African Health Professions Research Articles

Paving the Path to Patient-Centered Healthcare in Africa: Insights From a Student Led Initiative.

Patient-centered care (PCC) is a key domain of healthcare quality. Its importance is driven by evidence-based medicine, the predominance of chronic conditions requiring self-care, and the recognition of the priority of patient goals, values, priorities, and preferences in determining care plans. This article emphasizes the urgent need for Africa to develop PCC and a workforce committed to its implementation, as well as highlights an initiative by African medical students to champion PCC continent-wide. Embracing this transformative approach presents Africa with an unprecedented opportunity to improve care for each person. Through a comprehensive exploration of unique strategies and considerations in African health professions education, this viewpoint seeks to spark dialogue and inspire action towards a future where patient-centered care is the foundation of healthcare delivery in Africa.

Experiences of health professional students’ participation in the GEMx regional elective exchange program in Africa

BackgroundGiven the significant gap in International Electives (IEs) opportunities for African health professions students, ECFMG|FAIMER through its Global Educational Exchange in Medicine and other health professions (GEMx) program launched a pilot African regional elective exchange program in 2016. During IEs, students have a choice of discipline they would like to learn, and the location, often at a host institution in a different country. This study provides an overview of health professional students’ experiences through participation in the pilot GEMx regional elective exchange program in Africa.MethodsThis was a quasi-experimental, single-group post-test-only study using the survey method. Data were collected online using a self-administered survey through SurveyMonkey. Students (N = 107) received emails with a link to the survey as they completed the electives. The survey was open for a month for each student and weekly reminders were sent.ResultsThe survey obtained a 100% response rate. All postgraduate and undergraduate students from various professional training programs (n = 107) reported gaining knowledge that was applicable back home. Over 43.4% (n = 46) reported having formed professional networks that are valuable for career progression. More than half 59.8% (n = 64) gained clinical skills and learned various procedures while 26.2% (n = 28) recognized the need for increased reliance on history taking for disease diagnosis. More than a third, 34.6% (n = 37) appreciated the different cultures and the effect of cultural beliefs on health outcomes.Discussion and conclusionsThe GEMx regional elective exchange program in Africa provided a useful platform that enabled health professional students at undergraduate and postgraduate levels in their respective disciplines to gain enhanced perspectives on health issues, acquire clinical knowledge and skills applicable to their home country, strengthen personal and professional development, and develop positive attitude change in various health care delivery approaches.

An Assessment of Clinical Mentorship for Quality Improvement: The African Health Professions Regional Collaborative for Nurses and Midwives.

The African Regional Collaborative for nurses and midwives funded quality improvement projects in five countries to enhance clinical mentorship programs supporting HIV service delivery for women, infants, and children. Each country team implemented specific interventions focused on the application of nurse-initiated and managed antiretroviral therapy guidelines and competencies. A site-level tool, the nursing practice framework, measured structural maturation in clinical mentorship programs across five stages at eight facilities. Clinical competencies that aligned with the framework were evaluated through a provider-level knowledge assessment to identify on-going needs for mentees before and after the implementation period. Key trends observed in the assessment include positive program progression for all facilities; competencies were higher for pregnant and breastfeeding women and lower for HIV-exposed infants; there was an increase in posttest participation for all facilities. The nursing practice framework provides a rapid assessment of structural changes and exploration of context to identify quality improvement needs.

Strengthening the biokinetics workforce for improved services: A human resources for health review from 2000 to 2020.

Biokinetics is a South African (SA) health profession within the private health care sector. Biokineticists register with the Health Professions Council of SA (HPCSA). To describe the demographic trends of HPCSA registered biokineticists from 2000 to 2020 to understand the supply and status of human resources for health within the profession. The following data were collected and analysed: i) health personnel category, ii) geographical location, iii) age, iv) sex, and v) population category. The number of HPCSA registered biokineticists grew from 136 in 2000, to 1831 in January 2020 (67.8% women, 32.2% men). There was a sharp decline in numbers after the age of 45 years. The Western Cape (5.8) and Gauteng (5.1) provinces had the most biokineticists per 100 000 of the population, whilst smaller provinces like Kwazulu-Natal (1.6), Mpumalanga (1.6), North-West (1.6) and Limpopo (0.9) lagged. The demographic profile of registered Biokineticists changed steadily from 2000 to 2020. Registered biokineticists classified as White decreased from 91.6% to 80.4%, whilst substantial increases were observed among Black (5.0% to 8.3%), Coloured (0.02% to 5.3%) and Indian/Asian (0.02% to 6.0%) biokineticists. Thirteen tertiary institutions offered Biokinetics programmes in 2022. Seven offered the 3+1-year (Honours) programme and six have migrated to a 4-year professional degree. The profession is well established, growing, and dominated by women. The demographic profile has transformed steadily; however, the need to transform the profession remains strong. Strengthening investments aimed at the employment of biokineticists in the public health sector may serve as a key turning point for healthcare workforce planning.

Planetary health and environmental sustainability in African health professions education.

CliMigHealth and the Education for Sustainable Healthcare (ESH) Special Interest Group of the Southern African Association of Health Educationalists (SAAHE) call for the urgent integration of planetary health (PH) and environmental sustainability into health professions curricula in Africa. Education on PH and sustainable healthcare develops much-needed health worker agency to address the connections between healthcare and PH. Faculties are urged to develop their own 'net zero' plans and to advocate for national and sub-national policies and practices that promote the Sustainable Development Goals (SDGs) and PH. National education bodies and health professional societies are urged to incentivise innovation in ESH and to provide discussion forums and resources to support the integration of PH into curricula.Contribution: This article provides a position statement for integrating planetary health and environmental sustainability into African health professions education curricula.

Developing an African medical and health professions student regional elective exchange program: approaches and lessons learned

Background: Given the significant gap in International Medical Elective (IME) opportunities for African health professions students, the Educational Commission for Foreign Medical Graduates and the Foundation for Advancement of International Medical Education and Research (ECFMG|FAIMER) launched an African regional elective exchange program through the Global Educational Exchange in Medicine and the Health Professions (GEMx) in 2016. This paper provides an overview of the development of the GEMx program, the pillars of implementation, and lessons learned. Methods: The authors conducted a longitudinal qualitative study utilizing in-depth interviews with institutional leaders, program leaders, and faculty, participant observation through symposia, strategic planning meetings, staff meetings, and document review of the annual progress reports, strategic plans, and newsletter articles, abstracts, and concept notes. Common categories were identified and incorporated into a matrix to create themes. Data were analyzed using the manifest content approach guided by a literature review. Results: The key pillars for implementation of the GEMx Africa regional elective exchange program included: the commitment from African training institutional networks and their member institutions that enabled electives to be offered, the GEMx Charter (multilateral agreement) that enabled reciprocity and diversity of elective opportunities, GEMx web-based application system that enabled the centralization of the application process and real-time feedback on acceptance, GEMx Africa Regional Coordination Center in Kampala, Uganda that lead the development and implementation in Africa, and ECFMG mini-grants that helped defray elective costs. Conclusions: Through the development of multilateral partnerships across the continent, the GEMx regional elective exchange program contributed towards bridging a long-existing gap of inadequate opportunities for African health professions students to enhance their global exposure and strengthen their knowledge and skills. .

Developing an African medical and health professions student regional elective exchange program: approaches and lessons learned

Background: Given the significant gap in International Medical Elective (IME) opportunities for African health professions students, the Educational Commission for Foreign Medical Graduates and the Foundation for Advancement of International Medical Education and Research (ECFMG|FAIMER) launched an African regional elective exchange program through the Global Educational Exchange in Medicine and the Health Professions (GEMx) in 2016. This paper provides an overview of the development of the GEMx program, the pillars of successful implementation, and lessons learned. Methods: The authors conducted a longitudinal qualitative study utilizing in-depth interviews with institutional leaders, Program leaders, and faculty, participant observation through symposia, strategic planning meetings, staff meetings, and document review of the annual progress reports, strategic plans, and newsletter articles, abstracts and concept notes. Common categories were identified and incorporated into a matrix to create themes. Data were analyzed using the manifest content approach guided by a literature review. Results: The key pillars for the successful implementation of the GEMx Africa regional elective exchange program included: the commitment from African training institutional networks and their member institutions that enabled electives to happen, the GEMx Charter (multilateral agreement) that enabled reciprocity and diversity of elective opportunities, GEMx web-based application system that enabled the centralization of the application process and real-time feedback on acceptance, GEMx Africa Regional Coordination Center in Kampala, Uganda that lead the development and implementation in Africa, and ECFMG mini-grants that help defray the biggest part of the elective costs. Conclusions: Through the development of successful partnerships across the continent, the GEMx regional elective exchange program contributed towards bridging a long-existing gap of inadequate opportunities for African health professions students to enhance their global exposure and strengthen their knowledge and skills.

Developing an African medical and health professions student regional elective exchange program: approaches and lessons learned

Background: Given the significant gap in International Medical Elective (IME) opportunities for African health professions students, the Educational Commission for Foreign Medical Graduates and the Foundation for Advancement of International Medical Education and Research (ECFMG|FAIMER) launched an African regional elective exchange program through the Global Educational Exchange in Medicine and the Health Professions (GEMx) in 2016. This paper provides an overview of the development of the GEMx program, the pillars of successful implementation, and lessons learned. Methods: The authors conducted a longitudinal qualitative study utilizing in-depth interviews, participant observation, and document review. Common categories were identified and incorporated into a matrix to create themes. Data were analysed using the manifest content approach guided by a literature review. Results: The key pillars for the successful implementation of the GEMx Africa regional elective exchange program included: the commitment from African training institutional networks and their member institutions, the GEMx Charter (multilateral agreement), GEMx web-based application system, GEMx Africa Regional Coordination Center in Kampala, Uganda, and ECFMG mini-grants. Conclusions: Through the development of successful partnerships across the continent, the GEMx regional elective exchange program contributed towards bridging a long-existing gap of inadequate opportunities for African health professions students to enhance their global exposure and strengthen their knowledge and skills.

Self-Directed Learning During the COVID-19 Pandemic: Perspectives of South African Final-Year Health Professions Students.

PurposeSelf-directed learning (SDL) has been advocated for effective training of final-year health professions students. COVID-19 challenges conventional teaching, learning, and assessment in the clinical environment. This study aimed to identify and explore enablers and barriers to SDL among final-year health professions students training during the COVID-19 pandemic.MethodsAdopting the SWOT (strengths, weaknesses, opportunities and threats) framework, this study explored the clinical learning and training experiences of final-year health professions students during the pandemic. A survey was conducted via online platforms. Data from 155 respondents were thematically analyzed.ResultsPersonal attributes such as reflection, self-determination, motivation, resilience, and positive learning behaviors and skills were identified as SDL enablers. Collaborative learning networks and online learning platforms facilitate learning needs and goals. Fear and anxiety, untrusted learning sites, uncertainty about graduation, financial issues and challenges in the learning environments were the major themes related to barriers to SDL.ConclusionThe importance of SDL as a skill for uncertain times warrants further investigation in the training of future healthcare professionals. Inclusive planning and engagement with final-year health professions students to address identified stressors, as well as the creation of shared platforms where students are part of the decision-making processes for clinical learning and training are recommended. Responsive curricula that optimize unpredictable disruptions in clinical training are needed to equip students to diagnose their own learning needs and implement appropriate learning strategies.

'Going virtual': Innovative online faculty development during COVID-19

The 18-month SAFRI fellowship programme is aimed at developing African health professions educators as leaders, teachers, scholars and advocates for change. Included in the last session of the programme was an opportunity for fellows to develop and host face-to-face faculty development workshops. In 2020 the COVID-19 pandemic forced a change that required offering these workshops as online learning activities.

Assessing the employability and employment destinations of professional psychology alumni

Professional training in psychology typically focuses on competencies and learning outcomes. However, this does not necessarily translate into long-term employability. Graduate tracer studies are recommended for exploring employment destinations and employability. Graduate tracer studies are noted to be of particular use for investigating health professionals’ career paths and examining field-specific issues. The reported study examined the employability and employment destinations of 29 alumni from two psychology Master’s programmes at a South African higher education institution, by incorporating best practices for tracer studies and survey research. Results indicated that 86.2% had secured employment in various fields and sectors, suggesting their skills and training were relevant and transferable. Differential patterns of registration with the Health Professions Council of South Africa were reported. Most respondents identified their studies as closely related to their work, and pragmatic reasons were provided by those pursuing work in unrelated fields. Entrepreneurial skills were identified as a gap in their training, that, if included, has the potential to boost employability. Graduate employability was identified to be a complex, non-linear issue. Professional competencies are, therefore, not sufficient for conceptualising employability within the South African context. A broader and more nuanced understanding of employability is needed. Practically, this means that educational processes need to prepare students for securing long-term employment. The tracer study methodology applied in this study may be utilised by other institutions and disciplines to explore key issues of employment and employability in the South African health professions and higher education context.

The need for nationally accepted guidelines for undergraduate nuclear medicine teaching in MBChB programmes in South Africa.

According to the South African Health Professions Act No. 56 of 1974, specific skills outcomes of MBChB programmes are that a medical graduate must be able to utilise diagnostic aids, interpret findings and make diagnoses. Imaging techniques are an integral part of the numerous diagnostic and therapeutic aids used in contemporary medical practice; however, in South Africa, no formal directives exist to guide programme directors or nuclear medicine departments regarding an appropriate undergraduate nuclear medicine educational module. As of 2013, six South African schools of medicine are involved in undergraduate nuclear medicine teaching, in which it forms part of clinical modules taught at varying stages in the academic curriculum. Against this backdrop is the inequitable distribution of nuclear medicine resources, training facilities and staffing in the local state health sector. Inadequate undergraduate teaching and provincial differences in nuclear medicine service provision suggest that many clinicians and graduating medical students are unaware of how radionuclide techniques can facilitate patient management. This high level of imaging illiteracy has been associated with lack of patient referral, poor quality and inadequate referral, poor knowledge of radiation doses and poor awareness of radiation risks. Here we highlight the challenges of undergraduate nuclear medicine teaching in South Africa, emphasising the need for the implementation of guidelines for undergraduate nuclear medicine education. Employing nationally accepted guidelines for undergraduate nuclear medicine teaching in South African MBChB programmes will contribute to the effective utilisation of nuclear medicine and molecular imaging as a diagnostic and therapeutic modality by newly qualified medical practitioners.

Evaluation of the impact of the ARC program on national nursing and midwifery regulations, leadership, and organizational capacity in East, Central, and Southern Africa

BackgroundThe African Health Professions Regulatory Collaborative (ARC) was launched in 2011 to support countries in East, Central, and Southern Africa to safely and sustainably expand HIV service delivery by nurses and midwives. While the World Health Organization recommended nurse initiated and managed antiretroviral therapy, many countries in this region had not updated their national regulations to ensure nurses and midwives were authorized and trained to provide essential HIV services. For four years, ARC awarded annual grants, convened regional meetings, and provided technical assistance to country teams of nursing and midwifery leaders to improve national regulations related to safe HIV service delivery. We examined the impact of the program on national regulations and the leadership and organizational capacity of country teams.MethodsData was collected to quantify the level of participation in ARC by each country (number of grants received, number of regional meetings attended, and amount of technical assistance received). The level of participation was analyzed according to two primary outcome measures: 1) changes in national regulations and 2) improvements in leadership and organizational capacity of country teams. Changes in national regulations were defined as advancement of one “stage” on a capability maturity model; nursing and midwifery leadership and organizational capacity was measured by a group survey at the end of the program.ResultsSeventeen countries participated in ARC between 2012 and 2016. Thirty-three grants were awarded; the majority addressed continuing professional development (20; 61%) and scopes of practice (6; 18%). Fourteen countries (representing approximately two-thirds of grants) progressed at least one stage on the capability maturity model. There were significant increases in all five domains of leadership and organizational capacity (p < 0.01). The number of grants (Kendall’s tau = 0.56, p = 0.02), duration of technical assistance (Kendall’s tau = 0.50, p = 0.03), and number of learning sessions attended (Kendall’s tau = 0.46, p = 0.04) were significantly associated with improvements in in-country collaboration between nursing and midwifery organizations.ConclusionsThe ARC program improved national nursing regulations in participating countries and increased reported leadership, organizational capacity, and collaboration among national nursing and midwifery organizations. These changes help ensure national policies and professional regulations underpin nurse initiated and managed treatment for people living with HIV.

Promoting Regulatory Reform: The African Health Profession Regulatory Collaborative (ARC) for Nursing and Midwifery Year 4 Evaluation.

As countries across sub-Saharan Africa work towards universal health coverage and HIV epidemic control, investments seek to bolster the quality and relevance of the health workforce. The African Health Profession Regulatory Collaborative (ARC) partnered with 17 countries across East, Central, and Southern Africa to ensure nurses and midwives were authorized and equipped to provide essential HIV services to pregnant women and children with HIV. Through ARC, nursing leadership teams representing each country identify a priority regulatory function and develop a proposal to strengthen that regulation over a 1-year period. Each year culminates with a summative congress meeting, involving all ARC countries, where teams present their projects and share lessons learned with their colleagues. During a recent ARC Summative Congress, a group survey was administered to 11 country teams that received ARC Year 4 grants to measure advancements in regulatory function using the five-stage Regulatory Function Framework, and a group questionnaire was administered to 16 country teams to measure improvements in national nursing capacity (February 2011-2016). In ARC Year 4, eight countries implemented continuing professional development projects, Botswana revised their scope of practice, Mozambique piloted a licensing examination to assess HIV-related competencies, and South Africa developed accreditation standards for HIV/tuberculosis specialty nurses. Countries reported improvements in national nursing leaders' teamwork, collaborations with national organizations, regional networking with nursing leaders, and the ability to garner additional resources. ARC provides an effective, collaborative model to rapidly strengthen national regulatory frameworks, which other health professional cadres or regions may consider using to ensure a relevant health workforce, authorized and equipped to meet the emerging demand for health services.

Promoting Regulatory Reform: The African Health Profession Regulatory Collaborative (ARC) for Nursing and Midwifery Year 4 Evaluation

As countries across sub-Saharan Africa work towards universal health coverage and HIV epidemic control, investments seek to bolster the quality and relevance of the health workforce. The African Health Profession Regulatory Collaborative (ARC) partnered with 17 countries across East, Central, and Southern Africa to ensure nurses and midwives were authorized and equipped to provide essential HIV services to pregnant women and children with HIV. Through ARC, nursing leadership teams representing each country identify a priority regulatory function and develop a proposal to strengthen that regulation over a 1-year period. Each year culminates with a summative congress meeting, involving all ARC countries, where teams present their projects and share lessons learned with their colleagues. During a recent ARC Summative Congress, a group survey was administered to 11 country teams that received ARC Year 4 grants to measure advancements in regulatory function using the five-stage Regulatory Function Framework, and a group questionnaire was administered to 16 country teams to measure improvements in national nursing capacity (February 2011-2016). In ARC Year 4, eight countries implemented continuing professional development projects, Botswana revised their scope of practice, Mozambique piloted a licensing examination to assess HIV-related competencies, and South Africa developed accreditation standards for HIV/tuberculosis specialty nurses. Countries reported improvements in national nursing leaders' teamwork, collaborations with national organizations, regional networking with nursing leaders, and the ability to garner additional resources. ARC provides an effective, collaborative model to rapidly strengthen national regulatory frameworks, which other health professional cadres or regions may consider using to ensure a relevant health workforce, authorized and equipped to meet the emerging demand for health services.

Establishing an Online Continuing and Professional Development Library for Nurses and Midwives in East, Central, and Southern Africa

Over the past 4years, the African Health Profession Regulatory Collaborative for nurses and midwives has supported 12 countries establish national continuing and professional development frameworks and programs, linking continuing education to nursing and midwifery re-licensure through technical assistance and improvement grants. However, lack of electronic media and rural practice sites, differences in priority content, and varying legal frameworks make providing accessible, certifiable, and up-to-date online continuing education content for the more than 300,000 nurses and midwives in the 17 member countries of the East, Central, and Southern Africa College of Nursing a major challenge. We report here on how the East, Central, and Southern Africa College of Nursing, with technical assistance from an Afya Bora Fellow, developed an online continuing professional development library hosted on their Web site using data collected in a survey of nursing and midwifery leaders in the region.

Regulatory Advances in 11 Sub-Saharan Countries in Year 3 of the African Health Profession Regulatory Collaborative for Nurses and Midwives (ARC)

Sub-Saharan Africa carries the greatest burden of the HIV pandemic. Enhancing the supply and use of human resources through policy and regulatory reform is a key action needed to improve the quality of HIV services in this region. In year 3 of the African Health Profession Regulatory Collaborative for Nurses and Midwives (ARC), a President's Emergency Plan for AIDS Relief initiative, 11 country teams of nursing and midwifery leaders ("Quads") received small grants to carry out regulatory improvement projects. Four countries advanced a full stage on the Regulatory Function Framework (RFF), a staged capability maturity model used to evaluate progress in key regulatory functions. While the remaining countries did not advance a full stage on the RFF, important gains were noted. The year-3 evaluation highlighted limitations of the ARC evaluation strategy to capture nuanced progress and provided insight into how the RFF might be adapted for future use.

A Model for Advancing Professional Nursing Regulation: The African Health Profession Regulatory Collaborative

The African Health Profession Regulatory Collaborative (ARC) was launched in 2011 to help countries develop or strengthen nursing regulations to ensure safe and sustainable nurse-initiated and nurse-managed HIV treatment. ARC supports teams of national nursing leaders from 17 countries to engage in rapid regulatory strengthening through regional meetings, regulation improvement grants, and in-country technical assistance. The ARC initiative has awarded 33 regulation improvement grants on topics such as continuing professional development, scopes of practice, nurse practice acts, and entry-to-practice examinations. Progress is measured by a novel tool that captures meaningful advancements in national regulations. The ARC initiative facilitates rapid improvements in professional nursing regulation. The model and evaluation framework are highly transferable to other health care cadres and offer a platform for regulators, policy makers, professional bodies, and educators to collaborate on prioritized regulation issues.

Strategies to include sexual orientation and gender identity in health professions education

Background . Sexual orientation and gender identity are not taught in African health professions curricula. In order to improve the quality of care for lesbian, gay, bisexual, transgender and intersex (LGBTI) patients, health professionals need to shift their attitudes towards sexual orientation and gender identity, and learn about specific LGBTI health needs. Discussion. The curricula of African health professions education provide various opportunities to include teaching about sexual orientation and gender identity. Various disciplines can teach sexual orientation and gender identity issues in their context by challenging heteronormativity and highlighting specific LGBTI health concerns, and can do so more successfully with interactive teaching approaches that hold more potential than formalised lectures. Rights-based teaching frameworks should include sexual orientation and gender identity as markers of difference. To achieve this, educators need to build capacity to teach about these issues, and support LGBTI students in their institutions. Conclusion. Teaching about sexual orientation and gender identity is urgently needed in African health professions education, but it is complex. This article presents strategies to incorporate sexual orientation and gender identity into the curricula of medical schools, nursing colleges, and the allied health sciences.

A survey of nurse-initiated and -managed antiretroviral therapy (NIMART) in practice, education, policy, and regulation in east, central, and southern Africa.

In sub-Saharan Africa, nurses and midwives perform many HIV service delivery tasks, such as diagnosis of HIV and prescription of antiretroviral therapy (ART), which used to be the responsibility of physicians. While this task shifting is critical to scaling-up HIV services in Africa, the extent of HIV task shifting is not well understood. A survey of senior nursing leadership teams from 15 African countries was carried out to describe the extent of nurse-initiated and -managed antiretroviral therapy (NIMART) in practice, education, policy, and regulation. The survey took place at the African Health Professions Regulatory Collaborative meeting in Pretoria, South Africa, in June 2012. The findings indicated that NIMART is widely practiced and authorized in policy, but is not reinforced by regulation nor incorporated into preservice education. Further investment in policy, regulation, and pre-service education is needed to ensure sustainable, high quality ART service expansion through the region.