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Support, Train and Empower Managers


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This project is funded by the European Union and Irish Aid index_en.htm



The attainment of the Millennium Development goals (MDG) by the target date of 2015 is unlikely given the depleted capacity of many health systems to respond to their populations’ health needs (Joint Learning Initiative, 2004). It has therefore been suggested that countries need to move away from the expensive production of clinically oriented health professionals to focus instead on the more pragmatic production of health workers appropriate to their burden of disease, availability of resources and minimum standards of care (Huddart & Picazo, 2003). Indeed this strategy has already been adopted by several countries who are increasingly relying on mid-level cadres, such as medical assistants, clinical officers and enrolled nurses to provide health care (Buchan & Dal Poz, 2003). These cadres have shorter lengths of training than doctors or registered nurses. A recent review of mid-level health workers (WHO, 2009) suggests that more than 100 different categories of mid-level workers have been used to provide health care, particularly to underserved communities, and that this use has been widening in both high- and low-income countries. While the review notes that utilisation, skills, length of training and management practices vary quite substantially across cadres and countries, it highlights the success of Asian countries in developing a large number of local mid-level worker categories, from birth attendants to health assistants, who are not modelled on traditional health professions, but respond to specific country needs.
Mid-level cadres are well established within the public health systems of Mozambique and Tanzania. Recent studies provide strong evidence for the clinical efficacy (Chilopora et al., 2007; Pereira et al.,2007; McCord et al, 2009) and economic value (Kruk, et al, 2007) of these cadres, particularly in the provision of emergency obstetric care. Given such positive indicators it is important to recruit, retain and support these cadres to build the capacity of health systems in low-income countries. Educational qualifications that are less marketable internationally make it less likely that these staff will migrate. However, the belief that these cadres are not internationally marketable has given rise to some complacency in the management and motivation of such workers (McAuliffe et al, in press). Many countries introduced them as a short-term measure with the anticipation that once the country built up its stock of health workers they would no longer be needed. Because of this there has been little investment in developing their skills or their career pathways, which undoubtedly impacts on their motivation and relationships with other healthcare professionals (McAuliffe et al. 2009a).

Fig. 1 The WHO concept of Task Shifting.


However, as the costs associated with training and retaining internationally recognised health professionals become prohibitive, many African countries are turning their attention towards non-physician clinicians and other mid-level cadres. There is cumulative and strong evidence for the effectiveness of task shifting to alternative - or so-called ‘mid or low-level’ – cadres (McPake and Mensah, 2008; McCord et al, 2009). Figure 1 illustrates WHO’s working concept of task shifting, where specific tasks can be reallocated from more to less specialised personnel. At the core of this model are the important tasks of training and regulating, activities that are underpinned by mentoring, support and supervision.

Objective of the project

The overall objective of the proposed project, STEM - Support, train and empower managers, is to strengthen the human resource management (HRM) function at district and health facility level, by increasing the capacity of managers to support and supervise their staff. This will be achieved by the introduction of a systematic and structured approach to support and supervision of health workers in Tanzania and Mozambique (many of whom fall into this category of mid-level cadres or non-physician clinicians).


Research Partners

Ifakara Health Institute, Tanzania
Eduardo Mondlane University, Mozambique


For further information on this research project please contact Dr Ogenna Uduma, STEM Project Manager.



Project Team Meetings at the Centre for Global Health, TCD (26th January - 1st February 2012)


Back row, from left: Dr Tavares Madede, EMU; Ms Susan Bradley, CGH; Mr Fred Lwilla, IHI; Dr Henry Mollel, IHI; Ms Sara Melo, CGH; Mr Jonas Chambule, IA, Mozambique; Sitting in front, from left: Dr Mohsin Sidat, EMU; Dr Eilish McAuliffe, CGH; Dr Masanja Honorati, IHI.


Project Team Meetings in Arusha, Tanzania (9th - 14th December 2013)

STEM_team meeting

STEM Team with the district representatives.


Other Research Projects

Current Research
Evidence Aid
mHealth for CHWs
Finalised Research
LEARN Project
Max HR
Motivation Project


Last updated 23 November 2016 School Web Administrator (Email).