Case study: Developing a national strategy to address gaps in pre-service education in Tanzania
In Tanzania, private medical training institutes (PMTIs) produce 60 percent of staff in private facilities. Nursing and midwifery students who attended these institutions lacked access to practicums that prepare students to perform routine clinical tasks and procedures. Practicums in Tanzania were designed with public sector students and facilities in mind. Because the practicums were only available at a few public sector sites, the number of students exceeded the volume of patients, and students from public institutions were prioritized for placements over private students. There were too few clinical instructors to adequately supervise private students during their practicums. Tanzania lacked the capacity and a curriculum to produce more qualified supervisors, with most leaving the country to gain these skills. As a result of these constraints, many private graduates entered Tanzania’s private health workforce without the proper exposure or practical skills needed to provide care at an acceptable level of quality.
SHOPS Plus support
To strengthen the quality of pre-service education and ultimately the quality of care at private health facilities, SHOPS Plus worked with various stakeholders to design a practicum model that allowed PMTI students to rotate to learning sites at various health facilities and hospitals—including private ones—with sufficient volumes to provide all students with clinical experience in family planning, integrated HIV care, antenatal care, and primary health care. SHOPS Plus built the capacity of additional clinical instructors to provide oversight to students during their rotations. This included developing a curriculum with a range of stakeholders.
The project convened a broad range of private sector stakeholders, including the Association of Private Health Colleges in Tanzania and the Private Nurses and Midwives Association Tanzania, in co-creation roundtables. These roundtables were used to support the design of the practicum model by discussing persisting challenges and successes and soliciting their ideas to improve the quality of practical education within the private health sector.
The SHOPS Plus model was initially designed to be a private-to-private model. However, because private facilities did not have enough patients nor offer all the services that would allow the volume of students to gain comprehensive experience, the program added practicum sites in the public sector. By engaging these sites, SHOPS Plus was able to solicit the views of public sector staff on challenges and solutions. This helped further improve the rigor of the practicum and helped gain acceptance from public sector stakeholders, thereby improving the sustainability of the model.
SHOPS Plus also improved sustainability by embedding the pre-service education approach into the broader health system. The project engaged numerous public and private partners in workshops to develop national protocols and tools that would ensure the approach be standardized and applied nationwide and presented them to the Tanzania Ministry of Health, Community Development, Gender, Elderly and Children. This effort led to the creation of the National Guideline for Health Training Institutions and Teaching Health Facilities, released in December 2019.
Results
SHOPS Plus demonstrated a model that could be replicated to strengthen the quality of pre- service education for nearly any private cadre. As of May 2020, 90 nursing and midwifery students from PMTIs had completed the practicum. By leveraging the success of the model in dialogue with the ministry and supporting the development of new national training guidelines, the program built a strong model for an effective pre-service medical education that solidified standards in the public and private sectors. The partnerships established between public and private partners led to additional commitments. For instance, the Ministry of Health, Community Development, Gender, Elderly and Children committed to giving 10 percent of training slots to trainers of private sector clinical instructors.