The growing complexity of global health issues underscores the need for a skilled workforce, achievable through competency-based training (competency-based curricula, CBC) that integrates knowledge and practice. Starting from 2022, medical and nursing CBC were harmonised across universities in Tanzania to ensure all graduates attain nationally defined core competencies. The reform aligned programme structure, learning outcomes and assessment methods to promote consistency and interprofessional collaboration. However, questions remain about whether harmonisation alone can ensure the development of practical clinical competencies among students. This study explored the experiences of medical and nursing faculty and students in implementing clinical training as a component of CBC in two health training institutions in Tanzania.

An exploratory qualitative case study was conducted with 67 participants, using 8 in-depth interviews with administrators and 8 focus group discussions with faculty and students. Data were analysed using Braun and Clarke’s thematic approach.

Two private, faith-based medical universities in the United Republic of Tanzania.

The study purposefully recruited a total of 67 participants. The participants included university administrators (including Deputy Vice Chancellors for Academics, quality assurance officers and deans), medical and nursing faculty and students (fourth-year medical and third-year nursing students).

Two main themes emerged: challenges in implementing clinical training and strategies used to enforce clinical training. Key challenges included curriculum design gaps, inadequate faculty and clinical instructors, a large number of students and a shortage of hospital staff. Strategies used were utilisation of clinical skills and simulation laboratories, involvement of non-academic clinical specialists’ staff, use of student-centred learning methodologies and leveraging regional, district and specialised private hospitals for clinical teaching.

Despite notable challenges in clinical training, the institutions in this study have implemented proactive strategies to support clinical training. Based on the findings, stakeholders should invest in increasing faculty and clinical instructors and expanding clinical placements to regional, district and private hospitals.

To explore the experiences of different stakeholders on the balance of package training and deployment of highly skilled Human Resources for Health for specialised services in Tanzania.

An exploratory qualitative case study was used as part of a larger tracer study conducted by Muhimbili University of Health and Allied Sciences (MUHAS) for its postgraduate programmes being a requirement for quality assurance. Semi-structured interview guides were used for in-depth interviews (IDIs) and focus group discussions (FGDs). Qualitative content analysis was adopted to analyse the data.

The trace study was carried out in all seven geopolitical zones of the Tanzania mainland and Unguja in Zanzibar.

We conducted 14 FGDs and 301 IDIs. Participants included alumni, immediate supervisors at employment sites, MUHAS faculty, continuing students at MUHAS and management of professional councils in Tanzania.

Key findings revealed variations in demands and recognition within the scheme of services, even after registration by professional councils. Five main themes emerged from the qualitative interviews: Package training to improve service provision, Unprofessional collegial relationships or issues related to professionalism within interdisciplinary teams, Silence of scheme services on super specialisation in the medical cadre, Silence of scheme services on specialisation in the nursing cadre, Integrated scheme of services for specialties in pharmacy.

The findings highlight the demand for specialised training, challenges with professionalism and inconsistencies in the recognition and remuneration of specialists across medical, nursing and pharmacy cadres within existing service schemes. There is a need for harmonisation between specialisation/super specialisation and the scheme of services. This harmonisation is crucial to ensure the provision of quality healthcare services. Furthermore, harmonisation requires multistakeholder engagement to realise universal health coverage strategies.

Routine childhood immunisation is vital to preventing life-threatening illness; however, global coverage of routine childhood immunisations has fallen in recent years, leaving over 14 million children globally without protection. This study aimed to identify shared and context-specific drivers of routine childhood immunisation dropout in select sites in Mozambique and Malawi through a secondary analysis of qualitative data.

We conducted a secondary inductive thematic analysis on qualitative data from a community-based participatory research study. Co-creation workshops, guided by a human-centred design approach, were held to develop context-specific solutions in each study site. Data for this analysis were collected between February 2020 and March 2021 in Mozambique and between July 2022 and February 2023 in Malawi.

Zambezia, Mozambique and Lilongwe and Mzimba North Districts, Malawi.

Participants included caregivers of partially (n=60) and fully vaccinated (n=22) children aged 25–34 months, healthcare workers (n=12), community healthcare workers (n=30), Expanded Programme on Immunisation staff (n=11) and community representatives (n=14). Caregivers were identified through vaccination registers and with support from health workers, community leaders and health volunteers.

We identified four key contextual and health system differences between Malawi and Mozambique affecting dropout: the composition of the immunisation workforce, the state of the vaccine ecosystem, vaccination card policies and vaccination outreach models. Common challenges across both countries included gender roles that burdened mothers, limited vaccine information, negative health worker interactions, pandemic-related disruptions and stockouts. Common solutions generated through co-creation workshops included improving health worker–caregiver communication, vaccine education and immunisation outreach resources. Solutions in Mozambique emphasised strengthening the community health worker (CHW) role in immunisation, while in Malawi, whose CHW workforce already administers vaccines, solution ideas focused on improving CHW data management.

Our analysis highlights the opportunity for scalable solutions to identified common immunisation barriers, including tailored vaccine education that addresses caregiver knowledge gaps, improved caregiver–health worker communication, improved outreach models and addressing gender dynamics and vaccine stockouts.