions

• 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

▪ 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