Strengthening Rural Health Placements for Medical Students: Lessons for South Africa from International Experience

BACKGROUND:This article derives lessons from international experience of innovative rural health placements for medical students. It provides pointers for strengthening South African undergraduate rural health programmes in support of the government's rural health; primary healthcare and National Health Insurance strategies.METHODS:The article draws on a review of the literature on 39 training programmes around the world; and the experiential knowledge of 28 local and international experts consulted through a structured workshop.RESULTS:There is a range of models for rural health placements: some offer only limited exposure to rural settings; while others offer immersion experiences to students. Factors facilitating successful rural health placements include faculty champions who drive rural programmes and persuade faculties to embrace a rural mission; preferential selection of students with a rural background; positioning rural placements within a broader rural curriculum; creating rural training centres; the active nurturing of rural service staff; assigning students to mentors; the involvement of communities; and adapting rural programmes to the local context. Common obstacles include difficulties with student selection; negative social attitudes towards rural health; shortages of teaching staff; a sense of isolation experienced by rural students and staff; and difficulties with programme evaluation.CONCLUSIONS:Faculties seeking to expand rural placements should locate their vision within new health system developments; start off small and create voluntary rural tracks; apply preferential admission for rural students; set up a rural training centre; find practical ways of working with communities; and evaluate the educational and clinical achievements of rural health placements

Training of health personnel in Sierra Leone for primary health care

Sierra Leone; like many African countries; has experienced considerable delay in implementing programmes geared towards the achievement of health for all by the year 2000 through primary health care. There is widespread dissatisfaction towards health care delivery not only as a result of inadequate financing but also due to the general incompetence of health personnel to meet new challenges. A primary health care policy calls for the the training of health personnel of all types and in numbers to meet the needs of the entire country. Training is thus regarded as a priority intervention to meet these challenge. A guideline to relate education and training innovations to the elements of primary care is presented

The need for a training programme in community-oriented education for health personnel in Sierra Leone

There is a pressing need for a community-oriented medical training in Sierra Leone to cope with the country's health problems. To enable a community-oriented training programme to be succesfully implemented; it is first necessary to clarify the basic concepts of a community-oriented training programme in order to remove some misconceptions. The following is therefore an attempt aimed at clarifying the situation by giving a brief backgroung to the health needs of Sierra Leone followed by a definition of community-oriented medical education

Evaluation of the Nigerian National Antiretroviral (ARV) Treatment Training Programme

There is an understanding that greater availability of HIV treatment for the 40.3 million people currently infected with HIV is a humanitarian imperative that could prolong the lives of millions; restore economic productivity; and stabilise societies in some of the world's hardest-hit regions. The Nigerian government recognises that the country has the third highest burden of infection; with people living with HIV estimated to total 4.0 million; and so in 2002 commenced the implementation of one of Africa's largest antiretroviral (ARV) treatment programmes. A successful ARV programme requires that all components of a functional management system be put in place for effective and efficient functioning. This would include logistics; human resources; financial planning; and monitoring and evaluation systems; as well as sustainable institutional capacities. The Nigerian national ARV treatment training programme was conceived to meet the human resource needs in hospitals providing ARV therapy. This paper reports on the evaluation of the training programme. It examines knowledge and skills gained; and utilisation thereof. Recommendations are made for improved training effectiveness and for specific national policy on training; to meet the demand for scaling up therapy to the thousands who need ARV

Joint MoH/SIDA assessment of multidisciplinary training schools : phase 1: assessment of health manpower; education and cost aspects

In the Specific Agreement on Health Sector Co-operation between Sweden and Zimbabwe 1988.90; it was agreed taht SIDA would support construction of one additional Multidisciplinary Training School on condition that a joint assessment satisfactorily establishes cost effectiveness of such a school. This joint assessment should look into the social and economic cost effectiveness of another multidisciplinary school with regard to physical investment cost; running costs; management; relevance of training; selection of trainees; deployment of trainees in rural health service; as well as in relation to long term manpower needs and development priorities in implementing the decentralized primary health care service that Zimbabwe has established through its Health with Equity policy. In this agreement a tantative allocation of initially 4.0 millions SEK was made for the purpose of building one more Multidisciplinary Training School. Terms of Reference (see Appendix 5) for the assessment was prepared jointly by Ministry of Health SIDA. The assessment should be a joint effort between Ministry of Health and two consultants (Health Manpower Development and Construction) provided by SIDA. [abstract terminated]

Working together for health: the world health report 2006

This report was produced under the overall direction of Tim Evans (Assistant Director-General; Evidence and Information for Policy). The principal authors were Lincoln Chen; David Evans; Tim Evans; Ritu Sadana; Barbara Stilwell; Phyllida Travis; Wim Van Lerberghe and Pascal Zurn; assisted by Christie Aschwanden and Joanne McManus. Organizational supervision of the report was provided by Manuel M. Dayrit and Carmen Dolea. The Managing Editor of the report was Thomson Prentice. Valuable inputs in the form of contributions; peer-review; suggestions and criticisms were received from the Director-General's Office; and from Maia Ambegaokar; Dina Balabanova; James Buchan; Gilles Dussault; Martin McKee and Barbara McPake. Significant contributions to the analytical work were received from Mario Dal Poz; Sigrid Draeger; Norbert Dreesch; Patricia Hernandez; Yohannes Kinfu; Teena Kunjumen; Hugo Mercer; Amit Prasad; Angelica Souza and Niko Speybroek. Additional help and advice were kindly provided by Regional Directors and members of their staff. Other contributors were Sabine Ablefoni; Taghreed Adam; Alayne Adams; Chris Afford; Alan Leather; Fariba Aldarazi; Ghanim Al'Sheick; Ala Alwan; Sarah Barber; Kisalaya Basu; Jacques Baudouy; Robert Beaglehole; Habib Benzian; Karin Bergstrom; Isa Bogaert; Paul Bossyns; Jean-Marc Braichet; Hilary Brown; Paul Bunnell; Francisco Campos; Eleonora Cavagnero; Xuanhao Chan; Amelina Chaouachi; Ottorino Cosivi; Nadia Danon-Hersch; Khassoum Diallo; Alimata Diarra; Marjolein Dieleman; Dela Dovlo; Nathalie Drew; Sambe Duale; Steeve Ebener; Dominique Egger; JoAnne Epping-Jordan; Marthe-Sylvie Essengue; Edwige Faydi; Paulo Ferrinho; Noela Fitzgerald; Martin Fletcher; Helga Fogstad; Gilles Forte; Kathy Fritsch; Michelle Funk; Charles Godue; Sandy Gove; Alexandre Griekspoor; Steffen Groth; Anil Gupta; Piya Hanvoravongchai; Hande Harmanci; Lisa Hinton; Sue Ineson; Anwar Islam; Anna Iversen; PT Jayawickramarajah; Patrick Kadama; Hans Karle; Julia Karnaukhova; Guy Kegels; Meleckidzedeck Khayesi; Mireille Kingma; Stephen Kinoti; Etienne Krug; Yunkap Kwankam; Chandrakant Laharyia; Gaert Laleman; Jean Pierre Lokonga; Ana Lopes Temporao; Alessandro Loretti; Pat McCarty; Judith Mandelbaum- Schmid; Annick Manuel; Bruno Marchal; Tim Martineau; Liz Mason; Zoe Matthews; Sandra McGinnis; Abdelhay Mechbal; Remo Meloni; Nata Menabde; Phillipa Mladovski; Dominic Montagu; Jean Moore; Krishnan Natarajan; Mwansa Nkwane; John Norcini; Ezekiel Nukoro; Isabelle Nuttal; Jennifer Nyoni; Cornelius Oepen; Judith Oulton; Francis Omaswa; Mary O'Neill; Ariel Pablos-Mendez; Fred Peccaud; Margie Peden; Galina Perfilieva; Bob Pond; Raymond Pong; Amit Prasad; Usha Raman; Tom Ricketts; Robert Ridley; Arjanne Rietsema; Felix Rigoli; Barbara Rijks; Salif Samake; Benedetto Saraceno; Shekhar Saxena; Robert Scherpbier; Lee-Martin Shook-Pui; Kit Sinclair; Alaka Singh; Ronald Skeldon; Susan Skillman; Ajay Tandon; Tessa Tan-Torres Edejer; Linda Tawfik; Michel Thieren; Anke Tijstma; Nicole Valentine; Wim Van Damme; Dirk Van der Roost; Mark van Ommeren; Paul Verboom; Marko Vujicic; Lis Wagner; Eva Wallstam; Diane Whitney; Marijke Wijnroks; Paul Wing; Christiane Wiskow; Tana Wuliji; Jean Yan; Sandy Yule; Manfred Zahorka; Diana Zandi; and Lingling Zhang. Contributors to statistical tables not already mentioned were Endre Bakka; Dorjsuren Bayarsaikhan; Ties Boerma; Eduard Bos; Thomas Buettner; Veneta Cherilova; Trevor Croft; Driss Zine Eddine Elidrissi; Anton Fric; Charu Garg; Peter Ghys; Amparo Gordillo; Eleanor Gouws; Attila Hancioglu; Kenneth Hill; Chandika Indikadahena; Mie Inoue; Gareth Jones; Joses Kirigia; Jan Klavus; Joseph Kutzin; Eduardo Levcovitz; Edilberto Loaiza; Doris Ma Fat; Francois Pelletier; Ravi Rannan-Elyia; Hossein Salehi; Cheryl Sawyer; Kenji Shibuya; Karen Stanecki; Ruben Suarez; Emi Suzuki; Nathalie Van de Maele; Jakob Victorin; Neff Walker; Tessa Wardlaw; Charles Waza; Jens Wilkens; John Wilmoth; and many staff in WHO country offices; governmental departments and agencies; and international institutions. The report was edited by Leo Vita-Finzi; assisted by Barbara Campanini. Editorial; administrative and production support was provided by Shelagh Probst and Gary Walker; who also coordinated the photographs. Figures and tables were provided by Gael Kernen who also was responsible for the web site version; and other electronic media. Proofreading was by Marie Fitzsimmons. The index was prepared by June Morrison