Support Strengthening the institutional and educational capacity to deliver qualified graduates in medical sciences applying the Problem Based Learning (PBL) approach, focusing on the clinical phase

Project number: NPT/YEM/259.

The health situation in Yemen
With a life expectancy at birth of 57 years for men and 61 years for women Yemen ranks low in comparison with most other countries in the WHO Eastern Mediterranean Region. The life expectancy is comparable to countries such as Djibouti, Iraq and Sudan. The maternal mortality rate (570 per 100,000) is very high and correlates with the low percentage of births attended by skilled personnel (21.6%, only Afghanistan scores lower with 14%). The main problems that exist in the health sector are caused by various factors, but an important one is that the Yemeni government spends a low of 3.4 percent of its annual general budget on the health sector. Another issue is the lack of proper distribution of doctors and other health workers according to the real need of the governorates especially in the rural areas. Furthermore a lack of proper infrastructure and other facilities in most of the governorates and a weakness in the organization and management at all levels hamper the development of the health sector.
One contributing factor to the poor health situation is the low number of health workers. In the Middle East only Iraq and Yemen fall below the 2.28 health care professionals per thousand which according to the World Health Report can be taken as a threshold for identifying critical shortage of health professionals.
Within the Middle East Yemen has by far the lowest number of physicians per thousand inhabitants. Yemen’s 5-year health sector plan (2006-
2010) aims to improve access to health services especially in the rural areas where over 70% of the population resides. This requires, among other measures, an increase in the number of general practitioners.

History of HUCOM
The Hadramout University was established in 1995. The Hadhramout University College of Medicine (HUCOM) started operations in 1996. Because it is the only institution in Yemen using the PBL approach HUCOM faced problems with training staff, most of whom were trained in the traditional way of rote learning. HUCOM applied to NUFFIC for support to improve the Problem-Based Learning (PBL) approach to medical education. The Maastricht University, with vast experience in PBL, was contracted to assist HUCOM. In view of building a network of PBL Universities in the
region that can support each other, the Maastricht University also brought in the Suez Canal University (SCU) from Egypt (Ismalia). The project which started in 2004 included:

• A revision of the curriculum with a focus on community-oriented education,
training in problem formulation
• Improvement of PBL approach in basic and clinical training
• Improvement of skills training.

In 2007 HUCOM successfully applied to NUFFIC for a follow up NPT project which was granted and awarded again to Maastricht University. The total budget for the second phase amounts to EUR 1.800.000. HUCOM’s vision and capacity needs
Against the backdrop of the acute shortage of doctors in Yemen HUCOM’s vision for 2011 consists of the following elements:
•In terms of quality of education HUCOM’s ambition is to deliver well trained graduates equipped with relevant knowledge and skills to serve the people of Yemen. HUCOM has opted for Problem Based Learning as the most appropriate educational approach.
• HUCOM’s desire is to obtain the local accreditation with the Ministry of Higher Education and Scientific Research and also regional accreditation. International accreditation by the WHO is also an aim, but it is not sure whether this can be reached in the given project period, 2008- 2011. Before accreditation will be carried out, the quality assurance and evaluation mechanisms need to properly perform.
•In terms of quantity of education HUCOM wants to scale up. Currently HUCOM has 560 students (all year groups 1-6) and delivers approximately 70 graduates per year. HUCOM’s aim is that by 2011 capacity will have increased to 1800 students (all year groups 1-6) and with an annual outflow of 300 graduates per year.
• In terms of research and services HUCOM envisions to have:
o Research agendas on medical research and medical education research to further HUCOM’s objective to deliver quality graduates
o An academic hospital with 3-400 beds, an oncology centre and a cardiac centre. At present HUCOM has access to a new, recently constructed hospital for obstetric and paediatrics and skills labs where students from the clinical phase can practice. An Academic University hospital and the cancer centre will be established and funded by the Kingdom of Saudi Arabia.

The project
This project will help HUCOM to turn this vision into reality through upgrading knowledge and skills of staff, the internal organisation of HUCOM, as well as part of the ICT and library infrastructure to a level that the institute is able to offer a full-fledged PBL curriculum of adequate quality to an increased number of students on a sustainable basis. Emphasis will be on developing “the HUCOM approach to PBL”, on strengthening the implementation capacity and scaling up. PBL methods need to be captured in protocols, business processes and anchored in the structure of the
organisation. This requires a robust organisation and management whereby the burden of getting things done rests on the shoulders of many responsible and responsive staff members whose roles and responsibilities are clearly understood and made explicit in an organisational chart and
terms of reference.

Funding: Dutch Ministry of Foreign Affairs / NPT program.

Mundo Project Manager: Heinz Greijn.