Abstract:
Background: Africa’s health systems rely on services provided by mid-level health workers (MLWs). Investment in
their training is worthwhile since they are more likely to be retained in underserved areas, require shorter training
courses and are less dependent on technology and investigations in their clinical practice than physicians. Their
training programs and curricula need up-dating to be relevant to their practice and to reflect advances in health
professional education.
This study was conducted to review the training and curricula of MLWs in Kenya, Nigeria, South Africa and Uganda,
to ascertain areas for improvement.
Methods: Key informants from professional associations, regulatory bodies, training institutions, labour
organisations and government ministries were interviewed in each country. Policy documents and training curricula
were reviewed for relevant content. Feedback was provided through stakeholder and participant meetings and
comments recorded. 421 District managers and 975 MLWs from urban and rural government district health facilities
completed self-administered questionnaires regarding MLW training and performance.
Results: Qualitative data indicated commonalities in scope of practice and in training programs across the four
countries, with a focus on basic diagnosis and medical treatment. Older programs tended to be more didactic in
their training approach and were often lacking in resources. Significant concerns regarding skills gaps and quality of
training were raised. Nevertheless, quantitative data showed that most MLWs felt their basic training was adequate
for the work they do. MLWs and district managers indicated that training methods needed updating with
additional skills offered. MLWs wanted their training to include more problem-solving approaches and practical
procedures that could be life-saving.Conclusions: MLWs are essential frontline workers in health services, not just a stop-gap. In Kenya, Nigeria and
Uganda, their important role is appreciated by health service managers. At the same time, significant deficiencies in
training program content and educational methodologies exist in these countries, whereas programs in South
Africa appear to have benefited from their more recent origin. Improvements to training and curricula, based on
international educational developments as well as the local burden of disease, will enable them to function with
greater effectiveness and contribute to better quality care and outcomes.
