Regional Consultation on Continuing Medical Education (CME) in East Africa

See also

Report on second CME consultation workshop, Kenya 2003

Report on third CME consultation workshop, Tanzania 2004

Consultation meeting, Kampala 31 October - 2 November 2002

There is a great need for a programme in the East Africa region that focuses on improving the performance of health workers in order to ensure quality health service delivery. The programme needs to address all levels of healthcare providers.

Continuing Education is a process in which competencies continue to be maintained, improved and acquired following completion of basic training. CME was the focus of a regional consultation meeting on Continuing Medical Education (CME) in East Africa, which was organised by FSG communications Ltd in conjunction with the Uganda Medical Association. The meeting was the first of three events sponsored by Exchange and took place in Kampala, Uganda between 31 October and 2 November 2002.

The meeting attracted participants from Uganda, Kenya, Tanzania, South Africa, the United Kingdom and international consultants who came together to share experiences in various critical issues around CME.

According to presentations by representatives from the region, the great majority of health care providers in East Africa work in isolated rural areas overwhelmed by work with very few opportunities for updating their competencies. This is likely to lead to deterioration of their performance.

The meeting observed that the deterioration of quality of care was a result of forgetting relevant information and skills: such competencies have a limited shelf life and can easily be forgotten, especially if they are not being utilised constantly.

As a result of health sector reforms that have led to a change in the organisation of health systems in the region, the need to adapt to changing roles was also identified.

"The knowledge in the field of medicine is rapidly changing as new diseases appear and disease management strategies developed. The general public has of recent been more deeply and widely concerned over professional inadequacies and it is important for the health profession to establish and strengthen ways of updating and maintaining professional competencies to meet the public’s expectations"

Senga K. Pemba PhD, Medical Educationist and Head Educational Audit, Ministry of Health, Tanzania

Eugene Boostrom, an International Consultant in Human Resources for Health envisaged a crisis in human resources in the health sector. He emphasised human resources for health as a key factor, determinant and asset in the health sector. He also pointed out that human resources are the highest cost to health services, as appropriate skills, knowledge and competencies are required at all levels.

One of the ideas he brought up for consideration was that Continuing Professional Development (CPD) or CME needs to be problem oriented, competency based and focused on the needs of key staff.

It was also observed that training programmes for health professionals do not currently provide adequate skills for finding practical solutions to practical problems out in the field. Basic education should prepare health care providers for CME by implanting a respect, thirst and love for knowledge.

Access to information materials was seen as very useful for CME and participants were called upon to put more effort in using the libraries of various health institutions. Health workers were also advised to play an active part in contributing to the production of newsletters and where available to use information and communication technologies (ICTs) 

"Continuing Medical Education is obligatory for health professionals in Uganda and should be the same worldwide"

Dr Edward Kanyesigye, Assistant Commissioner of health Services and Human Resources Development in the Uganda Ministry of Health

Dr Kanyesigye described how the Uganda National Programme of CME has developed from a small beginning to influence the entire health sector in the country. Various strategies were employed to reach health care professionals including refresher courses and workshops; distant learning programmes; support, supervision and specialist visits; radio programmes under the name “Facts about Health”; scientific meetings by professional associations; production of health learning materials; the Uganda CME Newsletter; and clinical meetings at health unit level.

In Uganda, the CME National Structure has taken root up to the health unit level, which is responsible for leadership of the programme and drawing the different professional groups together. Regional coordinators and district persons, and a task force for the coordination of in-service training are already in place.

On the constraints of CME in the region, the programme is under funded, making coordinators work on a voluntary basis, which sometimes lead to low morale. This limits health workers' much-needed self-motivation. Health learning materials are also in short supply and requirements for accreditation of participants is not always specific enough.

To improve CME delivery in the East African region the following recommendations should be considered:

• Distance education
• Establish satellite centres for CME accessible to all health workers (using the FISD system)
• Earmark funds for CME activities
• Have focal persons at district level for all CME activities
• Portfolio-based learning
• Support supervision – through tuition and practical/clinical support
• Education of all stakeholders to appreciate and prioritise CME activities
• Integrate CME in all activities

The active participation of universities and other training institutions could be effective in providing CME. Also, frontline health workers should be provided with an opportunity to identify their own CME needs and to develop a CME link in the region and in the East African Community.

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