Knowledge gaps and research agenda
Evidence supporting a transformational change in the education and scaling up of health professionals is incomplete. Knowledge gaps exist, but well-designed and coordinated research can help fill them. The existing literature often lacks methodological rigor, and in most cases research results have little external validity. Efforts are made in this and other complex fields to develop methodological approaches that augment the strength of the evidence produced by research. The questions raised under each of the five domain areas during the search for evidence on which the recommendations could serve as a basis for further investigation.
These questions suggest a series of research activities that can help bridge the knowledge gaps identified and support the policy and decision-making processes. These are in addition to data collection on education and training institutions (infrastructure, personnel students, and financial resources) and to continuing and careful monitoring of the process of reform. Examples are:
- Exploration of the advantages and disadvantages of more innovative methods to deliver CPD, such as internet-based or use of mobile phones.
- Long-term evaluation of the impact of new curricula through cohort analysis.
- Longitudinal studies linking the retention of health workers trained in community and rural settings to changes in recruitment practices and in the curricula.
- Assessment of the impact of decentralizing education and training programmes on rural recruitment and retention of health professionals.
- Evaluation of the impact of inter-professional education on health professionals’ practice.
- Comparative studies on the process of accreditation, using criteria such as purpose, cost, transparency, and social accountability.
- Assessment of the impact of the regulation of health professional education on quality and relevance of practice.
- In countries where regulation is being introduced (e.g. Francophone West Africa) or strengthened, before-and-after studies comparing quality of education, professional practice, patient safety, etc.
- Economic research on the costs of:
- training and of utilizing existing categories of professionals;
- options of a mix of occupations to deliver the same services with the same quality;
- induced costs of scaling up production; and
- fiscal space for rapid scaling up.
- Expansion of research on professions other than medicine and nursing and on low- and middle-income countries.
- Case studies of governance structures and processes.