To improve the quality of the health workforce, the ministry of Education revised the curriculum followed by all health training institutions to make it competency-based as opposed to mere acquisition of educational certificates. However, institutions are struggling to live up to its expectations, writes YUDAYA NANGONZI.
The shift towards a competency-based curriculum (CBC) is to ensure that health professionals possess the required skills and knowledge to meet the evolving healthcare needs. Whereas the CBC offers a more practical approach to learning, the education ministry is concerned that institutions are not fully implementing the curriculum.
The first lady and minister of Education and Sports, Janet Museveni, expressed her concerns about the lag in the curriculum during a week-long second National Health Professionals’ Education and Training and Health Care conference held at Imperial Resort Beach hotel in Entebbe last week.
The conference, a forum where all health education players and healthcare providers come together to share knowledge and challenges affecting the sector, was held under the theme: “Enhancing Professionals’ Education and Training to Accelerate Health Coverage in Uganda”.
In a speech read on her behalf by the state minister for Works, Fred Byamukama, Museveni said Uganda will not achieve her universal health coverage targets if the skill-based curriculum is not followed to the letter.
“While officiating at the release of UNMEB results, I noted that some of the principals do not properly implement the competency-based curriculum. That less effort is given to clinical rotation and mentorship of the trainees,” Museveni was quoted as saying.
She added: “I am very sure that if that practice continues, then Uganda will never achieve the universal health care coverage. Teach the trainees in the classrooms, in skills laboratories, in the hospitals, and in communities. This will enable us to produce the health work this country wants.”
The June 2023 Uganda Nurses and Midwives Examinations Board (UNMEB) semester results released recently further exposed the minimal preparation of candidates on the curriculum. At least 10 cases of malpractice were cited and the affected candidates confessed to having committed the offense.
Health tutors at the conference reiterated that the curriculum came in the right direction to revamp health training. However, the hands-on curriculum remains cost-intensive for most institutions.
According to Wilber Tukamuhabwa, the principal of Ntungamo College of Nursing and Midwifery, the cur- riculum dictates that most of the time be spent on clinical areas, practicals, and simulations before students are passed out. He said the implementation is mainly hampered by inadequate teaching infrastructure and low staffing in institutions.
“This curriculum is the way to go since we are not only training for Uganda’s health workforce. When you have sufficient qualified tutors, some will manage classroom teaching while others follow up with students in clinical areas. When you have few, they are torn apart and spend more time teaching in classes,” Tukamuhabwa, who doubles as the general secretary for the Association of Principals of Health Training Institutions in Uganda (APHTIU), said.
At present, the recommended tutor- to-student ratio is one to 50 but some institutions have one tutor to about 120 students. He said the high fees charged by hospitals for clinical supervision have also heavily affected the implementation of the curriculum. Some hospitals charge as high as Shs 300,000 per student per clinical placement which lasts about one month. Institutions end up being “unfairly” prohibited from accessing some facilities, hence compromising the quality of health graduates.
“The ministry of Health says it has no budget lines to accommodate all the pressures of students. They consume hospital gloves, water, power, and all consumables used for clinical areas. At the same time, the ministry of Education demands implementing a competency-based curriculum. If a principal is not professional enough, they end up churning out half-baked graduates,” he said.
Tukamuhabwa urged the government to reinstate the monthly allowance for preceptors in hospitals to supplement the few health tutors in clinical areas.
The commissioner for Health Education and Training at the Education ministry, Dr Safinah Kisu Museene, urged principals to maximize the available resources to enrich the implementation of the competency- based curriculum as the government looks forward to recruiting more tutors.
“Recently, we promoted some tutors but the plan is to recruit more. Despite the challenges, principals should not pass out students without the right competencies. We should utilize the available resources to produce better graduates because there’s no day when resources shall be adequate,” Museene said.
Meanwhile, the ministry also launched a revised curriculum for the Diploma in Clinical Medicine and Community Health (DCM). A clinical officer in this field must be equipped with skills to manage an out-patient clinic. Currently, there are 197 health training institutions across the country. Of these, only 20 are government-owned.