Abstract:

Context:
The effectiveness of continuing professional development (CPD) is one of the indicators used in healthcare quality assurance systems to assess the excellence of services offered to populations. CPD contributes to maintaining and advancing healthcare professionals’ expected competencies after graduation. Well established in several European and North American countries for many healthcare professions, CPD is now gradually being implemented in other regions. Aim: The aim of this presentation is to describe the main components required for the development, implementation, and sustainability of a CPD system for nurses and midwives in a low- and low-middle-income country, and to present some of the contextual challenges to consider during this process.

Method:
We conducted a systematic rapid review of the literature; MEDLINE, CINAHL, and Web of Science databases were searched in December 2021. Inclusion criteria were:
1) published between 2011 and 2021;
2) written in French, English, or Spanish; and
3) described the development and/or implementation of a CPD system or broad program for healthcare providers in a low- and low-middle income country. Initial screening was independently conducted by two researchers. The selection of articles for full-text review (n = 14) was achieved through a consensus of four reviewers; two articles were subsequently excluded. Twelve articles met the criteria for data extraction. Data were extracted into an excel file and included: definition of CPD; system/program description; details pertaining to the system/program’s development or implementation; barriers and facilitators to the system/program’s development or implementation; and aspects relating to the political process and sustainability. All researchers participated in data extraction.

Results:
The 12 articles described the development, implementation, and/or sustainability of CPD systems for nurses and midwives (n = 7), physicians (n = 4), pharmacists (n = 1), and physiotherapists (n = 1); some included more than one type of healthcare professional. A range of countries in different world regions were represented including West Asia/Middle East, South Asia, West Africa, South Africa, East Africa, and Latin America/Caribbean. Key factors for successful development and implementation of a CPD system included: conducting of a needs assessment; use of a framework to guide the process; having all elements of the system explicitly articulated and defined; involvement of key stakeholders (government departments, professional agencies, healthcare institutions, and providers) throughout the process; implementation of strategies to promote uptake and compliance; use of existing structures and systems for monitoring; a staged implementation and gradual application of regulations; and the creation of or access to a core base of CPD activities. Sustainability requires buy-in from all stakeholders and the establishment of a robust regulation and monitoring structure. Frequent challenges to implementation include resistance from healthcare providers (resistance to change and lack of professional learning culture) and ensuring accessibility for care providers in rural areas.

Conclusions:
To ensure a CPD system is well implemented and will be sustainable, countries should consider step-wise planning, involvement of key stakeholders, and ongoing promotion to foster a learning culture and to encourage uptake.

Keywords:

Development, implementation, continuing professional development, health care professional, low- and middle-income countries.