Education In Low- And Middle-income Countries Research Articles

Tipping the scales: overcoming obstacles to support school readiness for all in low- and middle-income countries

ABSTRACT Despite evidence for the substantial benefits of school readiness among children in low- and middle-income countries (LMICs), most lack access to any pre-primary education at all, let alone high- quality preprimary education. In this article, we discuss obstacles and example of solutions to providing universal access to high-quality preprimary education in LMICs. We address (1) the need for a vision among policymakers, educators and families of what high-quality preprimary education should look like and how it could be provided in their context, and the motivation to make the vision a reality; (2) human resources, including motivated, skilled and qualified teachers as the center of a broad support system at national, regional and local levels; (3) material resources and infrastructure, including culturally appropriate play materials and child-friendly spaces; and (4) stable financing that allows for flexible adaptations of the model to different local contexts. For each element, we provide examples of these challenges and how they can be addressed, with a geographical focus on West Africa, the Middle East, Southern and Eastern Asia.

Global Health in the 21st Century: Equity in Surgical Training Partnerships

Safe and affordable surgical care has been recognized as an important component of global health. One of the challenges in providing safe and affordable surgical care is the shortage of trained surgical workforce. Partnerships have developed between institutions in high-income countries (HICs) and low- and middle-income countries (LMICs) to strengthen and expand surgical education in LMICs. As these relationships evolve, emphasis needs to focus on development of equitable, bilateral partnerships. We reviewed different global surgery education partnerships to describe key components and features of successful partnerships. We then provide a framework for equitable global surgical training partnerships. Key features of equitable global surgical education partnerships included an alignment with local priorities, long term collaborations, and locally integrated, competency-based training. To develop a partnership, both parties must meet and perform a needs assessment of the LMIC institution and jointly agree how the partnership can best address these needs. Both the HIC and LMIC institutions must clearly define their goals and expectations. Ideally, a set of output measures will be defined to assess the success of the partnership. Improving surgical education in LMIC countries is an integral part of health equity in global surgery. Key components of equitable education partnerships focus on local ownership and long-term relationships. Each party needs to clearly define goals and expectations for the partnership. Equity is essential and unequal relationships must be avoided.

Postgraduate Education in Radiation Oncology in Low- and Middle-income Countries

Radiation therapy is one of the most cost-effective ways to treat cancer patients on both a curative and palliative basis in low- and middle-income countries (LMICs). Despite this, the gap in radiation oncology capacity is enormous and is even increasing due to a rapid rise in the incidence of cancer cases in LMICs. The urgent need for radiotherapy resources in terms of bunkers and megavoltage machines is important, but equally important is the tremendous lack of properly educated health care professionals. This includes not just medical doctors, but also medical physicists, radiation therapists and nurses, as well as other supporting health care personnel. This overview discusses different ways to develop the standard setting of postgraduate specialist training and continuous medical education in LMICs.

Opportunities and barriers to public health nutrition education in Vietnamese universities.

A core challenge for low- and middle-income countries (LMICs) in combating the negative effects of the nutrition transition is to implement appropriate prevention strategies to halt the increasing prevalence of obesity and non-communicable diseases (NCDs), against a background of prevailing under nutrition. There have been several proposals for the enhancement of university nutrition education for future health and related professionals who are expected to communicate knowledge of health risks to the broad community. However, little is known about university nutrition education in LMICs. The present study aimed to investigate professional development opportunities and barriers for university nutrition lecturers to teach public health nutrition (PHN). An online survey was conducted among 242 Vietnamese health and education professionals and university nutrition lecturers across Vietnam. Purposive sampling was used to recruit participants. Comparisons of between the groups' responses were examined via SPSS Crosstabs. The structures of the perceived barriers and desired PHN training topics were examined via factor analyses. Multiple linear regression examined the influences on lecturers' learning interests in nutrition areas. The lecturers' learning interests spanned four areas: basic nutrition, basic food, food policy and 'new' trends (e.g. food policy, marketing). Major impediments to nutrition teaching in universities divided into two groups: resource limitations and professional constraints (e.g. lack of relevant training opportunities). The lecturers' perceptions of professional constraints influenced their interest in learning about 'new' trends. The results highlighted the need and opportunities to enhance PHN professional development for nutrition lecturers in Vietnam.

Enhancement of oncology nursing education in low- and middle-income countries: Challenges and strategies

Cancer prevalence is estimated to increase in low- and middle-income countries (LMICs) in the coming years, imposing a significant burden on these countries. Therefore, an effective oncology nursing workforce will become increasingly important. Previous studies have suggested that advances in oncology nursing education may contribute to both a reduction of the current cancer burden and improved patient outcomes. However, such education in LMICs is comparatively underdeveloped. Contributing to this phenomenon are the lack of educational pathways and legislation for mandatory training of nurses to specialize in oncology, insufficient opportunities for continuing education and inadequate time for nurses to undertake training. Therefore, strategies need to be developed and implemented to enhance oncology nursing education in LMICs. We discuss the challenges currently faced by LMICs in implementing effective oncology nursing training, and suggests recommended strategies to address these challenges.

Systematic Review of Postgraduate Surgical Education in Low- and Middle-Income Countries.

Surgical care is recognized as an important component of public health, however, many low- and middle- income countries (LMICs) are faced with a shortage of trained personnel. In response to this unmet need, many countries have developed local postgraduate training programs in surgery. This study aims to characterize general surgery postgraduate education in LMICs. PubMed, EMBASE, and Global Index Medicus databases were searched for articles related to postgraduate general surgery education in LMICs. Studies in other surgical specialties and those published prior to 1990 were excluded. Data were collected on the characteristics of postgraduate training programs. Sixty-four articles discussed postgraduate surgical education in LMICs. Programs in 34 different countries and 6 different regions were represented. Nine countries were low-income, 12 were low-middle-income, and 13 were upper-middle-income countries. Sixty-four articles described aspects of the local postgraduate training program. Prior to postgraduate training, residents complete an undergraduate medical degree with 19 programs describing a pre-training experience such as internship. Surgical curricula were broad-based to prepare trainees to work in low-resource settings. At the completion of postgraduate training, examination formats varied including oral, written, and clinical exams. Postgraduate general surgery programs ranged from 2.5 to 7years. Postgraduate surgical education is one mechanism to increase surgical capacity in LMICs. Different strategies have been employed to improve surgical education in LMICs and learning from these programs can optimize surgical education across teaching sites.

Enhancing Neurosurgical Education in Low- and Middle-income Countries: Current Methods and New Advances.

Low- and middle-income countries (LMICs) face a critical shortage of basic surgical services. Adequate neurosurgical services can have a far-reaching positive impact on society’s health care and, consequently, the economic development in LMICs. Yet surgery, and specifically neurosurgery has been a long neglected sector of global health. This article reviews the current efforts to enhance neurosurgery education in LMICs and outlines ongoing approaches for improvement. In addition, we introduce the concept of a sustainable and cost-effective model to enhance neurosurgical resources in LMICs and describe the process and methods of online curriculum development.

Essential Pain Management: An Educational Program for Health Care Workers

Education for health care workers on pain-related topics is not always readily available, and this is especially so in low and middle income countries (LMICs). The Essential Pain Management program (EPM) has been developed to offer a simple interactive educational opportunity for health care workers in LMICs. Following a needs analysis in Papua New Guinea, an 8 h educational program with the aims of improving pain knowledge and providing a simple pain management framework was developed. An evaluation of the program using the Kirkpatrick model is being used. The program has a "teach the teachers" component to encourage sustainability. The program has been run in 30 countries, delivered to 1,600 participants, and 340 instructors have been trained. Feedback has been positive, pre post testing in 27 sites showed a mean pre score of 65.89% rising to 75.23% (n = 581 respondents). A subanalysis demonstrates doctors and nurses improving by similar degrees. When local instructors have delivered the program after attending the trainer's session the participant test results were comparable to the results seen when the overseas instructors taught the course. The widespread adoption of the EPM program suggests there is a need for pain education in LMICs. The teach the teachers component of the program and the comparable results from their teaching should contribute to sustainability. Further support and mentoring using electronic systems such as Facebook, text messaging, and a website may also contribute to sustainability.

An integrative review and evidence-based conceptual model of the essential components of pre-service education

BackgroundWith decreasing global resources, a pervasive critical shortage of skilled health workers, and a growing disease burden in many countries, the need to maximize the effectiveness and efficiency of pre-service education in low-and middle-income countries has never been greater.MethodsWe performed an integrative review of the literature to analyse factors contributing to quality pre-service education and created a conceptual model that shows the links between essential elements of quality pre-service education and desired outcomes.ResultsThe literature contains a rich discussion of factors that contribute to quality pre-service education, including the following: (1) targeted recruitment of qualified students from rural and low-resource settings appears to be a particularly effective strategy for retaining students in vulnerable communities after graduation; (2) evidence supports a competency-based curriculum, but there is no clear evidence supporting specific curricular models such as problem-based learning; (3) the health workforce must be well prepared to address national health priorities; (4) the role of the preceptor and preceptors’ skills in clinical teaching, identifying student learning needs, assessing student learning, and prioritizing and time management are particularly important; (5) modern, Internet-enabled medical libraries, skills and simulation laboratories, and computer laboratories to support computer-aided instruction are elements of infrastructure meriting strong consideration; and (6) all students must receive sufficient clinical practice opportunities in high-quality clinical learning environments in order to graduate with the competencies required for effective practice. Few studies make a link between PSE and impact on the health system. Nevertheless, it is logical that the production of a trained and competent staff through high-quality pre-service education and continuing professional development activities is the foundation required to achieve the desired health outcomes. Professional regulation, deployment practices, workplace environment upon graduation and other service delivery contextual factors were analysed as influencing factors that affect educational outcomes and health impact.ConclusionsOur model for pre-service education reflects the investments that must be made by countries into programmes capable of leading to graduates who are competent for the health occupations and professions at the time of their entry into the workforce.