This thesis of Daniël Birhanu examines the implications of the expansion related to the competence of frontline health workers, and the quality of their education, professional practice, continuous professional development, and regulation. Across six studies, this thesis found that the training expansion exposed systemic gaps. Graduating medical students showed acceptable overall clinical competence, yet significant deficits in procedural, obstetric, and surgical skills. mirrored by junior doctors’ limited participation in several clinical tasks and competence gaps in procedures, research, and health programming.
Many educators lacked the motivation and essential teaching competencies, with most having no formal pedagogical training. Overcrowded and poorly supported clinical placements further constrained students’ skills development. The studies also highlighted the need to foster an institutional quality culture by focusing on staff needs, leadership, human resource development, and decentralized quality assurance, while identifying major regulatory weaknesses, including low registration, licensing renewal, continuing professional development participation, and enforcement capacity.
This thesis collectively underscores the urgent need to strengthen the competence of frontline health workers. A clear, forward-looking vision for health professional education—aligned with health system needs, institutional capacity, and education research—is essential to support workforce expansion. Priority investments include faculty development, student support, effective clinical and simulation-based training, curriculum implementation, quality assurance, accreditation, and licensing. Addressing regulatory and CPD gaps through mentorship, supervision, and orientation is equally critical.
