Investing in People: Health System Strengthening Through Education

Health system strengthening is now recognized as a pressing global health priority. Motivated and productive health workers are a critical component of health systems. Low and middle-income countries need many more health workers, but not simply more of the same. Insufficient collaboration between the health and education sectors creates a crippling mismatch between professional health service education and the realities of health service delivery. A transformative scale-up of health education is needed to increase the capacity of health systems to respond to population needs. We make the case for multi-sector innovation during the scale-up of health education-- ranging from new recruitment strategies, faculty development and curricular reform on the institutional level to cross-sector planning and investment on the national level. Such a transformation will require a broad process of multi-sector reform.

In Uganda the lack of formal health management education is a barrier to improved health systems and improved population health outcomes. Duke University partnered with executive leadership from the Ugandan Catholic and Protestant medical bureaus, the public health sector and the three leading schools of health management in Uganda to conduct a series of activities to strengthen the capacity for health management and leadership in Uganda. After a formative research process to describe the national health management training landscape, the partnership surveyed health managers in the Kabarole District in western Uganda. The partnership then designed and led a five day workshop on leadership, management and governance in the Kabarole District in western Uganda.

A series of pre- and post- surveys asked workshop participants to self-report their confidence, previous use and predicted use of skills in each of the five workshop modules as well as evaluate the course content, design and instruction. These data were analyzed to determine if the workshop showed potential for health system improvement.

All but one module demonstrated significant pre to post confidence effect-size change, as well as significant self-reported intent to practice new management skills. A module-based workshop that (1) is designed with evidence gathered with a country-level and local needs assessment; (2) combines global content with local context; and (3) uses experiential learning techniques, may be an effective intervention for organizational change. Further follow-up after post-workshop mentoring activities will be important to document this process. We describe a vision for how this follow-up might take place within the larger context of the partnership's future activities. We also include a manual based on the workshop instructional materials entitled: A Teaching Manual for Health Facility Management, Leadership and Governance in Uganda.