Strengthening Pre-Service Education: A Vital Effort

April 27, 2012

If, like many members of the global health community, you recognize an increasing need for qualified health care workers worldwide, I-TECH’s most recent publication, The I-TECH Approach to Strengthening Pre-Service Health Training Institutions (PDF), may be of interest to you. By way of introduction, I-TECH has invited Stacey Lissit, I-TECH’s Director of Training, to briefly discuss the evolution of the organization’s work in this arena.

In my eight years at I-TECH, I’ve witnessed remarkable growth and expansion in our activities in support of pre-service educational institutions and systems. Much of this growth has occurred within a very short time frame. A few years ago, I-TECH was just venturing into the pre-service field. Today, we have pre-service activities in nearly all of our partner countries worldwide, and pre-service has joined in-service training as the focus of our activities supporting health workforce development.


In Mozambique, an instructor speaks to young técnicos de medicina, a key mid-level cadre of health care workers. I-TECH has worked closely with the Ministry of Health (MISAU) to revise the curriculum for the cadre and support faculty at local training institutions.

This growth in pre-service training has paralleled the path along which global HIV care and treatment programs have evolved. Initially, global donors, including the President’s Emergency Plan for AIDS Relief (PEPFAR) staged an emergency response to the HIV pandemic, dedicating resources toward direct service provision in care and treatment. As this response continued to mature, however, it became clear that weaknesses within national health systems were creating barriers to sustainable, effective, and efficient delivery of services. In response, donors and leaders increased their emphasis on strengthening national health systems. The evolution of focus in the pre-service sector mirrored this shift within health services delivery. In the context of the emergency response, many leaders recognized relatively early that any sustainable care and treatment program would require health care workers to graduate from their institutions with the knowledge and skills to care for and treat people living with HIV and AIDS. Thus, early work with pre-service training institutions focused on integrating HIV clinical knowledge and skills into the curricula for cadres at all levels, and on training faculty to deliver this content.

It quickly became clear, however, that integrating new content into a weak infrastructure would not lead to effective education. Schools could benefit from strengthening curricula, improving classroom and clinical teaching methodologies, reducing class sizes, hiring additional tutors, upgrading facilities, and stocking libraries with updated materials. Students and teachers could learn better in less crowded teaching and housing facilities, and with more reliable Internet access. In short, training institutions, like the national health systems in which they were embedded, would benefit from comprehensive systems strengthening. 

As PEPFAR and other global leaders began to focus on health systems strengthening, “Health Workforce,” one of the six building blocks of the World Health Organization’s Framework for strengthening health systems, drew greater attention. Global data supported this focus, demonstrating then (as now) that health care worker shortages challenge the ability of all health care systems to improve health outcomes.

I-TECH responded. Drawing on our academic roots in two teaching institutions (the University of Washington and the University of California, San Francisco) and our extensive experience collaborating with local organizations, we expanded our work from integrating HIV and AIDS content into pre-service programs to revising the full curricula. And we went from training faculty in content and methods for delivering HIV material to broader efforts in faculty development, including strengthening clinical teaching and student assessment. The I-TECH approach expanded to include comprehensive efforts to ensure that all aspects of our partner training institutions were functioning effectively in order to ensure delivery of high quality education.

So what does it take to produce a doctor, nurse, or clinical officer who is equipped to effectively meet the health needs of her community? I-TECH believes that, among other factors, it takes

  • an evidence-based curriculum that addresses priority health conditions;
  • adequate numbers of well-trained, motivated faculty;
  • clinical sites with enough patients to support student learning (but not so many that the site is overwhelmed and staff have no time for student teaching);
  • resources and equipment–for example, well-stocked skills labs, gloves, computers, and adequate classroom and dormitory space.

I-TECH’s formalized approach to pre-service developed through years of experience, and recognizes that training institutions rely on a wide network of regulatory bodies, ministries, professional associations, and other stakeholders.

In addition, we’ve seen over and over again that pre-service institutions don’t exist in a vacuum. Professional regulatory bodies, ministries of education and health, professional associations, and communities all support training institutions, and in some cases we must put our focus there.

Ultimately, our goal is to sustainably increase the number of well-trained health care graduates in each of our partner countries. As an organization, we’ve arrived at a formalized approach to achieving this organically: through on-the-ground experience, flexibility, and the constant commitment, dedication, and support of our local institutional partners.

To learn more about our approach to building pre-service capacity with local training institutions and systems worldwide, and read a few specific examples, I invite you to peruse our new project profile, The I-TECH Approach to Strengthening Pre-Service Health Training Institutions (PDF, 2.5MB).

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