Paramedical Training in Algeria : Paramedics’ Relationship to Their Profession and Competency Assessment – Case of Paramedical Training Institutions and Hospitals in Oran and Constantine

Public authorities in Algeria pay significant attention to improving the quality of health services provided to citizens to meet their requirements, particularly as patients now demand high-quality care. Consequently, Algeria has launched a series of reforms aimed at promoting health and adhering to international standards for health services, especially regarding the level of health expenditure [1].

Since independence, the Algerian health system has undergone several reforms and changes, particularly in the training process for paramedical personnel through the evolution of special statutes for this category [2], and the establishment of numerous paramedical training schools across the national territory. The objective is to bridge the deficit in paramedical staff and improve health services, notably in the High Plateaus and the Southern provinces.

Furthermore, health system reform cannot succeed without qualified human resources, specifically in the paramedical category. As highlighted by Forest Pierre-Gerlier et al. (2004: 151) [3]: "the quality of health services in hospitals depends directly on the increase in the ratio of paramedical staff and the tasks they perform."

The number of paramedical staff across all specialties [4] in Algeria stands at approximately 90,000, distributed across various public and economic health sectors. Nevertheless, this resource still faces an acute shortage due to the following factors: the massive wave of early retirements at the end of 2016, occurring just before the freeze on the law governing proportional and early retirement (leading to a gap in the transfer of expertise to new graduates), and the migration of others to European and Gulf countries.

These factors have significantly contributed to the decline of health services. Among the measures adopted by public authorities to promote public health and adapt to global developments, many paramedical training schools [5] were transformed into Higher National Institutes (INFSP). Additionally, two faculties of nursing sciences were established at the universities of Mostaganem and Béjaïa under the LMD system, along with two higher institutes for midwifery training in Tlemcen and Tizi-Ouzou. The reform also introduced a series of decrees defining the organizational methods and content of specialized training programs for public health paramedical staff [6].

Despite these reforms, personal experience and field observations reveal that most human resource managers and department heads are dissatisfied with the competencies (cognitive, relational, and organizational) of newly graduated doctors and paramedical staff. This raises several questions regarding how to improve health service quality and promote public health as an indicator of sustainable development according to international classifications.

Paramedical training institutions strive to provide student trainees with the competencies necessary for the nursing profession; this is known as the professional socialization stage [7]. During this phase, professional ethics are internalized through theoretical lessons and field internships. This is followed by the recruitment phase, known as organizational socialization [8]. This is a crucial phase where the individual acquires the institution's culture, values, and relationships with colleagues. Western health systems place great emphasis on this stage, focusing on the orientation and adaptation of new employees. Human resource departments develop induction, training, and mentoring programs to ensure they become active, committed members, thereby increasing loyalty and performance. Furthermore, professional learning for nurses requires a set of competencies that reflect on their performance and, consequently, improve work quality.

The future challenges and stakes for Algeria regarding community health prompt us to highlight the mechanisms of professional socialization (acquired skills and competencies) in training institutions. This involves identifying the strengths and weaknesses of training and linking them to the requirements of paramedical practice in our health facilities. This gap between training and the cognitive skills required in the field leads us to pose several questions:

To what extent is the imbalance between training and hospital work requirements responsible?What is the role of health institutions in the socialization of new paramedical staff according to the specificities of each department?Which pedagogical methods allow trainees to bridge the gap between theoretical and practical aspects of the clinical process?What are the core competencies that trainees must acquire?Should current training programs be adapted to the transition phase the health sector is experiencing due to the "brain drain" of paramedical resources?How can global developments in health be integrated to reach the strategic goals of developing public health in Algeria?

Study Objectives:

This study aims to achieve the following objectives:

To assess the competencies acquired during the training process (professional socialization) and compare them with the needs of various healthcare services in hospitals and health institutions.In this part of the study, we will examine the criteria used to select candidates for training and whether their personal characteristics and abilities match the requirements of paramedical professions. This stage (selection and orientation) [9], considered highly important, may include psychological tests to identify the aptitudes, skills, and capacities required for nursing practice, as well as written examinations and oral interviews for admission to the profession. The study sample will include students currently enrolled in training institutes.To analyze the content of training programs, their effectiveness in developing the required competencies, and their responsiveness to new developments, while respecting international standards for delivering high-quality public health services.This objective also seeks to understand the role of the teaching staff in the training process. The study sample will include paramedical trainees as well as paramedical instructors, through their perceptions and representations of the nursing profession.To analyze and identify the strengths and weaknesses of the organizational socialization of paramedical staff during their first two years of employment.This analysis will consider the perspectives of human resources managers, department heads, coordinators, care directors, and paramedical staff themselves.

Among the long-term objectives of the study are:

To humanize hospitals, particularly intensive care services, by developing training programs focused on the caregiver–patient relationship, emphasizing communication skills and empathy, to ensure better patient care.To develop the content and programs of the National Higher Institutes of Paramedical Training, based on a competency-based approach, to meet patient needs and promote public health in society.To collaborate with hospital directors and heads of hospital departments to propose integration programs for paramedical graduates, tailored to the specific requirements of each service, while providing pedagogical tutors within hospitals. These tutors, drawn from experienced and highly competent paramedical staff, will contribute effectively to this process.[1] According to the WHO, Algeria spends $234.4 per capita, compared to $175.3 for Tunisia and $63 for Morocco.[2] Executive Decree No. 11-92 of February 24, 2011.[3] Forest Pierre-Gerlier, Gregory P. Marchildon, and Ton McIntosh (2004), The Forces of Change in the Canadian Health Care System, University of Ottawa Press, Canada.[4] It is stipulated in Executive Decree No. 11-121 of March 20, 2011, establishing the special status of paramedical personnel, particularly in Article 2, that the latter are divided into the following branches: the nursing care branch; the rehabilitation and readjustment branch; the medico-technical branch; the medico-social branch; and the paramedical teaching and pedagogical inspection branch.[5] By virtue of Executive Decree No. 11-319 of 9 Shawwal 1432 H, corresponding to September 7, 2011, concerning the transformation of paramedical training schools into national institutes.[6] Interministerial Decree of April 13, 2012, setting the organizational procedures and the content of specialized training programs for access to certain bodies of public health paramedical personnel (Official Gazette of the People's Democratic Republic of Algeria, No. 15 of March 17, 2013, p. 20).[7] The concept of socialization has expanded to include the world of work and professions. Some authors refer to this as organizational socialization, while others use the term professional socialization; however, studies establish a distinction between these two notions. According to the Encyclopedia of Sociology (1998/2008), professional socialization is a process of learning the attitudes and modes of behavior necessary for the acquisition of a recognized and lasting competence within the framework of practicing a given profession. It encompasses the attitudes, behaviors, and skills that the individual acquires through training, labor norms, peer values, and the professional relationships established between them. On their part, Martineau et al. (2009, p. 246) devote an entire chapter to the various definitions of professional socialization proposed by several researchers. Among these, Helm (2004) considers it a process through which the individual acquires the knowledge, skills, and values necessary to enter professional life at an advanced level of specialized knowledge and expertise. Clark (1997) defines it as the acquisition of knowledge, abilities, values, and roles related to the practice of a specific profession. As for Klossner (2004), he conceives it as a process during which individuals learn the roles and responsibilities of the profession and become socialized members within the professional culture.[8] As for organizational socialization, it is defined by E. Schein (1963) as a process during which the new employee learns the 'secrets of the trade' or the tasks they will be required to perform within the organization. Berger and Luckmann (2003, p. 189) distinguish between primary socialization and secondary socialization. According to their approach, secondary socialization corresponds to the “internalization of a specific institutional ethic, as well as the acquisition of specialized knowledge and roles that are, directly or indirectly, rooted in the division of labor”.