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Responding to the Urgent Need for More Health Workers: Rebecca Bailey on Health Workforce Education and Training

At 23, CapacityPlus’s Rebecca Bailey mailed two applications: to law school and to the Peace Corps. The Peace Corps called her first, and that’s when her work to improve health worker education and training took root.

As a communications officer for CapacityPlus, I do a lot of writing about our work to address the global health workforce shortage, but I rarely write about the people doing the work. Therefore it was a pleasure for me to speak with Rebecca and learn about her career and her current position as health workforce development team lead.

Taking an HR Angle

“Early on, my work took a human resources angle,” she says. As a Peace Corps volunteer in Thailand, Rebecca trained child development specialists to deliver services in village centers. At an NGO in Guinea, she again conducted trainings, this time with a focus on water quality.

When she finished her master’s degree in maternal and child health, Rebecca wrote to the director of the Department of Child Health at the World Health Organization (WHO), saying she would love to work with him. To her surprise, the director offered her an internship analyzing individuals’ choices of where to go first when they’re ill. “It was very interesting,” she recalls. “The third step is usually a medical practitioner. First is to the mother, second is to the local healer, and then, if they really have to, they go to a health worker.”

Focusing on Health Worker Education

Because of Rebecca’s experience with training, the WHO hired her to update curricula related to the integrated management of childhood illness. “WHO was conducting in-service training of health professionals,” she remembers, “and realized it doesn’t make sense to retrain graduates of preservice education in another approach. So we integrated a whole new approach to pediatrics into preservice education.” For the next five years Rebecca worked with stakeholders in education in several countries, to update curricula to reflect country needs and policies.

Since then, Rebecca has contributed to a number of key global health workforce initiatives, ones that I often reference or write about. For instance, shortly after the seminal 2006 World Health Report came out, the WHO recruited her to work on the Global Task Force for Scaling Up Education and Training for Health Workers.

Now with CapacityPlus, Rebecca is developing approaches and tools for the preservice education and in-service training of health workers, and leading the project’s work with the Nursing Education Partnership Initiative (NEPI) and the Medical Education Partnership Initiative (MEPI).

Overcoming Challenges

The urgency to have more health workers in place to deliver quality care, versus the time required to educate and train new health workers, are two challenges for Rebecca. “Training most new health professionals takes at least three years, and then s/he needs to be placed and start working,” she says. “So the time between your initial investment and when you can actually start to see some results is quite long.”

Rebecca cites an example from her work in Nigeria, where CapacityPlus recently received a request to train 400 midwives by October 2013. A midwifery training program, however, is typically three years long. “We will likely invest in the final year of midwifery programs, which tends to be the weakest part and when a lot of students drop out or don’t pass the certification exams,” she says.

Rebecca points out that a quick fix at the end of the program is not a satisfying solution: “I think we need to work backwards into the beginnings of the program, starting from how students are selected, and the likelihood that they will work in rural and underserved areas after graduation.” With this in mind, Rebecca is working with others on the project to develop recruitment, retention, and training strategies.

Moving Cemeteries

“A thought leader in Brazil said, ‘Changing a medical school is like moving a cemetery.’ It’s really that difficult,” says Rebecca. To be successful, Rebecca is again bringing together all the various stakeholders involved in health worker training and education.

In the Democratic Republic of the Congo, Rebecca recently facilitated a NEPI stakeholder meeting, which was the first time that the current representatives from the ministries of health and education sat across the table from each other. “The Ministry of Education had just conducted an audit of some of the nursing and midwifery schools and decided that they were going to close some down,” she explains.

“It’s not a question of shutting schools down,” she notes, “it’s about giving them support to improve.” One of the tools Rebecca is developing is the Bottlenecks and Best Buys Approach, which will help identify institutional bottlenecks in scaling up the production of quality health workers.

I tell Rebecca that I’m thinking about submitting my own application, to further my education in public health communications. “Do it!” she says. “The world desperately needs good health communicators who can inspire government leaders and decision-makers to take urgent action on the health workforce.” Rebecca knows from experience that a single application can change the path of your life.