Yekatit 12 Hospital, a city institution, is never short of patients waiting for treatment and families waiting for their loved ones. Tsedey Abebe is one of the family members waiting to visit her mother, who has been hospitalised for high blood pressure nearly three weeks ago. She sits on the stone steps of one of the buildings in the compound of the hospital, squinting against the already bright morning sun as she waits to go into her mother’s room.
“The service is alright here,” she explains. “But it’s very busy. Other than that, the experience we have been having is great.”
The public health care system in Addis Abeba is one of the popular talking points for the city’s residents. In particular, the quality of the teaching in both the public and private health colleges has recently become a subject of public scrutiny.
Health colleges and particularly private health colleges are a popular option amongst students wishing to study more transferable skills, particularly among those who wish to move abroad in the future. They offer courses in nursing, pharmacy technology, and public health, among other things, up to and including offering bachelors’ degrees in medicine.
However, as more stories surface about private health colleges that are found to be below the prescribed governmental standards, the public is becoming more aware of the issues that come with the country’s overstretched health education system.
Whether the reputation private health colleges have gained in some parts of the public is justified is still a subject that is up for debate.
“Everyone has heard about young students who make mistakes,” Tsedey explains. “Many times it is a student who has not been taught or prepared properly giving the wrong medicine, or not understanding what the patient needs.”
However, the quality of the education in some of the health colleges in the city has been cast into doubt, both by the students and regulatory agencies.
“I chose to study nursing because I can use it to get a job anywhere I am,” says Tigist Amare, a 20-year-old private health college student.”Even if I go to another country, I have a good skill.”
Ashenafi Kumilachew, a 22-year-old student of laboratory science feels that the career may not be a good pay off.
“Sometimes the classes are too crowded for everyone to get proper hands-on experience,” he says. “When we go to start our careers, I am afraid that we will be unprepared. My friends in the other medical classes have the same problem.”
There are around 10 accredited private health colleges in Ethiopia. The Higher Education Relevance and Quality Agency (HERQA), is the body responsible for assessing and accrediting all higher education institutions, including private health colleges.
In general, private health colleges are expected to fulfil a minimum set of standards including sufficient and up to date textbooks for each of the courses that they teach, a fully stocked lab, and enough anatomy models to allow students sufficient hands-on practice. The teachers of the institution are also expected to be qualified to teach the subjects that they are assigned to.
The colleges are not allowed to teach health courses outside of standard education hours; which means, colleges are no longer allowed to teach health-related courses at night or on the weekends, only.
“We found that students do not have good outcomes when schools try to cram the same material in shorter amounts of time,” explains Tarekegn Geressu, communications head of the Agency.
One of the more talked about cases handled by the Agency was Medco Bio Medical College. In November, HERQA ordered Medco, a private health care college to cease operations in its nursing department.
It was the second time in a year that the college failed to pass inspection by the Agency. The first inspection in May 2016 resulted in the college being found not to have an organised computer lab, not enough offices for teachers, and a shortage of anatomy models, as well as too few text books for certain courses. In a second round evaluation, conducted in October, the college was caught with similar problems.
On the basis of the failures, the College was ordered by the Agency to transfer the documentation of its nursing students to the Agency.
However, the college is now operational and teaching its courses, with the exception of nursing.
“We receive good feedback from the places that our students go to do apprenticeships and internships,” says Hailemariam Woldu, academic dean of the College. “We are back to working as normal, in line with the governmental standards.”
The management at institutions which do not deal with freshly graduated health professionals, or are doing internships and apprenticeships, notice no difference in the abilities of those who graduate from private health colleges, and those from public institutions.
“We have not had many new graduates. Most of our staff has been here for many years. But I do not notice many differences between new graduates from private colleges and public schools,” explains Elsabet Berhane (MD), medical director of Senay Clinic, located on Sierra Leone Street (Debrezeit Road). “I think the problem is that all new graduates, no matter where they study, have not had much exposure yet.”
“If they are willing to learn, then there is no reason they should be any worse than other students,” she adds.
Similarly, students from both private and public health colleges do not show much variation from each other, according to medical experts.
“There is more variation in ability amongst students from private colleges,” explains an expert with decades of experience in medical education and practice. “However, the most important thing for both sets of students is that they have good teachers.”
The quality of the follow up and experiences that students get in hospital settings is still short of ideal, according to the expert.
“Teaching hospitals tend to become overcrowded,” he explains. “When there are so many students, there is not enough time to follow them all up. But hopefully the focus of the government will turn to the quality of medical education, rather than the number of teaching institutions.”
Like many developing countries, Ethiopia suffers from a severe shortage of health professionals. The country has a health workforce of 0.7 per 1,000 population, which is below the WHO recommendations of 2.3 health workers per 1,000 people.
The number of physicians has been showing a decline in recent years, with estimates putting the number at one physician for every 42,706 people, amongst the lowest ratios in sub-Saharan Africa.
The numbers of other health professionals, like nurses, midwives, health extension workers and health officers have shown an upward trend over the past five years, with the country achieving the WHO recommendations of one nurse per 5,000 people.
The health sector as a whole has also recently come under fire. St Gabriel Hospital, one of Addis Abeba’s hospitals, was recently forced to stop operations for a few days resulting from violations of the standards set by the Addis Abeba Food, Medicine & Healthcare Administration & Control Authority (AAFMHACA).
It was part of the closure or suspension of 82 health centres and institutes in the first six months of the current fiscal year by the Agency. In addition, a number of medical professionals were also stripped of their licenses.
Health centres and pharmacies are inspected four times a year, with surprise inspections in between. Usually it is the surprise inspections that lead to catching violations of standards.
“In some of the cases, we received tips about the running of the centres or the service provision,” says Alemtsehay Paulos, deputy head of the Agency. “All of them were closed for one or more of three reasons: not meeting national healthcare standards, employing unqualified staff, or not handling patient information appropriately.”
“The surprise inspections mean that the centres cannot hide things or prepare for things. We see it in its everyday operation,” she adds.
Whether the problem with health professionals lies in the quality of their education, or whether it is simply a question of adequate exposure to real world scenarios, and competent management, some patients are optimistic about the capacity of the students that they are seeing.
“I am very grateful that my mother has so far been treated by good professionals and students,” adds Tsedey. “I hope that future patients also get that kind of treatment from well prepared students.”
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