The Liverpool School of Tropical Medicine (LSTM) Emergency Obstetric Care and Quality of Care Unit held its 3rd and final Knowledge Management and Learning (KML) event of the Quality Improvement of Integrated HIV, TB, and Malaria Services in Antenatal Care (ANC) and Postnatal Care (PNC) programme in Zanzibar in October 2024.
With funding from Takeda’s Global CSR Program through the Global Fund, the KML event is a knowledge-sharing forum where programme implementers share best practices and knowledge from implementation to influence policy and practice in providing quality maternal and child health services in Kenya, Tanzania and Nigeria.
Hosted by programme implementing partner – the State University of Zanzibar (SUZA) – this third and final forum convened (among other insightful panels) a panel on sustaining and scaling up healthcare worker (HCW) capacity in East and West Africa, focusing on in-service and pre-service strengthening. With leaders from diverse healthcare fields and regions, the discussions explored key lessons, challenges, and strategies for future implementation. Moderated by Dr Helen Allott from LSTM, the panel featured health officials from Kenya, Tanzania, Nigeria, and Zanzibar.
Key Lessons and Challenges in Implementation
Healthcare leaders underscored the essential role of community engagement, effective resource allocation, and capacity-building interventions. While scaling up HCW capacity has improved service delivery, resource constraints remain a critical challenge, especially in rural areas. Babatunde Olaniyan Akintunde, Director of Public Health, Oyo State Ministry, Nigeria, highlighted that LSTM’s timely intervention strengthened service delivery and capacity building, bridging gaps in human resources for health and materials. "We were struggling with the resources to deliver services effectively. LSTM’s support filled these gaps, particularly in community mobilisation and provision of equipment," said Dr Akintunde.
Due to training, counties like Garissa in Kenya have seen a remarkable transformation in maternal and child health services. Fatma Ibrahim Issa, Garissa’s County Reproductive Health Coordinator, shared how capacity-building programs have instilled confidence in managing maternal emergencies: "Training on emergency obstetric care has not only boosted my confidence but also significantly improved service quality in Garissa. This partnership has allowed us to reduce maternal mortality rates," underscoring the tangible benefits of health worker capacity-building programs.
Strategic Scaling and Sustainability
Panel speakers agreed that sustainability demands local buy-in, continuous mentorship, and embedding training within national policies. Dr Thomas Rutachunzibwa, Regional Medical Officer in Dodoma, Tanzania, advocated for blended learning to maximise reach, “The blended learning model saves costs and aligns with our national strategic plan for continued professional development. However, challenges like network issues and competing priorities at facilities need consideration for smoother implementation.”
Kaduna State’s Deputy Director of Family & Community Health, Nafisa Musa Isah, echoed the need for community ownership as a core element of sustainability. "We observed significant improvements when communities took ownership of health interventions, allowing for quality of care at the grassroots," Isah noted.
Enhancing Quality Improvement (QI) and Community Engagement
Quality Improvement (QI) initiatives have been critical in counties such as Uasin Gishu and Vihiga in Kenya, helping to enhance maternal and child health services. Veronica Musiega, County Reproductive Health Coordinator in Uasin Gishu, emphasised the role of QI in shaping policies for antenatal care (ANC) and postnatal care (PNC), "With QI training, we have made significant strides in ANC and PNC uptake. Sustained follow-ups and advocacy at the community level are essential for long-term success."
However, challenges such as staff turnover due to migration and resource shortages, as noted by Samson Mely, County Reproductive Health Coordinator in Vihiga, call for national policy interventions. “Migration of trained health staff to other countries has impacted our programs. A bilateral labour agreement could help mitigate this loss,” said Mely.
Key Takeaways for Policy and Practice
1. Community Ownership and Engagement: Community involvement and mobilisation are critical to ensure sustainability.
2. Blended Learning Models: Expanding blended learning for HCWs is effective but requires infrastructure support.
3. Advocacy for Local Funding: Regional partnerships and advocacy at county levels can secure budgets for sustained health improvements.
4. Bilateral Agreements to Curb HCW Migration: National policies addressing HCW migration can mitigate disruptions in HCW capacity.
As the session concluded, panellists affirmed the need to embed capacity-strengthening initiatives in national healthcare frameworks and leverage regional partnerships for resource mobilisation. The collective insights point to a shared commitment to fostering HCW capacity, enhancing healthcare delivery, and creating resilient systems that meet the needs of communities across East and West Africa.