Table 2 Key messages on healthcare worker education and training in north west Syria and broad recommendations to address challenges identified

1.

Syria’s protracted conflict has decimated its health system and led to a profound shortage of healthcare workers of sufficient number and skills, exacerbating pre-existing geographical inequalities.

2.

Both physician and non-physician healthcare worker undergraduate and post-graduate training has been affected across the whole of Syria but the impact has been greatest in areas outside of government controlled, particularly in north west Syria.

3.

Free Aleppo University and Idlib University and Shabha University are the main public universities which provide undergraduate medical and pharmacy education in north west Syria however they lack sufficient funds and faculty to support quality and sustainability.

4.

There has been an unregulated growth in the number of private universities which provide undergraduate physician and non-physician healthcare worker education.

5.

Unusually in a humanitarian response, non-governmental organisations have stepped in to provide some undergraduate courses as well as shorter, postgraduate continuous medical education opportunities for healthcare workers however this has been uncoordinated and unsustained.

6.

There remains a gap in post-graduate physician training though organisations like the Syrian Board of Medical Specialties provide some opportunities though they are affected by poor funding and insufficient numbers of faculty with the specialties required.

7.

Challenges can be broadly divided into 1. Organisational 2. Programmatic and 3. Healthcare system related

1.

Develop a locally driven healthcare worker education strategy for north west Syria which is developed in close collaboration with key local and international stakeholders and which could lead to the formation of a consortium focused on healthcare worker education.

2.

Ensure dedicated funding streams for healthcare worker education which are multi-year and accessed through the consortium is the ideal but may be not be feasible; however, allowing funding as part of grants could allow dedicated funds for healthcare worker education.

3.

Develop relevant governance and regulatory structures which standardise the minimum quality of public and private educational establishments which deliver healthcare worker education.

4.

Develop strategic partnerships with international institutions which could support accredited and recognized courses for physician and non-physician healthcare workers in north west Syria. This could be supported with more developed tele-education interventions.

5.

Increase focus on non-physician healthcare workers and skill substitution (task shifting) is required to ensure a healthcare workforce of sufficient skill and specialty to meet gaps.

6.

Conduct regular reviews of initiatives which have or have not been effective (e.g. quality, cost) in providing physician and non-physician healthcare worker education is needed to inform future initiatives.

7.

Continue to advocate for the protection of all health workers and healthcare provision in conflict, which is essential for the continuation of work and training without fear of attack.