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This report, produced with the help of Madagascar’s national education team in 2006-07, is designed to contribute to ongoing education reform discussions. It analyzes the constraints to system expansion and presents possible next steps for an appropriate course of action. This report aims to encourage discussion among policymakers, stakeholders and donors, and does not promote one approach over another. To promote a more competitive economy in Madagascar in the 21st century, the government expects to increase the average years of schooling from the current 4.5 years to about 9-10 years by 2015 for the relative age groups. This report discusses the ongoing reform and its impact and provides suggestions for implementation. This report is intended to be used as a discussion instrument and to be disseminated among Madagascar’s stakeholders in education. We hope this report will contribute to improved implementation of the secondary education reform in Madagascar.This study was prepared as part of the Secondary Education and Training in Africa (SEIA) initiative which aims to assist countries to develop sustainable strategies for expansion and quality improvements in secondary education and training.

This study is based on research on secondary textbook and school library provision in Botswana, Cameroon, Cote d'Ivoire, Ghana, Kenya, Malawi, Rwanda, Tanzania, and Togo, as well as existing recent country reports on textbook provision and an extensive desk research. Considerable variations exist in Sub-Saharan African textbook requirements needed to meet secondary curriculum specifications just as significant differences exist between and within countries in regard to the average price of recommended textbooks. Some countries have no approved textbooks list. This World Bank Working Paper aims to discuss the textbook situation in Sub-Saharan Africa with a special focus on secondary textbook availability, cost and financing, distribution and publishing, and the status of school libraries. Its objective is to analyze the issues in secondary textbook and school library provision and to provide some options and strategies for improvement.

This book offers comprehensive guidance to support those involved in primary education in developing the curriculum to meet the requirements of the new Ofsted (2019) framework. It addresses key issues such as the purposes of the curriculum, how to organise the curriculum, and the balance between knowledge and skills. It also goes beyond basic requirements, emphasizing the importance of a creative, child-centred and enquiry-based curriculum which is suited to the context of school communities. Responding to the increased emphasis on the quality of pupils' education, the book supports trainees, teachers and school leaders in developing and implementing an ambitious and diverse curriculum, including working with all stakeholders and offering practical strategies and solutions. It empowers practitioners to reclaim the curriculum by designing one which reflects the values and context of the school.

This study used the Human Rights Theory as a framework to examine the perceptions and alternative education models among the Datooga, a small pastoral community in northern and central Tanzania. A qualitative case study design was adopted, involving 48 participants, including educational officers, government officials, school heads, parents, and pupils, selected through purposive sampling. Data collection methods included semi-structured interviews, focus group discussions, and document reviews, with thematic analysis applied to the data. Findings revealed that the Datooga pastoralists prioritise livestock herding over education, reflecting negative attitudes toward formal schooling. To improve access to primary education, the study identified three alternative models: establishing boarding schools, providing school meals, and introducing alternative basic education programs. Boarding schools, in particular, were emphasised as essential to reduce the burden of long commutes for children. The study also highlighted the need for a national policy tailored to pastoralists to ensure greater educational access. Additionally, education stakeholders are urged to raise awareness within the Datooga and similar communities about the value of primary education. The study underscores the importance of culturally sensitive approaches and government support in addressing educational challenges faced by pastoralist groups.

The conference brought together 44 African ministers of finance and of education from 28 African countries for a structured dialogue on sustaining Africa's economic and educational progress in the current context of a global economic slowdown. African countries have achieved laudable progress during the last decade towards the Education for All (EFA) goals for 2015 that were agreed in Dakar in 2000, particularly with regard to Universal Primary Education (UPE). This progress reflects the combined impact of several factors, notably courageous education reforms, substantially increased public financing of education made possible largely by sustained economic growth and increased political priority for education-and greater inflows of external aid for education. The momentum may be jeopardized, however, by the current worldwide economic downturn. Tightening domestic budgets and external aid could increase the difficulty of sustaining policy reform and strategic investments, thereby putting at risk the hard won gains of the last ten years. They could also undermine Africa's efforts to develop post basic education and training and delay achievement of key goals of the African Union's Second Decade for Education in Africa. The result would be to frustrate the aspirations of the increasing numbers of African youth who seek to go beyond primary education and to deny their prospective employers the skilled workforce that could help boost business competitiveness and economic growth. The emerging global economic circumstances provided a key rationale for the Conference. Its purpose was to stimulate dialogue among senior policy makers on policy options to achieve a mutually reinforcing relation between education and the economy.

Background Clinical practice guidelines are an important source of information, designed to help clinicians integrate research evidence into their clinical practice. Digital education is increasingly used for clinical practice guideline dissemination and adoption. Our aim was to evaluate the effectiveness of digital education in improving the adoption of clinical practice guidelines. Methods We performed a systematic review and searched seven electronic databases from January 1990 to September 2018. Two reviewers independently screened studies, extracted data and assessed risk of bias. We included studies in any language evaluating the effectiveness of digital education on clinical practice guidelines compared to other forms of education or no intervention in healthcare professionals. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to assess the quality of the body of evidence. Results Seventeen trials involving 2382 participants were included. The included studies were diverse with a largely unclear or high risk of bias. They mostly focused on physicians, evaluated computer-based interventions with limited interactivity and measured participants’ knowledge and behaviour. With regard to knowledge, studies comparing the effect of digital education with no intervention showed a moderate, statistically significant difference in favour of digital education intervention (SMD = 0.85, 95% CI 0.16, 1.54; I 2  = 83%, n  = 3, moderate quality of evidence). Studies comparing the effect of digital education with traditional learning on knowledge showed a small, statistically non-significant difference in favour of digital education (SMD = 0.23, 95% CI − 0.12, 0.59; I 2  = 34%, n  = 3, moderate quality of evidence). Three studies measured participants’ skills and reported mixed results. Of four studies measuring satisfaction, three studies favoured digital education over traditional learning. Of nine studies evaluating healthcare professionals’ behaviour change, only one study comparing email-delivered, spaced education intervention to no intervention reported improvement in the intervention group. Of three studies reporting patient outcomes, only one study comparing email-delivered, spaced education games to non-interactive online resources reported modest improvement in the intervention group. The quality of evidence for outcomes other than knowledge was mostly judged as low due to risk of bias, imprecision and/or inconsistency. Conclusions Health professions digital education on clinical practice guidelines is at least as effective as traditional learning and more effective than no intervention in terms of knowledge. Most studies report little or no difference in healthcare professionals’ behaviours and patient outcomes. The only intervention shown to improve healthcare professionals’ behaviour and modestly patient outcomes was email-delivered, spaced education. Future research should evaluate interactive, simulation-based and spaced forms of digital education and report on outcomes such as skills, behaviour, patient outcomes and cost.

Background Primary healthcare plays a pivotal role in optimizing healthcare resource allocation and ensuring equitable access to services. In China, first-contact care within the tiered medical care system is essential for alleviating pressure on large hospitals and enhancing healthcare equity. However, challenges such as uneven resource distribution and low patient trust in primary institutions limit the effectiveness of first-contact care. This study aims to explore the dynamic interactions of key factors influencing first-contact effectiveness and provide evidence-based policy recommendations. Methods A systematic approach was employed, integrating a literature review, qualitative interviews, and MICMAC structural analysis. Using Causal Loop Diagram (CLD) methodology, this study mapped the causal pathways and feedback mechanisms among factors such as health insurance awareness, medical consortium development, and tiered healthcare policy guidance. MICMAC analysis quantified the influence and dependence of these variables to identify key drivers within the system. Results The study revealed that primary healthcare service quality, patient trust, and healthcare-seeking behaviors are are vital determinants for improving first-contact effectiveness. Key driving factors include health insurance awareness, medical consortium construction, and tiered healthcare policy guidance, which form reinforcing feedback loops to enhance system efficiency. The findings highlight the importance of resource sharing, trust-building, and policy support in optimizing the tiered medical care system. Conclusions This study provides a comprehensive framework for understanding the complexities of first-contact care within China’s healthcare system. The insights gained emphasize the need for targeted interventions, including promoting health insurance awareness, strengthening medical consortiums, and improving policy incentives. These recommendations can inform policy reforms aimed at achieving equitable and efficient healthcare systems globally. Trial registration Not applicable, as this study does not involve a healthcare intervention on human participants.

Background Improving primary health care (PHC) physician’s capacity has been identified as an important area in the healthcare reform. The continuing medical education (CME) training programs are conducive to enhancing competence of PHC physicians. But few studies have explored PHC physicians’ needs and preferences for CME training programs. This study aimed to explore the preferences for CME training programs from the perspective of PHC physicians, and to understand the willingness, tendency, and needs in CME. Methods A Discrete Choice Experiment (DCE) was developed based on literature review and semi-structured interviews with 4 general practitioners to identify key attributes of CME programs. The DCE survey was administered to 360 PHC physicians in Jiangsu Province, China, in August 2023, to elicit preferences for: training frequency, training time, training duration, training location, training content of basic medical services, and training content of basic public health services. A total of 281 valid responses were included after the quality control test, which involved checking completion time and consistency in repeated choice tasks. DCE data were analyzed using Mixed Logit, and Latent Class Models to explore preference heterogeneity and class membership. Results PHC physicians showed strong preference for CME training programs that were conducted during working hours on weekdays, once a year, at a local meeting place and training on health management of patients with multiple chronic diseases. Latent class analysis identified 2 preference classes, with half (51.2%) of the respondents focused only on training frequency and time while the rest considered training logistic arrangement as well as training content. These preferences could be explained by some observed characteristics of PHC physicians such as age and professional level. Conclusions Overall, PHC physicians valued the convenience of participation in CME training programs and training on health management of patients with multiple chronic disease. Our findings can be used to inform the design of CME training programs for PHC physicians in China.

Approximately 13% of the total UK workforce is employed in the health and care sector. Despite substantial workforce planning efforts, the effectiveness of this planning has been criticised. Education, training, and workforce plans have typically considered each health-care profession in isolation and have not adequately responded to changing health and care needs. The results are persistent vacancies, poor morale, and low retention. Areas of particular concern highlighted in this Health Policy paper include primary care, mental health, nursing, clinical and non-clinical support, and social care. Responses to workforce shortfalls have included a high reliance on foreign and temporary staff, small-scale changes in skill mix, and enhanced recruitment drives. Impending challenges for the UK health and care workforce include growing multimorbidity, an increasing shortfall in the supply of unpaid carers, and the relative decline of the attractiveness of the National Health Service (NHS) as an employer internationally. We argue that to secure a sustainable and fit-for-purpose health and care workforce, integrated workforce approaches need to be developed alongside reforms to education and training that reflect changes in roles and skill mix, as well as the trend towards multidisciplinary working. Enhancing career development opportunities, promoting staff wellbeing, and tackling discrimination in the NHS are all needed to improve recruitment, retention, and morale of staff. An urgent priority is to offer sufficient aftercare and support to staff who have been exposed to high-risk situations and traumatic experiences during the COVID-19 pandemic. In response to growing calls to recognise and reward health and care staff, growth in pay must at least keep pace with projected rises in average earnings, which in turn will require linking future NHS funding allocations to rises in pay. Through illustrative projections, we show that, to sustain annual growth in the workforce at approximately 2·4%, increases in NHS expenditure of 4% annually in real terms will be required. Above all, a radical long-term strategic vision is needed to ensure that the future NHS workforce is fit for purpose.

The report offers policy options to support developing countries and transition economies in adapting their secondary education systems to the demands arising from the successful expansion of primary education and the socio-economic challenges presented by globalization and the knowledge-based economy. The work is the result of an extensive consultative process that involved education specialists worldwide.