The objective of the project (initiated by the Treatment, Research and Expert Education (TREE) and the International Training and Education Center on Health (I-TECH) programs at the UW Department of Global Health), was to provide a comprehensive overview of the heath sector CPD environment including legislation and policies, current CPD interventions, and CPD needs, gaps, and opportunities in three target African countries (Malawi, Tanzania, and South Africa) with a focus on CPD programs for nurses, midwives, and doctors engaging in HIV and TB service delivery.
The START team searched and reviewed reports and articles from both peer-reviewed and grey literature on CPD in the three target countries as well as in other sub-Saharan African countries. Our review found that the CPD systems for the health sector in each country were at varying stages of implementation. In South Africa and Malawi, CPD guidelines for healthcare workers (HCWs) have been in place for at least two years. Meanwhile in Tanzania, the guidelines are still being finalized. We identified several examples of effective and feasible CPD interventions in the three target countries. These included Practical Approach to Lung Health and HIV/AIDS in Malawi (PALM-PLUS) and several e-learning interventions in Malawi; Harvard University and University of Washington e-learning platforms in Tanzania; and PALSA-PLUS and inPractice Africa e-learning programs in South Africa. Major barriers to CPD included limited capacity of regulatory bodies, negative attitudes of some HCWs towards CPD, financial constraints, poor quality of CPD activities, and limited access to CPD opportunities especially for HCWs working in rural areas and the private sector. The need to update current knowledge and acquire new skills, financial rewards, desire for promotion, and to meet licensing requirements (job retention) were the primary motivators for engaging in CPD. Major external agencies supporting CPD included CDC, USAID, GIZ, and the African Health Professions Regulatory Collaborative. This international support was identified as key to the formalization of the CPD regulatory environment and the expansion of CPD programs in the three target countries.