African Health Sciences, Vol. 4, No. 3, December, 2004, pp. 182- 184
Access to continued professional education among health
workers in Blantyre, Malawi.
Adamson S. Muula*, Humphreys Misiri, Yamikani Chimalizeni, Davis Mpando, Chimota Phiri, Amos Nyaka
Faculty of Medicine, University of Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi.
* Correspondence author:
Dr. Adamson S. Muula
Department of Community Health
University of Malawi, College of Medicine
Private Bag 360, Chichiri, Blantyre, Malawi.
Fax: (265)-1-674 700
Email: amuula@medcol.mw
Code Number: hs04033
ABSTRACT
Objective: To describe the current status of continued professional development (CPD) of healthcare personnel within the Ministry of Health (MoH) health centres in Blantyre, Malawi
Design: A cross-sectional descriptive study utilizing an interviewer-administered questionnaire.
Subjects: Healthcare workers in public health centers in Blantyre District, Malawi.
Results: Fifty-seven healthcare workers participated of whom 47 (82.5%) were nurses, 8 (14.0%) were either medical assistants or clinical officers, and one laboratory technician and a dental therapist. At the time of the study, 50(87.7%) were prescribers and 54 (94.7%) had ever issued a prescription for medications. Participation in workshops and seminars within the past 12 months was reported by 54 (94.7%) of the participants and 49 (86.0%) reported that their health facilities had clinical hand-over meetings. All participants indicated desire to receive professional journals for free while only 35 (61.4%) were willing to pay for a journal subscription. Current personal and institutional subscription to a journal was low, at 2 (3.5%) each. About 30% had been trained to conduct research and 23 (40.1%) had ever conducted research with only 3 (5.3%) ever written a journal or newsletter article. 47.4% had access to a working phone at work and only 3 (5.3%) had access to internet facilities at all. Only 21% were satisfied with their own knowledge on health matters.
Conclusions: Healthcare professionals in Blantyre’s DHO zone are using mostly clinical hand-over meetings, seminars and workshops for their CPD. There is need to improve access to relevant professional journals. The regulatory or licensing boards for healthcare professional in Malawi should seriously consider mandatory CPD credits for re-registration.
Keywords: Malawi, continued professional development
NTRODUCTION
Continued medical education (CME) or continued
professional development (CPD) is generally understood
to be crucial for the development and improvement in
quality of healthcare delivery services1-2 . It is for this
reason that international agencies, including the World
Health Organisation (WHO) facilitated, among other
initiatives, the provision and enhanced access to, mostly
electronic, biomedical journals to developing countries
3,4 . The Health Internet Access to Research Initiative
(HINARI) is one such effort that has potential to increase
access to health information5 . In only a few African
countries do regulatory or licensing boards of
professional healthcare workers require evidence that one
had attained enough credits in an approved continued
professional development program or CME to re-register
health practitioners. In most African countries however, CME is quite peripherally located in health practice and there is no
requirement for external verification and no professional or statutory
demand for accreditation of qualifications or competencies6 .
At the time of the study, the authors were unaware of
any published reports on CME or continued health professional
development in Malawi. The study was therefore carried out to
document the current situation regarding continued or in-service
training opportunities amongst healthcare workers serving in
government (public) health centres within Blantyre District Health
office. Knowledge of such a situation would better inform health
personnel trainers, professional regulatory bodies (Medical Council
of Malawi and the Nurses and Midwives Council of Malawi), the
Ministry of Health and international agencies to design appropriate
intervention programs towards professional development of
healthcare personnel.
MATERIALS AND METHODS
This study, carried out in 2003 was cross-sectional and descriptive
utilizing interviewer-administered questionnaires. Study
participants were nurses, clinical officers and medical assistants, a
laboratory technician and a dental therapist who were found at the
health centres visited during the period of the study. In Malawi,
health centres are mostly resourced with medical assistants, clinicalofficers and nurses. Doctors only serve at district and tertiary
health care levels.
Blantyre is the major commercial city of Malawi. The district
has the Queen Elizabeth Central Hospital (QECH) the
major referral and teaching hospital of Malawi’s only
medical school7 . Blantyre has no district hospital.
RESULTS
Characteristics of study participants
Fifty-seventy health workers in the Ministry of Health
(MoH) within the Blantyre District Health Office health
facilities participated in the study. Six of the health facilities
were urban while 4 were rural. Participants comprised 47
(82.5%) nurses, 5 (8.8%) clinical officers, 3(3.5%) medical
assistants, 1 laboratory technician and 1 dental therapist.
There were 45(78.9%) females while 12(21.1%) were males.
Participants’ ages ranged from 25-64 years (mean, 38.7 years
SD, 9.6 years) and the number of years served as health
care workers ranged from 1 to 37 years (mean, 14.2 years
and SD, 9.5 years). Fifty (87.7%) had written prescriptions
within the month of study as part of their service while 7
(12.3%) had not. However 54 (94.7%) had ever prescribed
in their health career. All except one were registered with
the appropriate regulatory bodies (Medical Council of
Malawi and the Nurses and Midwives Council of Malawi).
Continued professional development
When asked if their health facilities had clinical hand-over
meetings, 49(86.0%) indicated availability of hand-over
meetings while 8 (14.0%) were working in facilities without
clinical hand-over meetings. However, 54 (94.7%) had
participated in a workshop or seminar within the past 12
months of the study and only 3 (5.3%) had not.
With regard to access to professional journals only 2 (3.5%)
were personal subscribers to any professional journal and
only 3 (5.3%) were working at a health facility which
maintained a subscription to any journal. However, 20
(35.1%) had ever read a journal article in the past 6 months
while 37 (64.9%) had not. Eight (14.0%) participants
reported having a professional journal at work at the time
of the study. Despite the fact that all (100%) would be
happy to receive a journal for free, about 35(61.4%) were
prepared to subscribe to a journal at a fee while 15 (26.3%)
were not and 7 (12.3%) were not sure. Only 2 (3.5%)
participants worked at a facility that had a library. Twelve
(21.1%) of the participants reported being satisfied with
their own knowledge regarding health matters, 44 (77.2%)
were not satisfied while one (1.8%) was not sure.
Research experience
In order to determine research experience amongst the
participants, they were asked whether they had ever
conducted research, whether they had been trained to do
scientific research and whether they would be interested to
be trained. All (100%) indicated willingness to be trained,while only 18 (31.6%) had prior training in research methods.
Twenty-three (40.4%) had ever participated in a research project
and 3 (5.3%) had ever written a journal or health newsletter article.
Access to telecommunication
In order to determine whether participants could benefit from
internet-based professional development programs as currently
available in Malawi, they were asked about access to a working
telephone and the Internet. Twenty-seven (47.4%) of the
participants had a working phone at work while 30 (52.6%) had
no such access. With regard to the Internet, only 3 (5.3%) reported
any access to the Internet.
DISCUSSION
There is no published study to the authors’ knowledge describing
continued professional development of health care workers in
Malawi. This may suggest that this is an area that is little appreciated
by researchers and health care workers in the country.
This study suggests that workshops and seminars followed by
clinical hand-over meetings are the most common modes of
continued professional development (CPD) or CME efforts
amongst health care workers in the Ministry of Health facilities
outside the QECH tertiary hospitals in Blantyre, Malawi.
Workshops/seminars are usually organized by the MoH
headquarters, donor agencies or the District Health Office as way
of delivering in-service training. Non-governmental organizations
(NGOs) may also invite healthcare workers in the public service as
important stakeholders. In many cases, workshops are associated
with per diems and other than their training potential contribute to
a significant supplementation of personal financial resources to
participants. This is not to suggest that such an extra role of
workshops and seminars is less important.
This study was not designed to answer the question as
to why health facilities do not subscribe to professional journals
as they should. As only 2 (3.5%) indicated that they personally
subscribed to journals, it would be useful for a future study to
attempt to answer such question. While financial costs could be
among the reasons that individuals and institutions fail to
subscribe to journals, that is unlikely to be the only reason as there
are a few publications available for free to developing country
readers.
Study participants were asked whether they had access to
a working telephone in order to assess the potential for webbased/
email-based health information access. Only 3 had access
to the Internet at all. This would suggest quite a significant digital
divide as has been feared by many authors 8. While the telephone
and internet facilities are important assets to those who have access,
there is undoubtedly need to explore other information and
communication technologies (ICT) such as radio and television
as vehicles for transmission of health professional information
in Malawi 9 .
Providing a whole array of professional journals for free
will not be an effective solution to the paucity of publications
available to health care workers in developing countries. The
solution could be improvements in access to tailor-made, relevant publications that have potential to enhance knowledge and contribute to the improvement of care. Such may rather be viewed as paternalistic and restrictive as some health experts and others believe that unlimited access to knowledge should be the goal for all health care workers. The licensing boards and associations of nurses and clinicians (medical doctors and paramedicals) in Malawi should explore possibilities of mandatory CPD for reregistration so as to prevent compromise of healthcare services delivery.
ACKNOWLEDGEMENTS We are deeply indebted to the District Health Officer, Blantyre District, Dr. Atupele Kapito for permission to conduct the study within her operating district. Our appreciation also goes to all healthcare workers who graciously participated in the study. Funding was obtained from the Southern African Regional Network on Equity in Health (EQUINET) through the Malawi Health Equity Network (MHEN).
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