Original Research
Health Education

Importance and Performance of Quality Improvement at the Institutes of Health Profession Education in Yemen

Published: Malaysian Journal of Public Health Medicine, 2016; Volume 16, Issue 3

Publisher: Malaysian Public Health Physicians’ Association

Last reviewed: March 2026

Background

The quality of health profession education is a fundamental determinant of healthcare service delivery. In low- and middle-income countries, the alignment between health profession education outputs and the requirements of the health labour market is particularly critical, as gaps in this alignment directly translate to deficiencies in healthcare provision for vulnerable populations. Yemen, one of the world’s poorest countries even before the devastating civil conflict that began in 2014, has faced persistent challenges in developing and maintaining a competent health workforce.

This study, published in the Malaysian Journal of Public Health Medicine, examined the importance and performance of quality improvement at health training institutes in Yemen, providing insights into the disconnect between educational outputs and workforce requirements. The research is particularly significant given the subsequent deterioration of Yemen’s healthcare infrastructure due to prolonged conflict, which has made the quality of initial health profession training even more critical.

Study Design and Methods

The study employed qualitative research methods to capture in-depth perspectives from multiple stakeholder groups involved in health profession education and employment. Data collection took place in Sana’a, Yemen’s capital, and involved a diverse mix of healthcare professionals and key stakeholders. Six focus group discussions were conducted with a total of 42 graduates of health training institutes. Additionally, 20 in-depth interviews were carried out with health development partners and employers from both the public and private healthcare sectors.

This multi-stakeholder approach allowed the researchers to triangulate findings across different perspectives—those of graduates who had experienced the education system firsthand, those of employers who assessed the competence of graduates in practice, and those of development partners who provided system-level insights into health workforce challenges.

Principal Findings

Curriculum and Training Deficiencies

The most striking finding was the widespread dissatisfaction with the practical components of health profession education. An overwhelming 39 out of 42 participants (93%) reported that their practical training during education was deficient. This gap between theoretical knowledge and clinical competence was identified as a critical barrier to effective healthcare delivery. While 28 out of 42 participants (67%) expressed satisfaction with the theoretical content of their courses, the disconnect between theory and practice was pronounced.

Multiple factors contributed to the practical training deficit. Weak coordination between educational institutes and health facilities where clinical placements occurred was identified as a systemic problem. Equipment and tools required for practical training were often in short supply or outdated. These infrastructure limitations restricted students’ ability to develop the hands-on clinical skills essential for competent practice.

Career Development and Professional Satisfaction

Career development emerged as a major concern, with 33 out of 42 participants (78%) reporting dissatisfaction with their career progression opportunities. The fundamental issue was that degrees and certificates issued by health training institutes did not provide pathways for continuing education to bachelor’s degree level and beyond. This structural limitation trapped graduates in entry-level positions without realistic prospects for professional advancement.

Closely related was the finding that 35 out of 42 participants (83%) were not satisfied with how well their education had prepared them for their first professional role. This high rate of perceived unpreparedness points to a fundamental misalignment between the competencies developed during education and those required in clinical practice.

English Language Proficiency

Both graduates and employers identified insufficient English language proficiency as a significant barrier to effective professional practice. Interestingly, graduates themselves acknowledged this limitation, aligning with the perspectives of their employers. English language competency is important in healthcare settings for accessing international clinical guidelines, reading medical literature, and in some contexts, communicating with patients. The study referenced the experience of Malaysia, where a lack of English proficiency had contributed to unemployment among thousands of nursing graduates who could not secure positions.

Implications for Health Workforce Development

The study’s findings pointed to several priority areas for improving health profession education quality in Yemen. Regular curriculum updates incorporating practical components were identified as essential, with both educators and employers emphasising the need for teaching approaches to shift from teacher-centred to student-centred methods. Strengthening coordination between educational institutions and clinical training sites emerged as a systemic priority that would require institutional commitment and potentially regulatory reform.

The research also highlighted the need for continuous professional development frameworks that allow health professionals to upgrade their qualifications throughout their careers. In the absence of such pathways, health worker motivation and retention are likely to remain problematic, exacerbating existing workforce shortages.

Relevance in the Context of Yemen’s Ongoing Crisis

Since this research was conducted, Yemen’s humanitarian crisis has deepened dramatically. Approximately half of Yemen’s health facilities are non-functional, and millions of Yemenis lack access to basic healthcare services. The challenges identified in this study—inadequate training, workforce skill gaps, and limited career development—have been compounded by conflict-driven destruction of healthcare infrastructure, mass displacement of health workers, and the collapse of institutional support systems. The quality of initial health profession training has become even more critical as the remaining health workforce must operate under extraordinarily difficult conditions with limited access to continuing education.

Limitations

The study’s qualitative design, while providing rich contextual data, limits generalisability. The research was conducted exclusively in Sana’a, and findings may not fully represent conditions at health training institutes in other parts of Yemen. The pre-conflict timing of data collection means that the current situation is likely substantially worse than what was documented. The relatively small sample of 42 graduates and 20 stakeholders, while appropriate for qualitative research, does not permit statistical generalisation.