Fonjungo et al. Human Resources for Health 2013, 11:56 http://www.human-resources-health.com/content/11/1/56 RESEARCH Open Access Preservice laboratory education strengthening enhances sustainable laboratory workforce in Ethiopia Peter N Fonjungo1,8*, Yenew Kebede1, Wendy Arneson2, Derese Tefera1, Kedir Yimer1, Samuel Kinde3, Meseret Alem4, Waqtola Cheneke5, Habtamu Mitiku6, Endale Tadesse7, Aster Tsegaye3 and Thomas Kenyon1 Abstract Background: There is a severe healthcare workforce shortage in sub Saharan Africa, which threatens achieving the Millennium Development Goals and attaining an AIDS-free generation. The strength of a healthcare system depends on the skills, competencies, values and availability of its workforce. A well-trained and competent laboratory technologist ensures accurate and reliable results for use in prevention, diagnosis, care and treatment of diseases. Methods: An assessment of existing preservice education of five medical laboratory schools, followed by remedial intervention and monitoring was conducted. The remedial interventions included 1) standardizing curriculum and implementation; 2) training faculty staff on pedagogical methods and quality management systems; 3) providing teaching materials; and 4) procuring equipment for teaching laboratories to provide practical skills to complement didactic education. Results: A total of 2,230 undergraduate students from the five universities benefitted from the standardized curriculum. University of Gondar accounted for 252 of 2,230 (11.3%) of the students, Addis Ababa University for 663 (29.7%), Jimma University for 649 (29.1%), Haramaya University for 429 (19.2%) and Hawassa University for 237 (10.6%) of the students. Together the universities graduated 388 and 312 laboratory technologists in 2010/2011 and 2011/2012 academic year, respectively. Practical hands-on training and experience with well-equipped laboratories enhanced and ensured skilled, confident and competent laboratory technologists upon graduation. Conclusions: Strengthening preservice laboratory education is feasible in resource-limited settings, and emphasizing its merits (ample local capacity, country ownership and sustainability) provides a valuable source of competent laboratory technologists to relieve an overstretched healthcare system. Keywords: Preservice education, PEPFAR, Curriculum, Standardization, Laboratory workforce strengthening, Training, Sustainability Background Millennium Development Goals [1]. Due to this critical The strength of a healthcare system, in addition to phys- shortage, healthcare workers are overworked and health- ical infrastructure, depends on the skills, competencies, care gains are at risk of being reversed, especially with values and availability of its workforce. In sub Saharan the burden of diagnosing and monitoring HIV/AIDS Africa, there is a severe shortage and imbalance in its patients on antiretroviral therapy [2]. There is the need workforce that poses a major threat to achieving the to build and maintain an appropriate healthcare work- force to staff the different components of the healthcare * Correspondence: [email protected] system. 1 Division of Global HIV/AIDS, Centers for Disease Control and Prevention The clinical laboratory workforce plays a vital role in (CDC), Addis Ababa, Ethiopia 8Division of Global HIV/AIDS, Center for Global Health, Centers for Disease healthcare service delivery and has been recognized as Control and Prevention, Atlanta, USA one of the six key components for healthcare systems Full list of author information is available at the end of the article © 2013 Fonjungo et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Fonjungo et al. Human Resources for Health 2013, 11:56 Page 2 of 7 http://www.human-resources-health.com/content/11/1/56 strengthening that would impact and improve the well- prescribe and provide ART drugs to AIDS patients being of the community [3]. Properly trained laboratory [11-13]. For laboratory technologists, in-service training technologists are needed to obtain reliable results essen- on advanced and complex tests for antiretroviral therapy tial for service providers to accurately assess the status (ART) monitoring resulted in disruption of the services of a patient’s health, make accurate diagnoses, design they normally provided and in an increased task load be- treatment plans and monitor the effectiveness of a spe- cause of the shortage of laboratory technologists. Be- cific treatment, as well as for early detection, notification cause of a high staff turnover, in-service training became and response to disease outbreaks. Some of the short- quite repetitive, costly and not sustainable. ages have been linked to a lack of retention strategy and Preservice education training has an important role in a shortage of appropriate training institutions to build a maintaining a steady supply of skilled and knowledge- competent and critical workforce. In some instances, able healthcare workers to ensure country ownership training of healthcare professionals at institutions of hi- and sustainability. In the reauthorization of the US Pres- gher education has failed to meet current healthcare de- ident’s Emergency Plan for AIDS Relief (PEPFAR) II, mands due to a rigid curriculum that fails to evolve, PEPFAR set a target, supported with funding, for train- static pedagogy and a lack of adaption to local needs [4]. ing and retention of 140,000 new healthcare workers in In sub Saharan Africa, there is a shortage of healthcare recognition that maintaining an appropriate healthcare professional training schools. For example, the number workforce is a critical component for country ownership, of degree-granting schools for medical and public health- sustainability and overall healthcare system strengthen- care professionals was estimated at 134 and 51, respect- ing [14]. The curriculum for preservice education train- ively, for a population of 868 million, while in North ing for laboratory technologists in sub Saharan Africa, Africa and the Middle East there were 206 and 46 schools in most cases, is not standardized and is heavily skewed for medical and public healthcare professionals, respect- towards didactic training with little or no hands-on ex- ively, for a population of 450 million [4]. In Ethiopia there perience with the laboratory equipment used in the is a shortage of qualified laboratory technologists among workplace. This is historically due to lack of financial re- other healthcare workers. In the 2002/2003 Health and sources to fund and support this equipment in a teach- Health-related Indicators Report by the Planning and Pro- ing setting as well as lack of expertise and training of gramming Department of the Ministry of Health (MOH), the teaching staff. only 249, 223 and 302 laboratory technologists gradua- The absence of hands-on experience is a major chal- ted from five universities with medical laboratory train- lenge facing preservice education because medical la- ing in 2001, 2002 and 2003, respectively. Additionally, boratory technology graduates only see this equipment maintaining the quality of laboratory education has be- for the first time at healthcare facilities on the first day come an important challenge in recent years given ad- they have been employed. This may further exacerbate vances in technology. equipment maintenance problems as the newly em- The critical shortage of healthcare workers has been ployed laboratory technologists, if not properly trained, further revealed during the HIV/AIDS epidemic in sub often resort to trial and error with equipment at their Saharan Africa as countries tried to accelerate their re- new healthcare facility [15]. There is a critical need to sponse. There was already a shortage of skilled and build a strong and competent laboratory workforce to properly trained healthcare workers, which affected the properly staff public health laboratories and to provide care and treatment of AIDS patients. Many of the healt- quality laboratory services. The Field Epidemiology La- hcare workers themselves succumbed to AIDS [5,6]. In- boratory Training Program (FELTP) has largely focused novative ways were developed to address shortages of on building skills and competency of in-service staff to healthcare workers for HIV/AIDS care and treatment meet short and medium term skill shortages [16-18]. delivery services, including in-service training in which The goal of this research was to carry out a formative existing healthcare workers were trained in specialized evaluation of the feasibility of strengthening preservice skills and areas they lacked. This approach was short- laboratory education in partnership with local universities term and involved using multiple implementing partners to ensure a skilled and well trained laboratory workforce working with the government to train in-service health- for overall healthcare system strengthening. care workers as needed. Also, the task shifting strategy was emphasized in which a healthcare professional was Methods trained to provide services in more than one specialized Study design area, or the tasks of more highly trained healthcare pro- The provision of ART monitoring services in laboratory fessionals were shifted to less highly trained healthcare facilities