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Abstract Background The purpose of this paper is to describe and analyze the professional expectations of medical students during the 2007-2008 academic year at the public medical schools of Angola, Guinea-Bissau and Mozambique, and to identify their social and geographical origins, their professional expectations and difficulties relating to their education and professional future. Methods Data were collected through a standardised questionnaire applied to all medical students registered during the 2007-2008 academic year. Results Students decide to study medicine at an early age. Relatives and friends seem to have an especially important influence in encouraging, reinforcing and promoting the desire to be a doctor. The degree of feminization of the student population differs among the different countries. Although most medical students are from outside the capital cities, expectations of getting into medical school are already associated with migration from the periphery to the capital city, even before entering medical education. Academic performance is poor. This seems to be related to difficulties in accessing materials, finances and insufficient high school preparation. Medical students recognize the public sector demand but their expectations are to combine public sector practice with private work, in order to improve their earnings. Salary expectations of students vary between the three countries. Approximately 75% want to train as hospital specialists and to follow a hospital-based career. A significant proportion is unsure about their future area of specialization, which for many students is equated with migration to study abroad. Conclusions Medical education is an important national investment, but the returns obtained are not as efficient as expected. Investments in high-school preparation, tutoring, and infrastructure are likely to have a significant impact on the success rate of medical schools. Special attention should be given to the socialization of students and the role model status of their teachers. In countries with scarce medical resources, the hospital orientation of students' expectations is understandable, although it should be associated with the development of skills to coordinate hospital work with the network of peripheral facilities. Developing a local postgraduate training capacity for doctors might be an important strategy to help retain medical doctors in the home country.

Abstract Pharmacists' roles are evolving from that of compounders and dispensers of medicines to that of experts on medicines within multidisciplinary health care teams. In the developing country context, the pharmacy is often the most accessible or even the sole point of access to health care advice and services. Because of their knowledge of medicines and clinical therapeutics, pharmacists are suitably placed for task shifting in health care and could be further trained to undertake functions such as clinical management and laboratory diagnostics. Indeed, pharmacists have been shown to be willing, competent, and cost-effective providers of what the professional literature calls "pharmaceutical care interventions"; however, internationally, there is an underuse of pharmacists for patient care and public health efforts. A coordinated and multifaceted effort to advance workforce planning, training and education is needed in order to prepare an adequate number of well-trained pharmacists for such roles. Acknowledging that health care needs can vary across geography and culture, an international group of key stakeholders in pharmacy education and global health has reached unanimous agreement that pharmacy education must be quality-driven and directed towards societal health care needs, the services required to meet those needs, the competences necessary to provide these services and the education needed to ensure those competences. Using that framework, this commentary describes the Pharmacy Education Taskforce of the World Health Organization, United Nations Educational, Scientific and Cultural Organization and the International Pharmaceutical Federation Global Pharmacy and the Education Action Plan 2008–2010, including the foundation, domains, objectives and outcome measures, and includes several examples of current activities within this scope.

Une traduction en francais de ce resume figure a la fin de l'article. Al final del articulo se facilita una traduccion al espanol. [TEXT NOT REPRODUCIBLE IN ASCII.] Introduction Recently, [...], Objective To estimate systematically the inflow and outflow of health workers in Africa and examine whether current levels of preservice training in the region suffice to address this serious problem, taking into account population increases and attrition of health workers due to premature death, retirement, resignation and dismissal. Methods Data on the current numbers and types of health workers and outputs from training programmes are from the 2005 WHO health workforce and training institutions' surveys. Supplementary information on population estimates and mortality is from the United Nations Population Division and WHO databases, respectively, and information on worker attrition was obtained from the published literature. Because of shortages of data in some settings, the study was restricted to 12 countries in sub-Saharan Africa. Findings Our results suggest that the health workforce shortage in Africa is even more critical than previously estimated. In 10 of the 12 countries studied, current pre-service training is insufficient to maintain the existing density of health workers once all causes of attrition are taken into account. Even if attrition were limited to involuntary factors such as premature mortality, with current workforce training patterns it would take 36 years for physicians and 29 years for nurses and midwives to reach WHO's recent target of 2.28 professionals per 1000 population for the countries taken as a whole--and some countries would never reach it. Conclusion Pre-service training needs to be expanded as well as combined with other measures to increase health worker inflow and reduce the rate of outflow. Objectif Estimer de maniere systematique les flux entrants et sortants de personnel medical en Afrique et determiner si les effectifs actuellement formes dans la region avant l'entree en activite suffisent pour repondre a ce grave probleme, compte tenu de la croissance demographique et de l'attrition de la main-d'oeuvre resultant des deces prematures, des departs a la retraite, des demissions et des licenciements. Methodes Les donnees sur les effectifs actuels du personnel medical, les differents types de personnels de sante et les effectifs sortant des programmes de formation proviennent de l'enquete de 2005 de l'OMS sur la main d'oeuvre au service de la sante publique et les etablissements de formation. Des estimations demographiques et des donnees de mortalite supplementaires ont ete fournies respectivement par la Division de la population des Nations Unies et par les bases de donnees de l'OMS et des informations sur l'attrition de la main d'oeuvre ont ete tirees de la litterature publiee. En raison du manque de donnees pour certains pays, l'etude n'a porte que sur 12 pays d'Afrique sub-saharienne. Resultats Les resultats obtenus laissent a penser que la penurie de personnel de sante en Afrique est encore plus grave qu'on ne l'estimait auparavant. Dans 10 des 12 pays etudies, les effectifs actuellement formes avant leur entree en activite sont insuffisants pour maintenir la densite d'agents de sante existante une fois toutes les causes d'attrition prises en compte. Meme si cette attrition n'etait due qu'a des facteurs involontaires comme la mortalite prematuree, il faudrait, avec le rythme actuel de formation de la main d'oeuvre, 36 ans dans le cas des medecins et 29 ans dans le cas des infirmieres et des sages-femmes, pour atteindre l'objectif recemment fixe par l'OMS de 2,28 professionnels de sante pour 1000 habitants pour l'ensemble de ces pays--dont certains sont dans l'incapacite de realiser un jour cet objectif. Conclusion II faut developper les formations avant l'entree en activite et mettre en oeuvre parallelement d'autres mesures pour accroitre le flux entrant de main d'oeuvre et reduire le taux de depart. Objetivo Estimar sistematicamente el ritmo de incorporaciOn y abandono en puestos de trabajadores sanitarios en Africa y determinar si el nivel actual de formacion previa al empleo en la region es suficiente para afrontar ese grave problema, teniendo en cuenta el aumento de la poblacion y la disminucion natural de trabajadores sanitarios por muerte prematura, jubilacion, dimision y despido. Metodos Los datos sobre el numero actual y el tipo de trabajadores sanitarios y la cantidad de personas capacitadas en los programas de formacion proceden de las encuestas de 2005 de la OMS sobre el personal sanitario y las instituciones de formacion. La informacion complementaria sobre las estimaciones de poblacion y la mortalidad procede de las bases de datos de la Division de Poblacion de las Naciones Unidas y de la OMS, respectivamente, y la informacion sobre la diminution natural de les trabajadores se extrajo de diversas publicaciones. Debido a la falta de datos en algunos entornos, el estudio se limito a 12 paises del Africa subsahariana. Resultados Nuestros resultados llevan a pensar que la escasez de personal sanitario en Africa es aun mas grave de Io que se creia hasta ahora. En 10 de les 12 paises estudiados, la formacion previa al empleo es hoy dia insuficiente para mantener la actual densidad de trabajadores sanitarios una vez consideradas todas las causas de disminucion natural. Incluso si esa disminucion se debiera solo a factores involuntarios, como la mortalidad prematura, manteniendo el actual ritmo de formacion habrian de transcurrir 36 anos en el case de los medicos y 29 anos en el caso de las enfermeras para que pudiera alcanzarse la meta reciente de la OMS de 2,28 profesionales por cada 1000 habitantes para el conjunto de los paises, y ademas algunos paises nunca alcanzarian esa cifra. Conclusion Es necesario expandir la formacion previa al servicio y combinarla con otras medidas si se desea incrementar la incorporacion de trabajadores sanitarios y reducir la tasa de abandono.

In Guinea Bissau, the majority of university level professionals are still being trained abroad and most of them do not return to their country. This was a major incentive for creating Guinea Bissau's Medical School. An observational, cross-sectional, analytic study was conducted on the second trimester of 2007 to characterize the socio-demographic, familial and educational profile of medical students, their satisfaction levels, difficulties and expectations concerning the medicine course. A questionnaire was used and a response rate of 63% achieved (81 students). Data was analyzed using SPSS v.17 for descriptive statistics. Students are very committed to their education. They tend to decide to take the medicine course early in their lives and are influenced by their relatives. They choose to be medical doctors because they like it but also for altruistic reasons and the desire to save lives. Although many face financial and material difficulties, they tend to have success in their academic live. They live with their parents, do not have children and some have side jobs to provide for extra income to help with their education. They expect their education to make them good doctors in any part of the world and want to work simultaneously in the public (to serve their country and pay their debt to the State) and in the private sector (to enhance their income). The large majority wants to work in a hospital, in Bissau, and to be a pediatrician or obstetrician. They have unreasonably high expectations concerning their future income as medical doctors.