A project in Nigeria is transforming the health workforce in Cross River State and Bauchi State. Many health training schools are much stronger and are now training and producing highly qualified and skilled health workers.
Having the right numbers of qualified and skilled health workers to deliver frontline maternal, neonatal and child health care services at the primary health care level is crucial for UHC.
A rich reservoir of incoming health workers, quality training schools and a strategy for placing health workers where they are most needed are good steps towards a stronger health system and UHC.
The project is being implemented by WHO, Global Health Workforce Alliance and the Population Council, in partnership with the Federal Ministry of Health, the Bauchi State Ministry of Health and the Cross River State Ministry
The project has achieved numerous successes at federal levels and in Bauchi and Cross River states.
Without the support of Global Affairs Canada and WHO, the dream of establishing the College of Nursing and Midwifery would not have materialised.
This project is consistent with Nigeria’s drive towards achieving universal health coverage through Primary Health Care revitalization as outlined in the National Strategic Health Development Plan II.
This requires adequate numbers of competent, highly skilled, motivated and productive frontline health workers that are equitably distributed
In 2014, a project began called ‘Enhancing the Ability of Frontline Health Workers to Improve Health in Nigeria’, funded by the Government of Canada through the Global Affairs Canada (GAC). The project has the overall aim of improving the health of infants, children, women, and men in Bauchi and Cross River States by strengthening the capacities of frontline health workers to deliver maternal, neonatal and child health care services at the primary health care level.
The project is being implemented by WHO, the Global Health Workforce Alliance (GHWA) and the Population Council (PC) through partnerships formed with the Federal Ministry of Health, the Bauchi State Ministry of Health and its Departments, Agencies and Parastatals and the Cross River State Ministry of Health and its Departments, Agencies and Parastatals.
Health training institutions
One of the project’s key activities is training and producing skilled health workers which has has achieved many positive outcomes so far. Health training institutions in both States are much stronger and better able to produce sufficient number of qualified frontline health workers with appropriate skill-sets. Combined with increased government investment in the health workforce from the government, health services are heading in the right direction to achieve universal health coverage.
When the ‘Enhancing the Ability of Frontline Health Workers to Improve Health in Nigeria’ project started in 2014, only 3 out of 11 health training institutions in Bauchi and Cross River States had official accreditation from the regulatory bodies to train and confer degrees to health workers. The other institutions had their accredited status withdrawn for a range of reasons: they did not have adequate tutor- pupil ratios, their equipment was obsolete and not well maintained, or they did not have a conducive teaching, learning and housing environment to train health workers.
"The truth of the matter is that if you don’t have trainings going on, as the years go by and more people retire from service, they phase out and everywhere becomes empty and shutdown and of course we can’t offer services,” said Dr Betta Edu, Director General. Cross River State Primary Healthcare Development Agency
WHO conducted a needs assessment in these 11 institutions and clearly identified what they needed to improve in order to regain accreditation. With the government’s lead, WHO improved the teaching and learning conditions, providing technical assistance in reviewing and mentoring, while the government worked on improving the institutions’ physical infrastructure and refurbishment.
Now there is much cause for celebration. The health institutions regained their accreditation status and all 11 institutions are now training health workers with conducive teaching environments and state of the art equipment.
Cross River State
Health workforce training institutions in Cross River State have received a revitalizing boost since the ‘Enhancing the Ability of Frontline Health Workers to Improve Health in Nigeria’ project started in 2014. To date, all five of its nursing and midwifery schools are accredited and able to admit and train health workers. This means that the State can now recruit highly trained and professional front line health workers and place them where they are most needed.
The project supported the professional training for nursing school educators, provided contemporary teaching and learning equipment in demonstration rooms and laboratories, and provided technology support in the form of computers, printers and Internet connection. Libraries were replenished with contemporary text-books and learning tools, and technical support was provided to develop training curricula, manuals and methods. Offices, classrooms and dormitories were revamped with new furniture
and most schools also received a 32- seater bus so that students could easily travel between learning sites.
As of 2019, there are now over 400 nurses, midwives, community health extension workers (CHEWS) and junior community health extension workers (JCHEWS) in various health training institutions in Cross River State. They are now receiving training with modern demonstration equipment in an improved learning environment that is equipped with standard ICT facilities, updated curricula, and relevant books. This next generation of the health workforce also benefits from well-trained, qualified and motivated teaching staff.
Exposing these trainees to modern practical and demonstration equipment, and contemporary techniques and methods results in well-trained and high-quality professional frontline health workers. Now Cross River State has a rich reservoir of incoming health workers - some of whom started graduating in September 2018 - and quality schools. The health care delivery system will be stronger as a result, and the population will have access to better quality services
The Bauchi State College of Nursing and Midwifery has developed with support from the ‘Enhancing the Ability of Frontline Health Workers to Improve Health in Nigeria’ project. Established in 2011, but unable to obtain accreditation due to a lack of resources, the College is now a thriving hub for training health workers from all over the State. It now has teaching and learning equipment for demonstration rooms, libraries, dormitories and science laboratories and an additional 20 tutors.
The College of Health Technology Ningi has also grown its capacity to deliver world-class health training. The library is restocked with new books, and is now benefitting from new technology and equipment, instructional materials and student handbooks and curriculum. These interventions resulted in the Community Health Practitioners Board of Nigeria granting the school accreditation.
As part of the project, WHO supported Bauchi and Cross-River States in establishling gender desks and appointing gender desk officers. WHO worked with the University of Calabar’s Department of Public Health of the University of Calabar to develop a gender training manual. During a five-day training, the newlyappointed gender desk officers learned how to conduct gender analysis and mainstream gender into health planning to make activities and policies more gender sensitive. In Bauchi State in the north, where gender issues are keenly felt, there have been some advances. For example, a State gender policy has been developed and is being implemented. Generally, midwifery is seen as a female cadre. As a result, most of the training schools previously only admitted females, but now male students are also in midwifery schools. As simple as it sounds, this is progress.
WHO also supported the Nursing and Midwifery Council of Nigeria (NMCN) to review the curriculum training for midwives to include gender-based violence education and other gender-specific maternal and child health topics and themes. The curriculum has become far more gender transformative than before, and graduates are now able to apply a gender lens in whatever they are doing.
WHO was also part of a consortium of partners supporting the government to develop a national task-shifting and task-sharing policy. WHO then supported the Cross River and Bauchi States to adapt the national policy to their own particular contexts and the Population Council supported the States in the policy’s implementation with guidance from WHO.
First there was a need to train the cadre of health workers whose tasks would be shifted or shared. As a part of the project, the Population Council provided training around core maternal and child health interventions and emergency obstetric care at the primary care level. The Population Council also provided supportive supervision visits conducted by a joint team led by the Bauchi anc Cross River States’ State Primary Health Care Development Agency (SPHCDA) of Bauchi and Cross River States
In combination, these interventions in Cross River and Bauchi States have boosted the quality and professionalism of the health workforce. There is now a pool of well-trained
and skilled frontline health workers to enter into service upon graduation. The project has also enabled more strategic approaches for ensuring better distribution of the right number of workers with the right
skills across all health centres. In the future, this will have a powerful impact on the health services delivered and the wellbeing of the population, allowing for clear progress on the road towards UHC.