Besim Nuri
Unité de Santé Internationale
CHUM/Université de Montréal
The need for training in developing
countries
 In Sub-Saharan Africa:
 Only 4% of medical schools (64 out of 1642)
 21 countries had 1 medical school and 6 countries had none;
 Half of the African countries – no graduate program in
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public health
173 800 young doctors graduate each year in Europe versus
5100 in Africa
Curricula misaligned with countries health problems;
outdated pedagogical methods, excluding practical
problem-solving skills;
Few health leadership and management programs
Major gaps in continuing education
Human Resources for Health. Overcoming the crisis. Joint Learning Initiative, 2004
Proposed strategies
- Joint Learning
Initiative, 2004
Enhancing
competencies by
educating for
appropriate skills
Fostering leadership
and entrepreneurship
Training for continual
learning
Training programs in cooperation projects – an
engine for capacity building?
 Academic institutions (universities, schools, institutes,
centers…)
 Health service organizations (health centers, hospitals,
clinics, etc.)
 Sub-systems (PHC, HRH, MIS etc.)
Unité de Santé Internationale - UdeM
20 ans de partenariats pour la santé dans le monde
Population and Health Program in Africa,
2003-2013, 11 million $ US, Gates
Foundation
Support to Health Management capacities
in Haiti (PARC), 2006-2011, 15 million $C,
CIDA
Professional Development System in
Albania, Phase 1 - 2007-2010, 2,7 milion SFr,
Swiss Cooperation
Capacity building at academic level
Graduate and post-graduate training programs
Develop curriculum and
content
Professor/teachers/trainers
Institutional challenges
Teaching materials and
access to information
Financial resources to ensure
sustainability
Training programs: why their
impact is sometimes limited?
 Problems related with training needs assessment
 Traditional training courses and pedagogical methods
 Lack of support systems
 Enabling working conditions (salaries, motivation
etc.)
Challenges of implementation
Implementation of
knowledge and skills:
problems
 Frequent turn-over of
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directors and decisionmakers
Political influence versus
merit-based appointments
Autonomy of health services
not yet implemented in
practice
Not all members of health
teams are trained
Culture of health sector
organizations doesn’t allow
personal initiative
Training Program in Health Planning
and Management in Albania, 20052008
Leadership and Management in health systems
http://www.who.int/management/strengthen/en/index.html
Systemic capacity building
Ch.Potter and R. Brough, Health Policy and planning, 19(5), 2004
Systemic capacity building
Ch.Potter and R. Brough, Health Policy and planning, 19(5), 2004
Strengthening Health Management Capacities in Haiti
Conceptual framework of the project PARC (2006-2011)
Internal end external factors with an
impact on HRH :
- Governance - skills and appropriate use of HRH - availability of resources -
Learning and
continuing
education
HUMAN
CAPITAL
PersonnalitY
Qualities
Basic
éducation etc.
Individual
capabilities
Knowledge
and skills
CAPACITY
CAPACITY
CAPACITIY
Personal
Organiz.
System
(know-how)
NEEDS TO STRENGTHEN/BUILD/DEVELOP
PERFORMANCE
Performance of people
Performance
of
organizations
Performance
of the system
Beneficiaries: project PARC, Haiti
 Individuals:
 managers and
professionals attending
training programs
(graduate diploma and
Masters)
 Central level decisionmakers, mostly in the area
of HRH
 Organizations:
 Academic
 Health services
 Health system (MoH,
health departments, etc.)
PDS Project in Albania, 2007-2010
Schematic view
Certification
of health
workforce
Training programs
Quality of health
services and
performance of
health system
Centre of Cont. Education
Universities
Planning, organizing,
implementing, financing
Accreditation of
programs
Schools
Training org.
Summary of ideas…
 Training programs through cooperation project – an
engine for capacity building:
 Personal capacities
 Capacities of academic institutions - sustainability
 Training can have an impact on health organizations’
capacities when combined with other interventions
 Support to build/improve structures and processes in
order to enhance the impact of training/education
programs