Nigeria: Producing well-trained, skilled andqualified health workers to achieve UHC

July 2019

In 2014, a project began called ‘Enhancing theAbility of Frontline Health Workers to ImproveHealth in Nigeria’, funded by the Government ofCanada through the Global Affairs Canada (GAC).The project has the overall aim of improving thehealth of infants, children, women, and men inBauchi and Cross River States by strengtheningthe capacities of frontline health workers todeliver maternal, neonatal and child health careservices at the primary health care level. 

A project in Nigeria is transforming the health workforce in Cross River and BauchiStates. Many health training schools have regained accreditation and are nowtraining and producing highly qualified and skilled health workers.

Students of School of Midwifery, Moniaya, Ogoja learning at a practicum site. Photo: WHO

The project is being implemented by WHO, theGlobal Health Workforce Alliance (GHWA) and thePopulation Council (PC) through partnershipsformed with the Federal Ministry of Health, theBauchi State Ministry of Health and its Departments,Agencies and Parastatals and the Cross River StateMinistry of Health and its Departments, Agenciesand Parastatals.

Health training institutionsOne of the project’s key activities is training andproducing skilled health workers which has hasachieved many positive outcomes so far. Healthtraining institutions in both States are much strongerand better able to produce s sufficient number ofqualified frontline health workers with appropriateskill-sets. Combined with increased governmentinvestment in the health workforce from thegovernment, health services are heading in the rightdirection to achieve universal health coverage.   When the ‘Enhancing the Ability of Frontline HealthWorkers to Improve Health in Nigeria’ project startedin 2014, only 3 out of 11 health training institutions inBauchi and Cross River States had officialaccreditation from the regulatory bodies to train andconfer degrees to health workers. The otherinstitutions had their accredited status withdrawn fora range of reasons: they did not have adequate tutor-pupil ratios, their equipment was obsolete and notwell maintained, or they did not have a conduciveteaching, learning and housing environment to trainhealth workers. 

“The project has achieved numerous successes at federal levels

and in Bauchi and Cross River states.” Dr. Wondimagegnehu Alemu, WHO representative in Nigeria (2016 – 2018)

“The truth of the matter is that if you don’t havetrainings going on, as the years go by and morepeople retire from service, they phase out andeverywhere becomes empty and shutdown and ofcourse we can’t offer services,” said Dr Betta Edu,Director General. Cross River State PrimaryHealthcare Development Agency.

 WHO conducted a needs assessment in these 11institutions and clearly identified what they neededto improve in order to regain accreditation. With thegovernment’s lead, WHO improved the teaching andlearning conditions, providing technical assistance inreviewing and mentoring, while the governmentworked on improving the institutions’ physicalinfrastructure and refurbishment.

 Now there is much cause for celebration. The healthinstitutions regained their accreditation status and all11 institutions are now training health workers withconducive teaching environments and state of the artequipment.

Photo: WHOStudents in a science lab, Cross River State

Cross River StateHealth workforce training institutions in Cross RiverState have received a revitalizing boost since the‘Enhancing the Ability of Frontline Health Workersto Improve Health in Nigeria’ project started in2014. To date, all five of its nursing and midwiferyschools are accredited and able to admit and trainhealth workers. This means that the State can nowrecruit highly trained and professional front linehealth workers and place them where they aremost needed.

The project supported the professional training fornursing school educators, provided contemporaryteaching and learning equipment indemonstration rooms and laboratories, andprovided technology support in the form ofcomputers, printers and Internet connection.Libraries were replenished with contemporarytext-books and learning tools, and technicalsupport was provided to develop trainingcurricula, manuals and methods. Offices,classrooms and dormitories were revamped withnew furniture and most schools also received a 32-seater bus so that students could easily travelbetween learning sites. As of 2019, there are now over 400 nurses,midwives, community health extension workers(CHEWS) and junior community health extensionworkers (JCHEWS) in various health traininginstitutions in Cross River State. They are nowreceiving training with modern demonstrationequipment in an improved learning environmentthat is equipped with standard ICT facilities,updated curricula, and relevant books. This nextgeneration of the health workforce also benefitsfrom well-trained, qualified and motivatedteaching staff.

School of Midwifery, Ogoja, Cross River State Photo: WHO

Exposing these trainees to modern practical anddemonstration equipment, and contemporarytechniques and methods results in well-trainedand high-quality professional frontline healthworkers. Now Cross River State has a rich reservoirof incoming health workers - some of whomstarted graduating in September 2018 - andquality schools. The health care delivery systemwill be stronger as a result, and the population willhave access to better quality services.

Before now, we just taughtand did the best we could, butnow we have one of the bestdemonstration rooms and thishas enhanced the teaching ofthe students.” Mrs Edumaban Tangban, Principal,School of Midwifery, Calabar, CrossRiver State. By the time we get out tothe field, we will be betterequipped to delivery qualityhealth services, because wehave been practicing it here.” Precious Nwachukwu, studentmidwife, School of Midwifery, Calabar,Cross River State. Now we are sure that bythe time these schools startchurning out their products,the state is going to haveenough workforce to absorbinto the state system, becauseas they are finishing there areplans to absorb them” Dr Joseph Bassey, PermanentSecretary, State Ministry of Health,Cross River State

Bauchi StateThe Bauchi State College of Nursing and Midwiferyhas developed with support from the ‘Enhancingthe Ability of Frontline Health Workers to ImproveHealth in Nigeria’ project. Established in 2011, butunable to obtain accreditation due to a lack ofresources, the College is now a thriving hub fortraining health workers from all over the State. Itnow has teaching and learning equipment fordemonstration rooms, libraries, dormitories andscience laboratories and an additional 20 tutors. The College of Health Technology Ningi has alsogrown its capacity to deliver world-class healthtraining. The library is restocked with new books,and is now benefitting from new technology andequipment, instructional materials and studenthandbooks and curriculum. These interventionsresulted in the Community Health PractitionersBoard of Nigeria granting the school accreditation.

Before now, we just taughtand did the best we could, butnow we have one of the bestdemonstration rooms and thishas enhanced the teaching ofthe students.” Mrs Edumaban Tangban, Principal,School of Midwifery, Calabar, CrossRiver State. By the time we get out tothe field, we will be betterequipped to delivery qualityhealth services, because wehave been practicing it here.” Precious Nwachukwu, studentmidwife, School of Midwifery, Calabar,Cross River State. Now we are sure that bythe time these schools startchurning out their products,the state is going to haveenough workforce to absorbinto the state system, becauseas they are finishing there areplans to absorb them” Dr Joseph Bassey, PermanentSecretary, State Ministry of Health,Cross River State

Without the support of Global

Affairs Canada and WHO, the

dream of establishing the College

of Nursing and Midwifery would

not have materialised.” Hajiya Rakiya Saleh, Provost, College of Nursing andMidwifery, Bauchi State

Gender mattersAs part of the project, WHO supported Bauchi and Cross-River States in establishling gender desks and appointinggender desk officers. WHO worked with the University of Calabar’s Department of Public Health of the University ofCalabar to develop a gender training manual. During a five-day training, the newly-appointed gender desk officerslearned how to conduct gender analysis and mainstream gender into health planning to make activities andpolicies more gender sensitive. In Bauchi State in the north, where gender issues are keenly felt, there have beensome advances. For example, a State gender policy has been developed and is being implemented. Generally,midwifery is seen as a female cadre. As a result,  most of the training schools previously only admitted females, butnow male students are also in midwifery schools. As simple as it sounds, this is progress.

 WHO also supported the Nursing and Midwifery Council of Nigeria (NMCN) to review the curriculum training formidwives to include gender-based violence education and other gender-specific maternal and child health topicsand themes. The curriculum has become far more gender transformative than before, and graduates are now ableto apply a gender lens in whatever they are doing.

The College of Health Technology Ningi libraryPhoto: WHO

Bauchi State College of Nursing and Midwifery Photo: WHO

Task-shifting trainingWHO was also part of a consortium of partnerssupporting the government to develop anational task-shifting and task-sharing policy.WHO then supported the Cross River andBauchi States to adapt the national policy totheir own particular contexts and thePopulation Council supported the States in thepolicy’s implementation with guidance fromWHO.

 First there was a need to train the cadre ofhealth workers whose tasks would be shifted orshared. As a part of the project, the PopulationCouncil provided training around core maternaland child health interventions and emergencyobstetric care at the primary care level. ThePopulation Council also provided supportivesupervision visits conducted by a joint team ledby the Bauchi anc Cross River States’ StatePrimary Health Care Development Agency(SPHCDA) of Bauchi and Cross River States.

SummaryIn combination, these interventions in CrossRiver and Bauchi States have boosted thequality and professionalism of the healthworkforce. There is now a pool of well-trainedand skilled frontline health workers to enter intoservice upon graduation. The project has alsoenabled more strategic approaches for ensuringbetter distribution of the right number ofworkers with the right skills across all healthcentres. In the future, this will have a powerfulimpact on the health services delivered and thewellbeing of the population, allowing for clearprogress on the road towards UHC.

This project is consistent with Nigeria’s drivetowards achieving universal health coverage throughPrimary Health Care revitalization as outlined in theNational Strategic Health Development Plan II. This requires adequate numbers of competent, highlyskilled, motivated and productive frontline healthworkers that are equitably distributed.”

Dr Peter Clement Lasuba, Officer-in-Charge, WHO Nigeria.

Student nurses in a practical session at the Bauchi State College of Nursing and Midwifery  Photo: WHO