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Training of front-line health workers for tuberculosis control: Lessons from Nigeria and Kyrgyzstan

31 Oct 2008

Paul Chinnock

Source: Human Resources for Health (see original article)

Citation: Awofeso N, Schelokova I, Dalhatu A (2008). Training of front-line health workers for tuberculosis control: Lessons from Nigeria and Kyrgyzstan. Hum Resour Health; 6:20.

2008 Awofeso et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The quality and effectiveness of the health workers involved in tuberculosis control is often the most important factor determining the success or failure of these programmes. The Global Plan to Stop TB 2006-2015 acknowledges that the main human resource issues affecting TB control are the insufficient quality, quantity and distribution of health workers.

The authors of this article review experience in TB control efforts in two very different countries – Nigeria in Africa and Kyrgyzstan in Central Asia – both of which have much higher prevalence rates of the disease than the global average. Their article seeks to highlight context-specific training benchmarks, and propose how human resources deficiencies may be addressed, in part, through efficient (re)training of frontline TB workers. The article is timely, given that increased resources are now becoming available to allow such countries to improve their tuberculosis control efforts.

The issues of quality, quantity and distribution are examined in turn. The authors say that the training system for TB control workers in Nigeria exemplifies TB training programmes in sub-Saharan Africa, while training programmes for Kyrgyzstan’s tuberculosis workers exemplify those in Eastern Europe and Central Asia. There are marked differences between control programmes in the two countries, Nigeria’s being well integrated with other health care activities and Kyrgyzstan’s of a vertical nature. Nigeria’s cadre of skilled TB health workers is grossly inadequate for the country’s requirements, while Kyrgyzstan has a surplus of specialist TB physicians. Nevertheless, many of the issues relating to training are, in the view of the authors, of a similar nature.

1. Trained human resources operate in a ‘productivity mix’ comprising other factors such as adequate motivation and incentives, availability of required chemotherapy and supplies for appropriate patient care, and retention of qualified staff.
2. Planning for training needs of TB control programmes requires a good human resources information system.
3. More can and should be done by governments and training regulatory authorities in developing countries to improve the quality of TB education during the basic training of nurses, doctors and laboratory technicians.
4. Most post-basic TB training in developing countries is funded by international NGOs which therefore have a strong influence on the structure of TB training.
5. There is a need to standardize the training curriculum for post-basic training of staff.
6. It is important to evaluate the contribution of training to improving health workers’ productivity and the quality of TB control programmes.

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