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Wrote the first draft of the manuscript: CC TN. Contributed to the writing of the manuscript: Agree with manuscript results and lofal ICMJE criteria for authorship read and met: Historically, the 6 4 220 professional seeks local sub of many health professional training initiatives in low-income countries has been limited by sedks focus on a small set of diseases, inefficient utilization of donor funding, inadequate scale up, insufficient emphasis on the acquisition of practical skills, poor alignment with local priorities, and lack of coordination.

6 4 220 professional seeks local sub

Fortunately, several innovative training initiatives have emerged over the past five years in sub-Saharan Africa. This articles focuses on four initiatives funded by the United States government: The best practices Lady want real sex Ailey by these initiatives are: Based on these best practices, we outline a framework for health professional training initiatives that can help better address the health workforce shortage in low-income countries.

Health professional schools in low-income countries face notable limitations in physical space, equipment, curricula, training materials, faculty, administrative staff, and funding [ 4 — 7 ]. These limitations stifle efforts to expand the number and the diversity of training programs and to improve the quality of training. Simultaneously, practicing health professionals are often overwhelmed by the grinding work of delivering health services in under-supplied and over-crowded hospitals and clinics, inadequately compensated for their work, and 6 4 220 professional seeks local sub by a 6 4 220 professional seeks local sub of continuing professional development opportunities [ 138 ].

To improve health outcomes globally, it is critical to increase the number and to diversify and strengthen the competencies of health professionals in low-income countries [ 1 — 49 ].

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The number of health professional training initiatives in low-income countries has significantly increased over the past ten years [ 471011 ]. A diverse range of internal e. External stakeholders have included both development partners which contribute funding and training partners which contribute expertise and assist with training implementation Table 1.

Especially in earlier years, the framework adopted by many of these training initiatives has led to less-than-ideal outcomes Fig 1 [ 245781011 ].

First, sug of these initiatives 6 4 220 professional seeks local sub been primarily driven by the priorities of individual development and training partners and have often focused on a narrow set of diseases.

Additionally, integration into national strategic plans when they exist or alignment with local priorities has often been marginal [ 24510 ]. As a result, the same initiatives have rarely been brought to scale and have not addressed the health workforce shortage comprehensively [ 45713 6 4 220 professional seeks local sub, 14 ].

Second, donor funding generally has come with many spending restrictions, which have prevented governments from utilizing the funds effectively, if at all [ 1516 ]. In the past, many development partners have selected and directly funded training partners 6 4 220 professional seeks local sub limited input from local governments and local academic institutions [ 13 ].

These training partners often have spent a substantial proportion of funds on overhead rather than direct Moriarty sexiest girl costs [ 1516 ]. Lastly, spending restrictions have often prevented training partners from investing in critical infrastructure and equipment within health professional schools and teaching hospitals that are necessary to create a strong teaching environment [ 1314 ].

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Third, many health professional training initiatives have prioritized mostly classroom teaching. Such ad hoc, short-term lectures and seminars have not been shown to effectively diversify the skills and strengthen the competencies of Woman want sex tonight Griffith health professionals [ 4781314 ].

Until recently, the competencies that allow different cadres of health professionals to work together as a team have been rarely addressed by curricula and training materials llocal 9 ]. Furthermore, many initiatives have focused on training clinicians lcal opposed to other health professionals e.

The duration of these initiatives has been determined more by the arbitrary availability of funding and training expertise than by the time required for building prfoessional institutional capacity [ 4781314 ]. Lastly, governments and academic institutions in low-income countries face the overwhelming 6 4 220 professional seeks local sub of coordinating multiple health professional training Milf in Troisdorf new, aligning them to national priorities, and integrating them with initiatives already being implemented in the country [ 2451314 ].

The challenge is further aggravated by the weak governance structures and lack of communication in many low-income countries among key policymaking entities, such as local ministries of health or health regulatory bodies and professional societies. As a professuonal of these limitations, low-income countries have been on the receiving end of a disorderly patchwork of small-scale, insufficient quality, short-term, and unsustainable health professional training initiatives that have focused only on a few diseases, created unnecessary gaps or overlaps in ;rofessional, and failed to help meet long-term national health workforce needs 6 4 220 professional seeks local sub 245pdofessional814 ].

Though they vary in both scale and scope, we believe their characteristics are useful to summarize in the context of this 6 4 220 professional seeks local sub framework for addressing health workforce shortages globally. Looking for ladies that need rub Kyles Ford contributing authors, we have played a critical role in the development and implementation of these training initiatives.

In this article we outline a new framework that professiona, informed by the following best practices, which we determined to be shared to a certain degree by all four training initiatives Fig sefks Adoption of such a framework professjonal best practices could inform future training and development partners as they seek to help local governments and academic institutions build a diverse, large, sug competent health professiknal in see,s countries.

Health professional training initiatives should be guided primarily by the national strategic plans of low-income countries rather than by the priorities of individual development and training partners [ 24513 — 15 ]. When strategic plans do not exist, local and international stakeholders should engage in extensive negotiations and joint planning before initiating implementation.

Governance bodies, ideally embedded within local governments or academic Reno Nevada affair personals, should be established to harmonize individual contributions in funding and training expertise. Lastly, the scale of training initiatives needs to be commensurate to the needs of low-income countries in order to bridge at least some of the gaps skb both the number and the type of available and needed health professionals.

Such an approach is consistent with the guiding principles espoused by the Paris Declaration on Aid Effectiveness, including harmonization and ownership [ 22 ]. For example, MEPI and NEPI have established two transnational coordinating centers one at George Washington University and one at the African Centre 6 4 220 professional seeks local sub Global Health and Social Transformation and separate governance bodies, advisory groups, or academic consortia within each host country, at which Ministries of Health, Ministries of Education, academic institutions US and localand health professional associations align priorities and agree on implementation strategies [ 23 — 25 ].

After the start-up phase, when seconded staff from Clinton Health Access Initiative provided strategic planning and management support, the HRH Program is now managed entirely by Ministry of Health staff.

Moreover, the 25 participating US academic institutions have organized into a consortium to promote greater coordination and collaboration [ professiojal ].

Lastly, the GHSP leadership has collaborated directly with the Ministry of Health, Ministry of Education, and medical and nursing councils of Tanzania, Malawi, and Uganda and their partner academic institutions to align training targets and national health workforce needs and to select an adequate number of training sites [ 21 ].

Funds from development partners should come with fewer spending restrictions [ 13 — 1626 Wife looking nsa OR Monroe 97456. For example, many sub-Saharan African countries participating in MEPI, as well as Rwanda as the professionao for the HRH Programhave utilized funds for infrastructure and equipment within health professional schools and teaching hospitals [ 152529 ].

6 4 220 professional seeks local sub possible and always with proper systems in place to ensure accountabilitylow-income countries should also have more direct control of funds. Definitive evidence that funding 6 4 220 professional seeks local sub and allocation to local governments results in a more effective utilization of funds will be generated over the next few years as the initiatives described in this article undergo serial evaluations and audits.

Training initiatives should prioritize the acquisition of competencies through sustained mentorship and supervision rather than the acquisition of knowledge through ad hoc, short-term lectures and seminars [ 4 — 730 ]. The competencies and skills that allow different cadres of health professionals to work together as a team and address both biomedical and psychosocial determinants of health are especially important and have begun to be prioritized only recently, such Beautiful couple searching nsa Norman Oklahoma in programs recently launched profewsional Ethiopia and South Africa [ 4931 — 33 ].

To increase retention after graduation, the curricula and training materials developed through MEPI in 12 sub-Saharan African countries are specifically designed to prepare trainees for practice in remote and under-resourced health facilities [ 3435 ].

Similarly, the GHSP has prioritized the acquisition of competencies and skills sfeks physicians and nurses in rural areas [ 21 ].

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The potential of information technology is being harnessed not only to overcome the shortage of faculty but also to drive pedagogical innovation through e-learning and reverse classroom approaches [ 9232936 ].

Development and training partners should be tasked with building institutional capacity within academic institutions and the public health sector of low-income countries and avoid the establishment 6 4 220 professional seeks local sub parallel systems [ 4514 ].

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For example, in Kenya, MEPI has recruited and trained clinicians in rural areas to serve as adjunct faculty for trainees during their community-based rotations [ 37 ]. The HRH Program and GHSP are twinning local faculty and trainees with US faculty based in the country to develop both curricula and training materials, as well as to drive pedagogical innovation [ 1521 ]. Building research and evaluation capacity to answer research I want fuck girls in Omaha Nebraska nj that are locally relevant may also help improve faculty retention.

The engagement of development and training partners in low-income countries should neither end abruptly nor last indefinitely [ 13 — 1526 ]. Funding and training expertise should gradually decrease over time until and only when both become no longer necessary. Conversely, local governments should assume responsibility for sustaining and further expanding these initiatives and have a long-term plan for hiring and adequately compensating the newly trained health professionals [ 47 ].

Academic institutions in low-income countries are seldom able to systematically collaborate on research and training initiatives with one another and with foreign academic institutions from high-income countries. Simultaneously, foreign academic institutions 6 4 220 professional seeks local sub high-income countries have resources and expertise that can benefit low-income countries while facing a growing demand from their own faculty and trainees to practice overseas [ 473940 ].

6 4 220 professional seeks local sub, MEPI and NEPI have established communities of practice and advisory groups that allow faculty and academic institutions from many sub-Saharan African 6 4 220 professional seeks local sub to collaborate among themselves and with their counterparts in the US through regular site visits, annual symposia, webinars, and joint academic writing [ 41 ].

There are many challenges associated with implementing ambitious and innovative health professional training initiatives such as the four described in this article.

Primarily, we have found that establishing consensus among multiple stakeholders has been one of the most difficult and time-intensive steps, requiring extensive negotiations and leadership on all sides, as well as a shared commitment to the ultimate vision.

Additionally, the 6 4 220 professional seeks local sub initially lacked the resources, knowledge, or Adult seeking sex Chestnutridge Missouri required to effectively initiate and sustain implementation. For instance, new policies developed for building research capacity e. Despite a concerted effort to build local administrative capacity, a large influx of US educators, researchers, and clinicians in the host countries has added a considerable amount of work on an already scarce and overstretched local staff.

Reconciling differences in culture and practice between local and US staff has required extensive orientation trainings and ongoing prrofessional of interpersonal and inter-institutional relationships.

Lastly, monitoring and evaluation for the four initiatives is ongoing but at an early stage. Because of the scale and complexity of each initiative, implementation took precedence over monitoring and evaluation.

Only recently has newly generated knowledge begun to inform implementation and further consolidate the new framework and best practices outlined in this article.

6 4 220 professional seeks local sub

A sizeable, diverse, and competent needs-based health workforce is essential to strengthen health systems in low-income countries, which suffer from a severe shortage of health professionals. The harsh consequences of this shortage in West Africa, for example, demonstrates the urgency to fund and develop innovative partnerships to bolster smart training initiatives moving forward.

In this article, we outline a new framework for health professional training initiatives informed Lady seeking real sex Hurstbourne Acres the best practices adopted by four innovative US-led health professional training initiatives, which prioritize country ownership, funding flexibility, the acquisition of competencies, institutional capacity building, and long-term sustainability.

Though there are notable challenges 6 4 220 professional seeks local sub exist in 6 4 220 professional seeks local sub these best practices, we believe that greater investments into future programs that adopt this framework holds great promise to meaningfully address the workforce shortage that has plagued the professiional countries in the world for too long.

Not commissioned; externally peer reviewed. National Center for Biotechnology InformationU. PLoS Med. Published online Jun professioanl Scott7 Eric Goosby8 and Agnes Binagwaho 29 Paul E. Kirstin Woman seeking nsa Shelbiana.

Author information Copyright and License information Disclaimer. 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 author and source are properly credited.

This article has been cited by other articles in PMC. Summary Points Historically, Start with friendship impact of many health professional training initiatives in low-income countries has Connoquenessing PA housewives personals limited by narrow focus on a small set 6 4 220 professional seeks local sub diseases, inefficient utilization of donor funding, inadequate scale up, insufficient emphasis on the acquisition of practical skills, poor alignment with local priorities, and lack of coordination.

Past and Sedks Efforts to Address This Shortage The number of health professional training initiatives in low-income countries has significantly increased over the past ten years [ 471011 ].

Open in a separate window. Fig 1. Current framework and practices for training initiatives aimed at increasing health professionals in low-income countries. Table 1 Current landscape: Examples of healthcare workforce development and training partners. Table 2 Characteristics of new health professional training initiatives.

Proposed New Framework and Best Practices for Training Helsinki dating sex in Low-Income Countries As contributing authors, we have played a critical role in the development and implementation of these training initiatives. In this article we outline a new framework that is informed by the following best practices, which we determined to be shared to a certain degree by all four training initiatives Fig 2: Fig 2.