STRENGTHENING HEALTH WORKFORCE CAPACITY THROUGH GLOBAL LEARNING

(SCALE Programme)

INTRODUCTION

The Development of a committed, well-prepared, skilled, and knowledgeable health workforce is at the centre of achieving Universal Healthcare coverage and Health Related Sustainable Development Goals.

Health workforce Development however remains a common challenge in all regions of the world. Different countries face health workforce gaps at varying extents which include overall shortages, low productivity, inequitable distribution among others. It is estimated that the world will be short of an estimated 12.9 Million health workers by 2035.

This global deficit of skilled health workforce undermines the ability of healthcare systems to address healthcare needs of their populations and shared global health challenges.

To address these challenges, the World Health Organisation and partners have developed a Global Strategy on Human Resources for Health-2030 with a strategic vision to improve health, social and economic development outcomes by ensuring universal availability, acceptability and quality of the health workforce through adequate investments and the implementation of effective policies at national, regional and global levels.

Low and Middle Income Countries face the largest gaps in health workforce development which affects efforts to achieve the respective Health sector goals and contributes to poor Health Indicators.

Uganda like many countries in sub-Saharan Africa faces critical work force challenges. The Country still has a low Health worker to patient ratio (0.4 per 1000) which is in turn compounded by gaps in training, inequitable distribution, limited resources for retention among others.

The Health Sector through its Health Sector Strategic Plan and workforce Plan has put considerable efforts in addressing the country’s human Resource Gaps with a goal to; develop an adequately sized, equitably distributed, appropriately skilled, and productive workforce matched to the changing population needs and demands.

One of the guiding principles of this strategy is to utilise global collaboration in workforce development for critical services where there is lack of in-country capacity. The Ministry of Health in that regard is keen to strengthen its health workforce collaboration with the United Kingdom to mutually address key workforce challenges while creating opportunities for further partnership in global health.

HEE is the body responsible for education, training and workforce planning in England and has preeminent models and systems to facilitate global learning opportunities for UK healthcare professionals. HEE has over the past 5 years supported and facilitated the establishment of the Uganda UK Health Alliance through the Tropical Health and Education Trust. Over the years the Uganda UK Health Alliance has strengthened the coordination of UK derived activities in the Health sector and through this mechanism, HEE is keen to work with Uganda’s Ministry of Health and other strategic partners to support workforce development through the SCALE Program.

GOAL

To strengthen health workforce capacity in maternal, newborn, Critical Care and Emergency medicine through global learning between Uganda and UK.

OBJECTIVES

1. To establish pathways to foster shared learning and build leadership competencies
2. To establish sustainable pathways for bilateral research and strengthen its contribution to evidence-based practice
3. To share implementable and context specific quality improvement practices

IMPLEMENTATION

The SCALE Programme will be implemented in three phases.

1. Phase One; Virtual Health Network for Capacity Development
2. Phase Two; Placement of Ugandan Clinicians in UK Scale sites
3. Phase three; Placement of UK Clinicians in Ugandan Scale sites

Phase One: Virtual Health Network for capacity Development

Under this phase, the project will aim to build a virtual community of practice for clinicians in maternal fetal medicine, neonatology, critical care and emergency medicine between Uganda and the United Kingdom. HealthNet will aim to;

• Foster shared learning of knowledge and skills
• Build conduits for bilateral research
• Offer a foundation to establish bilateral action learning sets to foster mentorship in health leadership and governance
• Share internationally recognized standards of good practice to improve quality of care.

In the context of COVID-19, Phase one of the project  will comprise of a virtual community of practice which will be backed with technological support to enable free and convenient interaction among clinicians between the two geographical spaces.

SCALE Sites

Two pilot institutions will be identified in both Uganda and UK and a formal understanding will be reached between the two institutions to pilot the first phase of the SCALE Project. These will be referred to as the SCALE Sites. Currently, Uganda has developed curricula for training fellows in the following Programs at two sites as follows: – 1) Makerere University (MAK); Maternal Foetal Medicine as three-year Program to attain Medical Doctorate in Medical Practice (MD) by Department of Obstetrics and Gynaecology, Neonatology for Paediatricians as three-year Program to attain Medical Doctorate in Medical Practice (MD) by Department of Paediatrics and Child Health, Neonatology for Nurses as one-year Program to attain Certificate in Neonatology Nursing by Department of Nursing, and Emergency Medicine as three-year Program to attain Masters of Medicine in Emergency Medicine (MMed); and 2) Mbarara University of Science and Technology; Critical Care Nursing as one-year Program to attain Masters in Critical care Nursing. The two sites will be supported to develop short-term programs in the key select subspecialties.

Action Learning Sets

A total of 20 fellows will be identified from Uganda and 20 Fellows from the UK with three fellows identified per subspeciality. These will be recruited from cross cutting disciplines as bellow;

• Maternal Foetal Medicine
• Neonatology
• Critical Medicine
• Emergency medicine

The recruited fellows will be clustered into 4 Action Learning Sets (ALS) with a total of 10 Fellows in each set. The Action Learning Sets will be set up as par the subspecialities. Each ALS will have a a clinincal learning strategy with jointly set learning objectives and performance indicators. The development of the clinical learning strategies will be done with guidance from the SCALE mentors. The interaction of fellows in each ALS will be mostly virtual with IT support offered through the Uganda UK Health Alliance’s E-Learning Centre. Each ALS will not exceed a maximum of 20 Fellows. The virtual interaction of the Team will be through mails, zoom, Microsoft teams and various social media platforms.

Selection of 20 Fellows? will be conducted by the ALS coordination teams and submit names with contact details to Project Steering Committee (PSC)?. Fellows already enrolled in any of the four programs at Mak and MUST, potential candidates who intend to enrol or Fellows who have completed such programs will be eligible for the Phase one inclusive of nurses, doctors or allied professionals. This selection criteria will be revised each year lessons learnt get attained.

SCALE Mentors

Each SCALE ALS will have two mentors at a minimum attached and these will be senior clinicians inclusive of nurses in that discipline from both Uganda and UK. The mentors will be identified and agreed upon by the Project Steering Committee (PSC) based on their respective career development history.

SCALE Learning Strategies (CLS)

Each SCALE ALS will develop its own Clinical learning strategy (CLS) and this will be reviewed on an annual basis. The CLS will include a goal, objectives, activities, outputs, outcomes and impact each ALS would wish to mutually learn for a year. It will also contain CMEs and case discussions between the Ugandan fellows and UK fellows. Implementation of the CLS will be monitored by the SCALE mentors. All CLS once developed by each ALS will be reviewed at inception in a joint partners’ meeting as platform for refining, networking/ collaborations or harmonizing operations together with the PSC.

SCALE App

A clinical learning and interaction SCALE App will be developed for use by the Fellows under their respective ALS. The App will also offer a telemedicine consultative component that will enable clinical decision support to be offered amongst the fellows.

Phase Two:  Placement of Ugandan Clinicians in UK SCALE sites

Phase two of the project will focus on strengthening onsite or facility-based learning and transfer of knowledge and skills or curricula revisions between Uganda and the United Kingdom in maternal fetal medicine, neonatology, critical care and emergency medicine. This phase will ride on the existing professional exchange models established by Health Education England, the Royal College of Emergency Medicine (RCEM), the Royal College of Paediatrics and Child Health (RCPCH), and the Academy of Medical Royal Colleges. Some of these established schemes include the Medical Training Initiative (MTI) and the Global Learners Program.    The physical attachment of Ugandan clinicians to facilities in  UK will;

• Enable hands-on and clinincal skills development in the UK health care settings which can be translatable on return to Uganda.
• Foster acquisition of fine interpersonal skills relevant in clinical care including communication skills, team work and leadership skills and building confidence in the line of duty.
• Strengthen the virtual SCALE CoP and learning from the two different health care systems
• Strengthen the Uganda – UK institutional partnership in maternal-fetal medicine, neonatology, interventional radiology and intensive care.

Phase Three:  Placement of UK Clinicians in Ugandan SCALE sites

Phase two of the project will focus on strengthening onsite or facility-based learning and transfer of knowledge and skills or curricula revisions between Uganda and the United Kingdom in maternal fetal medicine, neonatology, critical care and emergency medicine. This phase will also ride on the existing professional exchange models established by Health Education England, the Royal College of Emergency Medicine (RCEM), the Royal College of Paediatrics and Child Health (RCPCH), and the Academy of Medical Royal Colleges (AMRC). Some of these established schemes include the Medical Training Initiative (MTI) and the Global Learners Program.    The physical attachment of UK clinicians to facilities in  Uganda will;

• Enable hands-on and clinincal skills development in the Ugandan health care settings which can be translatable on return to the UK NHS.
• Foster acquisition of context-specific fine interpersonal skills relevant in clinical care including communication skills, team work and leadership skills and building confidence in the line of duty.
• Strengthen the virtual SCALE CoP and learning from the two different health care systems

TARGETED DISCIPLINES

The SCALE programme aims to strengthen maternal fetal medicine, neonatology, critical care and emergency medicine collaborations between Uganda and UK through skilled and speciality workforce training and will focus on developing specialised training in these areas through strengthening mutually beneficial relationship between the NHS and the Ugandan Health System for professional exchange.

 SCALE-Critical Care

The SCALE program aims to strengthen mutual health workforce capacity development between the UK and LMICs

SCALE-Emergency Medicine

Emergency Medical Service (EMS) is defined as “a comprehensive system

SCALE-Neonatology

Globally, Children face the highest risk of dying in the first 28 days of life. In 2019, an estimated 2.4 Million neonatal deaths

SCALE-Maternal Fetal Medicine

The Program operates a two-prong approach including the virtual peer-peer