Health training institutions by country
Overall, there were 4001 health training institutions in the 43 countries that responded as shown in Table 1. One thousand and twenty-eight (26%) of the institutions were located in Nigeria, 870 (22%) in the Democratic Republic of Congo, and 281 (7%) in Tanzania. Four hundred and ten (410) of the 4001 health training institutions (10%) were medical training institutions with the Democratic Republic of Congo, Nigeria and Ethiopia having a total of 190 (46%) of the 410 medical training institutions in the Region (Democratic Republic of Congo—102 (25%), Nigeria—52 (13%) and Ethiopia—36 (36%)). The health sciences training institutions were 1,469 (37% of the health training institutions) with 1104 (75%) of the 1469 health sciences training institutions are located in four (4) countries: Nigeria—714 (49%), Tanzania—185 (13%), Democratic Republic of Congo—110 (7%) and Angola—95 (6%)). Fifty-three percent (2122) of the health training institutions in the Region are for training nurses and midwives. Of this number, 50% (1054) are in the Democratic Republic of Congo (658 representing 31%), Nigeria (262 representing 12%) and Chad (134 representing 6%).
Ownership of training institutions
Table 2 shows that of the 4001 health training institutions in the Region, 2221 (56%) were owned by the public sector, and 44% by the private sector 1359 (34%) by the private for-profit sector and 421 (10%) by private not-for-profit sector). In addition, 53% (2122) of the institutions were nursing and midwifery institutions, 37% (1469) were health sciences institutions, and 10% (410) were medical training institutions. 64% (264) of the 410 medical training institutions were owned by the public sector, 27% (111) by the private for-profit sector, and 9% (35) by the private not-for-profit. For the health sciences institutions, 69% (1015), 25% (367) and 6% (87) are owned by the public, private for-profit and private not-for-profit sectors, respectively.
Production of health workers
A total of 148 357 health workers were produced in the Africa Region in 2018 (Fig. 1). Of this 40% (59, 829) were nurses and midwives, 19% (28, 604) other health workers, and 14% (20 470) physicians. Health information technologists (11 639) and community health workers (11 447) comprised 8%, and laboratory officers and technicians, and dentists and technicians comprised 5% (6727) and 4% (6138), respectively. Forty percent of all health workers were produced by public sector-owned health institutions (n = 59 226) with 54% (n = 10 992) of physicians, 53% (n = 6025) community health workers, 46% (n = 2860) pharmacists and technicians and 43% (25 452) nurses and midwives graduating from public sector-owned schools.
Accreditation mechanisms for training institutions
To ascertain the progress made by countries towards strengthening the capacity and quality of educational institutions through their accreditation of programmes in their training schools, countries were asked to provide information on the availability of a national accreditation mechanism for health training institutions. Figure 2 shows the percentage of countries with accreditation mechanisms in place of the 39 countries that provided information. Thirty-one (31) countries (79%) had an accreditation framework for health training institutions. The countries with accreditation mechanisms were Angola, Botswana, Burundi, Cape-Verde, Central African Republic, Cote d'Ivoire, Democratic Republic of Congo, Eritrea, Eswatini, Ethiopia, Gabon, Ghana, Guinea, Guinea-Bissau, Lesotho, Liberia, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Senegal, Seychelles, Sierra Leone, Tanzania, Uganda, Zambia and Zimbabwe. Algeria, Benin, Burkina Faso, Congo, Mali, Mauritania and Togo (18% of the countries) do not have an accreditation mechanism. Chad was in the process of establishing an accreditation mechanism at the time of the study.