Scoping for technical assistance in enhancing medical education and regulation

The core objective of the study was to provide a concept note and recommendations to the Bangladesh Ministry of Health and Family Welfare (MoHFW) and the Department for International Development (DFID). This would cover the scope and content of technical assistance needed to assist the MoHFW with the design and implementation of a comprehensive package of activities to enable necessary reforms of medical education system and improvement of education services offered at medical colleges (MC) and their affiliated hospitals, alternate medical care (AMC) colleges and schools, medical assistants training schools (MATS), and institutes of health technology (IHT). Needs and demands expressed by all stakeholders as well as international standards, global trends and best practices in medical education, have been taken into consideration as along with health system requirements.

Challenges

Nursing care has not been looked at in detail, not because it isn’t a relevant subject in the context of this discussion, but simply because the team needed to prioritise sectors due to limited resource and time, and also because the education system for nurses and midwives has recently been reviewed.

Our approach

Based on the scope of the work, a data collection instrument was prepared considering criteria and standards (inspection checklist and other relevant documents) of MoHFW / Bangladesh Medical and Dental Council (BMDC) for establishment and operation of public and private medical colleges and schools relevant for the education of professionals in the above-mentioned disciplines. The instrument was validated through consultation with BMDC and the Director General of Health Services / MoHFW and then finalised.

Data collected used existing inspection reports and assessments and was completed through interviews of representatives of the respective facilities. After a first analysis of the results of the data collection exercise, site visits were performed to a sample of medical universities and medical colleges, dental colleges and units, medical assistants training schools  and institutes of health technology in order to get an impression of the realities of medical education at different levels (MBBS / BDS / AMC / MATS and IHT).  Focus group discussions were organised during site visits with faculty members and students to get their feedback and independent views on key issues and reform requirements. Data and information available were complemented through a thorough review of relevant documents and literature.

Further, in-depth interviews / meetings (based on a semi-structured interview guide) were conducted with key informants and stakeholders (e.g. Joint Secretary Human Resources Management of the MoHFW, BMDC, relevant NGOs / CSOs / professional associations, and development partners).

Outcomes

All the recommendations culminated in three key points:

1. The need for more qualified medical staff to face the demographic, epidemiological and health systems challenges of the future. Consequently, focus should be on quality and appropriateness of medical education and rational use of human resources for health, rather than on quantity.
2. The intensified use of information and communication technology to improve access and quality to medical education for both graduate and diploma courses, and to make education more attractive for both students and teachers (specifically for basic subjects).
3. Education for medical assistants and medical technologists needs to be strengthened and significant reform activities and investments will be needed to bring Diploma in Medical Faculty and Diploma in Medical Technology  courses to a minimum level of quality that would be compliant with basic international norms and standards. This in fact is the weakest element of the current medical education system identified by this study.

Implementing the proposed reform measures will require discipline and sometimes enforcement to achieve envisaged goals. The technical assistance to be provided by DFID may help moving forward in this direction. However, political commitment to the reform process has to be demonstrated by the Government and the MoHFW. A separate Directorate General of Medical Education has just been established.

We are thankful to Michael Niechzial, Abul Faiz, Dr Khaleda Islam, and Tasnia Nuran for their contributions in this project.