Transformative Education
for Health Professionals

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Increasing the production of competent and qualified frontline health workers in Nigeria

Heather Ross, Rebecca Bailey

Findings of a multi-state, rapid bottlenecks assessment of midwifery, nursing and health technology schools in Nigeria informed the USAID-funded CapacityPlus project worked with federal- and state-level stakeholders to develop a multi-pronged plan of support to increase the production of certified graduates. This included providing educational resources; training tutors in up-to-date clinical guidelines and computer assisted pedagogy; and supporting students at risk of dropping out through scholarships. This comprehensive set of learning support has reduced student drop-out rates and increased pass rates on national certification examinations.

Full project description: 

The USAID-funded CapacityPlus project aims to increase the availability of health workers to meet the priority health needs of Nigeria’s underserved populations through sustainable and scalable interventions. In 2012, CapacityPlus assessed bottlenecks to increasing the number of certified graduates from midwifery, nursing and community health education programs. The assessment found that less than 50% of students enrolled in these programs pass certifying examinations (figure 1). Students often discontinue their studies due to financial need, tutors rarely have training in up-to-date clinical guidelines, and schools are under-supplied with educational materials, particularly those needed to develop students’ clinical skills.

Number of Nigerian health workers who enroll in accredited programs, complete programs, and pass national examinations


CapacityPlus collaborated with federal- and state-level stakeholders to develop a multi-pronged plan of support for health workforce educational institutions. This included providing simulation models, teaching aids, and textbooks; and training tutors in emergency obstetric care, integrated management of childhood illnesses (IMCI), and computer assisted pedagogy. Additionally, CapacityPlus provided scholarship support directly to final year students at risk of dropping out due to financial need. 


Tutors at the assessed institutions were in great need of training about the latest evidence-based clinical guidelines. More than 80% of tutors interviewed had not received any refresher training in more than 5 years, meaning they were unable to teach updated clinical skills to their students. To meet this glaring need, CapacityPlus organized training of tutors courses – which were delivered at certified training institutes by nationally accredited master trainers - to 60 tutors from 21 midwifery, nursing, and community health schools.


Both demonstration equipment and textbooks are in extremely short supply in Nigerian health workforce educational institutions. Schools’ demonstration rooms – where students practice clinical skills before working directly with patients – lack demonstration models and teaching aids such as posters and flowcharts. Some libraries and laboratories assessed were completely empty, giving students and tutors no access to necessary study materials. The few models and textbooks available were nearly universally in disrepair. CapacityPlus collaborated with local stakeholders to identify required educational materials and competitively procure manikins, obstetric models, posters illustrating important concepts, textbooks, and demonstration equipment for 19 schools of midwifery and community health. With these items, tutors can reinforce practical and theoretical learning, contributing to students’ ability to provide quality patient care. 


In partnership with the relevant Nigerian professional councils, CapacityPlus competitively awarded scholarships to 2,065 final-year students from 92 schools of midwifery and health technology in 33 States plus Abuja. To the sustain the impact of CapacityPlus support where it is needed most, recipients were chosen based upon attributes found to be indicative of willingness to provide care in underserved locations such as rural origin, family pressure to stay, and a stated desire to practice in rural Nigeria.


CapacityPlus’s comprehensive set of learning support mechanisms has measurably improved schools’ learning environments and reduced student attrition in schools of midwifery and community health. Scholarships alone were found to increase the number of students successfully completing their training and professional examinations by more than 9%. Assessment of the effects of institutional support – training of tutors and provision of learning aids – is ongoing. Between 2013 and 2018, nearly 10,000 Nigerian students will graduate from Nigerian institutions with CapacityPlus support. 


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