Training a Fit-For-Purpose Rural Health Workforce for Low- and Middle-Income Countries (LMICs): How Do Drivers and Enablers of Rural Practice Intention Differ Between Learners From LMICs and High Income Countries?

Equity in health outcomes for rural and remote populations in low- and middle-income countries (LMICs) is limited by a range of socio-economic, cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the proportion of the health workforce that practices in underserved rural and remote areas. The Training for Health Equity Network (THEnet) is a community-of-practice of 13 health professional education institutions with a focus on delivering socially accountable education to produce a fit-for-purpose health workforce. The THEnet Graduate Outcome Study is an international prospective cohort study with more than 6,000 learners from nine health professional schools in seven countries (including four LMICs; the Philippines, Sudan, South Africa and Nepal). Surveys of learners are administered at entry to and exit from medical school, and at years 1, 4, 7, and 10 thereafter. The association of learners' intention to practice in rural and other underserved areas, and a range of individual and institutional level variables at two time points-entry to and exit from the medical program, are examined and compared between country income settings. These findings are then triangulated with a sociocultural exploration of the structural relationships between educational and health service delivery ministries in each setting, status of postgraduate training for primary care, and current policy settings. This analysis confirmed the association of rural background with intention to practice in rural areas at both entry and exit. Intention to work abroad was greater for learners at entry, with a significant shift to an intention to work in-country for learners with entry and exit data. Learners at exit were more likely to intend a career in generalist disciplines than those at entry however lack of health policy and unclear career pathways limits the effectiveness of educational strategies in LMICs. This multi-national study of learners from medical schools with a social accountability mandate confirms that it is possible to produce a health workforce with a strong intent to practice in rural areas through attention to all aspects of the rural pathway.

Developing a Continuing Professional Development Program to Improve Nursing Practice in Lesotho

INTRODUCTION

In 2010, the Lesotho Ministry of Health and Social Welfare (MOHSW) issued the Continuing Education Strategy for all Health Care Workers in Lesotho, requiring professional regulatory bodies to enforce continuing education requirements amongst their members. In order to comply with this strategy, the Lesotho Nursing Council worked to develop a national comprehensive program for continuing professional development (CPD).

METHODS

Through a seed grant and technical assistance from the African Health Professions Regulatory Collaborative (ARC), national nursing and midwifery leadership collaboratively developed a national CPD framework. The draft CPD framework and logbook were formally vetted with stakeholders during consultative meetings held around the country.

ACHIEVEMENTS

The CPD framework was successfully piloted prior to being launched nationally in October 2012. This is the first health professional CPD program in Lesotho. Development of a CPD program in Lesotho has created a platform to reconcile nursing practice with the legislative standards governing the workforce.

CHALLENGES

The one-year grant timeframe, along with limited financial and staff resources limited presented implementation challenges.

CONCLUSION

In establishing a comprehensive national CPD program, it is critical for countries to engage in a staged planning process that includes monitoring and evaluation.