Lessons Learned and Recommendations

• High dropout rates dramatically reduce the capacity of health professional schools throughout sub-Saharan Africa, with many having rates over 60%. In some countries (e.g., Nigeria), a significant factor is the cost of students’ national qualification examinations. Advocacy to decision-makers to spread this cost out over time or provision of loans and bursaries to students to cover the cost of taking the qualification examination after course completion are likely to have a large impact on graduation rates.
• It is important to bring schools out of isolation by linking the education, health, and employment sectors. Networking all stakeholders involved in training and hiring health workers is valuable for recommending new and validating existing strategies to increase the quantity and quality of health workers.
• Computers, mannequins, lab equipment, and textbooks are major expenses for health professional schools in low- and middle-income countries, and provision of high-quality materials became an important part of institutional support efforts in Mali, Nigeria, and Uganda. Giving schools the ability to bulk purchase such supplies, similar to the bulk purchasing of vaccines that Gavi oversees, and share supplies among several institutions, might lower these costs while increasing the quality of education. 
• Supporting students from and schools located in underserved locations are effective strategies for encouraging equitable distribution of the health workforce after those students graduate. Surveys of 357 scholarship recipients in Nigeria indicated that those who originated in rural areas or who attended rurally located schools were more likely than their peers to be employed in those locations after graduation. Surveys of students in Mali showed those who attended Gao Nursing School were significantly more likely to be employed in the underserved north than students educated elsewhere in the country. 
• Limited, cost-effective actions can be used to increase production of health workers and improve the quality of their education. However, it is vital that actions be taken on the basis of evidence. Use of specific, objective assessment techniques and consideration of the costs of proposed actions per graduate can help private and public institutions decide how to utilize their limited resources to best effect. Moreover, these considerations can assist educators as they advocate with policy-makers regarding HRH scale-up.