Creating a Field-Ready Health Workforce
Field-based learning experiences are preparing African university students for interdisciplinary work
A “One Health” workforce consists of professionals that not only have the technical skills and competencies to work within their own discipline or sector, but also possess skills to work across sectors to manage large-scale disease outbreaks. The One Health Central and Eastern Africa (OHCEA) university network is supporting member universities across Africa to create interdisciplinary and field-based student training programs to learn about and address One Health challenges at the interface of human, animal, and environmental health.
These One Health Field Attachment programs are designed to develop multidisciplinary One Health student teams who have expertise in their respective disciplines and also share a vision and commitment to holistic approaches to address complex community health problems. They aim to help these One Health student team members learn expertise in community engagement, communication, project management, and leadership. The programs involve an intensive field element, often times where students live and work in small multidisciplinary teams in an identified Demo Site. While there, the teams work closely with community partners to assess community strengths and concerns, develop and implement interventions based on assessment findings, and conduct some type of evaluation of the intervention.
These field attachment programs and the OHCEA network receive support from the One Health Workforce (OHW) project funded by the U.S. Agency for International Development (USAID) and led by the University of Minnesota (in partnership with Tufts University) since 2014. In 2018, a team of evaluators from OHCEA, the University of Minnesota, and Tufts University conducted an evaluation of select One Health Field Attachment programs in Kenya, Uganda, Tanzania, Ethiopia, and Rwanda. The purpose of the evaluation was to examine the design and implementation of these programs across different sites and explore how they are transforming academic learning while training future health workers and supporting community health.
Below are some key takeaways from the evaluation. You can read the full report here.
1. A ‘One Health’ workforce will not be built in a day.
Developing and strengthening a “One Health workforce” is a long-term endeavor and it will be years before we can truly evaluate the impact of these programs on the health workforce of their respective countries. To promote a positive long-term impact of these training programs, this evaluation examined key program features and functions and assessed immediate changes taking place within participating universities and communities. Where possible, we also sought to understand whether and how past student participants have embraced the One Health Core Competencies the program sought to foster.
2. Each country’s One Health Field Attachment program is unique.
While many universities in the region already had some form of field attachment activities, these are usually geared toward students of public health, are clinical in nature, and don’t offer a One Health component. These existing clinical field programs often provided the foundation for field programs that incorporated a multidisciplinary element. The variations amongst these existing programs, and the ways in which they evolved country to country meant that each One Health field attachment program in the OHCEA network was different and unique.
The first formal One Health Field Attachment program was implemented in Uganda in 2014 and consisted of students of nursing, veterinary medicine, and a few public health students. The program lasted for six weeks and was originally intended as a one off activity. Due to its popularity, however, it continued and eventually spread to other OHCEA member countries beginning with Tanzania. The program has since spread to 7 OHCEA partner countries. Some programs last for only a few days, while others go for almost three weeks. Many of these program variations are due to the country’s experience conducting other types of field attachments, budgetary constraints, or other country specific contexts.
3. The program creates meaningful opportunities for interdisciplinary collaboration currently lacking in many university programs.
Students overwhelmingly had positive things to say about their participation in the One Health Field Attachment programs, and many described it as their first opportunity to put One Health into action. Faculty and staff we talked to joked that when students first arrive they are hesitant to intermingle, but by the end of the program you can often find them working together in groups of different disciplines. As one student stated, “when you’re in a multidisciplinary group, be humble, and listen to others, let them express themselves and you can learn much from them.” Another added that “in a multidisciplinary team you can more easily find answers to the questions that the community asks you.”
This focus on mixing disciplines isn’t always easy to achieve, however. In our interviews, some students remarked that they were unsure of the One Health idea, and whether or not certain health sciences should have a say on issues related to human health. Others countered that the issue may be related to personalities: “I wouldn’t say it was interdisciplinary conflict, it was maybe personal conflict. Personalities in a pot, it’s bound to boil. But it was still workable, it wasn’t impossible.” Overall students were positive about working with other disciplines.
One of the key goals of the One Health Field Attachment is to foster collaboration, and in some countries that continues after the program ends. For universities that host student clubs or official WhatsApp groups, students are able to maintain the connections they made during the program. But sometimes, even with these in place, students maintain an appreciation for collaboration but are missing opportunities to do so. Barriers to collaboration can sometimes be simply explained by physical barriers — for example, schools of veterinary medicine and human medicine are often located far from one another.
4. The program ignites a passion and enhances critical skills for community health work.
The One Health Field Attachment program gives students the skills needed to conduct effective community health work. Some students have used the community entry skills to work on other projects in rural or remote communities. One woman described obtaining a short term job in which she trained others on these skills before they attended a similar field experience. Another skill that is utilized after the program is the consideration of One Health, and how that affects practitioners’ diagnoses. A nursing student explained that when a patient presents with certain problems, he may begin wondering if that patient also lives with animals or livestock, from which a disease could be transmitted. Many students expressed a desire to be engaged beyond the life of the program. Some requested the opportunity to revisit the demonstration sites to evaluate their efforts and see whether any interventions have been implemented. Others suggested that the universities and/or governments should utilize their skills working in multidisciplinary teams to tackle infectious disease outbreaks and other health challenges within their communities.
5. Community members see themselves as learning partners.
Through our interviews with students and members of the communities in which they work, it became abundantly clear that the program fosters mutual learning between the two groups. While students noted their role as collaborating with communities to conduct a needs assessment, they also saw themselves as educating the community on health issues specific to them. In doing this, the students viewed themselves as health educators. But in talking with community members it became clear that, while they did learn a great deal from the students, they also saw themselves as serving an important role in teaching the students about localized health concerns and community approaches to dealing with those concerns. As one community member said, “when the students came to teach us about pasture management, they didn’t know that we have traditional ways to manage pastures, so I think the students learned something from that. Maybe students didn’t know about conflicts between the humans and wildlife, but they learned about this from us.”
Students also learned a great deal about community culture and traditional practices. Those interviewed mentioned that this focus on community entry and ways to sensitize health issues will be helpful (or has been) in their future careers. On community skills, one student remarked, “I will apply it. Each time I go to talk to communities, I will refer and modify my messaging based on what I learned.”
These One Health Field Attachment programs bring together students from various health disciplines to work under the guidance of university faculty members and alongside community members to address local One Health challenges. Pre-existing clinical field programs often provided the foundation for field programs that incorporated a multidisciplinary element, and the country to country variation of these meant that each One Health Field Attachment supported by OHCEA is unique. Recently, OHCEA has developed guidelines for their experiential learning programs which they hope will help to standardize the program across different countries and universities. While this will allow for standardization of network activities, it may also present challenges for countries that have evolved their programs one way due to specific contextual parameters. In many ways, this evaluation can serve as a baseline for the program, which can be revisited periodically as network activities progress and advance.
About the Author
Ian Allen is an M&E Specialist on the USAID One Health Workforce project.
