Health Worker Education and Training
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education to community needs has been so successful that Malawi is now starting schools of dentistry, pharmacy, and physical therapy.
Public Sector Monopolies on Preservice Education Many African countries do not permit private health science schools, severely limiting resources for preservice education and therefore the number of graduates. Yet, many Sub-Saharan countries that increased the health worker supply rely on faith-based, not-for-profit, or for-profit private institutions. In the 1990s Ethiopia allowed private nursing schools to open, eliminating the shortage of nurses without cost to the government. In Uganda faith-based hospitals are the primary preservice trainer of nurses. Private health science schools are more likely to be located in rural or underserved areas than public schools (Longombe 2009). Situated in such areas, they can fill a critical gap in services. Ministries of health and education should improve coordination to maximize health system resources for education and training. They should also integrate public and private clinical training and ensure adequate supervision. Accreditation bodies are needed to ensure the quality of both public and private schools. A study by the Gates Foundation found that 35 percent of all African medical schools are private and private schools are the fastest school ownership model in Africa (Gates 2010). It is estimated that a higher percent of nursing schools are private, for example in Tanzania 55 percent of nursing schools were faith based, and their graduates are more likely to work in underserved communities (Capacity Project 2009). Faith-based schools increasingly require postgraduation contracts as a condition on acceptance, requiring that graduates work for them for a year or two to repay training costs.
School Governance In many countries the ministry of education rather than the ministry of health governs health science schools, leading to budgetary problems and opening a rift between the trainers and future health sector employers. When the budget for preservice education is separate from the ministry of health budget, the ministry of health cannot set preservice education as a priority over other investments. Many ministries of health build clinics they cannot staff and buy drugs they cannot dispense because they do not have the budgetary flexibility to shift funding to preservice education.