In 2009 the World Health Organisation (WHO) estimated that the current workforce in sub-Saharan Africa would need to be scaled up by as much as 140% to attain international health development targets set out in the Millennium Declaration. The WHO states that many African countries lack appropriate personnel to utilise effectively the financial awards which are needed to improve health.
Integral to the solution
The African Paediatric Fellowship Programme (APFP), established in 2007 at the University of Cape Town’s Department of Paediatrics and Health, is addressing the desperate need for specialised paediatric doctors and nurses in Africa. Funded by the Children’s Hospital Trust,this innovative Programme has already trained 66 doctors and 49 children’s nurses in highly specialised paediatric skills who are then able to return home to improve training and child health services in their own countries. The training they receive is designed to ensure that the new skills, techniques and expertise learned can be put straight into practice caring for sick children in Africa’s health care facilities.
Creating a network of healthcare skills
The programme’s purpose is to continue to train these paediatric doctors and nurses in various fields through an on-going partnership between tertiary centres in African countries, the Red Cross War Memorial Children’s Hospital and the University of Cape Town. Its aim is to create a network of skilled African healthcare professionals who can develop capacity in child healthcare through clinical service provision, training and research and capacity building. Crucial to the programme is working with partner institutions, including universities and teaching hospitals in other African countries,to strategically develop cluster paediatric expertise and also to develop multidisciplinary teams across the continent. Countries include Ghana, Kenya, Malawi, Tanzania, Uganda, Zambia and Zimbabwe. The programme has also recently begun to build training capacity for specialist paediatricrehabilitation therapists such as physiotherapists and speech therapists.
Jo Wilmshurst, Head of Paediatric Neurology at the Red Cross Children’s Hospital and Director of the APFP medical arm says, “Since the APFP was established, the programme has supported the training of66 doctors from 33 different centres in 12 different countries across Africa. The ripple effect of increasing and retaining this skills pool for paediatric healthcare in Africa is resulting in a network of motivated clinicians who are in a strategic position to target and reduce the impact from the key diseases in Africa.”
Boosting paediatric nursing numbers
The APFP Nursing Fellowships are delivered by the Child Nurse Practice Development Initiative. Based at the Red Cross Children’s Hospital, and supported by the Children’s Hospital Trust and the Harry Crossley Foundation, this initiative is now the main training hub for children’s nursing on the African continent.Nurses are offered one or two year programmes of studies with a focus on child health and illness or the care of the critically ill child, and many go on to lead important developments in child health systems and services throughout Africa.
Minette Coetzee, Associate Professor of Child Nurse Practice Development, is full of praise for what nurses go on to do when they have completed their training. “The real triumph is that returning nurses go back to their facilities with a really clear sense of what they contribute to health care and health systems in their own countries through their increased clinical skill and knowledge. They make a huge difference.”
Transformation through partnership
One of the hospitals in Africa that has partnered with the APFP is Komfo Anoyke Teaching Hospital (KATH) in Kumasi, Ghana. KATH aims to transform paediatric services in Ghana one sub-speciality at a time, including Critical Care, Gastroenterology, Urology, Haematology/Oncology, Emergency Medicine and Neurology. This institution, through strategic planning and dedication, has transformed its capacity and reach in providing these paediatric services by ensuring that multiple doctors and nurses are trained and continue to train. In a country that has a population of almost 14 million children, this is critical.
A perfect example
Dr John Adabie Appiah, one of the only paediatric critical care specialists in Ghana, completed his training through the APFP and is now one of the doctors spearheading change at Komfo Anoyke. He says, “My experience going back home with the acquired knowledge and skill to practise actually magnifies the benefit for the sick child. Mortality and complications averted cannot be quantified, but suffice to say the investment in my training has benefited my patients.”
Appiah says that it’s only thanks to funding that programmes like this are possible. He explains, “I believe that quite a number of Sub-Saharan Africanclinicians are missing this opportunity because of funding issues. Ultimately it is a sick child who needs specialists who will eventually suffer.”
Transfer of skills cross-continent
Dr John Appiah is part of a multi-disciplinary team taking paediatric skills back to Ghana. In 2014 his colleagues Abeiku Yankson and Caroline Essel graduated as APFP Nursing Fellows with Post Graduate Diplomas in Child Critical Care, becoming the first two paediatric critical care nurses in the country.
In 2015, a number of African doctors and nurses enrolled in APFP Medical and Nursing Fellowships, expanding this innovative programme that sees individuals choosing to study in South Africa and taking the skills home with them in order to transform paediatric health services in other African countries. Nine new APFP Nursing Fellows enrolled in the programme this year from Malawi, Zambia, Ghana and Namibia. 23 new APFP Medical Fellows will enrol in the programme in 2015, six of whom are from Ghana.
However, taking such rare and specialised skills home to under-resourced areas, such as Ghana, can be challenging when faced with the needs of more than 14 million children. But Appiah says that the successes of returning doctors assist in blazing a trail for other colleagues who have harboured the aspiration to get on board. He believes that this is how transformation takes place. He concludes, “It’s sending a message to the world that intensive care can be provided in resource-limited nations and that support needs to be provided.”
Visit www.childrenshospitaltrust.org.za for more information on the Children’s Hospital Trustor visit www.scah.uct.ac.za/scah/apfp or www.childnursepracticedevelopment.org.za