Higher education in Anglophone West Africa: needs, costs and scaling –up approaches

Presenter: Hortenzia Beciu, World Bank

Abstract

Summary: The presentation will describe the pre-investment studies in health education conducted in three Anglophone West African countries: Liberia, Sierra Leone and Ghana. The studies were meant to take stock of the current situation with the health training institutions in order to enable decision makers and development partners to better understand the needs and strategize the plans dedicated to scale up health manpower.

The methodology: The analytical studies conducted used a combination of quantitative and qualitative analytical techniques to analyze the economics of scaling up the education of health workers. To assess cost of scaling up health manpower, two main instruments were developed: an inventory and census survey and a costing tool.

The inventory and census survey was applied to all training institutions in Liberia and Sierra Leone and selected schools in Ghana. We sampled 29 schools in Ghana from 72 in existence to date.

The survey consisted of eight modules as follows: 1.interview with the director/dean of the institution; 2. administration/human resource module; 3. director of academic affairs module; 4. registrar; 5. estate manager; 6. financial/comptroller officer; 7. librarian; 8. laboratory technician. Ghana was the first country in which the study was piloted and thus the other countries benefitted from the inputs coming from the pilot. The methodology of the study, design of the survey and analysis plan was developed by the World Bank experts (health and education) with inputs from the country’s counterparts. In analyzing the cost per student we have used a bottom-up approach and we have cross-check the data using different public sources reports.

In Ghana a complete exercise on costing health manpower was conducted by the team at the same time with the education survey. The Global Task Force on Health Financing together with the World Bank developed a results requirement tool, with the purpose to guide countries in several areas: 1) to estimate and project the resources required for meeting countries HRH plans, including employment and pre-service training; 2) to analyze the affordability of countries’ HRH plan, including employment and pre-service training; 3) to allow the Ministry of Health, the Ministry of Education and other relevant ministries to analyze “what if” scenarios in their plans; 4) to facilitate the monitoring of HRH scale-up plans.

Thus we will be able to provide an example of a scale-up plan at the national level, using the bottom-up approach in data collection and costing.

Conclusions: Scaling up health education has major implications for financial sustainability in both the health and education sector. The resource envelope available to scale up human resources is a major binding constraint that needs to be considered on a country by country basis. Thus a significant donor funding with be needed to address the identified funding gap in reaching normative targets in scaling up the education for health workers; and individual countries need to make a institutional reforms in the education system a major priority in order to improve efficiency and effectiveness in the deployment of human resources, productivity, and public/private mix.