Building A Stronger Health Workforce

Preparing to train ten thousand new health workers a year for Tanzania

Challenge

An ongoing shortage of trained health workers is one of the biggest obstacles to improving public health outcomes in Tanzania. In response, the government has set an ambitious goal: double training capacity and student intake to more than 10,000 annually. In 2010, Burk was asked by the health ministry to conduct a detailed assessment of what it will take to meet this objective.

The Burk team was already familiar with the challenges. The firm had been working with the Ministry of Health and Social Welfare since 2003, first helping to identify the biggest opportunities for improved health outcomes, then assessing the scale of the health worker shortfall and the level of investment required to address the issue. The data and the strategy developed in these earlier phases had supported a successful application by Tanzania to the UN Global Fund. With the strategy in place and funding secured, attention turned to implementation. At the level of individual training institutions, how could the ministry increase training capacity most effectively? What were the on-the-ground barriers to execution and how could they be overcome?

Discovery

The team conducted a first wave of assessments at nine campuses across the country, some in extremely remote locations. These institutions accounted for about twenty percent of Tanzania’s health worker training capacity and presented a representative range of opportunities and challenges. In each case, the emphasis was on identifying practical steps to maximize training capacity. The Burk team worked with local administrators and educators to identify bottlenecks and constraints, determine whether facilities needed to be reconfigured or renovated, and develop action plans down to the level of procurement requirements and phasing.

A number of common themes emerged. For example, with better facilities and additional support staff, tutors could teach up to 100 students—double the current average class size—with no reduction in the quality of instruction. This increased the productivity of highly-qualified educators, created the potential for better education through maximizing the use of existing clinicians in training, and reduced per-student costs. Moreover, building new, larger classrooms enabled the schools to inexpensively covert older buildings into labs, libraries, IT centers, and other facilities.

Similarly, assessing classroom capacity on campuses as a whole, rather than focusing on individual schools, often revealed unexpected opportunities to increase capacity at low cost. In one case, a health training school requiring additional classroom space found that a neighboring school had eight times more capacity than it needed. Sharing facilities enabled both schools to expand student intake without new building. Working from the ground up in partnership with educators and administrators, the Burk team developed detailed plans to more than double training capacity at the nine campuses assessed. The lessons learned could be applied across the system as a whole. 

Impact

The project demonstrated that the government’s ambitious target to double the number of health workers that can be trained per year could be achieved by increasing the utilization of existing facilities, making carefully-targeted investments in new infrastructure, and increasing teacher support. Moreover, by increasing utilization and productivity along with implementing expansion plans, costs were reduced by almost half—from $19,000 to $10,000 per student place—saving over $90 million over the life of the expansion program.

In parallel, we are working with the Ministry of Health and Social Welfare in an initiative to enhance the performance and ‘health’ of its own organization. Innovations include creation of a performance management unit to drive success in specific implementation programs and a more decentralized accountability structure for schools management - both to ensure Tanzania maintains momentum toward rebuilding its health workforce.