If Somaliland’s healthcare system is to be resilient, autonomous and meet the needs of its people, it requires a sufficient number of well-trained health professionals. Establishing high quality health training institutions from scratch leads to a dilemma. A critical shortage of health professionals has made it imperative for Somaliland to rapidly expand its training sector, but a scarcity of experienced local clinicians, educators and managers has resulted in faculties lacking the necessary skills and experience.
In particular, KSP’s partners requested support in: developing curricula and assessments; training trainers in neglected specialties, such as mental health; and, providing continuous professional development (CPD) for faculty to develop interactive training styles in classroom and clinical environments.
Establishing Rigorous Examinations in Medicine and Nursing
- Introduced to Somaliland the Objective Structured Clinical Examinations (OSCEs), now used by six faculties at three of the main health training institutions
- Examined 100% of all Somaliland doctors that have graduated since the war and the majority of degree level nurses who have qualified locally
OSCEs are an internationally-recognised way of objectively assessing students in clinical environments, and serve as a quality check on graduates entering the health sector. Students are tested on clinical skills, often practicing on a real patient or actor. Performance at each station is scored by a trained observer against pre-determined criteria.
I have watched Somaliland nurses working in clinical settings and there is great variability. OSCEs are a reliable way of saying that nurses have gotten to a level of clinical expertise.
Jo De Souza, KSP Nursing and Midwifery Lead
The OSCEs give our students a chance to show what they have learned. Wherever they go, they say they feel very confident doing any nursing skills, and that they stand out in any part of Somalia.
Fadma Abubaker, Dean of Amoud School of Nursing
To date 155 medical, 155 BSc nursing, and 152 diploma nursing students have sat OSCEs as part of their final examinations in Somaliland. Furthermore, following KSP capacity building, Amoud nursing faculty are now so capable in delivering OSCEs that they have begun training for faculties at other nursing schools.
Developing the First Generation of Mental Health Trainers
- Starting from zero, trained 11% of the medical workforce to be mental health trainers
KSP’s annual Mental Health Training Skills course trains participants in lecturing, small group teaching, role play, and bedside teaching in psychiatric wards.
This aims to mitigate the fact that mental health facilities have no psychiatrists and few mental health nurses, which combined with the stigma attached to mental illness, can result in extremely poor patient care, with many inpatients being restrained or ending up in prison.
28 doctors and 2 nurses have completed the course and, in-turn, delivered training to a minimum of 68 medical students. Nine of the new tutors later assisted the KSP Mental Health Lead as co-tutors on the annual undergraduate psychiatry course. Two of the tutors, one in Boroma and one in Hargeisa, went on to supervise medical students during the first-ever undergraduate clinical placements in psychiatry.
Establishing Regular CPD for Lecturers and Clinical Teachers
- Main provider of CPD for lecturers and clinical teachers in Somaliland.
KSP support has improved the capacity of our teaching staff which has great impact in the delivery of our curriculum. It is now far better than before the volunteers’ contribution
Dr Said Ahmed Walhad, Principal of Amoud College of Health Sciences
Between 2013 and 2015, volunteers led six teaching trips and three online courses for faculty members at partner institutions, aimed at developing their skills as educators. Training has covered topics such as lecturing, small group teaching, teaching in clinical settings/mentorship, feedback and assessment.
Volunteers have introduced a number of new practices to staff, including approaches to collecting students’ feedback, and peer-teaching observations. Although it is expected that some of these practices may take time to become routine, some quality improvement projects are beginning to be implemented. For example, following training delivered by KSP volunteers in 2014, Mohamoud Ismail Adam, Director of Amoud College of Health Science Education Developmental Centre, introduced teaching observations across the faculty.