Building mental health workforce capacity through training and retention of psychiatrists in Zimbabwe

Abstract

Despite the need to improve the quantity and quality of psychiatry training in sub-Saharan Africa (SSA), very little is known about the experiences of psychiatric trainees in the region. This is the first study examining psychiatric trainees in a low-income country in SSA. It was carried out as part of the needs assessment for a unique Medical Education Partnership Initiative (MEPI) programme to find African solutions for medical shortages in Africa. We approached all doctors who had trained in post-graduate psychiatry in Zimbabwe in 2010 and conducted in-depth qualitative interviews with all except one (n = 6). We analysed the data using constant comparison and thematic analysis.

Trainees described the apprenticeship model as the programme's primary strength, through providing clinical exposure and role models. Programme weaknesses included shortages in information sources, trainee salaries, trainers, public health education, and in the mental health service. Most respondents were, however, eager to continue practising psychiatry in Zimbabwe, motivated by family ties, national commitment and helping vulnerable, stigmatized individuals. Respondents called for sub-speciality training and for infrastructure and training to do research. Resources need to be made available for psychiatric trainees in more SSA settings to develop public health competencies. However, investment in psychiatry training programmes must balance service provision with trainees’ educational needs. Directing investment towards needs identified by trainees may be a cost-effective, context-sensitive way to increase retention and learning outcomes.

Acknowledgements

A.I., D.C. and M.A. conceptualized the study. M.A. wrote the first draft, and undertook data collection and analysis. A.P. wrote the second draft and undertook analysis. E.B. supervised data analysis, S.N., W.M., D.C, A.C. and F.C. undertook data analysis. H.J. and F.C. and S.N. interpreted and wrote the third draft. All authors edited and contributed to final draft.

Declaration of interest: The Fogarty International Centre, the Office of the Director, National Institute of Health (IR24TW008893-01REVISED) contributed to costs of transcribing, data analysis and write-up through a grant to the University of Zimbabwe, but took no role in study design or interpretation. The authors alone are responsible for the content and writing of the paper.