Voices from the Field: Enhancing Education and Training Programs for Health Workers in Mali

“The competency-based approach is popular among faculty and students. It puts the students at the center of the learning process. It gives students the opportunity to look for answers themselves,” says Mohamed Salia Maiga, Director of Studies at the nursing school in Gao, Mali. “It is an interactive process that makes it easy for students and faculty to move forward.”

Lack of access to high-quality health care services in Mali is due to many factors: one is the failure of pre-service education curricula to adequately prepare health care workers. To improve the quality and accessibility of health services in three underserved northern regions, the IntraHealth-led, USAID-funded Capacity Project strengthened instruction at the Ecole des Infirmiers de Gao (EIG), a private-sector nursing school.

With more than 350 students, EIG trains health workers to serve the regions of Gao, Kidal and Tombouctou. The Project supported the revision of EIG curricula using the IntraHealth-developed Learning for Performance (LFP) approach, which connects learning to specific job responsibilities and competencies students will need.

“Students were used to lectures. Basically, you say whatever you have to say and at the end you ask your students if they have any questions,” notes Maiga. “This approach was not as proactive.”

The LFP approach shortens the required training time by focusing students’ learning on what is most essential for the job—in this case, what students need to work in a hospital, health clinic or community health center. LFP can also improve job performance by teaching what is relevant to specific duties.

IntraHealth has used LFP to design and implement training for a variety of health workers—from community volunteers to professional nurses and doctors—in the public, private and nongovernmental organization sectors. For example, in Tanzania, LFP was used to revise the national provider-initiated testing and counseling for HIV/AIDS curriculum; in Nepal, it was used to revise in-service training and pre-service education curricula for physicians and nurses to be trained as skilled birth attendants.

Working closely with EIG, the Capacity Project introduced a French version of the Learning for Performance guide and workbook. LFP was then used to finalize family planning/reproductive health and child health modules—identified as important because of the regions’ high maternal and child mortality rates—for EIG’s curriculum, as well as curricula developed by USAID’s National Technical Assistance Plus and Keneya Ciwara projects, in which IntraHealth partners.

Maiga appreciated the highly participatory process, which included students, trainers, alumni and school leaders. He adds that faculty felt so much enthusiasm that they set up working groups to focus on changing the other modules using the LFP approach.

One of the positive outcomes from LFP is that the curricula can now be standardized—whereas previously, the module content varied from teacher to teacher. Comments Cissé Adiza, midwife and tutor at the school, “In the past, everyone had their own way of doing things.”

In addition, supervision in the clinical practica has improved. Cisse says that before LFP, “[t]here was not as much supervision. Supervision simply consisted in checking whether students were attending the clinical practicum.” Now, she says, the tutors work with the students, using assessment forms to ensure procedures are performed correctly.

“Students are more committed to what they do,” adds Maiga. “And there is a real focus on the practical aspect of things . . . . This will strengthen the skills of our health workers, especially in the three northern regions.”

The Capacity Project evaluated the newly developed reproductive health and child survival modules by testing students’ knowledge before and after training. Midwives pre-test scores averaged 51%; post-test scores improved to 66%. The pre- to post-test scores of obstetrical nurses went from an average of 31% to 52%. Students at EIG had a greater increase in scores compared with students in other schools who did not learn using the LFP approach.

Because of the positive evaluation, EIG faculty branched out beyond just training midwives and nurse obstetricians in these areas. They have now trained 45 public health nurses in the same subjects during two-week intensive sessions.