ZMA Report On The State of Medical Training Institutions in Zambia PDF

Report on the State of
Medical Training Institutions

in Zambia
By
The Zambia Medical Association Medical Education and
Research Board (ZMA-MERB)
Technical Working Group
Dr. Citonje Msadabwe (Consultant Medical Radio-oncologist)
Dr. Mulindi Mwanahamuntu (Consultant ObstetricianGynaecologist)
Dr. Joseph Musowoya (Consultant Surgeon)
Dr. Michael Mbambiko (Consultant Surgeon)
Dr. Jonathan Kaunda Mwansa (Consultant Paediatrician)
Dr. Masiku Phiri (Registrar in Transfusion Medicine)
Professor James Chipeta (Associate Professor of Paediatrics and Clinical Immunology)
March 2019
TABLE OF CONTENTS
Foreword....................................................................................................................................... 2
Acknowledgements....................................................................................................................... 3
Acronyms and Abbreviations……………………………………………………………............ 4
Project Technical Team and Co-authors to the report................................................................... 5
1.0 Executive Summary............................................................................................................. 6
2.0 Introduction......................................................................................................................... 8
3. 0 Assessment Methodology.................................................................................................... 9
3.1 The Scope of the 2018 ZMA Assessment of the State of Medical Training Institutions in
Zambia................................................................................................................................. 9
3.2 Assessment Approach and data collection……………………………………………...... 13
3.3 Data analysis and Interpretation………………………………………………………....... 14
4.0 Assessment Findings........................................................................................................... 15
4.1 Key Findings........................................................................................................................ 15
4.2 Overall and Program Specific Assessment Findings…………………………………....... 15
5.0 Discussion and Summary of Noted Successes and Challenges of the Various
Programs………………………………………………………………………………….. 21
6.0 Recommendations................................................................................................................ 25
7.0 References............................................................................................................................ 26
8.0 Appendices.......................................................................................................................... 28
8.1 Appendix 1. Detailed List of the Zambia Medical Association (ZMA) 2018 Identified
Medical Institutions and their respective training programs……………………………... 28
8.2 Appendix 2. The Medical Training Institution Status Assessment Form............................ 31
8.3 Appendix 3. Assessment Results summary tables............................................................... 38
Report on the State of Medical Training Institutions in Zambia
FOREWORD
The Zambia Medical Association is not for profit voluntary base representative body of medical
doctors practicing in Zambia. With a wide presence in Zambia and membership drawn from the
various fields including academia, the Association seeks to influence policy on health matters in
Zambia. Medical training is a very important component in the quest to promote quality health
care to the Zambian people and the world at large. With the growing number of medical training
institutions and the opening up of more internship sites for medical doctors and the
commencement of the specialty training program for medical doctors across the country, the
Association undertook an assessment of the state of medical training in Zambia. This report
highlights this and offers recommendations on the best practices for the interest of the
stakeholders in medical training.
A group of experts chosen from the members of the Association which included seasoned
academics, consultants and administrators undertook the exercise. The team drew the mandate
from the ZMA Constitution and formulated the terms of reference and developed the
questionnaires to administer. They visited all the ten provinces of Zambia and interacted with
consenting medical schools, teaching hospitals and internship sites and interacted with teachers,
human resource personnel and managers of the institutions. They then had several meetings to
consolidate the findings of the research that they carried out.
This report is presented for all the managers, trainers, trainees and consumers of the products of
medical training as a guide to the quality improvement process. It reflects the current state of
medical training and the Association is hopeful that the relevant stakeholders will take keen
interest in the findings of the research.
Special gratitude goes to Professor James Chipeta (Chairperson), Dr Mulindi Mwanahamuntu,
Dr Michael Mbambiko, Dr Citonje Msadabwe, Dr Jonathan Mwansa and Dr Joseph Musowoya
for the commitment, dedication and sacrifice towards the work that made it possible for this
report to be produced.
Dr. Abidan Chansa (BSc<HB>, MBChB, MMED)

ZMA – PRESIDENT
2
ACKNOWLEDGEMENTS
The 2018 Zambia Medical Association (ZMA) assessment of the state of medical training institutions
in Zambia was made possible through the impeccable commitment to the whole exercise displayed by
the ZMA President, Dr. Abdidan Chansa, and the staff (Ms Angella Munkombwe and Ms Fatumata
Diallo) at the ZMA secretariat led by the ZMA vice president Dr. Sam Chisele. I, thus, on behalf of the
ZMA Medical Education and Research Board Technical Working Group (ZMA-MERB TWG) would
like to express my appreciation to the ZMA president and his team for ably facilitating this arduous and
yet noble work. In addition, this assessment would not have been successful had it not been for the
corporation and exceptional hospitality we received from each of the health training institutions we
visited and assessed in the nine out of the ten provinces (Northern Province, Copperbelt, Central,
Eastern, Luapula, Lusaka, Western, North Western and Southern). In particular we mention here
institutional heads and senior staff of various training sites who facilitated the assessment visits at their
respective institutions – Profesor Seter Siziya (Dean, Copperbelt University School of Medicine),
Profesor Kasonde Oliver Bowa (Founding and immediate past Dean, Copperbelt University School of
Medicine), Professor Peter Mwaba (Dean, Lusaka Apex Medical University School of Medicine),
Dr. Welani Chilengwa (Assistant Dean, Cavendish University School of Medicine), Dr. Gibson
Sijumbila (Dean, Mulungushi University School of Medicine), Professor Trevor Kaile (University of
Zambia School of Medicine), Mr. Emmanuel Makungu (Assistant Registrar, University of Zambia
School of Medicine), Dr. John Musuku (Senior Medical superintendent, UTHs- Lusaka Children
Hospital), Dr. Mutati (Senior Medical superintendent, UTHs- Lusaka Eye Hospital), Dr. Alex Makupe
(Senior Medical superintendent, UTHs- Lusaka Adult and Emergency Hospital), Dr. Maureen
Chisembele (Senior Medical superintendent, UTHs- Lusaka Women and Newborn Care Hospital),
Dr. Chileshe Mboni (HCC, Kitwe Teaching Hospital), Dr. Funjika (HCC, Ndola Teaching Hospital),
Dr. Mwate Mwambazi - Mweene (HCC, Arthur Davison Children Hospital),Dr. John Kachimba
(Senior Medical superintendent, Livingstone Teaching Hospital), Dr. Dominique G. Chimanuka
(Senior Medical Superintendent, Mansa General Hospital), Dr. Humphrey Chanda (Senior Medical
superintendent, Kasama General Hospital), Dr. Mbinga Mbinga (Senior Medical superintendent,
Chipata Central Hospital),Dr. Edward Chilekwa (Director Medical Services, Konkola Mines
Nchanga South Hospital), Dr. Lalick Banda (Senior Medical superintendent, St. Francis General
Hospital),Dr. Victor kesweje (Senior Medical superintendent, Kabwe General Hospital), Dr.
SamutumwaNjekwa (Senior Medical superintendent, Lewanika General Hospital), Dr. Kennedy
Gondwe (Senior Medical superintendent, Solwezi General Hospital), Dr. Siamalambwa (Senior
Medical superintendent, Choma General Hospital), and Dr. Eugene Kaunda (Senior Medical
superintendent, Monze General Hospital). I also acknowledge and appreciate the linkage coordination
facilitation by the respective Provincial Health Directors of each of the visited provinces that was
rendered to our team as well as several moral and technical support we received from many
colleagues, friends and our respective families - the list too long to mention here. Above all we
recognize God's favor on our team that we traversed the massive landscape of our country incident free
and successfully carried out the assessment all by His grace.
Finally, I would like to thank my fellow ZMA-MERB TWG members who worked tirelessly against
many odds and ensured the work was successfully accomplished. The success of the assessment and
this report squarely lies on their incomparable commitment and diligence to the task assigned to us.
Professor James Chipeta (BSc<HB>, MBChB, PhD)

ZMA – MERB TWG CHAIRMAN
3
ACRONYMS AND ABBREVIATIONS
ADCH - Arthur Davison Children Hospital

CBU - Copperbelt University
CBU-SOM - Copperbelt University School of Medicine
COSECSA - College of Surgeons of East, Central and Southern Africa
COSECSA -ORTHO - College of Surgeons of East, Central and Southern Africa
Orthopaedics surgery
ECSACOP - East, Central and Southern Africa College of Physicians
HEA - Higher Education Authority
HPCZ - Health Professions Council of Zambia
FCS - Fellow of College of Surgeons
FCS-SGY - Fellow of College of Surgeons in general surgery
KTH - Kitwe Teaching Hospital
LCH - Lusaka Children Hospital
MBChB - Bachelor of Medicine and Bachelor of Surgery
MMED - Master of Medicine
MMED -ORTHO - Master of Medicine in Orthopaedic surgery
MMED - OBGY - Master of Medicine in Obstetrics and Gynaecology
MMED - URO - Master of Medicine in Urology
MMED - PAEDS - Master of Medicine in Paediatrics and Child Health
MMED - SGY - Master of Medicine in general surgery
NTH - Ndola Teaching Hospital
STP - Specialists Training Program
STP - SGY - Specialist Training in General surgery
STP - PAEDS - Specialist Training in Paediatrics
STP - ORTHO - Specialist Training in Orthopaedics surgery
STP - OBGY - Specialist Training in Obstetrics and Gynaecology
STP – URO - Specialist Training in urology
UTH - University Teaching Hospital, Lusaka
UNZA - University of Zambia
UNZA-SOM - University of Zambia School of Medicine
WHO - World Health Organisation
ZACOMS - Zambia College of Medicine and Surgery
ZMA - Zambia Medical Association
ZMA-MERB - Zambia Medical Association Medical Education and Research Board
4
THE 2018 ZAMBIA MEDICAL ASSOCIATION (ZMA) MEDICAL EDUCATION AND

RESEARCH BOARD (ZMA-MERB) TECHNICAL WORKING GROUP AND CO-
AUTHORS TO THE REPORT
Name Position and Institution Affiliation Status on the

ZMA Technical
Working Group
Consultant Medical Member
Dr. Citonje Msadabwe Radio-oncologist, Cancer Diseases
Hospital, Lusaka
Consultant Obstetrician Gynecologist, Member
Dr. Mulindi Mwanahamuntu University Teaching Hospitals
(UTHs) –Lusaka Women and
Newborn Care Hospital
Consultant Surgeon & Senior Medical Member
Dr. Joseph Musowoya Superintendent, Ndola
TeachingHospital,Ndola (NTH)
Zambia College of Medicine and Member
Surgery(ZACOMS) President&
Dr. Michael Mbambiko Consultant Surgeon, University
Teaching Hospitals (UTHs) –Lusaka
Adult and Emergency Hospital
Consultant Paediatrician& Senior Member
Medical Superintendent, Arthur
Dr. Jonathan Kaunda Mwansa
Davison Children Hospital, Ndola
(ADCH)
Regional Director – Northern Region, ZMA Medical
Zambia National Blood Transfusion Education &
Dr. Masiku Phiri
Service & Registrar in Transfusion Research Board
Medicine, Gronigen University, (MERB) Chair
Netherlands
Associate Professor of Pediatrics and Technical
Clinical Immunology, University Working Group
Professor James Chipeta
Teaching Hospitals (UTH) –Lusaka Chair
Children Hospital & Assistant Dean
Research, UNZA School of Medicine
5
EXECUTIVE SUMMARY
Background
Over the months of November and December 2018, the Zambia Medical Association (ZMA) through
its Medical Education and Research Board (ZMA-MERB) technical working group carried out a
country-wide assessment of medical training institutions with the objective of collecting
data/information that would inform ZMA, the nation, partners and various stakeholders on the state of
medical education in the country. This was in the backdrop of the recent proliferation of medical
schools and several newly introduced postgraduate specialist training programs questioning the
capacity and quality of medical education in the country. The assessment evaluated the state of medical
training institutions in seven thematic areas of governance, academic progression assessment
processes, accreditation and affiliation status, human resource, existence of innovation alongside the
learning and training activities, training resources/funding, and availability of learning/training
facilities. The assessment targeted a total of 23 medical training institutions with a total of 91 training
program activities across all the nine of ten provinces. In total, excluding PhD and public health
programs, only 19 out of the 34 medical training programs offered across all the 23 visited medical
training institutions were assessed. These assessed programs included the undergraduate Bachelor of
Medicine and Bachelor of surgery (MBChB) program, the internships, the postgraduate medical
doctors' master of medicine (MMED) programs for various disciplines, the COSECSA, ECSACOP
and ZACOMS specialist training programs.
Key findings
The assessment, as presented and discussed in details elsewhere in this report, has elucidated the
following key findings with respect to the seven status thematic areas;
Governance: Whereas governance of the programs was well established across all the training
institutions/sites of the respective training programs, there was generally lack of documentation worse
so in public institutions compared to private institutions threatening not only the respective
institutional memory but also weakening the running of the various programs
Academic Progression Assessment Processes: The assessment found strong progression and
assessment processes in each of the training programs across the sites but with generally weak
documentation.
Accreditation and Affiliation Status: The majority of the assessed training institutions did not meet the
required standards of accreditation and affiliation
Human Resource Development Status: Generally, the institutions offering the programs were noted to
have invested in human resource development as well as in its documentation.
Availability of Training Innovations: With a few exceptions training and learning inbuilt innovations
were lacking across the majority of programs”.
Training Resources: Though training resources with respect to human resources for training were
scored adequate across most programs there was noted inadequacies in some programs and sites.
Funding: Funding across all the programs was observed to be inadequate especially in the visited
institutions with the exception of some private institutions. Some programs even had no specific
program budgets.
Adequacy of training Facilities: With a few exceptions, the assessment across all programs and
training sites, found key training facilities such as Library services, specialised lab services,
specialized clinical equipment/Clinical Skills services, and Information and Communication
Technology services for the training activities generally to be either not available or inadequate.
6
Observed successes and Challenges

A close analysis of the assessment noted both successes and challenges across the sites and the
respective training programs. The observed successes included:
(a) the availability of basic minimum infrastructure for training in most programs,
(b) the noted potential multiplier effects of many training programs at various sites entailing that in a
short time the needed targeted specialists national shortfall may be met and thereby providing
solution to the current national health workforce crisis,
(c) the conspicuous benefits and advantages of training institutions with linkages and multiple
partnerships, and
(d) the noted strong available academic progression and assessment processes across all the
programs.
On the other, hand the noted challenges that the assessment revealed included:
(a) lack of training dedicated support staff across all the programs especially the STP sites,
(b) Lack of accreditation and affiliation status with appropriate regulatory and professional bodies of
most training programs and their respective training sites,
(c) Poor documentation in all the thematic areas and programs affects institutional memories and
renders programs at risk,
(d) the human resource across all programs especially in public institutions has challenges especially
in governance related issues that puts the long-term sustainability at risk,
(e) the low presence of innovation in each program limits the optimum success of the programs,
(f) non-availability of specific funding renders some programs at risk of unsustainability, and
(g) the generally inadequate appropriate training facilities across all programs especially the post
graduate programs.
Recommendations
The report extensively discusses these findings and has identified appropriate recommendations that
are both across all the training programs as well as program specific. It is observed that maximizing on
the noted successes while addressing the various challenges will go a long way in attaining and
maintaining high medical education systems in the country and thereby assuring the country of
provision of adequate competent health workforce to effectively and successfully attain universal
health coverage.
7
INTRODUCTION
1 2
Working within its constitutional and current 2016 -2021 strategic plan mission of participating in the building
of a healthy and productive nation by promoting high standards of medical practice and influencing policy and
public opinion on health matters in Zambia, the Zambia Medical Association (ZMA), in 2018, tasked its Medical
Education and Research Board (ZMA-MERB) to carry out an assessment of the state of all medical doctors
training institutions in the republic of Zambia. ZMA is cognisant of the various factors that hamper the full
attainment of both high standards of medical practice and quality health care in Zambia and on the continent of
Africa. These factors as reported elsewhere3-11 include the unacceptable imbalance between disease burden and
respective health workforce on the continent. Africa contributes only 3% of the World health workforce despite
suffering 24% of the world's disease burden3.Indeed, various health professionals are required to have functional
health systems of any community or country and critical of these are medical doctors who serve as clinicians,
managers, trainers, and policymakers. The quality and various necessary competencies of this critical mass of
7-11
health workforce is not only important but also cardinal for effective health service delivery .What guarantees
both adequate numbers and high quality health workforce are the capacity of respective production lines, the
medical training institutions of respective countries. It is in this context that ZMA primarily sought to assess the
current state of medical training institutions in the republic of Zambia so as to ascertain the capacity of the
institutions to provide adequate and high quality health workforce for Zambia and the region.
12,13
Until recently Zambia depended on a single medical school (the University of Zambia School of Medicine -
UNZA-SOM, founded just after independence in 1967) with its affiliated only teaching hospital, the University
Teaching Hospital, Lusaka(UTH) for the training and provision of medical doctors. In addition, for a long time
there were only two other hospitals besides UTH - Ndola Central Hospital and Kitwe Central Hospital, that could
offer internship for the new graduate medical doctors. Over the years, this was not sufficient for the rapidly
growing national population. This weak capacity of the medical school to meet the medical workforce needs of
the growing Zambian population was worsened by the fact that the medical school was also training medical
doctors for countries in the region with no medical schools at that time, especially immediate after independence
and in the South African apartheid era, including Malawi, Namibia, Botswana, Lesotho, and Swaziland.
However, this scenario over time, has changed in the country with the proliferation of both private and public
universities alongside the establishment of new medical schools12, 13. Just in the past 5 -10 years, five new medical
schools have emerged two of which are public(Copperbelt University school of medicine and Mulungushi
University school of medicine) and three are private (Lusaka Apex Medical University school of medicine,
Cavendish University School of medicine, and Texila American University school of medicine). More are in the
pipeline. Besides the proliferation of medical schools there has been a remarkable increase in the number of
medical institutions (Hospitals) offering internship and other postgraduate medical education programs. By
2018 there were 23 medical training institutions/Hospitals offering internship and other postgraduate programs
(refer to appendix1 for details of these facilities and respective training programs). Besides the traditional
medical schools, various local and regional professional bodies have innovatively come on board to train and
produce health professionals at specialist level. These, as detailed in box1 and appendix1 include;1) the now well
established College of Surgeons of East, Central and Southern Africa (COSECSA) that trains various surgical
specialists, 2) the recently established Zambia College of Medicine and Surgery (ZACOMS) that trains various
health workforce specialists, and the just ushered in East, Central and Southern Africa College of Physicians
(ECSACOP) that has begun training physicians. This unprecedented explosion of medical education activities is
not unique phenomenon to Zambia but appears to be a common trend on the African continent in the past two
decades14- 17 and has reportedly been associated with various quality assurance related problems in the training of
medical doctors. These noted problems include 1)over enrolment of students without adequate resources,
2)weak medical education systems such as lack of qualified faculty, 3)poor funding, and 4)weak or none
existence of monitoring and evaluation systems. This in many instances, elsewhere, has led medical educational
systems to suffer major setbacks.
8
To avert these invertible setbacks of growth, recently there has been robust enhancement and strengthening of
the Health Professional Council of Zambia (HPCZ) at Ministry of Health level besides establishing the Higher
Education Authority (HEA) by the Ministry of Higher Education. These two regulatory bodies are mandated and
enhanced to foster improvement in both the quality of medical education and practice in the country. However,
these two bodies are primarily regulatory in nature and fall short of advocacy and actual facilitation of improved
th 18
medical education and practice in the country. It is in this context that ZMA on 24 November 2017 engaged
various stakeholders and partners of the medical training fraternity with the aim of getting feedback on the state
of medical training institutions in the country. This consultative meeting, among other recommendations,
recommended the need for ZMA to independently carry out research/a snap survey of all medical training
institutions in order to objectively ascertain the state of medical training institutions. This recommendation was
19 th
upheld in a follow up ZMA-Medical schools deans' meeting a year later held on 14 November 2018. It was
envisioned that such a survey would yield results that could inform various ZMA advocacy activities. Thus
on20thNovember 2018 a task team of consultants chaired by Professor James Chipeta of the University Of
Zambia School Of Medicine was appointed with specific terms of reference to collect data on the state of
medical training institutions throughout the country.
ASSESSMENT METHODOLOGY
The Scope of the 2018 ZMA Assessment of the State of Medical Training Institutions in Zambia
The overarching objective of the 2018 ZMA medical institutions assessment was to collect data/information that
would inform ZMA and its related stakeholders on the state of all medical training institutions in the country. The
'state' of medical institutions was defined by seven thematic areas including governance, Academic Progression
Assessment Processes, accreditation and affiliation status, Human resource, Innovation in the learning and
training activities, training resources/funding and existing learning/training facilities. These were the main
focus and terms of reference of the assessment. The assessment targeted a total of 23 medical training
institutions with a total of 91 training program activities across all the ten provinces of Zambia except Muchinga
province where by the time of the assessment there was no training medical institution (Table 1). The assessment
visits to these sites were carried out over a period of close to three weeks (22 November – 10th December, 2018).
Apart from the various public health programs and PhD programs, there are a total of 34 medical training
programs in Zambia being offered at the various 23 medical training institutions (Box1 and see Appendix1 for
details). All these 34 programs were targeted for the assessment.
Table 1. Coverage of the 2018 ZMA Assessment of the state of Medical Institutions in Zambia
Province Number of Number Of Period of the ZMA
Assessment Visit Programs 2018 Assessment
Targeted Visits
Institutions
Central 1 1
Copper belt 5 28
Eastern 2 5
Luapula 1 4 22nd November –
Lusaka 10 43 10th December 2018
Northern 1 2
Southern 2 6
Western 1 1
North Western 1 1
TOTAL 23 91
9
10
Assessment Approach and data collection

The assessment employed both quantitative and qualitative approaches including 1)Desk reviews with reference
to terms of reference relevant documents and literature, 2)On site visits of targeted training institutions/medical
schools to collect physical information and data respective of the terms of reference of the assessment,
3)Qualitative snap analysis (utilizing in-depth interviews of respective institutions' key personnel) of the current
training institutions medical education learning environment focusing on Human resource, Student welfare,
infra-structure, learning and training resources/facilities and curricula.
The work of the assessment began with a comprehensive literature review and a series of meetings by the
appointed technical working group to develop data collecting tools. Primary data from the desk reviews as well
as data of the site physical visit verifications of the respective institution training/learning facilities was collected
by using a developed data collection form (see Photo plates C to E and for details of the assessment form
appendix 2) covering all the seven assessment focused thematic areas. Site visits were conducted to all the 23
medical training institutions gathering on-site and largely qualitative information about the running of the
respective medical training programs at each of the visited sites. In-depth interviews were audio recorded in
transcribed formats. The participating institutions were as listed in appendix1. The ZMA appointed technical
working group of six consultants was divided into two teams with one team, the Northern team, comprising Dr.
Mbambiko, Dr. Mwanahamuntu and Professor Chipeta covering the Copper belt, Luapula and Northern
Provinces sites while the second team, the Southern team, comprising Dr. Mwansa Kaunda, Dr. Msadabwe and
Dr. Musowoya covered the Southern, Eastern, Central, Western and North-Western provinces (See Photo plates
A and B). Lusaka province was covered by both teams. The assessment site visits followed a semi-structured
interview protocol, and included meetings with institution senior administrative members of staff, key faculty
members, and students. Each site visit included a physical onsite tour of the learning/training facilities and
concluded with an audio recorded structured in-depth interviewof institutional senior administrative members
of staff, students and key faculty.
Photo Plate A: The 2018 ZMA Medical Education and Research Board Technical Working Group Consultants –
the Southern Team (Dr. Joseph Musowoya - Right, Dr. Citonje Msadabwe- in the middle, and Dr. Jonathan
Kaunda Mwansa - left)
11
Photo Plate B: The 2018 ZMA Medical Education and Research Board Technical Working Group Consultants –
the Northern Team (Dr. Mulindi Mwanahamuntu - Extreme Right, Professor James Chipeta in a black Jacket,
and Dr. Michael Mbambiko on Prof. Chipeta's immediate right)
Photo Plate C: A Desk review session at an assessment site - the Northern Team at Mansa General Hospital
12
Photo Plate D: Site facility assessment visit - the Northern Team at Konkola Copper Mine Nchanga South
Hospital, Chingola, Copperbelt
Photo Plate E: Site Facility assessment visit - the Southern Team at St. Francis General HospitalHospital,
Katete, Eastern Province
13
Data analysis and Interpretation
The collected data was entered into crude analysis tables first and then computed using excel software into
results summary tables profiling the training/learning capacity status of each assessed institution with regard to
the seven thematic areas. For the quantitative part of the collected data, state of each thematic area was
expressed in percentages with regard to both availability as well as documentation of the respective assessed
training/learning systems. Meanwhile collected qualitative data was expressed in form of 'adequacy' or
'inadequacy'. Prior to the data computations and analysis the tasked technical working group team came up, by
consensus discussions, with definitions as well as bench marks for acceptable percentages of
availability/documentation and adequacy/inadequacy in each of the seven thematic areas. These defined bench
marks are stipulated in table2.These consensus definitions resolutions were based on extensive literature
review14, 20 - 22. Indeed the commonly used acceptable rates such as the faculty –student ratio are evidence –based.
It is well observed that medical schools with favourable faculty –student ratios tend to be high performing
schools in medical education outputs compared to those with unfavourable rations.
Table 2. Acceptable Bench marks defining adequacy and inadequacy of the various assessment thematic areas.
Assessment Thematic Baseline Bench Marks

Area
Acceptable availability of governance systems at 75%
and above is considered adequate and minimum
Governance availability of governance is at 50%.
Acceptable Documentation of Governance related

system is at 50 % or above
Academic Progression Acceptable availability is at 80% and above
Assessment Processes Acceptable Documentation is at 80% and above
Accreditation and Acceptable Accreditation is at 100 %
Affiliation Status Documentation 80 %
Human Resource Adequacy is at 75 % and acceptable minimum is at
Development Status 50%
Documentation 50%
Availability of Training Adequate Availaibility is 50 %

Innovations Documentation is at 50%
Training Resources and Full Time faculty: Student ratio was based on WHO
Sources of Funding standards
undergraduate 1:20
Post Graduate 1: 5
Budget (Relative to respective programs)
Adequacy of Facilities Adequacy was considered as a score of at least 5 of the
available total of 7 assessed facility systems (Hence 70% and
above)
14
ASSESSMENT FINDINGS
With the afore described assessment approach, the tasked technical working group carried out assessment visits
to all the 23 medical training institutions in 9 provinces managing to assess the state of 19 out of the 34 targeted
medical training programs. Appendix3 of this report presents detailed results summary tables profiling the state
of the assessed medical training institutions with respect to the seven thematic areas. Here a synopsis of key
findings, overall trends and state of Specific Training Programs of respective Institutions is presented.
Key Findings
1. Governance: Generally, all the programs have well established governance systems. Documentation of
the existing governance systems was however lacking in most programs. Lack of documentation was
worse in public compared to private institutions.
2. Academic Progression and Assessment Processes: Academic progression and assessment processes
were in place across almost all the programs. Despite the strong progression and assessment processes,
there was weak documentation at one of the programs (STP ophthalmology at Kitwe Central Hospital)
3. Accreditation and Affiliation Status: Generally, the institutions did not meet the required standards of
accreditation and affiliation
4. Human Resource Development Status: Generally, the institutions offering the programs have
invested well in human resource development as well as documentation of the programs.
5. Availability of Training Innovations: A few institutions did quite well in innovative methods of
teaching whereas the bulk of the institutions have not invested in innovative teaching methodologies
with complete absence in some programs (MMED in Surgery at the Copperbelt University).
6. Training Resources: Generally, Human resources for training were adequate in most programs with the
exceptions of Chipata Central internship program, Kasama General Hospital in all the programs, and
Mulungushi University and Lusaka Apex Medical University for MBCHB. There were a few centres
that had a very high faculty trainee ratio (some programs in the UTHs)
7. Funding: Generally, funding for all the programs was inadequate with the exception of some private
institutions reporting adequate funding for their programs. The specialist training programs reported no
specific budget line whatsoever.
8. Adequacy of Facilities: Library services, specialised lab services, Amenities for Student welfare,
specialised clinical equipment, Clinical Skills services and Information and Communication
Technology services for the training activities are generally either not available or inadequate across all
programs except for MBCHB at Mulungushi and Cavendish Universities and relatively the specialist
training program in Clinical Oncology at the Cancer Diseases Hospital.
Overall and Programs Specific Training Assessment Findings

Overall
Details of the training programs specific assessment findings both overall across the sites as well as per each
assessed training institution are presented by the respective programs summary tables in appendix 3. Using the
average faculty to student ratios across the visited sites, Table 3 summarizes the state of each assessed training
program with regard to the availability of Human Resource/training resources. The assessment found that,
generally, the majority of the programs except MMED – Urology (1:12) at both UTH/UNZA school of medicine
(UTH/UNZA-SOM) and the Copperbelt University School of Medicine (CBU-SOM),MMED-Pathology (1:6)
at UTH/UNZA-SOM , FCS- General Surgery (0:4) at 4 visited sites (Chipata Central Hospital, Kitwe Teaching
Hospital, Ndola Teaching Hospital and Nchanga South Mine Hospital), and FCS – Orthopaedics (0:3) at
Nchanga South Mine Hospital were within the set bench marks of acceptable ratios. The common phenomenon
of the programs found with unacceptable ratios was that they were all predominantly staffed with part time
faculty with the COSECSA/FCS programs having virtually no full time staff while the pathology and urology
15
programs each had only one fulltime faculty member. As expected in these programs the students bemoaned lack
of contact time with their respective consultants.
Table 3. Summary Table of Overall Faculty- Student Ratios of the Assessed Medical Training Programs
Assessed Training Program Number of Training Faculty: Student Ratio

Institutions assed
MBChB 5 1:14
Internship 14 1:2
MMED Paediatrics and child health 1 1:5
MMED Obstetrics and gynaecology 2 1:5
MMED General Surgery 1 1:3
MMED Urology 2 1:12
MMED Ophthalmology 1 1:1
MMED Pathology 1 1:6
STP General Surgery 5 1:1
STP Orthopaedics 3 1:1
STP Pathology 1 2:1
STP Paediatrics and child health 7 1:1
STP Radiology 1 1:2
STP Urology 2 1:2
STP Clinical Oncology 1 1:1
STP Internal Medicine 8 1:2
STP Obstetrics and gynaecology 7 1:1
FCS General Surgery 4 0:4
FCS Orthopaedics 1 0:3
Figures 1-3 profiles, respectively, the state of Governance & Academic progression, Accreditation & Human
Resource, and incorporation of Innovation of the assessed training programs among the various visited sites. All
the 19 training programs across the visited 23 sites overall met the minimum governance systems availability of
50% and the majority also met the acceptable availability of governance of 75 %( Figure1). The strongest
governance systems scores were observed with the MMED –general surgery (100%availability and
70%documentation), MMED-Pathology (100%availability and 38%documentation) and MMED-
Ophthalmology (100%availability and 100%documentation). Similarly the majority of programs across the
sites scored acceptably having academic progression processes in place both in terms of availability as well as
documentation (Figure1). All the training programs, on average, across the sites score the adequacy level of 75%
and above in terms of availability as well as the meeting acceptable documentation level of 50% (Figure2).
However, all the programs except MMED-Pathology and MMED- Ophthalmology did not meet the acceptable
standard of accreditation both in terms of availability and documentation. Similarly innovation incorporation in
the learning/training activities was scored lower than acceptable standards in all programs except in STP-
Clinical oncology, STP-Pathology, MMED Pediatrics, MMED – Ophthalmology, and MMED Pathology.
These findings of the performance of the 19 assessed medical training programs with regard to the seven
thematic areas are further highlighted at the individual program level in the narratives as detailed in the
narratives of the results summary tables in appendix 3.
16
Figure 1. Overall Governance and Academic Progression Systems status Profiles of Respective Medical training Programs at various medical training
institutions in Zambia
17
Figure 2. Overall Accreditation and Human Resources status Profiles of Respective Medical training Programs at various medical training institutions in
Zambia
18
Figure 3. Overall Innovationstatus Profiles of Respective Medical training Programs at various medical training institutions in Zambia
19
Programs Specific Findings

The findings of the performance of the 19 assessed medical training programs with regard to the seven thematic
areas are further highlighted at the individual program level (Internship, MBChB, COSECSA, MMED,
ZAMCOM and ECSACOP programs) as summarized in table 4 and in the followingrespective narratives. The
detailed findings are as in the results summary tables in appendix 3.
Table 4. Summary thematic areas mean results scores across the five assessed training Program categories
Training Number Number of Governance Academic Accreditation Human Training Funding

Programs of Sites Systems Progression Status Resource Innovations Status
Category Training For the (%A±SD) Systems (%A±SD) Development (%A±SD) (%A)
Programs Programs (%A±SD) (%A±SD)
Assessed
MBChB 1 5 92±11.7 100±0 80±24.5 95±10 83.4±14.8 40
Intership 1 14 75.1±11.8 81.3±22.8 65.5±17.8 89.3±15.6 52±32.01 14.3
ZACOMS 9 21 73.6±4.7 86.1±10.3 55.1±20.9 90.3±8.2 56.6±24.6 8.7
STPs
UNZA & 6 2 93.2±7.8 89.5±7.8 81.3±13.9 100±0 65.3±38.0 41.7
CBU
MMEDs
COSECSA 2 5 70.5±0.5 68.0±11 62.5±12.5 78±3 29.0±4 12.5
Fellowships
Overall 19 23 80.5±11.0 85±11.5 66±20.7 92.3±8.7 57.6±29.8 18.6
Note: ‘A%’ denotes percentage availability of the required adequacy of the respective training resource while ‘SD’ is the calculated
statistical Standard deviation of the respective mean.
Bachelor of Medicine and Bachelor of Surgery (MBChB) Programs

All the assessed five medical schools (UNZA School of medicine, CBU, LAMU, Cavendish and Mulungushi
University School of Medicine offering MBChB, generally had adequate governance processes (overall
average 92%) and documentation (76%) and all the institutions were adequate in both processes and
documentation. Highest scoring was in the private institutions. They also all generally have invested well in
human resource development as well as documentation. Generally, Human resources for training are adequate
with an average ratio of 1:14 for the programs across the five schools. UNZA School of Medicine had the most
adequate faculty: student ratio at 1:10 while Mulungushi University and Lusaka Apex Medical University with
ratios of 1:25 each did not meet the standard of faculty student ratio of 1:20. Public universities need to improve
in governance processes and especially documentation. The five institutions, however, did not meet the required
accreditation status standard that was generally poorer performance in the government institutions. Generally
funding the program was inadequate among public institutions with private universities reporting adequate
funding. Library services, specialized lab services, Amenities for Student welfare, specialized clinical
equipment, Clinical Skills services and Information and Communication Technology services for the training
activities are generally either not available or inadequate in both public and private institution sites. Investment
into these areas needs to be made to ensure quality of training. The general MBCHB program, scored 14%.
Internship
Overall the 14 internship sites were very strong in Human Resource Development (89%) and its full-time
faculty student ratio stood at ratio of 1:2. ADCH, NTH and LCH on the other hand did very well in governance
and academic progression despite the general poor performance by all. However, the program did very badly in
accreditation, affiliation and innovation. Facilities were overly inadequate except for ICT services, we however,
note that UTH and Mansa General Hospital were better than the others. In addition, close scrutiny of the
20
internship training sites outside the line of rail, in institutions other than the central and major tertiary hospitals,
revealed an apparent weakness in the seemingly acceptable faculty- student ratios in that invariably at all the
sites the number of consultants or senior clinicians was not even across the intern targeted clinical departaments
of internal medicine, paediatrics, obstetrics and gynaecology, and surgery with some departments being either
Senior House Officer (SHO) or General Practitioner (GP) led negating the essence of effective internship
program rotations.
The COSECSA Programs

The College of Surgeons of East Central and Southern Africa (COSECSA) training programs have been in
existence in Zambia for some time now and during this assessment two of its programs (COSECSA –
Orthopedics and Fellowship of the College of Surgeons-FCS) in five sites were assessed. The programs showed
inadequacy in most of the thematic areas except Governance and Human resource development. The program
has neither full-time faculty nor support staff and depends entirely on part-time staff. Hence the Faculty to
student ratio averaged 0:4. In addition there is no defined funding to the programs in the respective training sites.
The ZACOMS Programs

The Zambia College of Medicine and Surgery (ZACOMS) Specialist Training Program (STP) is a
newlyestablished initiative of training various medical specialists across the country. During this assessment
nine of its programs (STP-Urology, STP- Radiology, STP-Pathology, STP-Clinical Oncology, STP-Internal
Medicine, STP-Paediatrics and Child Health, STP-OBGY, STP-Orthopaedics surgery, and General
surgery)were assessed in 21 sites. Its inherent innovation of having a potential multiplier effect and thereby
achieving higher yield of specialists in a short time was apparent in this assessment. 2018 was its first inaugural
year and already it has more training sites than any other program. However, though it scored strongly in human
resource development and academic progression, it was found inadequate in the other thematic areas especially
funding where there was virtually no defined funding systems for the program. In addition faculty distribution,
specialist training resources and innovation across the training sites are uneven questioning the stability and
long term sustainability of the program.
The MMED Programs

The Master of Medicine (MMED) is the oldest of all the postgraduate medical training programs in the country
and currently trains medical doctors at specialist level in all the major disciplines of medicine including several
subspecialty areas. In this assessment six of the programs (MMED –Paediatrics and Child Health, MMED –
Urology, MMED-OBGY, MMED-Pathology, MMED-Ophthalmology, and MMED- General Surgery) were
assessed at two sites. The program scored strongly in most of the seven thematic areas but was weak in funding
resources and innovation. In addition, though it registered adequate faculty to student ratios across the programs,
some individual programs showed unacceptable levels such as the MMED pathology.
DISCUSSION AND SUMMARY OF NOTED SUCCESSES AND CHALLENGES OF THE VARIOUS

MEDICAL TRAINING PROGRAMS
The 2018 ZMA assessment of medical training institutions in the republic of Zambia, as reported here, has
revealed a number of key findings on the state of medical training institutions that will not only inform ZMA in
its advocacy activities but will also provide base information on the state of medical education in the country for
all interested stake holders – training institutions, cooperating partners and the general public. The assessment
has revealed a number of successes and challenges of the existing medical training programs as summarized in
21
box 2.The key findings of acceptable existence of governance, academic progression processes and favorable
faculty to student ratios are important to note here. Alongside these noted strengths of the current state of
programs are the noted successes as listed in box2. As presented at the beginning of this report medical education
in Zambia was limitedfor a long time being solely dependent one medical school and only three teaching
hospitals. It is thus a huge success that within the past 5-10 years, five medical schools have emerged coupled
with three professional bodies coming on board offering medical training services. The latter have extended
their respective training sites beyond the traditional medical schools and teaching hospitals resulting into a total
of 23 active medical training sites. The multiplier effect of this innovative approach cannot be overestimated.
Going the traditional way would take this country probably another 50 years to have another 2000 medical
graduates but with this approach probably just 15 -20 years even if say only 5 specialists were to graduate from
each of these 23 training sites annually. This multiplier effect has been documented elsewhere in another sub-
Saharan country, Nigeria, with positive results of attaining high numbers of required health workforce16. Indeed
Professor Friday E Okonofua, in a recent review of postgraduate medical education in Nigeria, has reported that
this innovative approach has helped the county train thousands of specialists in a relatively short period of time.
The other success noted by this assessment is the observations that the training programs with strong linkages
and partnerships tended to perform better with respect to scores in the seven assessed thematic areas. Indeed the
program with highest scores, STP-ophthalmology at Kitwe teaching hospital, was also found to be a well linked
program both locally and internationally. This phenomenon has been reported elsewhere in a report of a similar
14, 15, 16, 17,20,21,22
assessment of medical schools in the SADC region .
However, the assessed programs were not without challenges. Foremost of these challenges as also charted in
box2 included human resource related issues, inadequate funding, accreditation status issues and lack of and
inadequate facilities in particular specialized laboratory services and specialized equipment for the respective
training programs. These findings have been also reported elsewhere in the region 14 -17 and they tend to be the
main factors negatively affecting medical education services. As noted in the background to this report, central
to the attainment of health equity is having in place strong health systems which are in most cases hampered by
lack of human resources. Medical doctors are a critical core component of the human resource pool and our
continent needs clinicians in large numbers but at the same time we must ensurethe quality and relevance of our
medical training institutions graduates. This calls for strong medical education systemswith strong medical
training institutionsthat have less of these noted challenges. Indeed not addressing such challenges results into
poor medical education outcomes including low quality of the health workforce. This can negate even the
multiplier effect of producing adequate health workforce discussed here in this report. Indeed, in the same
16
report of the Nigerian experience Professor Okonofua bemoans the fact that despite mass productions of
health specialists over the years, Nigeria's health service delivery is poor and is least ranked by WHO at 187/192
in the world. It is also generally noted that Non-Availability of specific funding renders some programs at risk of
unsustainability. Thus these noted challenges must be curbed for effective and productive medical education
systems that can meet the needs of our society.
22
23
Photo Plate F: Some impressive new institutional infrastructure found during the assessment Visits – The
Michael Chilufya Sata School of Medicine for Copperbelt University in Ndola, Zambia
Photo Plate G: Some impressive health service equipment found during the assessment site visits– The Renal
Unit at Mansa General Hospital
24
All spaces MUST be filled in.

?
Interviewer Code:
?
1.0 General Questionnaire Particulars
1.1 Name of Institution:
1.2: Province:
1.3 District:
1.4 Assessment Program: MBChB Internship MMED STP

COSECSA Fellowship
1.4 Date:
D D M M Y Y
2.0 Questionnaire on Current Training Institution Status

(This Questionnaire's respondents must preferably be key faculty members running the respective programs
besides the institutional administrators)
32
REFERENCES
1. Zambia Medical Association (ZMA) Constitution and Policy Statements, Lusaka, Zambia: ZMA 2009
2. Zambia Medical Association: Working toward a Healthy and Productive Nation Through Motivated
Doctors that Uphold Professionalism and Excellence -Strategic Plan 2016 – 2021; ZMA February 2016.
3. WHO. Working together for health; the World Health Report 2006. Geneva: World Health
Organization, 2006.
4. Ferrinho P, Siziya S, Goma F, Dussault G. The human resource for health situation in Zambia: deficit
and maldistribution. Hum Resour Health. 2011; 9(1):30. [PubMed: 22182366]
5. World Health Organization. [Accessed February 21, 2019] Country Data Profile on the Pharmaceutical
Situation in the Southern African Development Community (SADC): Zambia. 2010. http://
apps.who.int/medicinedocs/documents/s17217e/s17217e.pdf 4.
6. World Bank. World Bank Working paper no 24. Washington, The World Bank; 2011. The Human
Resources for Health Crisis in Zambia: An Outcome of Health Worker Entry, Exit, and Performance
within the National Health Labor Market. http://elibrary.worldbank.org/doi/book/ 10.1596/978-0-
8213-8761-0 [Accessed February 21, 2019]
7. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new cen-
tury: transforming education to strengthen health systems in an interdependent world. The Lancet.
376(9756): 1923–58. DOI: https://doi.org/10.1016/ S0140-6736(10)61854-5
8. Kasper J, Bajunirwe F. Brain drain in sub-Saharan Africa: contributing factors, potential remedies and
the role of academic medical centres. Arch Dis Child. 2012 Nov; 97(11):973–9. [PubMed: 22962319]
9. WHO.The Kampala declaration and agenda for global action. 2008; Available from:
https://www.who.int/workforcealliance/Kampala%20Declaration%20and%20Agenda%20web%20fi
le.%20FINAL.pdf
10. WHO. Report on the WHO/PEPFAR planning meeting on scaling up nursing and medical education.
Geneva: World Health Organization, 2009. http://www.who.int/hrh/resources/scaling-up_
planning_report.pdf (accessed February 21, 2019).
11. WHO. Global strategy on human resources for health: Workforce 2030.Available from:
https://apps.who.int/iris/bitstream/handle/10665/250368/9789241511131-eng.pdf?sequence=1
12. Simuyemba M, Talib Z, Michelo C, Mutale W, Zulu J, Andrews B, Nzala S, Katubulushi M, Njelesani
E, Bowa K, Maimbolwa M, Mudenda J, Mulla Y. Strengthening faculty recruitment for health
professions training in basic sciences in Zambia.Acad Med. 2014 Aug;89(8 Suppl):S98-S101. doi:
10.1097/ACM.0000000000000352.
13. Michelo C, Zulu JM, Simuyemba M, Andrews B, Katubulushi M, Chi B, Njelesani E, Vwalika B, Bowa
K, Maimbolwa M, Chipeta J, Goma F, Nzala S, Banda S, Mudenda J, Ahmed Y, Hachambwa L, Wilson
C, Vermund S, Mulla Y. Strengthening and expanding the capacity of health worker education in
Zambia.Pan Afr Med J. 2017 Jun 7;27:92. doi: 10.11604/pamj.2017.27.92.6860. eCollection 2017.
14. Mullan F, Frehywot S, Omaswa F, Buch E, Chen C, Greysen SR, et al. Medical schools in sub-
Saharan Africa. Lancet. 2011 Mar 26; 377(9771): 1113–21. PubMed PMID: 21074256. DOI: https://
doi.org/10.1016/S0140-6736(10)61961-7
15. The SAMSS team (2009). The Sub-Saharan African Medical School Study Data, Observation, and
O p p o r t u n i t y. h t t p s : / / w w w. k 4 h e a l t h . o rg / s i t e s / d e f a u l t / f i l e s / S u b -
Saharan%20African%20Medical%20School%20Study.pdf
16. Friday E Okonofua. Postgraduate medical education in Nigeria: Past, present, and
Future.https://www.researchgate.net/publication/325713660_Postgraduate_medical_education_in_N
igeria_Past_present_and_future (Accessed February 21, 2019)
17. Ahmed Hassan Fahal. Medical Education in the Sudan: Its Strengths and Weaknesses. Medical
Teacher; December 2007 DOI: 10.1080/01421590701812991
18. Zambia Medical Association (ZMA). Report on the Postgraduate Training in Zambia Symposium
Held at Fringilla on 24th Novemebr 2017.ZMA 2017
26
19. Zambia Medical Association (ZMA). Minutes of the Stakeholder's Meeting On Medical Education
In Zambia Held On the 14th November 2018 at Mika Lodge, Lusaka. ZMA 2018
20. .Kiguli-Malwadde E, Talib ZM, Wohltjen H, Connors SC, Gandari J, Banda SS, Maggio LA, van
Schalkwyk SC. Medical education departments: a study of four medical schools in Sub-Saharan Africa.
BMC Med Educ. 2015 Jul 1;15:109. doi: 10.1186/s12909-015-0398-y.
21. Bowser D, Abbas Y, Odunleye T, Broughton E, Bossert T. Pilot study of quality of care training and
knowledge in Sub-Saharan African medical schools.Int J Med Educ. 2017 Jul 24;8:276-282. doi:
10.5116/ijme.595b.b38c.
22. Candice Chen , Eric Buch , Travis Wassermann , SebleFrehywot , Fitzhugh Mullan , Francis Omaswa ,
S Ryan Greysen , Joseph C Kolars , DelanyoDovlo , DiaaEldin El Gali Abu Bakr , Abraham Haileamlak
, Abdel Karim Koumare and EmiolaOluwabunmiOlapade-Olaopa. A survey of Sub-Saharan African
medical schools. Human Resources for Health 2012, 10:4 http://www.human-resources-
health.com/content/10/1/4
27
APPENDICES
APPENDIX 1: Detailed List of the Zambia Medical Association (ZMA) 2018 Identified Medical Institutions and their respective training
programs
PROVINCE SERIAL INSTITUTION TRAINING PROGRAM

NUMBER
1 Copper belt University School of 1. Bachelor of Medicine and Bachelor of
Medicine surgery (MBChB)
2. Master of Medicine (MMED) in
Copper belt Surgery
Urology
Obstetrics and Gynaecology
Arthur Davison Children Hospital 1. Bachelor of Medicine and Bachelor of
2 surgery (MBChB)
2. Specialist training Program ( STP) in
Paediatrics
3. Internship
1. Bachelor of Medicine and Bachelor of
surgery (MBChB)
2. Specialist training Program (STP) in
Paediatrics
Kitwe Teaching Hospital 3. Specialist training Program (STP) in
3 surgery
Internal medicine
ophthalmology
obstetrics and gynaecology
Urology
orthopaedic surgery
9. FCS –general Surgery
10. Internship
4 Ndola Teaching Ho1spital 1. Bachelor of Medicine and Bachelor of
surgery (MBChB)
surgery
Internal medicine
Urology
6. COSECSA –Orthopaedics surgery
orthopaedic surgery
9. Internship
5 Kokola Copper &Nchanga South 1. Internship
Mine Hospitals 2. FCS –general Surgery
28
6 University of Zambia School of 1. Bachelor of Medicine and Bachelor of

medicine & the University surgery (MBChB)
Teaching Hospitals (UTHs) 2. Master of Medicine (MMED) in
Lusaka Paediatrics and Child Health
Urology
Pathology
ophthalmology
Neurosurgery
Anaesthesiology
internal medicine
10. Master of Medicine (MMED) in general
surgery
Paediatrics surgery
Lusaka paediatrics surgery
Infectious Diseases
neurology
Pyschiatry
7 University Teach5ing Hospitals 1. Specialist training Program (STP) in
(UTHs) –Adult and Emergency general surgery
Hospit6al 2. Specialist training Program (STP) in
Internal medicine
Urology
Pathology
Anaesthesiology
orthopaedic surgery
Radiology
neurosurgery
paediatric surgery
10. COSECSA –Orthopaedics surgery
12. Internship
29
8 University Teaching Hospitals – 1. Specialist training Program (STP) in

Women and New born care obstetrics and gynaecology
Hospi8tal 2. Internship
9 University Teaching H9ospitals – 1. Specialist training Program (STP) in
Lusaka Children Hospital paediatrics and child health
2. Internship
10 University Teaching Hospitals – 1. Specialist training Program (STP) in
Lusaka Eye Hospital ophthalmology
2. Internship
11 Cancer Diseases Hospital 1. Specialist training Program (STP) in
Clinical Oncology
12 Levy Mwanawasa Teaching 1. Bachelor of Medicine and Bachelor of
Hospital surgery (MBChB)
2. Internship
general surgery
Internal medicine
paediatrics and child health
7. Internship
13 Lusaka Apex Medical University 1. Bachelor of Medicine and Bachelor of
surgery (MBChB)
14 Cavendish School of medicine 1. Bachelor of Medicine and Bachelor of
surgery (MBChB)
Central 15 Kabwe Central Hospital 1. Internship
Luapula 16 Mansa General Hospital 1. Internship
2. STP – Internal Medicine
Paediatrics and child health
Eastern 17 Chipata Central Hospital 1. Internship
3. Specialist training Program (STP in
General surgery
18 St Francis Katete General Hospital 1. Internship
Northern 19 Kasama General Hospital 1. Internship
Southern 20 Livingston Teaching Hospital 1. Internship
Paediatrics and child health
General surgery
21 Mulungushi University School of 1. Bachelor of Medicine and Bachelor of
medicine surgery (MBChB)
Western 22 Lewanika General Hospital 1. Internship
North- 23 Solwezi General Hospital 1. Internship
Western
30
APPENDIX 2: The 2018 Zambia Medical Association (ZMA) Medical Training Institutions Status
Assessment Form
ZAMBIA MEDICAL ASSOCIATION

MEDICAL EDUCATION TECHNICAL WORKING
GROUP
HEALTH TRAINING INSTITUTIONS CURRENT

STATUS ASSESSMENT
nd th
(22 November –10 December 2018)
Information Collecting Form
Developed and Compiled by Professor James Chipeta for ZMA Medical Education Technical Working
Group, 26 November, 2018
31
University of Zambia 100 70 100 86 100 75 100 75 83 83 0 4 11 0:11 2 0 A IA A A IA I I A IA
52
(UNZA) School of
A A
Medicine
AVERAGE 90 55 86 78 75 38 100 88 42 42 0.5 3 6 1:12 1 0 100 50 50 50 50 0 0 50 50

OVERALL TOTAL –
WHERE
APPLICABLE
PROHRAM AND INSTITUTIONAL NAARATIVE SUMMARIES:
(For each of your entered results summaries of the respective program and the institutions please write precise narratives as your interpretation of the results commenting on i) observed successes and challenges of the
program ii) possible evidence-based solutions or recommendations. The narratives must not exceed a page in the space below)
Governance and Academic progression were outstanding in this program. Budget was adequate for the program. Accreditation, innovation and full-
time faculty student ratio (1:12) were all very poor. Student facilities are inadequate.
2.0 Questionnaire on Current Training Institution Status
(This Questionnaire’s respondents must preferably be key faculty members running the respective
programs besides the institutional administrators)
A. CORE INSTITUTION STATUS FOCUSSED AREAS
Institution Status Focussed Itemised Status Comments

Area
(Mark Yes (Y) or No (N) appropriately as to the response of availability of each item)
2.1 Governance Issues Available Copy

(Availability of Institutional
2.1a Institution management Policy
Policies and MOUs)
2.1b Policy HR
2.1c Policy Finance Management
2.1d Policy/Regulations on Student admissions
2.1e Student Regulations Policy
2.1f Institution Strategic Plan
2.1g Institution Vision and Mission
2. 1h MOU with Ministry of Health
2.1i MOU with Ministry of Higher Education
2.1j MOU with other line ministries or stakeholders
(If available in 2.1j list state them in the comment area)
2.2 Academic Progression 2.2a Curriculum availability

Assessment Processes 2.2b Curriculum implementation plans and reviews
2.2c Academic Calendar
(Formative and Summative) 2.2d Previous academic performance
(State specific responses in the comment column)
2.2e Lecture to student contact times
(State specific times as per response in the comment column)
2.2f Student Log books
2.2g Availability of both summative and formative
Program progression Assessment Modalities
(Counter check with the curricula and assessment criteria)
2.3 Existing Active 2.3a Accreditation certificate with HEA

Academic programmes and 2.3b Accreditation certificate with HPCZ
2.3c Affiliation status with appropriate local professional
their respective executing
bodies (e.g. NSTC, ZACOMS,etc: State the appropriate affiliation as per response in
bodies/Committees the comment column)
2.3d Affiliation status with appropriate international
professional bodies ( e.g. FEMA, RCPCH, etc)
(State the appropriate affiliation as per response in the comment column)
2.4 Institutional Human 2.4a Evidence of CMEs activities

Resource (HR) 2.4b HR Recruitment Institutional policy
2.4c Staff development programmes
Development
2.4d Employment status – full time vs part time
Programs/activities & respective CVs for Key staff
33
2.5 Existing Innovative 2.5a Existence of Innovation in the Curriculum

learning/Training 2.5b Internet (local area network plan)
2.5c Evidence of subscription to any e-resource
services/Facilities
2.5d Clinical skills laboratory
2.5e Evidence of faculty exchange programmes
(check MOUs)
2.5f Evidence of Student Electives
(Check related documentation)
2.6 Training/learning 2.6a Full-time faculty population for the program

Institutional Resources
2.6b Part-time faculty population for the program
and Sources of funding
2.6c Support staff population for the program
(Please enter the 2.6d Student Population for the program
response number in the 2.6e Fulltime faculty -Student ratio
respective box as (Calculate from 2.7a and 2.6c)
2.6f Number of faculty exchange programmes in the
confirmed by an official
previous two ac academic years (check MOUs,etc)
list/Register) 2.6g Number of student elective programmes activities in the
previous two academic years (check MOUs,etc)
2.6h Capacity of the largest Lecture theatre available for the
Program learning activities
2.6i Total number of seminar/lecture/tutorial rooms/spaces
available to the program
2.6j Total capacity of Lab oratories dedicated for
learning/training
2.6k Total Capacity of the wet (Anatomy dissection) Laboratory
2.6l Total Capacity of clinical skills laboratory
2.6m Total occupancy capacity of library
2.6n Total collections/resource capacity of the library
2.6o Total annual cost (Budget) of running the program/s
2.6p Total amount made available for the current academic year
2.6q Total number of program/s funding sources
(List the funding sources in the comment column)
2.6r Total capacity of major student amenities
(Student common rooms/Interns facilities/etc)
B. ON SITE PHYSICAL VISIT OF THE TRAINING INSTITUTION LEARNING/TRAINING FACILITIES
Institutional Learning/Training Itemised Status Comments

Facility(Mark “Y” for yes and “N” for no
(Mark appropriately as seen onsite of each respective facility)
for availability and adequacy and enter
in the status box “F” for functional or
“NF” for non-functional)
3.1 Learning /training space Available Adequate Status
3.1a Largest Lecture Theatre/Hall
3.1b Seminar/tutorial rooms
3.1c Operating theatres
3.1d Emergency/ICUs facilities
3.1e Follow up Specialised Clinics
3.1f Special Treatment rooms
34
3.2 Library Services 3.2a Library study spaces
3.2b Library e- services
3.2c Library lending services
3.2d Library collection stocks
3.3 Clinical Skills centre 3.3a Clinical Skills service scope with
regard to the programs
3.3a Clinical Skills service capacity with
regard to the programs
3.4 General Laboratory including 3.4a Biochemistry

radiology and imaging studies
3.4 b Pathology and Molecular biology
3.4c Microbiology/Immunology
3.4d Radiology and other imaging studies
3.4e Ultrasonography
3.4f Echocardiography
3.4 Specialised laboratory as per

program
3.5 Specialised laboratory as per

program
(Enter availability/adequacy/status as
per attached respective program
specialist list)
3.6 Dedicated learning/training

Equipment as per program
(Enter availability/adequacy/status as
per attached respective program
specialist list)
3.7 ICT installations
35
C. IN-DEPTH INTERVIEWS (IDI) AT THE SITES(The interviews must be recorded besides your interview notes of the responses)
Target IDI Interviewee IDI thematic/guide questions
4.1 Institution Heads (Director; Deans, Interview lead Question: We would like to know how your institution runs these programs
Senior Medical Superitendent,etc)
The hematic areas to be included in the response should include
organization structure
funding
successes and challenges
C. IN-DEPTH INTERVIEWS (IDI) AT THE SITES(The interviews must be recorded besides your interview notes of the responses)
Target IDI Interviewee IDI thematic/guide questions
4.1 Institution Heads (Director; Deans, Interview lead Question: We would like to know how your institution runs these programs
Senior Medical Superitendent,etc)
The hematic areas to be included in the response should include
organization structure
funding,
successes and challenges
*Is there any other thing you would like to tell us?
4.2 Registrar/Institution Official Interview lead Question: We would like to know how your institution runs these programs
responsible for overall academic and
include organization structure,
none academic management
funding,
successes and
challenges
4.3 Academic Program Coordinator Interview lead Question: Describe your views on academic, management & support staff and students
for your program.
Ask to see curriculum,

admission criteria for academic staff ,support staff and students,
timetables,
innovative teaching methods,
contact time between student and teaching staff ,
competences of teaching staff
4.4 Institution accountant/Financial Interview lead Question: Describe the resources and budget lines for academic programs at this
manager institution
ask to see budget,amounts allocated to teaching, mode of disbursement, various sources of

finance
36
4.5 Ordinary Faculty member Interview lead Question: How do you implement the teaching of the program as a tutor/
consultant/registrar?
Explain actual contact time such as lecture/tutorial/teaching ward rounds/operating theatre

times,
how the curriculum is delivered,
show teaching materials
4.6 Student Representative Interview lead Question: What is your learning experience this far in the program you are enrolled?
admission criteria
Contact time with academic staff
support staff and students,
timetables,
innovative teaching methods,
contact time between student and teaching staff ,
competences of teaching staff
37
APPENDIX 3: THE 2018 ZAMBIA MEDICAL ASSOCIATION (ZMA) MEDICAL TRAINING

INSTITUTIONS ASSESSMENT: DETAILED RESULTS SUMMARY TABLES
SUMMARY TABLE KEY
KEY:
%TFA: % Total Frequency availability (Yes) of the respective items
%] D: % Total available documentation of the respective items
ATN: Absolute Number of the requested number
A: Adequacy of the available inquired item and must be entered as 'A' for adequate and 'IA' for
Inadequate and this must be derived from the sum total of 4 responses ('Y' for Adequate; 'N' for not
Adequate) of the various facility items.
F:S Ratio: The Faculty to student ratio must be the nearest absolute ratio numbers calculated from
number of total program students divided by number of full time faculty
FEP: Faculty exchange programs. Must be entered as absolute number and these must be formal FEPs
with signed MOUs
SE: Student Electives. Must be entered as absolute numbers and these must be formal SEs inculcated in
the program curriculum.
LT: Lecture Theatre of the largest sitting capacity and the capacity response must be entered in a
qualitative manner of either Adequate (A) or inadequate (IA).
Bu: Budget for the cost of running the program and must be entered as being available (A) or not
Available or Inadequate (IA). Note that the 'budget' here denotes 4 actual funds availability and not
just written budget.
La: Laboratory services accessible for training/learning activities and must be expressed as being
adequate (a) or Inadequate (IA)
Li: Library services for the training activities and must be expressed as being adequate (A) or
Inadequate (IA)
An: Amenities for Student welfare and must be expressed as being adequate (A) or Inadequate (IA)
SL: Specialised lab services for the training activities and must be expressed as being adequate (A) or
Inadequate (IA)
Sie: Specialised clinical equipment for the training activities and must be expressed as being adequate
(A) or Inadequate (IA)
CS: Clinical Skills services for the training activities and must be expressed as being adequate (A) or
Inadequate (IA)
IT: Information and Communication Technology services for the training activities and must be
expressed as being adequate (A) or Inadequate (IA)
38
APPENDIX 3A. The Bachelor of Medicine and Bachelor of Surgery (MBChB) Programs
ASSESSMENT STATUS
Governance Academic Accreditatio Human Availability Training Resources and Sources of Funding Adequacy of Facilities
Progression n and Resource of Training F/Faculty P/time S/Pop F: S FEP SE LT Bu La Li An SL Sie CS IT
INSTITUTION Pop Faculty Ratio
Assessment Affiliation Development Innovations
Processes Status Status
%TFA %D %TFA %D %TFA %D %TFA %D %TFA %D ATN ATN ATN Ratio AT AT A A A A A A A A A
N N
Cavendesh University 100 100 100 100 100 75 75 75 67 67 24 22 400 1:17 0 0 A A IA A A IA A A A
University of Zambia 90 40 100 86 100 75 100 100 100 10 57 78 595 1:10 8 8 A IA A A A IA IA A A
(UNZA) School of 0
Medicine
Copperbelt University 70 40 100 100 50 50 100 100 67 67 31 65 15 1:13 4 0 A IA IA IA IA IA IA IA IA
School of Medicine
Mulungushi University 100 100 100 100 50 50 100 100 100 10 8 10 21 1:25 0 0 A A A A A A A A A
School of Medicine 0
Lusaka Apex Medical 100 100 100 100 100 75 100 100 83 50 47 73 1200 1:25 2 0 A A IA IA IA IA IA IA A
University (LAMU)
AVERAGE OVERALL 92 76 100 97 80 65 95 95 83 77 31 47 446 1:14 3 2 1 4 4 6 6 2 4 6 8
TOTAL –WHERE 0 0 0 0 0 0 0 0 0
APPLICABLE 0
The above table summarizes the visit to MBChBCentres namely, Cavendishi University, The University of Zambia, Copperbelt Univ ersity, Mulungusi University and
Lusaka Apex University.
Governance
Generally adequate for governance processes and documentation. Highest scoring scoring was in the private institutions. The public universities need to improve in
governance processes and especially documentation
Academic Progression Assessment Processes
Institutions were adequate in both processes and documentation
Accreditation and Affiliation Status
Generally the institutions did not meet the required standard with generally poorer performance in the government institutions.
Human Resource Development Status
Generally, the institutions offering the programs have invested well in human resource development as well as Documentation.
Availability of Training Innovations
Generally innovative methods of teaching are employed
Training Resources and Sources of Fundi ng
Generally, Human resources for training are adequate with a ratio of 1:14 for the programs. However, some institutions (Mulun gushi University and Lusaka Apex
Medical University) did not meet the standard of faculty student ratio of 1:20.
Generally funding the program was inadequate with private universities reporting adequate funding
Adequacy of Facilities
Library services, Specialised lab services, Amenities for Student welfare, Specialised clinical equipment, Clinical Skills services and Information and Communication
Technology services for the training activities are generally either not available or inadequate in both sites. Investment into these areas needs to be to ensure quality of
training. The general MBCHB program, scored 14%.
39
APPENDIX 3B. Internship Programs
ASSESSMENT STATUS
Governance Academic Accreditation Human Resource Availability Training Resources and Sources of Funding Adequacy of Facilities
INSTITUTION Progression and Affiliation Development of Training
Status Status Innovations F/Fac P/time S/Pop F:S FEP SE LT Bu La Li An SL Sie CS IT
Assessment
ulty Faculty Ratio
Processes Pop
%TFA %D %TFA %D %TFA %D %TFA %D %TF %D ATN ATN ATN Ratio ATN ATN A A A A A A A A A
A
Arthur Davison 88 75 100 83 67 67 100 100 60 60 8 2 8 1:1 0 0 IA IA IA IA A IA IA IA A

Children Hospital
Chipata Central 60 50 100 100 50 50 75 75 17 0 4 0 36 1:9 0 0 IA IA IA IA IA IA IA IA A

Hospital
Livingstone 90 90 57 14 75 50 75 75 86 86 15 0 30 1:2 0 0 IA IA IA IA IA IA IA IA A
Teaching Hospital
Katete General 70 60 57 57 75 75 100 100 83 67 7 0 13 2:1 0 0 IA IA IA IA IA IA IA IA IA
Hospital
Kitwe Teaching 50 50 67 67 50 50 100 100 0 0 16 0 30 1:2 1 0 A IA A IA IA IA IA IA IA

Hospital
Ndola Teaching 83 83 100 100 100 100 100 100 0 0 20 6 32 1:2 5 0 A IA IA A IA IA IA AI A

Hospital
Nkokola South 80 80 100 71 50 50 100 100 67 67 10 0 3 1:3 0 0 A A A IA IA IA IA IA A

Mine Hospital
Kabwe Central 80 50 57 57 75 75 100 100 83 67 3 1 8 1:3 0 0 IA IA IA IA IA IA IA IA IA

Hospital
Mansa General 70 30 86 71 75 75 75 75 33 17 11 0 23 1:2 0 0 A IA IA IA A IA IA IA A

Hospital
Kasama General 60 0 28 14 50 0 50 25 33 33 14 1 9 2:1 0 0 IA IA IA IA IA IA IA IA IA

Hospital
Solwezi General 70 10 86 28 50 25 75 75 33 17 9 0 7 1:1 0 0 IA IA IA IA A IA IA IA IA

Hospital
Mongu General 90 90 100 100 50 50 100 100 100 100 3 1 8 2:1 5 0 IA IA IA IA IA IA IA IA IA

Hospital
Levy Mwanawasa 80 80 100 100 50 50 100 75 50 50 17 0 34 1:2 0 0 IA IA IA IA IA IA IA IA A

Teaching Hospital
University 80 80 100 100 100 100 100 100 83 83 26 0 16 6:1 0 0 A IA A A IA A IA IA A

Teaching Hospital s
–Lusaka (UTH)
AVERAGE 75.07 59.14 81.28 68.71 65.5 58.35 89.28 85.71 52 46.2 12 1 16 1:2 1 0 36 7 21 14 21 7 0 0 64
OVERALL
TOTAL –WHERE
APPLICABLE
40
APPENDIX 3C. Zambia College of Medicine and Surgery (ZACOMS) Programs.
i. STP –Internal Medicine
STP -INTERNAL MEDICINE ASSESSMENT STATUS

Governance Academic Progression Accreditation and Human Resource Availability of Training Resources and Sources of Funding Adequacy of Facilities
INSTITUTION Assessment Processes Affiliation Status Development Status Training Innovations
F/Faculty Pop P/time Faculty S/Pop F:S FEP SE LT Bu La Li An SL Sie CS IT
Ratio
%TFA %D %TFA %D %TFA %D %TFA %D %TFA %D ATN ATN ATN Ratio ATN ATN A A A A A A A A A
Chipata Central Hospital 67 33 86 43 33 33 100 100 28 28 1 0 1 1:1 0 0 IA IA IA IA IA IA IA IA A
Livingstone Teaching Hospital 100 100 100 100 75 75 25 25 50 50 2 0 5 1:2 5 0 A IA A IA IA IA IA A A
Kitwe Teaching Hospital 40 10 71 71 25 25 75 75 0 0 3 0 8 1:3 0 0 A IA IA IA IA IA IA IA A
Ndola Teaching Hospital 80 80 57 57 0 0 100 100 16 16 3 0 6 1:2 0 0 A IA IA A IA IA IA IA A
41
Mansa General Hospital 80 50 86 86 50 25 75 75 33 33 7 0 3 1:2 0 0 A IA IA IA IA IA IA IA A
Kasama General Hospital 70 20 57 14 50 50 100 75 50 50 3 0 1 1:2 0 0 A A IA IA IA IA IA IA A
Levy Mwanawasa Teaching Hospital 70 70 100 100 75 75 100 50 50 50 3 0 5 1:2 0 0 IA IA IA IA IA IA IA IA A
University Teaching Hospitals –Lusaka 90 60 100 100 100 75 100 100 100 100 15 0 2 1:4 0 0 A IA A A IA A IA
(UTH)
AVERAGE OVERALL TOTAL –WHERE 75 53 71 61 51 45 75 75 41 41 5 0 4 1:2 1 0 75 25 25 25 0 12 0 12 100

APPLICABLE
(For each of your entered results summaries of the respective program and the institutions please write precise narratives as your interpretation of the results commenting on i) observed successes and challenges of the program ii) possible evidence-based solutions or
recommendations. The narratives must not exceed a page in the space below)
All the facilities had strong HRD, the faculty student ratio stood at 1:2. The documented governance policy was very good at 75%. There was however paucity of innovative ideas and very poor budgetary allocation. Facilities supportive of student training were generally
lacking except for the ICT services
ii. STP –Clinical Radiology
STP-CLINICAL RADIOLOGY ASSESSMENT STATUS

Governance Academic Accreditation Human Availability Training Resources and Sources of Funding Adequacy of Facilities
Progression and Affiliation Resource of Training F/Faculty P/time S/Pop F: S FEP SE LT Bu La Li A SL Sie CS IT
INSTITUTION Pop Faculty Ratio n
Assessment Status Development Innovations
Processes Status
%TFA %D %TFA %D %TFA %D %TFA %D %TFA %D ATN ATN ATN Ratio ATN AT A A A A A A A A A
N
Cancer Diseases Hospital 70 60 100 10 75 25 100 100 100 10 9 0 9 1:1 1 1 IA IA A IA I A A A A
0 0 A
AVERAGE OVERALL 70 60 100 10 75 25 100 100 100 10 9 0 9 1:1 1 1 0 0 100 0 0 100 100 1OO 100
TOTAL –WHERE 0 0
APPLICABLE
(Foreach of your entered results summaries of the respective program and the institutions please write precise narratives as your interpretation of the results commenting on i)
observed successes and challenges of the program ii) possible evidence-based solutions or recommendations. The narratives must not exceed a page in the space below)
Governance
The STP program did not meet the set standards in systems and but documentation.
42
The program scored well meeting both availability and documentation
Scored 75% due to non-accreditation with HEA and affiliation status. Need to get STP programs accredited to HEA and improve documentation of affiliation
The programs have invested well in human resource development and evidence available
The program has well utilised innovation in teaching
Training Resources and Sources of Funding
According to set standards human resources are adequate but there is need to financially invest in the program for sustainabilit
Specialised lab services, Information and Communication Technology, specialised clinical equipment, Clinical Skills services for the training activities were avail able. However,
Library services and Amenities for Student welfare were inadequate. Investment into these areas needs to be done to ensure quality of training. The actual score was 70% indicating
adequacy.
iii. STP – Radiology
STP – RADIOLOGY ASSESSMENT STATUS
Progression and Affiliation Resource of Training F/Faculty P/time S/Po F: S FEP SE LT Bu La Li An SL Sie CS IT
INSTITUTION Pop Faculty p Ratio
Processes Status
N
University Teaching 70 60 100 86 75 50 100 100 50 50 4 0 6 1:2 0 2 A IA IA IA IA IA IA IA A
Hospitals – Lusaka (UTH)
AVERAGE OVERALL 70 60 100 86 75 50 100 100 50 50 4 0 6 1:2 0 2 100 0 0 0 0 0 0 100 100

TOTAL –WHERE
APPLICABLE
(For each of your entered results summaries of the respective program and the institutions please write precise narrativesas your interpretation of the results commenting on i) observed successes and challenges of the program ii) possible evidence-based
solutions or recommendations. The narratives must not exceed a page in the space below)
Governance
The STP program did not meet the set standards in systems but documentation is adequate
43
The program scored well meeting both availability and documentation
Scored 75% due to non-accreditation with HEA and affiliation status. Need to get STP programs acc redited to HEA and improve documentation of affiliation
The programs have invested well in human resource development and evidence available
According to set standards human resources are adequate with a faculty student ratio of 1:2 but there is need to financially invest in the program for sustainability
Specialised lab services, specialised clinical equipment, Clinical Skills services were available. Library services and Amenities for Student welfare for the training
activities were unavailable. Investment into these areas needs to be done to ensure quality of training. The actual score was 29% indicating inadequacy
iv. STP – Paediatrics and Child Health
STP –PAEDIATRICS AND CHILD HEALTH ASSESSMENT STATUS
Governanc Academic Accreditatio Human Availabilit Training Resources and Sources of Funding Adequacy of Facilities
INSTITUTION e Progressio n and Resource y of
Affiliation Developmen Training F/Fac P/ti S/Po F:S FEP S LT Bu La Li An SL Sie CS IT
n
ulty me p Ratio E
Assessment Status t Status Innovation Pop Fac
Processes s ulty
%TFA %D %TF %D %TFA %D %TFA %D %TF %D ATN AT ATN Ratio AT A A A A A A A A A A

A A N N T
N
Arthur Davison 70 40 100 86 0 0 100 75 67 67 10 0 9 1:1 1 0 IA IA IA IA IA IA IA IA IA

Children Hospital
Chipata Central 80 80 86 86 25 25 100 100 0 0 2 0 3 1:1 0 0 A IA IA A IA IA IA A IA

Hospital
Livingstone Teaching 100 100 86 86 75 75 100 100 67 67 2 1 1 2:1 0 0 A IA IA A A IA IA A A

Hospital
Kitwe Teaching 50 20 71 71 0 0 75 75 17 17 1 0 4 1:4 0 0 IA IA IA IA IA IA IA IA IA

Hospital
Mansa General 70 30 86 71 50 50 75 75 33 17 7 0 2 2:1 0 0 A IA IA IA IA IA IA IA IA

Hospital
44
Levy Mwanawasa 80 0 100 10 50 50 100 10 50 50 3 2 4 1:1 0 0 A IA IA IA IA A A A A
Teaching Hospital
0 0
University Teaching 90 70 100 71 75 25 100 75 100 10 26 0 5 4:1 4 3 A IA IA IA IA IA A IA A

Hospitals –Lusaka
0
(UTH)
AVERAGE 77 49 90 82 39 32 93 86 48 45 7 0.4 4 1:1 0.7 0 71 0 0 28 14 14 28 43 43

OVERALL TOTAL –
WHERE
APPLICABLE
(For each of your entered results summaries of the respective program and the institutions please write precise narratives as your interpretation of the results commenting on i) observed successes and challenges of the program ii)
possible evidence-based solutions or recommendations. The narratives must not exceed a page in the space bel
Overall, the program was strong in academic progression monitoring and documentation, and in Human Resource Development attaining 90% and 93%
respectively. Governance, the overall trend passed the recommended score(77%) failing on documentation at 49%. In particular, Kitwe performed
unsatisfactory (50%). Full time faculty student ratio was strong at 1:1. The program failed to attain the recommended innovation (48%) while the budget
was inadequate. Training facilities were inadequate in all centres.
v. STP –urology
STP- UROLOGY ASSESSMENT STATUS

Governanc Academic Accreditation Human Availabilit Training Resources and Sources of Funding Adequacy of Facilities
INSTITUTION e Progressio and Affiliation Resource y of
Status Developm Training F/Faculty P/time S/Pop F:S FEP SE LT Bu L Li An SL Sie CS IT
n
Pop Facult Rati a
Assessment ent Status Innovation y o
Processes s
%TFA %D %TF %D %TFA %D %T %D %TF %D ATN ATN ATN Rati AT A A A A A A A A A A
A FA A o N T
N
Kitwe Teaching 70 60 86 86 25 25 75 75 33 33 1 0 4 1:4 0 0 IA IA I IA IA IA IA IA IA

Hospital A
Ndola Teaching 70 60 71 71 0 0 100 100 17 17 3 0 4 3:4 0 0 A IA I IA A IA IA IA IA

Hospital A
45
AVERAGE 70 60 78 78 12.5 12.5 88 88 25 25 2 0 4 1:2 0 0 50 0 0 0 50 0 0 0 0
OVERALL TOTAL –
WHERE
APPLICABLE
(For each of your entered results summaries of the respective program and the institutions please write precise narratives as your interpretation of the results commenting on i) observed successes and challenges of the program ii) possible
evidence-based solutions or recommendations. The narratives must not exceed a page in the space below)
This program is strong in HRD (88%), it's full-time faculty to student ratio was strong at 1:2. However, in all other aspects this program fail short of the recommended standards.
vi. STP –Pathology
STP-PATHOLOGY ASSESSMENT STATUS

Governance Academic Accreditatio Human Availability Training Resources and Sources of Funding Adequacy of Facilities
Progression n and Resource of Training F/Faculty P/time S/Pop F:S FEP SE LT Bu La Li An SL Sie CS IT
N
University Teaching 70 60 71.4 71.4 75 75 100 100 100% 100 2 0 1 2:1 - - A IA IA IA IA IA IA IA A
Hospitals STP PTH %
AVERAGE OVERALL 70 60 71.4 71.4 75 75 100 100 100% 100 2 0 1 2:1 - - 10 0 0 0 0 0 0 0 100%
TOTAL – WHERE % 0 % % % % % % %
APPLICABLE %
(For each of your entered results summaries of the respective program and the institutions please write precise narratives as your interpretation of the results commenting on i)
Governance
The STP programs did not meet the set standards in both systems and documentation and needs to put these in place
46
The program did not meet the standard accepted and neither were documents in place. The program needs to ensure proper academic processes
Scored 75% due to non-accreditation with HEA. Need to get STP programs accredited to HEA
Generally, the institutions offering the programs have invested well in human resource development and evidence available
According to set standards human resources are adequate but there is need to financially invest in the program for sustainability
Library services, Specialised lab services, Amenities for Student welfare, specialised clinical equipment, Clinical Skills services for the training activities are generally
either not available or inadequate in both sites. Investment into these areas needs to be to ensure quality of training.Information and Communication Technology services
were adequate
vii. STP – Obstetrics and Gynaecology
STP- OBGY ASSESSMENT STATUS

INSTITUTION Progression and Affiliation Resource of Training
Assessment Status Development Innovations F/Faculty P/time S/Pop F:S FEP SE LT Bu La Li An SL Sie CS IT
Pop Faculty Ratio
Processes Status
N
Chipata Central Hospital 70 60 86 46 67 33 100 100 33 33 1 0 2 1:2 0 0 A IA IA IA IA A IA A IA
Livingstone Teaching 70 60 100 100 100 67 100 100 66 66 2 0 1 2:1 0 0 A IA IA A IA IA IA A A
Hospital
Kitwe Teaching Hospital 70 60 100 100 50 50 50 50 33 33 1 0 4 1:4 0 0 IA IA IA IA IA IA IA IA IA
Ndola Teaching Hospital 70 60 71 71 50 50 100 100 17 17 2 0 7 1:4 6 0 IA IA IA IA IA IA IA IA IA
Mansa General Hospital 70 60 86 86 66 33 75 75 33 33 7 0 3 2:1 0 0 A IA IA IA IA IA IA IA IA
Levy Mwanawasa 70 60 100 71 100 67 100 100 67 50 4 0 4 1:1 0 0 A IA A IA IA IA IA A A
Teaching Hospital
University Teaching 70 60 100 100 100 100 100 100 100 100 14 0 5 3:1 0 0 IA IA IA IA IA IA IA IA IA
AVERAGE OVERALL 70 60 91 82 76 57 89 89 49 47 4.4 0 3.7 1:1 1 0 25 0 14 14 0 14 0 43 29

TOTAL –WHERE
APPLICABLE
47
Governance
The STP programs did not meet the set standards in systems but documentation was available
Generally available in all institutions offering the program. There needs to be more communication between ZACOMS/ the National Director of training in the
program to ensure that these processes and progression are made available to the respective institutions and in order to standardize better the program.
Generally, did not meet standards but varied across institutions. National directors of training need to help the institutions with affiliation and together with ZACOMS
help the institutions with accreditation.
Generally, the institutions offering the programs have invested well in human resource development
Availability of Traini ng Innovations
Generally, the program scored below the set standard, however it v aried across institutions with better scoring in urban areas compared to rural/ out of Lusaka with UTH scoring
100%. National directors of training need to coordinate with all institutions offering the training to make available the innovations in other centres as most are low resource
innovations.
Generally, Human resources for training are available in all facilities with a higher fa culty to student ratio in Lusaka. Challenges especially in centres outside Lusaka is balancing
teaching and clinical services. More specialists need to be available outside Lusaka as well to ensure adequacy of training.
Generally, no specific funding for specialist training. Funding for the STP program needs to be made available via MOH/ZACOMS.
Library services, Specialised lab services, Amenities for Student welfare, specialised clinical equipment, Clinical Skills services and Information and Communication Technology
services for the training activities are generally either not available or inadequate in most sites. Investment into these areas needs to be done to ensure quality of training.
viii.STP- Orthopaedic surgery
ASSESSMENT STATUS
Progression and Affiliation Resource of Training F/Faculty P/time S/Pop F:S FEP SE LT Bu La Li An SL Sie CS IT
Processes Status
N
Kitwe Teaching Hospital 80 40 75 75 25 25 75 75 50 50 4 0 7 4:7 0 0 IA A IA A IA IA IA IA A
Ndola Teaching Hospital 60 60 71.4 85. 0 0 75 100 16.7 16. 1 2 5 0 0 0 A IA IA IA IA IA IA IA IA
7 7
University Teaching 87.5 37. 100 10 100 25 100 75 100 83 8 0 3 8:3 2 0 A IA IA A A IA IA IA IA
5 0
AVERAGE OVERALL 76 46 85 87 42 17 83 83 56 50 4 1 5 6:5 1 0 6 3 0 3 3 0 0 0 6
TOTAL –WHERE 7 3 3 3 7
APPLICABLE
48
In governance, STP orthopaedics had adequate policies at 76%. However, documentation was inadequate at 46%. Academic proggression was above 50%. HRD was
also adequate at 83% and documentation of 88%. Innovative learning exceeded the 50% set index at 56%. Full time to student ration was at 6:5 which was very good
for training. However, budget was inadequate and student facilities were also inadequate. Noteworth was that they failed accreditation at 42% with only 17%
documentation to support accreditation.
ix.STP – General Surgery
ASSESSMENT STATUS
Processes Status
N
Chipata Central Hospital 100 50 100 57. 50 0 75 50 16.7 16. 1 0 2 1:2 0 0 A IA A IA IA IA IA IA A
1 7
Livingstone Teaching 100 75 100 85. 75 50 100 100 83.3 66. 2 0 2 1:1 2 0 A IA IA IA IA A A A A
Hospital 7 7
Kitwe Teaching Hospital 50 50 85.7 85. 25 25 50 75 33.3 33. 4 1 5 4:5 0 0 A A IA IA IA IA IA A IA
7 3
Ndola Teaching Hospital 70 60 57.1 57. 25 0 100 100 33.3 33. 0 4 9 4:9 0 0 A IA IA A A IA IA A IA
1 3
Levy Mwanawasa 100 75 100 62. 75 50 100 100 33.3 33. 5 0 3 5:3 0 0 A IA IA IA IA IA IA IA A
Teaching Hospital 5 3
AVERAGE OVERALL 84 62 89 70 50 25 85 85 40 37 2.4 1 4 3:4 0 0 1 2 2 2 2 2 2 6 6
TOTAL – WHERE
0 0 0 0 0 0 0 0 0
APPLICABLE
49
0
On governance, the programme exceeded the set standard at 84% with documentation of 60%. HRD achieved 85% with supported documentation of also 85%. Faculty
to student ratio was strong at 3:4. Academic progression documentation was narrowly missed, although they recorded 89% availability. Accreditation was poor at
50%. Innovative learning was also poor at 40%. The budget support was inadequate and the student amenities were inadequate at 43%.
APPENDIX 3D. College of Surgeons of East, Central and Southern Africa (COSECSA) Programs
I. COSECSA – Orthopaedic surgery
ASSESSMENT STATUS
Processes Status
N
Ndola Teaching Hospital 70 50 57.1 71.4 75 25 75 100 33.3 33.3 0 3 2 0:3 0 80 A IA IA IA A IA A A IA
AVERAGE OVERALL 70 50 57.1 71.4 75 25 75 100 33.3 33.3 0 3 2 0:3 0 80 10 0 0 0 10 0 10 10 0
0 0 0 0
TOTAL–WHERE
APPLICABLE
COSECSA had adequate Human Resource Development availability at (75%) supported by 100 documentation. Governance was 70% short of the target of 75%.
Documentation was however adequate at 50%. The rest of the thematic parameters were inadequate (Academic progression-57%, accreditation -75%, training
innovations-33% were inadequate. The college had no full time faculty for the training site. There was no budget support and student facilities were also not adequate
(43%).
50
ii.Fellow of College of Surgery (FCS)
ASSESSMENT STATUS
Processes Status
N
Chipata Central Hospital 75 37. 71.4 0 50 0 75 50 0 0 0 1 1 0 0 0 A I A IA IA IA IA A IA
5 A
Kitwe Teaching Hospital 50 20 100 100 25 50 75 75 33.3 33. 0 7 5 0:5 0 0 IA A IA IA IA IA IA IA IA
3
Ndola Teaching Hospital 70 60 57.1 71. 75 25 75 100 33.3 33. 0 4 9 0:9 0 0 I I IA A A IA IA IA IA
4 3 A A
Nchanga South Mine 87.5 50 85.7 42. 50 50 100 100 33.3 16. 10 0 1 0:1 0 1 A I IA IA A IA A IA IA
Hospital 9 7 A
AVERAGE OVERALL 71 42 79 54 50 31 81 81 25 21 2.5 3 4 0:4 0 0 5 2 2 2 5 0 2 2 0
TOTAL –WHERE 0 5 5 5 0 5 5
APPLICABLE
COSECSA Surgery scored well in HRD at 81% supported with documentation also at 81%. However, the narrowly missed some areas such as governance at 71%
(75%) and academic progression at 79% (80%). Accreditation, innovation, faculty to student ratio, budget support and student amenities were inadequate.
APPENDIX 3E. The Master of Medicine (MMED) Programs
I. MMED – Paediatrics and Child Health
MMED- PAEDIATRICS AND CHILD HEALTH ASSESSMENT STATUS

Governanc Academic Accreditati Human Availability Training Resources and Sources of Funding Adequacy of Facilities
INSTITUTION e Progression on and Resource of Training
Affiliation Developme Innovations F/F P/ti S/Po F:S FE SE LT Bu La Li An SL Sie CS IT
Assessment
acu me p Ratio P
Processes Status nt Status lty Facu
Pop lty
%TFA %D %TF %D %T %D %TF %D %TF %D AT ATN ATN Ratio AT A A A A A A A A A A

A FA A A N N T
N
University of Zambia 90 90 100 100 75 75 100 100 100 100 4 26 20 1:5 5 3 A A IA IA A IA IA IA A

(UNZA) School of
Medicine
51
(For each of your entered results summaries of the respective program and the institutions please write precise narratives as your interpretation of the results commenting on i) observed successes and challenges of
the program ii) possible evidence-based solutions or recommendations. The narratives must not exceed a page in the space below)
The program attained high scores in Governance at 90%, Academic progression, Human Resource development and Innovation all attained
100% scores. However, Accreditation and Affiliation narrowly failed at 75%. Full time faculty to Student ratio attained the recommended ratio
of 1:5. Budget to run the program was adequate.
Report on the State of Medical T
RECOMMENDATIONS
The findings of the 2018 ZMA assessment of the curre
presented and discussed here draw a number of recom
specific as well as across all the assessed 19 training prog
Recommendations across all the assessed programs

1. Investment into incorporating innovation in the
optimise attainment of the respective program go
2. The various institutions must maximise modal
costs of their programs including engaging priva
3. Accreditation, linkages and documentations/re
programs
4. Medical training institutions offering variou
employing fulltime program academic staff oth
staffing levels and should not heavily rely on
situations prevailing in many of the visited traini
Hospitals where critical faculty are in senior adm
engaged in prolonged absence necessitated by th
5. There is need to recruit adequate and appropri
administrative issues of the programs especia
ZACOMS specialist training programs
Programs specific recommendations

1. The COSECSA - general surgery, STP-U
Orthopaedics as well as others with no or inadequ
2. Internship sites with inadequate or no senior
Registrars) in major internships disciplines of g
Health, and Obstetrics and Gynaecology must h
gaps.
3. The Private medical schools running the MBCh
academic full time staff appointed as adjunct/h
public teaching hospitals where their students a
their respective MOUs.
4. The MMED, STP, COSECSA and ECSACOP p
(affiliated teaching hospitals) have minimum ba
of health professionalsat a specialist level. This
with regard to specialized clinical laboratories
library services.
25
iii. MMED – Obstetrics and gynaecology
MMED – OBSTETRICS AND GYNAECOLOGY ASSESSMENT STATUS
INSTITUTION Progression and Affiliation Resource of Training
Assessment Status Development Innovations F/Faculty P/time S/Pop F:S FEP SE LT Bu L Li An SL Sie CS IT
Pop Faculty Ratio a
Processes Status
N
Ndola Teaching Hospital 70 40 57 29 25 0 100 75 0 0 1 1 6 1:6 0 0 A ? I IA IA IA IA IA A
A
University Teaching 88 63 100 86 100 0 100 50 100 67 4 10 25 1:4 4 3 A ? A A IA IA IA IA IA
Hospitals –Lusaka (UTH)
AVERAGE OVERALL 79 51.5 78.5 57.5 62.5 0 100 62.5 50 33.5 2.5 5.5 15.5 1:6 2 1.5 100 ? 5 50 0 0 0 0 50
0
TOTAL –WHERE
APPLICABLE
Governance
Generally adequate, documents and systems not in place at CBU. Need to ensure adequate record keeping and improved governance
53
CBU needs to ensure proper academic processes
Very poor at CBU. Documentation poor at both institutions. Institutions nee d to ensure adequate leadership and support structure to ensure these issues are dealt with.
Generally, the institutions offering the programs have invested well in human resource development. Documentation poor at UNZA-SOM
Good at UNZA-SOM. Poor CBU. CBU needs to explore and invest in this area
Generally, Human resources for training are available in both facilities with a higher faculty to student ratio in UNZA. No data available on funding
Library services, Specialised lab services, Amenities for Student welfare, specialised clinical equipment, Clinical Skills services and Information and Communication
Technology services for the training activities are generally either not available or inadequate in both sites. The score was 43%. Investment into these areas needs to be
to ensure quality of training.
iv. MMED – Pathology
MMED – PATHOLOGY ASSESSMENT STATUS
Governance Academic Accreditatio Human Availability of Training Resources and Sources of Funding Adequacy of Facilities
Progression n and Resource Training F/Faculty P/time S/Pop F:S FEP SE LT Bu La Li An SL Sie CS IT
N
University of Zambia 100% 37.5 86 71.4 100 75 100 100 100% 100 2 2 12 1:6 - - A IA IA IA IA IA IA IA A
(UNZA) School of %
Medicine MMED PTH
AVERAGE OVERALL 100% 37.5 86 71.4 100 75 100 100 100% 100 2 2 12 1:6 - - A IA IA IA IA IA IA IA A
TOTAL –WHERE %
APPLICABLE
54
Governance
Though Governance processes were in place, documentation was poor. UNZA needs to improve on documentation
Processes in place but documentation poor. The program needs to ensure proper documentation
Scored well with 100% but documentation not in place
Generally, the institutions offering the programs have invested well in human resource development and evidence available
According to set standards human resources are adequate but there is need to financially invest in the program for sustainability
Library services, Specialised lab services, Amenities for Student welfare, specialised clinical equipment, Clinical Skills services for the training activities are generally
either not available or inadequate in both sites. Investment into these areas needs to be to ensure quality of training.
Information and Communication Technology services were adequate
v. MMED – Ophthalmology
MMED – OPHTHALMOLOGY ASSESSMENT STATUS

Processes Status
N
University Teaching 100 100 100 100 100 100 100 100 100 10 8 0 10 4:5 2 2 A IA IA A IA IA IA A A
Hospitals –Lusaka (UTH) 0
AVERAGE OVERALL 100 100 100 100 100 100 100 100 100 10 8 0 10
1 0 0 1 0 0 0 1 1 4:5 2 2
TOTAL –WHERE 0 0 0 0 0
APPLICABLE 0 0 0 0
UNZA MMed Ophthalmology scored very high (100%) in administrative thematic parameters (governance, academic progression, accreditation/affiliation, HR and training resources
as well as innovations) in terms of availability and documentation. It however had inadequate student amenities, inadequate specialised laboratory and inadequate clinical equipment
relevant to postgraduate training in ophthalmology.
vi. MMED – General Surgery
55
ASSESSMENT STATUS
Processes Status
N
Ndola Teaching Hospital 100 70 85.7 85.7 75 50 100 75 0 0 1 4 3 1:3 0 0 A A A A A IA IA IA A
AVERAGE OVERALL 100 70 85.7 85.7 75 50 100 75 0 0 1 4 3 1:3 0 0 10 10 10 10 10 0 0 0 10
0 0 0 0 0 0
TOTAL –WHERE
APPLICABLE
Governance policies were adequate at 100% with 70% documentation. Academic progression was above the set standard at 86%. HRD was also good at 100% with
75% documentation. Budget support and student amenities were also adequate. However accreditation was missed at 75% although the documentation was available at
100%. There was no innovation at all for the training.

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Report on the State of

Medical Training Institutions

Dr. Abidan Chansa (BSc<HB>, MBChB, MMED)

Professor James Chipeta (BSc<HB>, MBChB, PhD)

ACRONYMS AND ABBREVIATIONS

ADCH - Arthur Davison Children Hospital

THE 2018 ZAMBIA MEDICAL ASSOCIATION (ZMA) MEDICAL EDUCATION AND

Name Position and Institution Affiliation Status on the

Observed successes and Challenges

Assessment Approach and data collection

Data analysis and Interpretation

Assessment Thematic Baseline Bench Marks

Acceptable Documentation of Governance related

Availability of Training Adequate Availaibility is 50 %

Overall and Programs Specific Training Assessment Findings

Assessed Training Program Number of Training Faculty: Student Ratio

Programs Specific Findings

Training Number Number of Governance Academic Accreditation Human Training Funding

Bachelor of Medicine and Bachelor of Surgery (MBChB) Programs

The COSECSA Programs

The ZACOMS Programs

The MMED Programs

DISCUSSION AND SUMMARY OF NOTED SUCCESSES AND CHALLENGES OF THE VARIOUS

All spaces MUST be filled in.

1.0 General Questionnaire Particulars

1.1 Name of Institution:

1.4 Assessment Program: MBChB Internship MMED STP

2.0 Questionnaire on Current Training Institution Status

PROVINCE SERIAL INSTITUTION TRAINING PROGRAM

6 University of Zambia School of 1. Bachelor of Medicine and Bachelor of

8 University Teaching Hospitals – 1. Specialist training Program (STP) in

ZAMBIA MEDICAL ASSOCIATION

HEALTH TRAINING INSTITUTIONS CURRENT

Information Collecting Form

Group, 26 November, 2018

AVERAGE 90 55 86 78 75 38 100 88 42 42 0.5 3 6 1:12 1 0 100 50 50 50 50 0 0 50 50

2.0 Questionnaire on Current Training Institution Status

A. CORE INSTITUTION STATUS FOCUSSED AREAS

Institution Status Focussed Itemised Status Comments

2.1 Governance Issues Available Copy

2.1c Policy Finance Management

2.1d Policy/Regulations on Student admissions

2.1e Student Regulations Policy

2.1f Institution Strategic Plan

2.1g Institution Vision and Mission

2. 1h MOU with Ministry of Health

2.1i MOU with Ministry of Higher Education

2.1j MOU with other line ministries or stakeholders

(If available in 2.1j list state them in the comment area)

2.2 Academic Progression 2.2a Curriculum availability

2.3 Existing Active 2.3a Accreditation certificate with HEA

2.4 Institutional Human 2.4a Evidence of CMEs activities

2.5 Existing Innovative 2.5a Existence of Innovation in the Curriculum

2.5f Evidence of Student Electives

(Check related documentation)

2.6 Training/learning 2.6a Full-time faculty population for the program

B. ON SITE PHYSICAL VISIT OF THE TRAINING INSTITUTION LEARNING/TRAINING FACILITIES