1. WHO Regional Office for Africa
Reality and challenges of Health Professional Education for strengthening of Portuguese speaking African countries health systems Akpa R. Gbary, Regional Adviser, Human Resources for Health, WHO/AFRO
11TH WORLD CONGRESS ON PUBLIC HEALTH AND 8TH BRAZILIAN CONGRESS ON COLLECTIVE HEALTH, RIOCENTRO CONVENTION CENTRE, AUGUST 2006
WHO
Regional Office for Africa

2. Introduction Health systems in PALOPs in development
Human resources for health (HRH) as one of their main components
HRH Strategic Plan developed in 2001, but not implemented
Need to continue the reflection for action

3. Objectives of the presentation
Give a brief overview of health systems in PALOPs
Review the overall situation of health workers in PALOPs
Review the status of education, training and skills development in PALOPs
Highlight the constraints and challenges facing education, training and skills development in PALOPs
Propose some prospects for action

4. Health systems in PALOPs
Population: over 42 million
Variety of socio-economic situations
Angola and Mozambique
Guinea-Bissau
Health budgets: 4 to 8% of national health budgets
Organization of health system: central, intermediate and peripheral levels
Heavy hospital-centered organization in most countries

5. Health systems in PALOPs (2): disease burden
Double burden
Communicable diseases
Non communicable diseases
Situation of complex emergencies
Floods (Mozambique)
Re-emerging diseases (Cholera, Ebola fever): Guinee Bissau, Angola
Clear epidemiological transition in Cape Verde
Negative impact on health indicators

6. Health systems in PALOPs (3): some health indicators
Name of the country
Infant mortality (p. 1000)
Under 5 mortality (p. 1000)
Maternal mortality (p. 100,000)
Skilled birth attendance (%)
Guinea-Bissau
203.8
125.8
1,100 35
Mozambique
158.2
106.9
1,000 48
Angola
259.7
153.8
1,700 45

7. Situation of HRH in Africa

8. Situation of HRH in PALOPs
Lack of HRH policies and plans except for Cape Verde and Mozambique
High migration to OECD countries (Portugal +++)
High dependency on foreign countries for training of specialized HRH
Ageing specialized HRH without replacement
Huge imbalances of HRH distribution

9. Education and training of HRH in PALOPs
Nursing schools
In all five countries
Several health cadres trained
Faculty of Medicine: 3 countries
Physicians
Pharmacists
Specialized physicians (Angola and Mozambique)
Promising practices in Cape Verde

10. Education and training of HRH in PALOPs (2)
Private higher education institutions
Universidade Jean Piaget (Private, Cape Verde): training of specialized nurses at B.Sc level
Faculty of Medicine in Beira (Mozambique)
4 medical institutes in Angola
Two higher level institutes of health sciences in Mozambique
Two regional training centres
Centro Regional de Desenvolvimento Sanitario (CRDS, Mozambique)
Instituto Superior de Enfermagem (ISE, Angola)

11. Education and training of HRH in PALOPs: constraints
Insufficient capacities of production of HRH
Mismatch between training curricula and health systems needs
Weak culture of institutional and curricula evaluation
Quality of training threatened by mushrooming of private institutions
Weak stewardship role of countries

12. Education and training of HRH in PALOPs: constraints (2)
Insufficient physical facilities and infrastructures
Limited and/or obsolete equipment
Inadequate numbers and quality of tutors and lecturers
Insufficient training materials in Portuguese
Weak collaboration between PALOPs countries

13. Education and training of HRH in PALOPs: challenges
In what ways could the training in health sciences training institutions better prepare the trainees for the difficult situations prevailing in the field?
How could quality and improvement in HRH be ensured owing to changing ownership of health sciences training institutions?
How best could health sciences training institutions adapt to government reforms?
How could PALOPs scale up training of trainers?

14. Education and training of HRH in PALOPs: challenges (2)
How could collaboration and utilization of scarce resources be optimized between and within PALOPS?
How could PALOPs increase mobilization of resources for education and training?
How could PALOPs streamline establishment of health sciences training institutions?
How could national and international partners be fully involved in and support scaling up of education and training?

15. Education and training of HRH in PALOPs: some prospects for action
Match the educational capacities and health challenges and needs
Develop and implement joint inter-country projects/programmes in HRH development and education of health workers
Mobilize resources for education of HRH in the health sector (GAVI, GFATM) and beyond (HIPC, MTEF, PRSP, budgetary support)
Evaluate health sciences training institutions regularly and undertake reforms of curricula

16. Education and training of HRH in PALOPs: some prospects for action (2)
Countries to improve their regulatory role with regard to establishment of private health sciences training schools
Come up with innovative ways such as distance education to scale up training of trainers
Maintain advocacy with development partners for massive investments in production of health workers in PALOPs

17. Conclusion Fragile health systems in PALOPs
HRH crisis as one of the greatest challenges for health systems
Offer of training to be enhanced for health system strengthening
Conditions of success
Collaborative efforts
Comprehensive approaches
Sustainability of efforts

18. THANK YOU OBRIGADO GRACIAS
WHO/AFRO Division of Health Systems & Services Development