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ec
if
ic
ally
n
u
r
s
in
g
an
d
m
id
wif
er
y
co
lleg
es
(
NM
T
C
s
)
,
in
v
o
lv
es
th
e
p
r
o
v
is
io
n
o
f
s
er
v
ices
th
at
m
ee
t
ex
p
ec
tatio
n
s
o
f
all
k
ey
s
tak
eh
o
ld
er
s
,
p
ar
ticu
lar
ly
t
h
e
lab
o
r
m
ar
k
et
s
an
d
t
h
e
s
tu
d
e
n
ts
wh
o
ar
e
d
ir
ec
t
b
e
n
ef
iciar
ies
[
5
]
,
[
8
]
.
T
er
tiar
y
in
s
titu
tio
n
s
r
ec
o
g
n
ized
b
y
Natio
n
al
Acc
r
e
d
itatio
n
B
o
ar
d
(
NAB)
o
f
G
h
a
n
a
ar
e
r
eq
u
ir
ed
to
s
et
u
p
in
ter
n
al
q
u
ality
ass
u
r
an
ce
u
n
it
(
I
QAU)
with
in
a
m
ax
im
u
m
o
f
f
iv
e
y
ea
r
s
f
r
o
m
th
e
d
ate
o
f
f
ir
s
t
ac
cr
e
d
itatio
n
[
6
]
,
[
7
]
.
Pe
r
th
e
NAB
d
ir
ec
tiv
e,
th
e
ex
is
ten
ce
o
f
u
s
ef
u
l
I
QAU
co
u
ld
b
e
a
k
e
y
m
ar
k
er
in
e
v
alu
atin
g
th
e
ex
ec
u
tio
n
o
f
an
in
s
titu
tio
n
to
war
d
s
o
r
g
an
izatio
n
r
e
-
ac
cr
ed
itatio
n
an
d
th
e
g
r
an
t
o
f
p
r
esid
en
tial
ap
p
r
o
v
al.
T
h
is
u
n
it
,
lik
e
o
th
e
r
q
u
ality
ass
u
r
an
ce
b
o
d
ies
g
lo
b
all
y
,
is
ex
p
ec
ted
to
co
n
d
u
ct
o
cc
asio
n
al
s
u
r
v
ey
s
t
o
ev
alu
ate
th
e
d
eg
r
ee
to
wh
ic
h
o
b
je
ctiv
es
ar
e
m
et
in
s
id
e
th
e
s
y
s
tem
o
f
th
e
r
u
les,
an
d
wh
eth
er
th
e
s
tr
ateg
ies
f
o
r
in
s
tr
u
ctio
n
al
d
eliv
er
y
an
d
lear
n
in
g
,
th
e
o
f
f
ices,
an
d
th
e
b
u
d
g
eta
r
y
a
n
d
h
u
m
an
r
eso
u
r
ce
f
o
r
t
h
e
c
o
n
v
e
y
an
ce
o
f
th
e
ed
u
ca
tio
n
al
p
r
o
g
r
am
b
o
ls
ter
th
e
o
b
jectiv
es
[
6
]
.
T
h
e
Nu
r
s
in
g
/Mid
w
if
er
y
T
r
ai
n
in
g
C
o
lleg
es in
Gh
an
a
ar
e
u
n
d
er
th
r
ee
q
u
ality
s
u
p
er
v
is
io
n
b
o
d
ies an
d
a
Un
iv
er
s
ity
f
o
r
th
e
en
s
u
r
in
g
o
f
q
u
ality
.
T
h
ese
in
cl
u
d
e
t
h
e
N
atio
n
al
Acc
r
ed
itatio
n
B
o
ar
d
(
NAB),
Nu
r
s
in
g
an
d
Mid
wif
er
y
C
o
u
n
cil
(
NM
C
)
,
Hea
lth
T
r
ain
in
g
I
n
s
titu
tio
n
Secr
etar
iat
(
HT
I
S)
u
n
d
er
th
e
Min
is
tr
y
o
f
Hea
lth
(
Mo
H)
,
an
d
Kwa
m
e
Nk
r
u
m
ah
Un
iv
er
s
ity
o
f
Scien
ce
an
d
T
ec
h
n
o
l
o
g
y
(
KNUST
)
wh
ic
h
all
p
u
b
lic
Nu
r
s
in
g
/Mid
wif
er
y
T
r
ain
in
g
C
o
lleg
e
is
af
f
iliated
to
f
o
r
th
e
awa
r
d
o
f
d
ip
lo
m
a
in
n
u
r
s
in
g
f
o
r
th
e
g
r
a
d
u
ates.
Desp
ite
all
th
ese
m
ec
h
an
is
m
s
,
B
ö
h
m
ig
[
9
]
in
d
i
ca
ted
th
at
n
u
r
s
in
g
s
tu
d
en
ts
f
r
o
m
th
e
NM
T
C
s
an
d
u
n
i
v
er
s
ities
,
ex
p
er
ien
ce
a
g
ap
b
etwe
en
th
e
th
eo
r
etica
l
teac
h
in
g
s
y
llab
u
s
an
d
th
e
p
r
ac
tical
wo
r
k
in
g
co
n
d
itio
n
i
n
th
e
h
o
s
p
ital.
He
ag
ain
in
d
icate
d
th
at
th
er
e
is
also
a
lack
o
f
s
u
p
er
v
is
io
n
at
th
e
clin
ical
s
ite
d
u
e
to
a
lack
o
f
clin
ical
tu
t
o
r
s
(
also
k
n
o
wn
as
p
r
ec
ep
to
r
s
)
.
On
th
e
asp
ec
t
o
f
af
f
iliatio
n
,
Alab
i
,
et
a
l
.
[
8
]
p
o
s
tu
lated
th
at
Priv
ate
I
n
s
titu
tio
n
s
in
Gh
an
a
als
o
co
m
p
lain
ed
ab
o
u
t
th
e
ef
f
ec
tiv
e
n
ess
o
f
af
f
iliatio
n
as
a
m
en
to
r
i
n
g
p
r
o
ce
s
s
wh
ich
r
es
u
lts
in
n
eg
ativ
e
co
n
s
eq
u
en
tial
ef
f
ec
ts
.
Patien
ts
ar
e
n
o
t g
ettin
g
th
e
s
p
ec
if
ied
ca
r
e
th
at
is
r
eq
u
ir
ed
f
o
r
th
em
f
r
o
m
n
u
r
s
es [
1
0
]
.
Ad
u
-
Gy
am
f
i
an
d
B
r
en
y
a
[
1
0
]
also
d
is
co
v
er
ed
th
at
th
e
n
u
r
s
in
g
p
r
o
f
ess
io
n
in
Gh
an
a
p
r
e
s
en
tly
h
as
b
ec
o
m
e
a
r
ef
u
g
e
am
id
th
e
jo
b
l
ess
n
ess
s
y
s
tem
f
o
r
th
e
p
o
p
u
lac
e
s
in
ce
o
n
e
is
s
ec
u
r
ed
o
f
h
is
/h
e
r
wo
r
k
af
ter
n
u
r
s
in
g
s
ch
o
o
l.
Als
o
,
in
s
tr
u
ctio
n
f
o
r
n
u
r
s
es
in
Gh
an
a
in
t
h
e
y
ea
r
s
en
s
u
in
g
was
tr
o
u
b
led
with
d
if
f
ic
u
lties
f
o
r
tu
to
r
s
an
d
tex
tb
o
o
k
s
.
T
h
ese
tex
tb
o
o
k
s
w
h
en
ac
ce
s
s
ib
le
wer
e
o
b
s
o
lete
an
d
s
tu
d
en
ts
d
id
n
o
t
h
av
e
th
e
f
in
an
cial
s
tr
en
g
th
to
ac
q
u
ir
e
th
em
.
Als
o
,
ch
ec
k
s
o
n
th
e
n
atio
n
al
ac
c
r
ed
itat
io
n
b
o
ar
d
,
Gh
a
n
a
[
1
1
]
in
d
icate
d
th
at
o
n
ly
1
6
o
f
all
th
e
p
u
b
lic
n
u
r
s
in
g
an
d
m
i
d
wif
er
y
tr
ain
in
g
co
lleg
es
in
Gh
an
a
h
a
v
e
ac
tiv
e
ac
cr
ed
itatio
n
an
d
f
r
o
m
wh
ich
o
n
l
y
two
(
Mid
wif
er
y
T
r
ain
in
g
C
o
lleg
e
-
T
u
m
u
an
d
Nu
r
s
in
g
T
r
ai
n
in
g
C
o
lleg
e
-
L
awr
a)
o
u
t
o
f
th
e
s
ev
en
co
lleg
es
in
th
e
Up
p
er
W
est
R
eg
io
n
wer
e
p
ar
t
[
1
1
]
.
T
h
er
ef
o
r
e
,
th
is
s
tu
d
y
s
o
u
g
h
t
to
b
r
id
g
e
th
ese
g
ap
s
b
y
ass
ess
in
g
th
e
s
ta
te
o
f
QA
p
o
licies
as
well
as
th
eir
im
p
lem
en
tat
io
n
in
n
u
r
s
in
g
an
d
m
id
wif
er
y
tr
ain
in
g
c
o
lleg
es
(
NM
T
C
s
)
in
th
e
Up
p
er
W
est
R
eg
io
n
o
f
Gh
an
a.
I
t
will
also
ad
d
t
o
th
e
s
ca
n
ty
liter
atu
r
e
o
f
q
u
ality
ass
u
r
an
ce
in
NM
T
C
s
in
Gh
an
a.
T
h
e
r
esear
ch
q
u
esti
o
n
s
th
at
p
iv
o
ted
th
e
s
tu
d
y
wer
e:
1
)
W
h
at
is
th
e
ev
id
en
ce
o
f
q
u
ali
ty
ass
u
r
an
ce
p
o
licies
in
NM
T
C
s
m
ea
n
t
to
e
n
s
u
r
e
th
e
q
u
ality
o
f
tr
ain
in
g
in
t
h
e
Up
p
e
r
W
est
R
eg
io
n
o
f
Gh
an
a
?
2
)
Ho
w
ar
e
q
u
ality
ass
u
r
an
ce
p
o
licies im
p
lem
en
ted
in
NM
T
C
s
in
th
e
Up
p
er
W
est R
eg
io
n
o
f
Gh
an
a
?
E
u
r
o
p
ea
n
Ass
o
ciatio
n
f
o
r
Qu
a
lity
Ass
u
r
an
ce
in
Hig
h
er
E
d
u
c
atio
n
Ar
ea
[
1
2
]
ass
er
ted
th
at
p
o
licies
an
d
p
r
o
ce
s
s
es
f
o
r
q
u
ality
ass
u
r
an
ce
in
an
o
r
g
an
izatio
n
ar
e
th
e
p
r
im
ar
y
m
ain
s
tay
s
o
f
an
in
tel
lig
ib
le
in
s
titu
tio
n
al
q
u
ality
co
n
f
ir
m
atio
n
f
r
am
ewo
r
k
th
at
s
h
ap
es
a
cy
cle
f
o
r
p
er
p
etu
al
ad
v
an
ce
m
e
n
t
an
d
a
d
d
s
t
o
th
e
r
esp
o
n
s
i
b
ilit
y
o
f
th
e
f
o
u
n
d
atio
n
.
T
h
e
p
o
lic
y
s
tatem
en
t
f
o
r
ad
v
an
ce
d
tu
itio
n
in
s
titu
tio
n
s
in
th
e
No
r
m
s
an
d
g
u
id
elin
es
f
o
r
in
ter
n
al
q
u
ality
ass
u
r
an
ce
with
in
ad
v
a
n
ce
d
tu
itio
n
in
s
titu
tio
n
s
ar
e
ex
p
ec
ted
to
in
cl
u
d
e
t
h
e
r
elatio
n
s
h
ip
b
etwe
en
in
s
tr
u
ctio
n
s
an
d
r
esear
ch
with
in
th
e
estab
lis
h
m
en
t;
th
e
in
s
titu
tio
n
'
s
p
r
o
ce
d
u
r
e
f
o
r
v
al
u
e
an
d
b
en
c
h
m
ar
k
s
;
th
e
o
r
g
an
izatio
n
o
f
t
h
e
q
u
ality
ass
u
r
an
ce
s
y
s
tem
;
th
e
o
b
lig
atio
n
s
o
f
o
f
f
ices,
s
ch
o
o
ls
,
f
ac
u
lties
,
an
d
o
th
e
r
u
n
its
an
d
p
eo
p
le
f
o
r
t
h
e
af
f
ir
m
atio
n
o
f
q
u
ality
;
s
tu
d
en
ts
r
o
le
in
q
u
alit
y
ass
u
r
an
ce
;
an
d
h
o
w
th
e
a
p
p
r
o
ac
h
is
ac
tu
a
lized
,
o
b
s
er
v
ed
an
d
ch
a
n
g
ed
[
1
3
]
.
N
ew
Z
ea
lan
d
h
as
d
etailed
ap
p
r
o
ac
h
es
with
r
esp
ec
t
to
q
u
ality
a
s
s
u
r
an
ce
ex
ec
u
tiv
es
an
d
th
at
th
ese
ar
r
an
g
e
m
en
ts
ar
e
ex
p
an
s
iv
e
a
n
d
s
p
r
ea
d
all
p
ar
ts
o
f
th
eir
f
r
am
ewo
r
k
s
.
T
h
e
ap
p
r
o
ac
h
es
ar
e
ar
ch
iv
ed
as
an
in
s
titu
tio
n
al
q
u
ality
ass
u
r
an
ce
m
a
n
u
al
w
h
ich
i
s
ex
p
o
s
ed
to
a
co
n
s
is
ten
t
s
u
r
v
e
y
.
T
h
e
s
am
e
ca
n
n
o
t
b
e
s
aid
o
f
Gh
an
a
b
ec
au
s
e
h
ig
h
er
ed
u
ca
tio
n
in
s
titu
tio
n
s
in
Gh
an
a
r
ar
ely
h
a
v
e
ev
id
en
ce
o
f
p
o
licies
o
n
q
u
ality
ass
u
r
an
ce
p
r
o
ce
d
u
r
es a
n
d
th
e
d
o
cu
m
e
n
tatio
n
o
f
th
ese
in
m
a
n
u
als [
7
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J E
v
al
&
R
es E
d
u
c
I
SS
N:
2252
-
8
8
2
2
Qu
a
lity a
s
s
u
r
a
n
ce
p
o
licies a
n
d
imp
leme
n
ta
tio
n
in
n
u
r
s
in
g
a
n
d
mid
w
ifer
y
…
(
P
h
ilip
A
n
ye
l
b
a
Ta
n
kp
a
r
a
)
457
Sen
iwo
lib
a
[
1
4
]
ass
u
m
ed
t
h
at
asid
e
f
r
o
m
th
e
p
r
in
cip
les
s
et
a
s
id
e
b
y
th
e
q
u
ality
ass
u
r
an
ce
b
o
d
ies
f
o
r
th
e
ass
u
r
an
ce
o
f
q
u
ality
;
ea
ch
o
r
g
an
izatio
n
h
as
its
in
ter
n
al
p
o
licies
an
d
m
ec
h
an
is
m
s
f
o
r
en
s
u
r
in
g
t
h
e
f
u
lf
illme
n
t
o
f
it
s
m
an
d
ate
as
a
cr
ed
ib
le
Sch
o
o
l.
Au
g
m
en
tatio
n
o
f
q
u
ality
in
ad
v
an
ce
lear
n
i
n
g
d
em
a
n
d
s
q
u
alif
ied
an
d
h
ig
h
ly
m
o
tiv
ated
s
taf
f
m
em
b
er
s
wh
o
ar
e
co
m
m
itted
to
q
u
ality
o
u
tco
m
es
[
1
5
]
.
I
n
ad
d
itio
n
,
it
ca
n
b
e
ac
h
iev
ed
b
y
en
s
u
r
in
g
t
h
at
wo
r
k
e
r
s
ar
e
in
v
o
lv
ed
in
q
u
ality
as
s
u
r
an
ce
ac
t
iv
ities
th
r
o
u
g
h
ef
f
ec
tiv
e
an
d
r
ea
s
o
n
ab
le
to
p
-
d
o
wn
an
d
b
o
tt
o
m
-
u
p
co
m
m
u
n
icatio
n
ch
an
n
els
as
well
as
r
ig
o
r
o
u
s
lab
o
r
en
lis
tm
en
t
p
r
o
ce
s
s
es,
d
ev
elo
p
m
en
t,
a
n
d
s
tim
u
lu
s
s
y
s
tem
s
.
T
h
er
e
s
h
o
u
ld
also
b
e
an
ad
m
in
is
tr
ativ
e
s
tr
u
ctu
r
e
th
at
h
as
th
e
r
esp
o
n
s
ib
ilit
y
f
o
r
ca
r
r
y
in
g
o
u
t
th
e
p
o
licies
o
f
th
e
o
r
g
an
izatio
n
b
y
its
v
is
io
n
,
m
is
s
io
n
,
g
o
al,
an
d
o
b
jectiv
es
[
4
]
.
T
h
e
NM
E
I
p
r
in
cip
al
o
u
g
h
t
to
h
av
e
a
r
u
d
im
en
ta
r
y
ed
u
ca
tio
n
al
ex
p
er
ien
ce
i
n
n
u
r
s
in
g
o
r
m
i
d
wif
er
y
an
d
th
at
th
e
m
an
a
g
e
m
en
t
o
f
t
h
e
Nu
r
s
in
g
an
d
Mid
wif
er
y
E
d
u
c
ati
o
n
I
n
s
titu
tio
n
(
NM
E
I
)
is
im
p
lem
en
ted
,
s
u
p
er
v
is
ed
,
an
d
v
al
u
ed
b
y
co
m
m
ittees.
T
h
e
ad
m
in
is
tr
ativ
e
s
taf
f
s
h
o
u
ld
b
e
ad
eq
u
ate
an
d
co
m
p
ete
n
t
in
th
e
ir
wo
r
k
.
T
h
e
g
en
er
al
ad
m
in
is
tr
ativ
e
b
o
d
y
s
h
o
u
ld
also
h
o
ld
r
e
g
u
lar
m
ee
ti
n
g
s
,
t
ak
es
m
in
u
tes,
an
d
co
m
m
u
n
ic
ates
r
elev
an
t
in
f
o
r
m
atio
n
to
s
taf
f
.
Acc
o
r
d
in
g
to
Natio
n
al
Acc
r
ed
itatio
n
B
o
ar
d
,
th
e
im
p
o
r
tan
t
d
u
ty
o
f
ter
tiar
y
in
s
titu
tio
n
s
is
to
s
ea
r
ch
f
o
r
k
n
o
wled
g
e
eith
er
f
o
r
its
o
wn
s
ak
e
o
r
to
a
p
p
ly
s
u
ch
k
n
o
wled
g
e
to
e
n
h
an
ce
,
d
ir
ec
tl
y
o
r
in
d
ir
ec
tly
,
th
e
m
ater
ial
w
ell
-
b
ein
g
,
h
ap
p
i
n
e
s
s
,
an
d
co
m
f
o
r
t
o
f
h
u
m
an
k
in
d
[
1
1
]
.
B
ased
o
n
t
h
is
ter
tiar
y
in
s
titu
tio
n
s
u
ch
NM
T
C
s
ar
e
o
b
lig
ated
to
p
er
i
o
d
ically
co
n
d
u
ct
a
n
d
p
u
b
lis
h
r
esear
ch
t
o
im
p
r
o
v
e
in
th
e
k
n
o
wled
g
e
le
v
el
o
f
th
e
in
s
titu
tio
n
as
well
as
Gh
an
a
as
a
wh
o
le.
2.
RE
S
E
ARCH
M
E
T
H
O
D
T
h
e
s
tu
d
y
r
elied
o
n
a
q
u
an
tita
tiv
e
m
eth
o
d
th
at
h
elp
ed
t
h
e
r
e
s
ea
r
ch
er
s
to
d
ed
u
ce
th
e
s
tate
o
f
q
u
ality
ass
u
r
an
ce
in
NM
T
C
s
in
th
e
U
p
p
er
W
est
R
eg
io
n
o
f
Gh
an
a.
T
h
e
r
ea
s
o
n
f
o
r
ad
o
p
tin
g
a
q
u
a
n
titativ
e
ap
p
r
o
ac
h
is
to
h
elp
g
ath
er
in
-
d
ep
th
in
f
o
r
m
atio
n
ab
o
u
t
q
u
ality
ass
u
r
an
ce
ac
tiv
ities
in
NM
T
C
s
a
s
co
n
jectu
r
ed
b
y
C
r
eswell
[
1
6
]
.
T
h
e
s
tu
d
y
p
o
p
u
latio
n
en
t
ails
Hea
l
th
tu
to
r
s
an
d
s
tu
d
en
ts
in
th
e
s
ev
en
NM
T
C
s
in
th
e
U
p
p
er
W
est
R
eg
io
n
o
f
Gh
a
n
a.
T
h
e
ac
ce
s
s
ib
le
p
o
p
u
latio
n
in
clu
d
ed
h
ea
lth
tu
to
r
s
wh
o
h
a
v
e
s
p
e
n
t
at
least
o
n
e
a
ca
d
em
ic
y
ea
r
in
th
e
in
s
titu
tio
n
an
d
h
ea
lth
tu
to
r
s
wh
o
a
r
e
m
e
m
b
er
s
o
f
th
e
q
u
ality
ass
u
r
an
ce
co
m
m
ittee
as
well
a
s
f
in
al
y
ea
r
s
tu
d
e
n
ts
in
th
e
i
n
s
titu
tio
n
s
s
tu
d
ied
.
W
e
ag
r
ee
with
R
y
an
[
1
7
]
th
at
s
tu
d
en
ts
wh
o
ar
e
im
p
o
r
tan
t
s
ta
k
eh
o
ld
er
s
in
q
u
ality
ass
u
r
an
ce
p
o
licy
d
ev
elo
p
m
en
t
a
n
d
im
p
lem
en
tatio
n
is
cr
u
cial
t
o
b
e
in
clu
d
ed
i
n
an
y
q
u
ality
ass
u
r
an
ce
s
tu
d
y
.
T
h
e
s
am
p
le
s
ize
o
f
th
e
s
tu
d
y
was
d
eter
m
in
ed
as
2
7
2
Hea
lth
tu
t
o
r
s
an
d
f
in
al
y
ea
r
s
tu
d
e
n
ts
o
f
all
th
e
s
ev
en
h
ea
lth
tr
ain
in
g
in
s
titu
tio
n
s
in
th
e
r
eg
i
o
n
.
T
h
is
s
am
p
le
s
ize
was
d
eter
m
i
ne
d
u
s
in
g
th
e
Yam
a
n
e'
s
f
o
r
m
u
la
[
=
/
1+
(
е)
2
]
A
ce
n
s
u
s
was u
tili
ze
d
to
c
h
o
o
s
e
th
e
co
lleg
es (
s
ev
en
in
th
e
r
e
g
io
n
)
,
s
tr
atif
ied
p
r
o
p
o
r
tio
n
ate
s
am
p
lin
g
tech
n
i
q
u
e
f
o
r
ac
ad
em
ic
s
taf
f
(
6
7
)
an
d
f
in
al
y
ea
r
s
tu
d
en
ts
(
2
0
5
)
,
p
u
r
p
o
s
iv
e
s
am
p
lin
g
f
o
r
s
elec
tin
g
b
o
t
h
s
taf
f
s
(
tu
to
r
s
wh
o
h
av
e
ad
eq
u
ate
k
n
o
wled
g
e
o
n
QA)
an
d
s
tu
d
en
ts
.
A
s
tr
u
ctu
r
ed
q
u
esti
o
n
n
air
e
was
d
esig
n
ed
a
n
d
u
s
ed
f
o
r
g
ar
n
e
r
in
g
th
e
q
u
a
n
titativ
e
d
at
a
f
o
r
th
e
s
t
u
d
y
[
1
6
]
.
T
h
e
th
r
ee
q
u
esti
o
n
n
air
es
d
esig
n
ed
f
o
r
th
e
s
tu
d
y
w
er
e
p
ilo
t
test
ed
o
n
a
s
m
all
s
ec
tio
n
o
f
th
e
s
am
p
le
g
r
o
u
p
s
to
v
o
u
ch
f
o
r
th
eir
v
alid
it
y
[
1
8
]
.
Af
ter
th
e
p
ilo
t
s
tu
d
y
,
th
e
f
ee
d
b
ac
k
o
b
tain
e
d
was u
s
ed
in
im
p
r
o
v
in
g
th
e
q
u
e
s
tio
n
n
air
es th
at
wer
e
f
in
ally
a
d
m
in
is
ter
ed
f
o
r
th
e
f
u
ll
-
s
ca
le
s
tu
d
y
.
T
h
e
d
ata
co
llected
with
th
e
ai
d
o
f
th
e
q
u
esti
o
n
n
ai
r
e
wer
e
an
aly
z
ed
u
s
in
g
SP
SS
v
er
s
io
n
2
0
an
d
Stata.
Descr
ip
tiv
e
an
aly
s
is
was
em
p
lo
y
ed
wh
ich
in
clu
d
ed
m
ea
n
,
s
tan
d
ar
d
d
ev
iatio
n
,
a
n
d
f
r
eq
u
e
n
cy
(
p
e
r
ce
n
tag
e)
t
o
ex
p
lain
th
e
av
ailab
ilit
y
o
f
q
u
a
lity
ass
u
r
an
ce
p
o
licies
an
d
th
eir
im
p
lem
en
tatio
n
in
NM
T
C
s
in
th
e
Up
p
er
W
est
R
eg
io
n
,
th
e
p
r
ac
tice
o
f
q
u
ality
ass
u
r
an
ce
ac
tiv
ities
(
s
u
ch
a
s
q
u
ality
o
f
in
f
r
astru
ctu
r
e,
t
h
e
v
alu
e
o
f
ac
ad
em
ic
s
taf
f
an
d
v
alu
e
o
f
e
x
am
in
atio
n
)
.
C
h
i
-
s
q
u
ar
e
was
u
s
ed
to
e
x
p
lai
n
v
ar
iatio
n
s
in
t
h
e
m
ag
n
itu
d
e
o
f
q
u
ality
ass
u
r
an
ce
p
o
licy
im
p
lem
e
n
tatio
n
in
NM
T
C
s
in
th
e
Up
p
er
W
est R
eg
io
n
.
3.
RE
SU
L
T
S
A
ND
D
I
SCU
SS
I
O
N
3
.
1
.
Av
a
ila
bil
it
y
o
f
qu
a
lity
a
s
s
ur
a
nce
po
licies in hea
lt
h t
ra
ini
ng
f
a
cilit
ies
Qu
ality
a
s
s
u
r
an
ce
p
o
licies
ar
e
n
ec
ess
ar
y
an
d
s
er
v
e
as
s
tan
d
ar
d
g
u
id
elin
es
f
o
r
an
in
s
titu
tio
n
t
o
p
r
o
d
u
ce
th
e
b
est
n
u
r
s
in
g
an
d
m
id
wif
e
r
y
p
r
o
f
ess
io
n
al
as
m
an
d
ated
b
y
th
e
s
e
co
lleg
es
[
1
3
]
.
T
h
is
s
ec
tio
n
ex
am
in
es
th
e
av
ailab
ilit
y
o
f
QA
p
o
licies
in
NM
T
C
s
in
th
e
r
e
g
io
n
.
T
h
e
r
es
u
lts
in
T
ab
le
1
s
h
o
ws
th
at
3
4
.
3
%
o
f
h
ea
lth
tu
to
r
s
wh
o
r
esp
o
n
d
ed
to
t
h
e
q
u
esti
o
n
s
aid
‘
y
es’
wh
ile
4
1
.
8
%
in
d
icate
d
‘
n
o
’
to
t
h
e
av
ailab
il
ity
o
f
a
QA
p
o
licy
d
o
cu
m
e
n
t.
2
3
.
9
%
o
f
th
e
s
u
r
v
ey
ed
tu
to
r
s
d
id
n
o
t
k
n
o
w
wh
eth
er
o
r
n
o
t
a
QA
p
o
licy
wa
s
av
ailab
le
in
th
e
in
s
titu
tio
n
in
wh
ich
th
e
y
wo
r
k
as
ac
ad
em
ic
s
taf
f
.
T
h
eir
v
iew
s
s
u
p
p
o
r
t
th
e
f
in
d
in
g
s
o
f
Utu
k
a
[
7
]
wh
o
p
o
s
ited
th
at
h
ig
h
er
e
d
u
ca
tio
n
in
s
titu
tio
n
s
in
Gh
an
a
r
ar
ely
h
a
v
e
ev
id
en
ce
o
f
a
p
p
r
o
ac
h
es
o
n
v
alu
e
a
f
f
ir
m
atio
n
m
et
h
o
d
s
an
d
th
e
d
o
cu
m
en
tatio
n
o
f
th
e
s
e
in
b
o
o
k
s
.
Ho
wev
er
,
th
e
f
i
n
d
in
g
s
co
n
tr
a
d
ict
with
W
HO
's
[
4
]
g
u
id
elin
e
s
f
o
r
n
u
r
s
in
g
an
d
m
id
wif
er
y
e
d
u
ca
ti
o
n
in
s
titu
tio
n
s
wh
ich
in
d
icate
d
th
at
ev
er
y
NM
E
I
o
u
g
h
t
to
b
u
ild
u
p
th
eir
s
tr
ateg
ies
an
d
c
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
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co
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r
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1
4
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th
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Gh
an
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ter
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Ta
b
le
1.
Q
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ality
ass
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r
an
ce
p
o
l
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im
p
lem
en
tatio
n
le
v
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in
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MT
C
s
in
th
e
Up
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er
W
est R
eg
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n
Lo
w
(
%)
H
i
g
h
(
%)
To
t
a
l
(
%)
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u
a
l
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t
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ss
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3
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4
1
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r
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2
.
Q
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ality
ass
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r
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ce
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T
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est R
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1
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2
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1
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To
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16
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2
.
I
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plem
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lity
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p
le
m
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[
4
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[
1
9
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.
B
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in
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s
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th
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er
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t
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w
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ated
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p
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d
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ac
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n
its
in
th
e
in
s
titu
tio
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s
b
y
p
r
in
cip
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s
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p
r
o
v
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a
n
d
/o
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m
ain
ten
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ce
o
f
p
h
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ical
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ac
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o
n
g
o
th
e
r
s
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e
n
o
t p
u
t
in
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lace
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d
h
en
ce
t
h
e
lo
w
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tatio
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ate.
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n
g
th
e
in
d
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al
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NM
T
C
s
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eg
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-
W
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h
as
th
e
h
ig
h
est
im
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as
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m
p
ar
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to
in
s
titu
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n
s
th
at
h
av
e
th
e
QA
p
o
licy
(
1
6
%:
p
=0
.
0
1
)
.
Desp
ite
th
e
av
ailab
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y
o
f
th
e
QA
p
o
licy
d
o
c
u
m
en
t
in
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ir
ap
a
MT
C
,
th
e
im
p
lem
en
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o
f
t
h
e
p
o
licy
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v
er
y
lo
w
(
1
.
5
%:
p
=0
.
0
2
)
.
T
a
b
le
3
s
h
o
w
s
th
e
d
etails
o
f
th
e
i
n
d
iv
id
u
al
co
lleg
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lev
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(
%)
o
f
QA
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im
p
lem
e
n
tatio
n
.
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h
ese
f
in
d
in
g
s
r
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e
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at
p
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ity
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ited
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ted
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2
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l
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[
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th
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f
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.
QA
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y
in
s
titu
tio
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s
N
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me
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t
i
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m
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t
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t
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b
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t
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t
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s
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h
To
t
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i
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P
-
v
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l
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e
N
(
%)
N
(
%)
N
(
%)
N
TC
,
J
i
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1
2
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a
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1
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C
H
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8
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T
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3
.
0
)
8
(
1
1
.
9
)
To
t
a
l
4
4
(
6
5
.
6
)
2
3
(
3
4
.
4
)
6
7
(
1
0
0
)
S
o
u
r
c
e
:
F
i
e
l
d
d
a
t
a
(
2
0
1
9
)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J E
v
al
&
R
es E
d
u
c
I
SS
N:
2252
-
8
8
2
2
Qu
a
lity a
s
s
u
r
a
n
ce
p
o
licies a
n
d
imp
leme
n
ta
tio
n
in
n
u
r
s
in
g
a
n
d
mid
w
ifer
y
…
(
P
h
ilip
A
n
ye
l
b
a
Ta
n
kp
a
r
a
)
459
3
.
2
.
1
.
Q
ua
lity
a
s
s
ura
nce
pra
ct
ices in nur
s
ing
a
nd
m
idwif
er
y
t
ra
ini
ng
co
lleg
es in t
he
up
per
west
re
g
io
n
T
h
is
s
ec
tio
n
s
h
o
ws
th
e
g
en
er
al
in
s
titu
tio
n
al
QA
p
r
ac
ticed
r
ate
f
r
o
m
th
e
p
er
s
p
ec
tiv
e
o
f
b
o
th
tu
to
r
s
an
d
s
tu
d
en
ts
in
th
e
Up
p
er
W
est R
e
g
io
n
.
a.
Q
ua
lity
a
s
s
ura
nce
co
m
m
it
t
e
e/uni
t
So
m
e
o
f
th
e
v
ar
ia
b
les
ass
ess
ed
in
th
e
ar
ea
o
f
p
r
ac
tices
b
y
NM
T
C
s
f
r
o
m
th
e
p
e
r
s
p
ec
tiv
e
o
f
h
e
alth
tu
to
r
s
an
d
s
tu
d
en
ts
in
th
e
Up
p
er
W
est
R
eg
io
n
in
clu
d
ed
;
th
e
f
u
n
cti
o
n
ality
o
f
QA
u
n
its
o
r
co
m
m
i
ttee
in
th
e
co
lleg
es,
q
u
ality
o
f
ac
ad
em
ic
s
taf
f
,
q
u
al
ity
o
f
ad
m
is
s
io
n
p
r
o
ce
s
s
,
th
e
v
alu
e
o
f
in
f
r
astru
ctu
r
e
an
d
q
u
al
ity
o
f
g
o
v
er
n
an
ce
.
T
h
ese
ac
co
r
d
in
g
to
W
HO
[
3
]
wi
ll
cr
ea
te
an
atm
o
s
p
h
er
e
f
o
r
tu
to
r
s
to
g
iv
e
q
u
ality
tr
ain
in
g
a
n
d
p
lay
th
eir
ass
ig
n
ed
r
o
le
v
iab
ly
in
d
eliv
er
in
g
q
u
a
lifie
d
alu
m
n
i
wh
o
will
ad
d
r
ess
th
e
is
s
u
es
an
d
d
esire
s
f
o
r
s
o
ciety
.
Po
s
itiv
e
co
llab
o
r
atio
n
b
etwe
en
th
e
ed
u
ca
to
r
an
d
th
e
s
tu
d
en
t
an
d
th
e
a
g
g
r
eg
at
e
h
o
n
esty
an
d
p
o
lis
h
ed
m
eth
o
d
o
l
o
g
y
o
f
th
e
s
ch
o
last
ic
n
etwo
r
k
is
ex
p
ec
ted
to
y
ield
q
u
alif
ied
g
r
ad
u
ates.
Fin
d
in
g
s
in
d
icate
d
th
at
6
5
.
7
%
o
f
th
e
s
u
r
v
ey
ed
tu
t
o
r
s
s
tated
'Ye
s
'
f
o
r
th
e
av
ailab
ilit
y
o
f
th
e
QA
u
n
it/co
m
m
ittee
in
th
e
co
lleg
es.
Ho
wev
er
,
th
e
m
ajo
r
ity
(
5
0
.
0
%)
ass
er
ted
th
at
th
ese
co
m
m
ittee
s
ar
e
n
o
t
ac
tiv
e
a
n
d
1
8
.
8
%
ar
e
n
o
t
ce
r
tain
wh
et
h
er
o
r
n
o
t
t
h
ese
co
m
m
ittees
ar
e
ac
tiv
e.
I
n
co
n
ce
s
s
io
n
with
a
s
tu
d
y
co
n
d
u
cted
in
th
e
No
r
th
er
n
r
eg
io
n
b
y
E
s
s
el,
B
o
ak
y
e
-
Yiad
o
m
,
an
d
Mo
h
am
m
e
d
[
2
3
]
wh
ich
also
r
ev
ea
led
th
a
t
a
m
o
r
e
p
r
o
m
i
n
en
t
n
u
m
b
er
o
f
tu
to
r
s
f
r
o
m
th
e
t
h
r
ee
N
MT
C
s
d
ec
lar
ed
th
e
av
ailab
ilit
y
o
f
q
u
ality
ass
u
r
an
c
e
u
n
it/co
m
m
ittee
in
th
eir
s
ch
o
o
ls
.
T
h
is
is
al
s
o
u
n
d
er
th
e
W
HO
r
ec
o
m
m
en
d
atio
n
o
f
th
e
s
elec
tio
n
o
f
a
v
alu
e
af
f
ir
m
ativ
e
co
m
m
ittee
in
ch
ar
g
e
o
f
au
d
itin
g
in
ter
n
ally
,
w
atch
in
g
o
v
er
,
an
d
ass
ess
m
en
t
o
f
QA
s
y
s
tem
s
.
Gr
an
ted
,
ter
tiar
y
in
s
titu
tio
n
s
th
r
iv
e
o
n
th
e
co
m
m
ittee
s
y
s
tem
[
2
4
]
an
d
as
s
u
ch
,
p
u
ttin
g
in
p
lace
a
QA
co
m
m
ittee
in
th
e
Up
p
er
W
est
R
eg
io
n
is
co
m
m
en
d
a
b
le.
Ho
wev
er
,
th
e
in
ac
tiv
en
ess
o
f
t
h
e
QA
co
m
m
ittees
in
th
e
Up
p
e
r
W
est
R
eg
io
n
will
d
ef
ea
t
th
e
o
b
jectiv
e
o
f
m
o
n
ito
r
in
g
a
n
d
ev
al
u
atin
g
t
h
e
q
u
ality
o
f
in
s
tr
u
ctin
g
a
n
d
le
ar
n
in
g
in
t
h
eir
r
esp
ec
tiv
e
in
s
titu
tio
n
s
.
T
h
e
im
p
ac
t
will
b
e
th
e
p
r
o
d
u
ctio
n
o
f
g
r
a
d
u
ates
with
lo
w
s
tan
d
ar
d
s
o
f
p
r
o
f
ess
io
n
alis
m
[
2
5
]
.
Qu
ality
o
f
a
c
ad
em
ic
St
af
f
v
alu
e
an
d
th
at
o
f
th
e
ad
m
is
s
io
n
p
r
o
ce
s
s
was
h
ig
h
am
o
n
g
tu
to
r
s
(
6
6
.
7
%
an
d
7
9
.
1
%
r
esp
ec
tiv
ely
)
.
T
h
is
was
n
o
t
d
if
f
er
en
t
f
r
o
m
th
e
p
er
s
p
ec
tiv
e
o
f
th
e
s
tu
d
en
ts
as
8
4
.
4
%
o
f
t
h
e
s
tu
d
en
ts
af
f
ir
m
ed
t
h
e
q
u
ality
o
f
Aca
d
em
ic
s
taf
f
to
b
e
h
ig
h
.
W
a
NT
C
r
ec
o
r
d
ed
th
e
h
i
g
h
est
(
2
1
.
5
%:
P=0
.
0
3
)
in
ter
m
s
o
f
q
u
ality
o
f
ac
ad
em
ic
s
taf
f
wh
ile
Nan
d
o
m
NT
C
r
ec
o
d
ed
th
e
least
(
5
.
9
%)
as
s
ee
n
in
T
ab
le
4
.
Staf
f
e
v
alu
atio
n
is
cr
u
cial
f
o
r
e
n
s
u
r
in
g
t
h
e
v
alu
e
o
f
tr
ain
in
g
o
f
n
u
r
s
es
an
d
b
ir
t
h
in
g
atten
d
a
n
ts
[
2
6
]
.
T
h
e
Nat
io
n
al
Acc
r
ed
i
tatio
n
B
o
ar
d
[
1
1
]
r
ec
o
m
m
e
n
d
s
th
at
ac
a
d
em
ic
s
taf
f
m
u
s
t
b
e
ev
alu
ate
d
esp
ec
ially
b
y
s
tu
d
en
ts
as
th
ey
ar
e
t
h
e
p
r
i
m
ar
y
b
e
n
ef
iciar
y
o
f
t
h
ese
s
taf
f
.
T
h
is
is
im
p
o
r
tan
t
b
ec
au
s
e
s
tu
d
en
ts
o
f
f
er
th
e
lear
n
in
g
c
h
allen
g
es
f
r
o
m
th
eir
p
er
s
p
ec
tiv
e
an
d
th
is
e
n
h
an
ce
s
th
e
e
v
alu
atio
n
o
f
q
u
ality
[
2
7
]
.
R
esp
o
n
s
es
f
r
o
m
s
tu
d
e
n
ts
r
eg
ar
d
in
g
s
taf
f
ev
alu
atio
n
r
ev
ea
led
th
at
W
a
NT
C
ev
alu
ates
h
ea
lth
tu
to
r
s
o
n
ce
ev
er
y
s
em
este
r
as
in
d
icate
b
y
NAB.
Ho
wev
er
,
s
tu
d
en
ts
f
r
o
m
J
ir
ap
a
NT
C
in
d
icate
d
th
at
t
h
ey
d
o
n
o
t
ev
alu
ate
ac
ad
em
ic
s
taf
f
r
eg
a
r
d
in
g
ac
ad
em
ic
s
ta
f
f
p
er
f
o
r
m
an
ce
as
f
ar
as
tr
ain
in
g
n
u
r
s
es
is
a
co
n
ce
r
n
.
Stu
d
en
ts
f
r
o
m
th
e
r
em
ain
in
g
NM
T
C
s
ar
e
u
n
ce
r
t
ain
ab
o
u
t
wh
eth
er
o
r
n
o
t
th
e
y
ev
alu
ate
h
ea
lth
tu
to
r
s
in
th
eir
v
ar
io
u
s
in
s
titu
tio
n
s
as
p
r
esen
ted
in
T
ab
le
5
.
T
ab
le
4
r
ep
r
esen
ts
r
esp
o
n
s
es
f
r
o
m
h
ea
lth
tu
to
r
s
i
n
th
e
Up
p
er
W
est
r
eg
io
n
r
eg
ar
d
in
g
th
e
co
n
d
u
ctio
n
an
d
p
u
b
licatio
n
o
f
r
esear
ch
i
n
th
eir
v
ar
io
u
s
in
s
titu
tio
n
s
as
r
ec
o
m
m
en
d
e
d
b
y
NAB.
Fin
d
in
g
s
r
ev
ea
led
th
at
n
o
NM
T
C
in
th
e
Up
p
er
W
est
r
eg
io
n
f
u
lf
ills
th
is
m
an
d
ate
b
y
th
e
Nati
o
n
al
Acc
r
ed
itatio
n
B
o
ar
d
[
1
1
]
.
T
h
is
m
ay
b
e
attr
ib
u
ted
t
o
th
e
lack
o
f
p
ar
ticip
ato
r
y
g
o
v
er
n
an
ce
an
d
th
e
e
x
is
ten
ce
o
f
p
o
o
r
co
m
m
u
n
icatio
n
s
y
s
tem
b
etwe
en
s
taf
f
an
d
h
ea
d
s
in
th
eir
r
esp
ec
tiv
e
in
s
titu
tio
n
s
[
2
8
]
.
T
ab
le
4
.
T
u
to
r
s
’
r
esp
o
n
s
es o
n
r
esear
ch
an
d
p
u
b
licatio
n
V
a
r
i
a
b
l
e
R
e
s
p
o
n
se
s
I
n
st
i
t
u
t
i
o
n
s
N
TC
,
Ji
r
a
p
a
N
TC
,
Wa
M
T
C
,
Ji
r
a
p
a
C
H
N
TC
,
Ji
r
a
p
a
M
T
C
,
N
a
n
d
o
m
M
T
C
,
Tu
m
u
N
TC
,
La
w
r
a
R
e
se
a
r
c
h
a
n
d
p
u
b
l
i
c
a
t
i
o
n
b
y
t
u
t
o
r
s
Y
e
s
0
.
0
0
%
6
.
0
0
%
7
.
5
0
%
0
.
0
0
%
1
.
5
0
%
4
.
5
0
%
3
.
0
0
%
No
1
9
.
4
0
%
1
7
.
9
0
%
4
.
5
0
%
1
1
.
9
0
%
9
.
0
0
%
6
.
0
0
%
9
.
0
0
%
S
o
u
r
c
e
:
F
i
e
l
d
d
a
t
a
(
2
0
1
9
)
T
ab
le
5
.
Stu
d
e
n
ts
’
r
esp
o
n
s
es to
tu
to
r
s
’
ev
al
u
atio
n
in
NM
T
C
s
in
th
e
Up
p
er
W
est R
eg
io
n
V
a
r
i
a
b
l
e
s
S
t
u
d
e
n
t
s’
r
e
sp
o
n
s
e
s
I
n
st
i
t
u
t
i
o
n
s
N
TC
,
Ji
r
a
p
a
N
TC
,
Wa
M
T
C
,
Ji
r
a
p
a
C
H
N
TC
,
Ji
r
a
p
a
M
T
C
,
N
a
n
d
o
m
M
T
C
,
Tu
m
u
N
TC
,
La
w
r
a
Ev
a
l
u
a
t
i
o
n
o
f
t
u
t
o
r
s
Y
e
s
0
.
0
%
2
0
.
6
%
7
.
4
%
5
.
4
%
4
.
4
%
2
.
5
%
7
.
4
%
No
1
4
.
2
%
1
.
5
%
8
.
3
%
7
.
8
%
2
.
9
%
9
.
3
%
8
.
3
%
N
u
mb
e
r
o
f
t
i
mes
e
v
a
l
u
a
t
i
o
n
i
s
d
o
n
e
p
e
r
s
e
mes
t
e
r
O
n
c
e
0
.
0
%
3
4
.
3
%
9
.
1
%
1
.
0
%
7
.
1
%
2
.
0
%
8
.
1
%
Tw
i
c
e
0
.
0
%
8
.
1
%
5
.
1
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2
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1
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1
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4
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8
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1
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Q
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Q
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1
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.
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l
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1
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5
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3
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4
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)
7
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1
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1
)
1
(
1
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)
5
(
7
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)
5
(
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)
3
6
(
5
7
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1
)
0
.
0
0
2
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i
g
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0
.
0
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1
1
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7
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5
)
5
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7
.
9
)
1
(
1
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)
5
(
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)
2
(
3
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)
3
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)
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(
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2
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To
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l
1
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1
6
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6
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S
o
u
r
c
e
:
F
i
e
l
d
d
a
t
a
(
2
0
1
9
)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J E
v
al
&
R
es E
d
u
c
I
SS
N:
2252
-
8
8
2
2
Qu
a
lity a
s
s
u
r
a
n
ce
p
o
licies a
n
d
imp
leme
n
ta
tio
n
in
n
u
r
s
in
g
a
n
d
mid
w
ifer
y
…
(
P
h
ilip
A
n
ye
l
b
a
Ta
n
kp
a
r
a
)
461
T
ab
le
7
. Q
u
ality
ass
u
r
an
ce
ac
tiv
ities
,
s
tu
d
en
ts
V
a
r
i
a
b
l
e
s
(
Q
u
a
l
i
t
y
a
ssu
r
a
n
c
e
i
n
d
i
c
a
t
o
r
s
-
st
u
d
e
n
t
s
)
N
TC
,
Ji
r
a
p
a
N
TC
,
Wa
M
T
C
,
Ji
r
a
p
a
C
H
N
TC
,
Ji
r
a
p
a
M
T
C
,
N
a
n
d
o
m
M
T
C
,
Tu
m
u
N
TC
,
La
w
r
a
To
t
a
l
P
-
v
a
l
u
e
Q
u
a
l
i
t
y
o
f
i
n
f
r
a
s
t
r
u
c
t
u
r
e
No
19
3
10
18
9
12
25
96
0
.
0
0
Y
e
s
10
42
22
9
6
12
8
1
0
9
To
t
a
l
29
45
32
27
15
24
33
2
0
5
Q
u
a
l
i
t
y
o
f
a
c
c
o
mm
o
d
a
t
i
o
n
No
20
45
23
18
13
14
32
1
6
5
0
.
0
0
Y
e
s
9
0
9
9
2
10
1
40
To
t
a
l
29
45
32
27
15
24
33
2
0
5
Q
u
a
l
i
t
y
o
f
a
c
a
d
e
mi
c
st
a
f
f
No
4
1
3
7
3
7
7
32
0
.
0
3
Y
e
s
25
44
29
20
12
17
26
1
7
3
To
t
a
l
29
45
32
27
15
24
33
2
0
5
Q
u
a
l
i
t
y
o
f
s
t
u
d
e
n
t
a
c
a
d
e
m
i
c
s
No
18
13
13
16
9
11
16
96
0
.
0
7
Y
e
s
11
32
19
11
6
13
17
1
0
9
To
t
a
l
29
45
32
27
15
24
33
2
0
5
Q
u
a
l
i
t
y
o
f
e
x
a
mi
n
a
t
i
o
n
No
12
20
15
15
12
7
16
97
0
.
0
9
Y
e
s
17
25
17
12
3
17
17
1
0
8
To
t
a
l
29
45
32
27
15
24
33
2
0
5
Y
e
s
10
30
16
7
5
8
3
79
To
t
a
l
29
45
32
27
15
24
33
2
0
5
S
o
u
r
c
e
:
F
i
e
l
d
d
a
t
a
(
2
0
1
9
)
T
ab
le
8
.
Qu
ality
o
f
in
f
r
astru
ct
u
r
e
in
NM
T
C
s
:
S
tu
d
en
ts
V
a
r
i
a
b
l
e
R
e
s
p
o
n
se
s
Tu
t
o
r
s
S
t
u
d
e
n
t
s
n
=
6
7
n
=
2
0
7
P
h
y
s
i
c
a
l
f
a
c
i
l
i
t
i
e
s
a
v
a
i
l
a
b
l
e
a
n
d
m
a
i
n
t
a
i
n
e
d
Y
e
s
7
9
.
1
5
8
.
5
No
2
0
.
9
4
1
.
5
S
k
i
l
l
l
a
b
o
r
a
t
o
r
y
i
s
a
d
e
q
u
a
t
e
l
y
s
p
a
c
e
d
Y
e
s
4
6
.
3
3
5
.
1
No
5
3
.
7
6
4
.
9
Th
e
l
a
b
o
r
a
t
o
r
y
i
s we
l
l
e
q
u
i
p
p
e
d
Y
e
s
7
9
.
1
5
7
.
6
No
2
0
.
9
4
2
.
4
Le
c
t
u
r
e
h
a
l
l
s
a
r
e
l
a
r
g
e
a
n
d
w
e
l
l
v
e
n
t
i
l
a
t
e
d
Y
e
s
5
8
.
2
3
6
.
1
No
4
1
.
8
6
3
.
9
A
v
a
i
l
a
b
i
l
i
t
y
o
f
i
n
t
e
r
n
e
t
s
e
r
v
i
c
e
i
n
s
c
h
o
o
l
Y
e
s
7
1
.
6
7
9
.
5
No
2
8
.
4
2
0
.
5
A
v
a
i
l
a
b
i
l
i
t
y
o
f
i
n
t
e
r
n
e
t
a
t
a
l
l
t
i
m
e
Y
e
s
4
0
.
3
1
6
.
1
No
3
5
.
8
3
2
.
2
I
s t
h
e
s
c
h
o
o
l
l
i
b
r
a
r
y
w
e
l
l
st
o
c
k
e
d
w
i
t
h
u
p
-
to
-
d
a
t
e
b
o
o
k
s
f
o
r
e
a
s
y
r
e
f
e
r
e
n
c
i
n
g
?
Y
e
s
4
6
.
3
3
4
.
1
No
5
3
.
7
6
5
.
9
I
s t
h
e
l
i
b
r
a
r
y
sp
a
c
i
o
u
s
f
o
r
s
t
u
d
i
e
s
?
Y
e
s
3
7
.
3
58
No
6
2
.
7
42
Th
e
l
i
b
r
a
r
y
i
s re
a
d
i
l
y
a
c
c
e
ss
i
b
l
e
b
y
s
t
u
d
e
n
t
s
a
n
d
t
u
t
o
r
s a
t
a
l
l
t
i
me
Y
e
s
7
4
.
6
6
3
.
4
No
2
5
.
4
3
6
.
6
Th
e
sc
h
o
o
l
I
T
l
a
b
o
r
a
t
o
r
y
i
s
l
a
r
g
e
w
i
t
h
a
d
e
q
u
a
t
e
c
o
m
p
u
t
e
r
s
Y
e
s
4
4
.
8
3
2
.
1
No
5
5
.
2
6
7
.
9
A
v
a
i
l
a
b
i
l
i
t
y
o
f
a
u
d
i
o
v
i
su
a
l
d
e
v
i
c
e
s
Y
e
s
5
2
.
2
2
7
.
3
No
4
7
.
8
7
2
.
7
S
o
u
r
c
e
:
F
i
e
l
d
d
a
t
a
(
2
0
1
9
)
Data
s
h
o
r
tag
e
an
d
p
o
o
r
n
etwo
r
k
co
n
n
ec
tio
n
s
wer
e
s
o
m
e
m
aj
o
r
ch
allen
g
es c
o
n
f
r
o
n
ted
b
y
th
e
tu
to
r
s
in
ter
m
s
o
f
in
te
r
n
et
co
n
n
ec
tiv
ity
.
T
h
e
av
ailab
ilit
y
o
f
a
g
o
o
d
co
m
p
u
ter
lab
o
r
ato
r
y
a
n
d
in
ter
n
et
s
er
v
ices
wer
e
also
ass
es
s
ed
.
Un
if
o
r
m
ly
m
aj
o
r
ity
o
f
tu
to
r
s
(
5
5
.
2
%)
a
n
d
s
tu
d
e
n
ts
(
6
7
.
6
%)
wer
e
o
f
t
h
e
v
iew
th
at
t
h
eir
I
T
lab
o
r
ato
r
ies
wer
e
n
o
t
well
s
p
ac
ed
an
d
eq
u
ip
p
ed
with
co
m
p
u
ter
s
to
e
n
co
u
r
ag
e
in
s
tr
u
ctin
g
an
d
lear
n
in
g
.
T
h
is
tr
an
s
lated
to
th
e
ac
ce
s
s
ib
ilit
y
o
f
in
ter
n
et
s
er
v
ices
f
o
r
in
s
tr
u
ctin
g
a
n
d
lear
n
in
g
wh
er
e
th
e
m
ajo
r
ity
o
f
tu
to
r
s
(
7
1
.
6
%)
a
n
d
s
tu
d
en
ts
(
7
9
.
5
%)
in
d
icate
d
t
h
at
th
er
e
is
in
ter
n
et
s
er
v
ice
av
ailab
le
in
th
eir
co
lleg
es,
h
o
wev
er
,
th
e
r
e
wer
e
d
is
p
ar
ities
in
th
e
ac
ce
s
s
ib
ilit
y
to
th
e
s
er
v
ice,
4
0
.
3
%
o
f
h
ea
lth
tu
to
r
s
in
d
icate
d
h
a
v
in
g
ac
ce
s
s
to
th
e
in
ter
n
et
s
er
v
ices
as
co
m
p
a
r
ed
with
1
6
.
1
%
o
f
th
e
s
tu
d
en
ts
.
R
ea
s
o
n
s
g
iv
en
i
n
clu
d
e
d
p
o
o
r
n
etwo
r
k
(
1
8
%),
s
h
o
r
tag
e
o
f
b
u
n
d
le
(
5
.
4
%),
n
a
r
r
o
w
c
o
v
er
a
g
e
o
f
in
ter
n
et
s
er
v
ices
(
5
.
4
%),
I
T
o
f
f
icer
s
h
u
ttin
g
it
d
o
wn
(
1
.
5
%)
am
o
n
g
o
t
h
er
s
,
an
d
th
is
d
o
es
n
o
t
d
if
f
e
r
f
r
o
m
th
e
r
esp
o
n
s
es
o
f
s
o
m
e
tu
to
r
s
w
h
o
d
i
d
n
o
t
g
et
ac
ce
s
s
to
th
e
in
t
er
n
et
s
er
v
ices.
Yet,
th
ese
ar
e
r
eso
u
r
ce
s
th
at
m
u
s
t
b
e
p
r
esen
t
f
o
r
ef
f
ec
tiv
e
teac
h
i
n
g
an
d
lear
n
i
n
g
b
y
b
o
t
h
tu
to
r
s
an
d
s
tu
d
en
ts
,
y
et,
th
ey
ar
e
n
o
t
[
4
]
,
[
2
9
]
.
T
h
e
in
a
cc
ess
ib
ilit
y
o
f
th
ese
f
ac
ili
ties
b
y
s
tu
d
en
ts
will
af
f
ec
t
th
eir
ab
ilit
y
to
tak
e
co
n
tr
o
l
an
d
co
o
r
d
in
ate
th
eir
claim
lea
r
n
in
g
e
n
co
u
n
ter
s
an
d
p
er
s
o
n
al
s
tu
d
ies
in
s
tead
o
f
b
ein
g
o
v
er
-
r
elian
ce
o
n
tu
to
r
s
.
Fu
r
th
er
m
o
r
e
,
th
e
m
o
r
e
s
tu
d
e
n
ts
ar
e
co
m
f
o
r
ta
b
le
wi
th
tea
ch
in
g
a
n
d
lear
n
in
g
f
ac
ilit
ies,
th
e
m
o
r
e
th
ey
ar
e
en
co
u
r
a
g
ed
to
lea
r
n
o
n
th
eir
o
wn
,
an
d
th
e
b
etter
th
e
y
b
ec
o
m
e
as st
u
d
en
ts
[
1
9
]
,
[
2
4
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
2
2
I
n
t
J
E
v
al
&
R
es E
d
u
c
,
Vo
l
.
10
,
No
.
2
,
J
u
n
e
2
0
2
1
:
4
5
5
-
4
6
4
462
T
h
e
m
ajo
r
it
y
o
f
th
e
r
esp
o
n
d
e
n
ts
;
tu
to
r
s
(
5
3
.
7
%)
a
n
d
s
tu
d
e
n
ts
(
6
4
.
9
%)
in
d
icate
d
a
lack
o
f
ad
e
q
u
ate
s
p
ac
e
in
th
eir
s
k
i
ll
lab
o
r
ato
r
ies
alth
o
u
g
h
,
th
ese
lab
o
r
ato
r
ies
ar
e
well
eq
u
ip
p
ed
.
T
h
e
d
is
p
le
asu
r
e
b
y
b
o
th
tu
to
r
s
an
d
s
tu
d
en
ts
wer
e
s
tatis
tically
s
ig
n
if
ican
t
(
p
=
0
.
0
0
)
,
th
e
ac
c
ess
ib
ilit
y
o
f
s
atis
f
ac
to
r
y
h
ar
d
war
e
f
o
r
i
n
s
tr
u
ctin
g
an
d
lear
n
i
n
g
will
en
h
an
ce
th
e
co
n
f
id
e
n
ce
lev
el
o
f
s
tu
d
e
n
ts
an
d
tu
to
r
s
in
h
a
n
d
lin
g
m
ed
ica
l
co
n
d
itio
n
,
d
u
e
to
p
r
io
r
f
ir
s
t
-
h
an
d
clin
ical
p
r
ac
ti
ce
s
.
Ab
o
u
t
4
1
%
o
f
s
tu
d
en
ts
a
s
s
er
ted
th
at
th
eir
s
ch
o
o
ls
d
o
n
o
t
p
r
o
v
id
e
an
d
/o
r
m
ain
tain
p
h
y
s
ical
in
f
r
astru
ctu
r
e
as
ag
ain
s
t
2
0
.
9
%
o
f
tu
to
r
s
.
A
d
if
f
er
e
n
ce
o
f
2
0
.
1
%
is
s
ig
n
if
ican
t
in
d
icatin
g
a
d
is
p
ar
ity
b
etwe
en
ac
ce
s
s
b
y
t
u
to
r
s
to
in
f
r
astru
ctu
r
e
as
ag
ain
s
t
th
at
o
f
s
tu
d
en
ts
(
P=0
.
0
0
)
.
T
h
is
will
im
p
ac
t
teac
h
in
g
an
d
lear
n
in
g
as
d
en
i
al
to
r
eso
u
r
ce
s
,
is
d
en
ial
to
k
n
o
wled
g
e
ac
q
u
is
itio
n
.
A
co
n
d
u
civ
e
atm
o
s
p
h
e
r
e
en
h
an
ce
s
q
u
ality
in
s
tr
u
ctin
g
a
n
d
lear
n
i
n
g
f
o
r
b
o
th
tu
to
r
s
a
n
d
s
tu
d
en
ts
r
esp
ec
tiv
ely
,
b
u
t
in
th
is
cu
r
r
en
t
s
tu
d
y
m
ajo
r
ity
o
f
th
e
tu
to
r
s
(
5
8
.
2
%)
ag
r
ee
d
th
at
th
e
lectu
r
e
h
alls
wer
e
s
p
ac
io
u
s
an
d
well
v
en
tilated
f
o
r
in
s
tr
u
ctin
g
an
d
lear
n
i
n
g
,
b
u
t
c
o
n
tr
ar
y
to
th
at
wer
e
th
e
v
iews
o
f
th
e
s
tu
d
en
ts
wh
o
ar
e
th
e
d
ir
ec
t
u
s
er
s
o
f
t
h
e
f
ac
ilit
y
,
m
ajo
r
it
y
(
6
3
.
9
%)
d
is
ag
r
ee
d
.
I
n
d
icatin
g
th
at
lectu
r
e
h
alls
wer
e
to
o
s
m
all
an
d
p
o
o
r
ly
v
en
tilate
co
n
s
id
er
in
g
th
eir
n
u
m
b
e
r
p
er
class
.
A
p
o
o
r
ly
v
e
n
tilated
atm
o
s
p
h
er
e
cr
ea
tes
f
atig
u
e
an
d
s
tr
ess
th
er
ef
o
r
e
im
p
ac
tin
g
th
e
v
alu
e
o
f
i
n
s
tr
u
ctin
g
an
d
lear
n
in
g
.
I
t
also
p
r
o
n
e
th
e
o
cc
u
p
an
ts
t
o
d
i
v
er
s
e
p
u
b
lic
h
e
alth
co
m
m
u
n
icab
le
d
is
ea
s
e
s
u
ch
as
m
e
n
in
g
itis
an
d
tu
b
er
cu
lo
s
is
th
at
co
m
es
with
s
u
ch
u
n
f
r
ie
n
d
ly
co
n
d
itio
n
s
esp
ec
ially
in
t
h
e
war
m
s
ea
s
o
n
with
o
v
er
cr
o
w
d
in
g
.
I
n
T
ab
l
e
9
,
6
8
.
8
%
o
f
th
e
s
tu
d
en
ts
ar
e
ac
co
m
m
o
d
ated
b
y
th
eir
r
e
s
p
ec
tiv
e
s
ch
o
o
ls
.
Me
an
wh
ile,
4
9
.
3
%
o
f
th
em
ar
e
n
o
t
s
atis
f
ied
with
th
e
co
n
d
itio
n
s
o
f
th
e
h
o
s
tels
th
e
s
ch
o
o
ls
p
r
o
v
id
e
f
o
r
th
em
b
ec
a
u
s
e
o
f
p
o
o
r
v
e
n
tilatio
n
an
d
lig
h
tin
g
,
co
n
g
esti
o
n
,
a
d
is
tan
ce
f
ar
awa
y
f
r
o
m
ca
m
p
u
s
,
a
n
d
lac
k
o
f
m
ai
n
ten
an
ce
b
y
m
a
n
ag
em
en
t.
T
h
e
r
e
m
ain
in
g
3
1
.
2
%
o
f
s
tu
d
en
ts
ar
e
n
o
t
p
r
o
v
id
ed
with
ac
co
m
m
o
d
atio
n
an
d
h
en
ce
s
tu
d
en
ts
s
o
r
t
th
is
b
y
t
h
em
s
elv
es.
Fig
u
r
e
4
.
5
d
ep
icts
th
at
s
tu
d
en
ts
o
f
W
a
NT
C
ar
e
n
o
t
p
r
o
v
id
ed
with
an
y
f
o
r
m
o
f
h
o
s
tel
f
ac
ilit
y
b
y
th
e
s
ch
o
o
l,
th
ey
s
o
lely
ca
ter
f
o
r
th
em
s
elv
es a
s
f
ar
as a
cc
o
m
m
o
d
atio
n
is
c
o
n
ce
r
n
ed
w
h
ile
L
awr
a
NT
C
ca
n
p
r
o
v
i
d
e
a
cc
o
m
m
o
d
atio
n
f
o
r
4
2
.
4
%
o
f
h
er
s
tu
d
e
n
ts
'
p
o
p
u
latio
n
.
T
h
e
p
o
o
r
s
tu
d
en
ts
'
ac
co
m
m
o
d
atio
n
m
ay
also
h
a
v
e
a
n
e
g
ativ
e
im
p
ac
t
o
n
t
h
eir
a
ca
d
em
ic
p
er
f
o
r
m
a
n
ce
[
5
]
,
[
1
9
]
,
[
3
0
]
.
T
h
e
av
ailab
ilit
y
o
f
au
d
io
v
is
u
a
l
d
ev
ices
f
o
r
teac
h
in
g
an
d
lear
n
in
g
was
p
er
ce
iv
ed
d
if
f
er
e
n
tly
b
y
tu
to
r
s
an
d
s
tu
d
en
ts
.
T
h
e
h
ea
lth
tu
to
r
s
(
5
2
.
2
%)
wer
e
o
f
th
e
v
iew
th
at
au
d
io
-
v
is
u
als
(
e.
g
.
,
p
r
o
jecto
r
s
an
d
p
u
b
lic
ad
d
r
ess
s
y
s
tem
s
)
f
o
r
teac
h
i
n
g
an
d
lear
n
in
g
wer
e
ad
eq
u
ately
p
r
o
v
id
e
d
as
ag
ain
s
t
7
2
.
7
%
o
f
s
tu
d
en
ts
wh
o
s
aid
th
e
au
d
io
-
v
is
u
als we
r
e
n
o
t a
d
eq
u
ately
p
r
o
v
id
ed
.
T
ab
le
9
.
Qu
ality
ass
u
r
an
ce
ac
c
o
m
m
o
d
atio
n
: S
tu
d
en
ts
Q
u
a
l
i
t
y
a
ss
u
r
a
n
c
e
a
c
c
o
mm
o
d
a
t
i
o
n
Y
e
s (%)
N
o
(
%)
To
t
a
l
(
%)
A
v
a
i
l
a
b
i
l
i
t
y
o
f
h
o
s
t
e
l
f
a
c
i
l
i
t
y
6
8
.
8
3
1
.
2
1
0
0
S
a
t
i
sf
a
c
t
i
o
n
w
i
t
h
t
h
e
h
o
st
e
l
f
a
c
i
l
i
t
y
1
9
.
5
4
8
.
3
6
8
.
8
S
o
u
r
c
e
:
F
i
e
l
d
d
a
t
a
(
2
0
1
9
)
T
ab
le
1
0
.
A
v
ailab
ilit
y
o
f
ac
c
o
m
m
o
d
atio
n
f
ac
ilit
y
f
o
r
s
tu
d
en
t
s
in
th
e
v
ar
io
u
s
MN
T
C
,
U/W
/
R
A
v
a
i
l
a
b
i
l
i
t
y
o
f
h
o
s
t
e
l
f
a
c
i
l
i
t
y
Y
e
s (%)
N
o
(
%)
N
TC
,
J
i
r
a
p
a
1
0
0
0
N
TC
,
W
a
0
1
0
0
M
T
C
,
J
i
r
a
p
a
1
0
0
0
C
H
N
TC
,
Ji
r
a
p
a
1
0
0
0
M
T
C
,
N
a
n
d
o
m
1
0
0
0
M
T
C
,
T
u
m
u
1
0
0
0
N
TC
,
La
w
r
a
42
57
S
o
u
r
c
e
:
F
i
e
l
d
d
a
t
a
(
2
0
1
9
)
4.
CO
NCLU
SI
O
N
T
h
is
s
tu
d
y
p
r
o
v
id
e
d
s
h
r
ed
s
o
f
ev
id
en
ce
r
e
g
ar
d
i
n
g
th
e
lack
o
f
QA
ac
tiv
ities
as
well
as
f
ac
to
r
s
th
at
af
f
ec
t
QA
in
s
o
m
e
NM
T
C
s
in
Gh
an
a.
T
h
e
m
ajo
r
ity
(
5
o
u
t o
f
7
NM
T
C
s
)
o
f
th
e
in
s
titu
tio
n
h
ad
n
o
Qu
ality
Ass
u
r
an
ce
p
o
licy
d
o
cu
m
en
t.
T
h
e
s
tu
d
y
'
s
f
in
d
in
g
s
r
ev
ea
led
th
at
th
ese
in
s
titu
tio
n
s
h
ad
q
u
ality
ass
u
r
an
ce
u
n
its
/co
m
m
ittees
th
at
ar
e
in
ac
tiv
e
d
u
e
to
th
e
ab
s
en
ce
o
f
an
o
p
er
atio
n
al
d
o
cu
m
e
n
t
th
at
will
g
u
id
e
th
e
o
p
er
atio
n
s
o
f
th
e
co
m
m
ittee/u
n
it.
I
n
ter
n
al
q
u
alit
y
p
r
ac
tices
in
r
elatio
n
to
g
o
v
er
n
an
ce
,
ac
c
o
u
n
tab
ilit
y
,
an
d
t
r
an
s
p
ar
en
cy
wer
e
lo
w
am
o
n
g
h
ea
lth
tu
t
o
r
s
m
ea
n
wh
ile
in
ter
n
al
q
u
ality
to
p
r
o
m
o
t
e
s
taf
f
p
r
o
f
ess
io
n
al
d
ev
elo
p
m
en
t
was
h
ig
h
an
d
s
tu
d
en
ts
attested
to
th
e
h
ig
h
v
alu
e
o
f
ac
ad
e
m
ic
s
taf
f
.
Desp
ite
h
av
in
g
h
ig
h
ly
q
u
alif
ied
a
ca
d
em
ic
s
taf
f
,
m
o
s
t
NM
T
C
s
in
th
e
r
eg
io
n
d
o
n
o
t
c
o
n
d
u
ct
s
taf
f
ev
alu
atio
n
.
Per
io
d
ic
s
taf
f
m
ee
tin
g
s
ar
e
r
a
r
ely
o
r
g
an
ized
f
o
r
tu
to
r
s
to
d
is
cu
s
s
m
atter
s
r
eg
ar
d
in
g
ac
tiv
ities
to
war
d
s
th
e
q
u
ality
tr
ain
in
g
o
f
n
u
r
s
es
an
d
m
id
wiv
es
in
th
e
r
eg
io
n
.
T
h
is
is
p
ar
tly
r
elate
d
to
th
e
lack
o
f
p
ar
ticip
ato
r
y
g
o
v
e
r
n
an
ce
an
d
th
e
ex
is
ten
ce
o
f
p
o
o
r
co
m
m
u
n
icati
o
n
s
y
s
tem
b
etwe
en
s
taf
f
an
d
h
ea
d
s
in
th
eir
r
esp
e
ctiv
e
in
s
titu
tio
n
s
.
T
h
is
s
tu
d
y
r
ec
o
m
m
en
d
s
th
at
th
er
e
is
a
n
ee
d
f
o
r
m
a
n
ag
er
s
o
f
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J E
v
al
&
R
es E
d
u
c
I
SS
N:
2252
-
8
8
2
2
Qu
a
lity a
s
s
u
r
a
n
ce
p
o
licies a
n
d
imp
leme
n
ta
tio
n
in
n
u
r
s
in
g
a
n
d
mid
w
ifer
y
…
(
P
h
ilip
A
n
ye
l
b
a
Ta
n
kp
a
r
a
)
463
Hea
lth
T
r
ain
in
g
I
n
s
titu
tio
n
s
(
HT
I
s
)
to
en
s
u
r
e
th
e
f
o
r
m
u
latio
n
an
d
im
p
lem
en
tatio
n
o
f
QA
p
o
licy
d
o
cu
m
en
ts
in
th
eir
r
esp
ec
tiv
e
co
lleg
es.
Als
o
,
h
ea
d
s
(
Prin
cip
als)
1
1
o
f
N
MT
C
s
in
th
e
Up
p
er
W
est
R
e
g
io
n
an
d
Gh
an
a
as
a
wh
o
le
s
h
o
u
ld
e
n
s
u
r
e
t
h
e
f
o
r
m
a
tio
n
an
d
f
u
n
ctio
n
in
g
o
f
QA
u
n
i
ts
in
th
eir
v
ar
io
u
s
in
s
titu
tio
n
s
.
T
h
ese
u
n
its
s
h
o
u
ld
b
e
em
p
o
wer
ed
an
d
allo
wed
b
y
th
e
h
ea
d
s
o
f
th
e
in
s
titu
tio
n
s
to
f
u
n
ctio
n
as
p
er
r
ec
o
m
m
en
d
atio
n
s
b
y
th
e
r
eg
u
lato
r
y
b
o
d
ies to
s
u
p
p
o
r
t to
en
s
u
r
e
q
u
ality
tr
ain
in
g
o
f
n
u
r
s
es a
n
d
m
id
wiv
es
.
RE
F
E
R
E
NC
E
S
[1
]
P.
M
a
teru
,
Hig
h
e
r
e
d
u
c
a
ti
o
n
q
u
a
li
ty
a
ss
u
ra
n
c
e
in
S
u
b
-
S
a
h
a
r
a
n
A
frica
:
st
a
t
u
s,
c
h
a
ll
e
n
g
e
s,
o
p
p
o
rtu
n
it
ies
a
n
d
p
ro
misin
g
p
ra
c
ti
c
e
s
.
W
o
rld
Ba
n
k
W
o
rk
i
n
g
P
a
p
e
r
N
o
.
1
2
4
,
Afric
a
Hu
m
a
n
De
v
e
lo
p
m
e
n
t
S
e
ries
.
Was
h
in
g
to
n
,
DC
:
Wo
rld
Ba
n
k
,
2
0
0
7
.
[2
]
Wo
rld
He
a
lt
h
Or
g
a
n
iza
ti
o
n
,
A
g
u
id
e
to
n
u
rs
i
n
g
a
n
d
mid
wif
e
ry
e
d
u
c
a
t
io
n
sta
n
d
a
rd
s
.
W
o
rld
He
a
lt
h
Org
a
n
iza
ti
o
n
.
Re
g
io
n
a
l
Offic
e
fo
r
th
e
E
a
ste
rn
M
e
d
it
e
rra
n
e
a
n
.
EM
RO
P
u
b
li
c
a
ti
o
n
s
,
2
0
1
5
.
[On
li
n
e
].
Av
a
il
a
b
le:
h
tt
p
s:/
/ap
p
s.w
h
o
.
in
t/
iri
s/h
a
n
d
le/1
0
6
6
5
/
1
9
5
7
2
6
.
[3
]
Wo
rld
He
a
lt
h
Or
g
a
n
iza
ti
o
n
,
“
Qu
a
li
ty
a
ss
u
ra
n
c
e
a
n
d
a
c
c
re
d
it
a
ti
o
n
o
f
n
u
rsin
g
a
n
d
m
i
d
wife
ry
e
d
u
c
a
ti
o
n
a
l
in
stit
u
ti
o
n
s,
”
WHO
Re
g
io
n
a
l
Offic
e
fo
r
S
o
u
th
-
Eas
t
As
ia
,
2
0
0
8
.
[On
l
in
e
].
Av
a
il
a
b
le:
h
tt
p
s:/
/ap
p
s.w
h
o
.
in
t/
iri
s/h
a
n
d
le/1
0
6
6
5
/
2
0
5
7
1
5
.
[4
]
Wo
rld
He
a
lt
h
Org
a
n
iza
ti
o
n
,
“
G
u
id
e
li
n
e
s
o
n
q
u
a
li
ty
a
ss
u
ra
n
c
e
a
n
d
a
c
c
re
d
it
a
ti
o
n
o
f
n
u
rsin
g
a
n
d
m
id
wi
fe
ry
e
d
u
c
a
ti
o
n
a
l
in
stit
u
ti
o
n
s
,”
WHO
Re
g
i
o
n
a
l
Offic
e
fo
r
S
o
u
th
-
E
a
st
As
ia
,
2
0
1
0
.
[On
li
n
e
].
Av
a
il
a
b
le:
h
tt
p
s:/
/ap
p
s.w
h
o
.
in
t/
iri
s/h
a
n
d
le/1
0
6
6
5
/
2
0
5
1
9
5
.
[5
]
J.
W.
Bo
a
ten
g
,
“
Ba
rriers
to
In
te
rn
a
l
Qu
a
li
t
y
As
su
ra
n
c
e
in
G
h
a
n
a
ian
P
riv
a
te
Tertiar
y
In
sti
tu
ti
o
n
s
,
”
Res
e
a
rc
h
o
n
Hu
ma
n
it
ies
a
n
d
S
o
c
i
a
l
S
c
ien
c
e
s
,
v
o
l.
4
,
n
o
.
2
,
p
p
.
1
-
9
,
2
0
1
4
.
[6
]
K.
A.
A.
G
a
m
a
g
e
,
R.
G
.
G
.
P
ra
d
e
e
p
,
V.
Na
jd
a
n
o
v
ic
-
Visa
k
,
a
n
d
N.
Gu
n
a
wa
rd
h
a
n
a
,
“
Ac
a
d
e
m
ic
S
tan
d
a
r
d
s
a
n
d
Qu
a
li
t
y
As
su
ra
n
c
e
:
Th
e
Im
p
a
c
t
o
f
COV
I
D
-
1
9
o
n
U
n
iv
e
rsit
y
De
g
re
e
P
ro
g
r
a
m
s,”
S
u
sta
i
n
a
b
il
i
ty
,
v
o
l
.
1
2
,
n
o
.
1
0
0
3
2
,
p
p
.
1
-
1
4
,
2
0
2
0
.
[
7
]
G
.
U
t
u
k
a
,
“
Q
u
a
l
i
t
y
a
s
s
u
r
a
n
c
e
i
n
h
i
g
h
e
r
e
d
u
c
a
t
i
o
n
:
C
o
m
p
a
r
a
t
i
v
e
a
n
a
l
y
s
i
s
o
f
p
r
o
v
i
s
i
o
n
s
a
n
d
p
r
a
c
t
i
c
e
s
i
n
G
h
a
n
a
a
n
d
N
e
w
Z
e
a
l
a
n
d
,
”
D
o
c
t
o
r
a
l
T
h
e
s
i
s
,
V
i
c
t
o
r
i
a
U
n
i
v
e
r
s
i
t
y
o
f
W
e
l
l
i
n
g
t
o
n
,
201
2
.
[8
]
J.
Ala
b
i
,
G
.
Ala
b
i,
R.
A
d
jei,
P.
Dz
a
n
d
u
,
G.
Utu
k
a
,
a
n
d
A.
M
u
n
k
a
il
a
,
Q
u
a
li
ty
Assu
ra
n
c
e
in
G
h
a
n
a
ia
n
Hig
h
e
r
Ed
u
c
a
ti
o
n
In
st
it
u
t
io
n
s: Op
p
o
rtu
n
i
ti
e
s a
n
d
Co
n
stra
i
n
ts
.
S
e
n
e
g
a
l:
CO
DES
RIA,
2
0
1
8
.
[9
]
C.
Bö
h
m
ig
,
G
h
a
n
a
i
a
n
n
u
rs
e
s
a
t
a
c
ro
ss
ro
a
d
s
M
a
n
a
g
i
n
g
e
x
p
e
c
ta
ti
o
n
s
o
n
a
me
d
ica
l
wa
r
d
.
Leid
e
n
:
Afric
a
n
S
t
u
d
ie
s
Ce
n
tre,
2
0
1
0
.
[1
0
]
S.
A
d
u
-
G
y
a
m
fi
a
n
d
E.
Bre
n
y
a
,
“
Nu
rsin
g
in
G
h
a
n
a
:
A
S
e
a
rc
h
fo
r
F
l
o
re
n
c
e
Ni
g
h
t
in
g
a
le
in
a
n
Afric
a
n
Ci
ty
,”
In
ter
n
a
t
io
n
a
l
S
c
h
o
la
rly
Res
e
a
rc
h
No
ti
c
e
s
,
v
o
l.
20
1
6
,
2
0
1
6
,
d
o
i:
1
0
.
1
1
5
5
/
2
0
1
6
/
9
7
5
4
8
4
5
.
[1
1
]
Na
ti
o
n
a
l
Ac
c
re
d
it
a
ti
o
n
Bo
a
r
d
,
T
e
rtia
ry
in
stit
u
ti
o
n
s
(e
sta
b
li
s
h
me
n
t
a
n
d
a
c
c
re
d
it
a
ti
o
n
)
re
g
u
la
t
io
n
s
,
2
0
1
0
(L
.
I
.
1
9
8
4
)
.
Ac
c
ra
:
M
in
istry
o
f
E
d
u
c
a
ti
o
n
,
2
0
1
0
.
[1
2
]
Eu
ro
p
e
a
n
As
so
c
iatio
n
fo
r
Qu
a
li
t
y
As
su
ra
n
c
e
in
Hig
h
e
r
Ed
u
c
a
ti
o
n
Are
a
,
S
ta
n
d
a
rd
s
a
n
d
G
u
id
e
li
n
e
s
fo
r
Qu
a
li
ty
Assu
ra
n
c
e
in
th
e
E
u
ro
p
e
a
n
Hig
h
e
r E
d
u
c
a
ti
o
n
Are
a
.
Bru
ss
e
ls:
EUR
ASHE
,
2
0
1
5
.
[1
3
]
S.
Ok
a
e
Ad
jei,
”
Qu
a
li
t
y
As
su
ra
n
c
e
P
ra
c
ti
c
e
s
in
G
h
a
n
a
ian
P
o
l
y
t
e
c
h
n
ics
:
Th
e
Ca
se
o
f
Ko
f
o
ri
d
u
a
P
o
l
y
tec
h
n
ic,”
In
ter
d
isc
ip
li
n
a
ry
J
o
u
rn
a
l
o
f
Co
n
t
e
mp
o
ra
ry
Res
e
a
rc
h
in
Bu
si
n
e
ss
,
v
o
l.
4
,
p
p
.
2
9
3
-
2
9
9
,
2
0
1
2
.
[1
4
]
A.
S
e
n
iwo
l
ib
a
,
“
Ac
a
d
e
m
ic
Qu
a
li
t
y
As
su
ra
n
c
e
P
ra
c
ti
c
e
s
in
G
h
a
n
a
ian
P
u
b
li
c
U
n
iv
e
rsiti
e
s:
E
x
p
e
rien
c
e
fro
m
Un
iv
e
rsit
y
fo
r
De
v
e
lo
p
m
e
n
t
S
t
u
d
ies
,
”
Glo
b
a
l
Ed
u
c
a
ti
o
n
a
l
Res
e
a
rc
h
J
o
u
rn
a
l,
v
o
l.
1
0
,
n
o
.
1
6
,
p
p
.
2
3
3
1
-
2
3
3
9
,
2
0
1
4
.
[1
5
]
F.
An
sa
h
,
P.
S
wa
n
z
y
,
a
n
d
H.
P
.
N
u
d
z
o
r,
“
Ba
lan
c
in
g
t
h
e
fo
c
u
s
o
f
Qu
a
li
ty
As
su
ra
n
c
e
F
ra
m
e
wo
rk
s
o
f
Hi
g
h
e
r
E
d
u
c
a
ti
o
n
In
stit
u
t
io
n
s
in
Afric
a
:
A
G
h
a
n
a
ian
Co
n
tex
t
,”
i
n
S
.
L
.
Re
n
e
s
,
Ed
.
,
Glo
b
a
l
V
o
ice
s
in
Hi
g
h
e
r
E
d
u
c
a
t
i
o
n
.
In
tec
h
O
p
e
n
,
2
0
1
7
,
d
o
i:
1
0
.
5
7
7
2
/
in
tec
h
o
p
e
n
.
6
8
6
6
5
.
[1
6
]
J.
W.
Cre
sw
e
ll
,
Res
e
a
rc
h
d
e
sig
n
:
q
u
a
li
ta
ti
v
e
,
q
u
a
n
t
it
a
t
ive
,
a
n
d
mix
e
d
me
th
o
d
s
a
p
p
ro
a
c
h
,
1
4
t
h
e
d
.
USA:
S
AG
E
P
u
b
l
ica
ti
o
n
s,
2
0
1
4
.
[1
7
]
T.
Ry
a
n
,
“
Qu
a
li
t
y
As
su
ra
n
c
e
in
Hig
h
e
r
E
d
u
c
a
ti
o
n
:
A
Re
v
iew
o
f
Li
tera
tu
re
,
”
Hig
h
e
r
L
e
a
r
n
in
g
Res
e
a
rc
h
Co
mm
u
n
ica
ti
o
n
s
,
v
o
l
.
5
,
n
o
.
4
,
2
0
1
5
,
d
o
i:
1
0
.
1
8
8
7
0
/h
lrc.v
5
i4
.
2
5
7
.
[1
8
]
A.
L.
Wh
it
e
h
e
a
d
,
S
.
A.
J
u
li
o
u
s,
C.
L.
Co
o
p
e
r
,
a
n
d
M
.
J.
Ca
m
p
b
e
ll
,
“
Esti
m
a
ti
n
g
t
h
e
S
a
m
p
le
S
ize
fo
r
a
P
il
o
t
Ra
n
d
o
m
ise
d
Tri
a
l
to
M
i
n
imis
e
t
h
e
Ov
e
ra
ll
Tr
ial
S
a
m
p
le
S
ize
f
o
r
th
e
Ex
tern
a
l
P
i
lo
t
a
n
d
M
a
in
Tri
a
l
fo
r
a
C
o
n
ti
n
u
o
u
s
Ou
tco
m
e
Va
ri
a
b
le
,”
S
ta
ti
stica
l
M
e
th
o
d
s
in
M
e
d
ica
l
Res
e
a
rc
h
,
v
o
l
.
2
5
,
n
o
.
3
,
p
p
.
1
0
5
7
-
1
0
7
3
,
2
0
1
6
.
[1
9
]
J.
M
a
in
a
,
a
n
d
J
.
Y.
Aji,
“
In
f
lu
e
n
c
e
o
f
a
c
c
o
m
m
o
d
a
ti
o
n
o
n
t
h
e
a
c
a
d
e
m
ic
p
e
rfo
rm
a
n
c
e
o
f
a
rc
h
it
e
c
tu
re
stu
d
e
n
ts,”
Bu
il
t
En
v
iro
n
me
n
t
J
o
u
rn
a
l
,
v
o
l.
1
4
,
n
o
.
2
,
p
p
.
4
7
-
50
,
2
0
1
7
.
[2
0
]
Na
ti
o
n
a
l
Ac
a
d
e
m
y
o
f
S
c
ien
c
e
s,
T
h
e
F
u
t
u
re
o
f
N
u
rs
in
g
:
L
e
a
d
i
n
g
Ch
a
n
g
e
,
Ad
v
a
n
c
in
g
He
a
l
th
.
Un
it
e
d
S
tate
s
o
f
Am
e
rica
:
Na
ti
o
n
a
l
Ac
a
d
e
m
y
P
re
ss
,
2
0
1
1
.
[2
1
]
J.
A.
S
e
n
iwo
li
b
a
a
n
d
R
.
N.
Ya
k
u
b
u
,
“
An
a
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a
ly
sis
o
f
th
e
q
u
a
li
ty
a
ss
u
ra
n
c
e
p
o
li
c
ies
in
a
G
h
a
n
a
ian
Un
i
v
e
rsity
,
”
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d
e
mic
J
o
u
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a
ls
,
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l.
18
,
p
p
.
2
3
1
-
2
3
9
,
2
0
1
5
.
[2
2
]
C.
M
.
V.
Ba
n
k
a
n
d
B.
A.
P
o
p
o
o
la
,
“
A
Th
e
o
re
ti
c
a
l
F
ra
m
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wo
rk
o
f
T
o
tal
Qu
a
li
t
y
As
su
ra
n
c
e
in
a
Un
i
v
e
rsity
o
f
Tec
h
n
o
l
o
g
y
,
”
Aca
d
e
mic
J
o
u
r
n
a
l
o
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ter
d
isc
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ry
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ies
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l.
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.
4
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p
p
.
4
0
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4
0
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,
2
0
1
4
.
[2
3
]
H.
B.
Esse
l
,
M
.
Bo
a
k
y
e
-
Yia
d
o
m
,
a
n
d
S
.
M
o
h
a
m
m
e
d
,
“
In
tern
a
l
Qu
a
li
ty
As
su
ra
n
c
e
P
ra
c
ti
c
e
s
o
f
Nu
rsi
n
g
a
n
d
M
id
wife
ry
Train
i
n
g
Co
ll
e
g
e
s
a
n
d
t
h
e
Ro
le
o
f
Re
g
u
lat
o
ry
Bo
d
ies
:
Th
e
P
e
rsp
e
c
ti
v
e
s
o
f
H
e
a
lt
h
Tu
t
o
rs,”
J
o
u
rn
a
l
o
f
Nu
rs
in
g
Ed
u
c
a
ti
o
n
a
n
d
Pr
a
c
ti
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e
,
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l.
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p
.
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5
,
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0
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8
.
[2
4
]
G
.
K.
An
a
n
e
a
n
d
M
,
Ad
d
a
n
e
y
,
“
M
a
n
a
g
in
g
Q
u
a
li
t
y
As
su
ra
n
c
e
i
n
Hig
h
e
r
Ed
u
c
a
ti
o
n
:
T
h
e
Ca
se
o
f
t
h
e
Un
i
v
e
rsity
o
f
En
e
rg
y
a
n
d
Na
tu
ra
l
Re
so
u
rc
e
s,
G
h
a
n
a
,
”
J
o
u
r
n
a
l
o
f
Ed
u
c
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ti
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n
d
Pra
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ti
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e
,
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l.
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,
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o
.
2
2
,
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p
.
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6
,
2
0
1
6
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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N
:
2
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[2
5
]
M.
S
e
y
frie
d
a
n
d
P.
P
o
h
le
n
z
,
“
As
se
ss
in
g
q
u
a
li
t
y
a
ss
u
ra
n
c
e
in
h
ig
h
e
r
e
d
u
c
a
ti
o
n
:
q
u
a
li
t
y
m
a
n
a
g
e
rs’
p
e
rc
e
p
ti
o
n
s
o
f
e
ffe
c
ti
v
e
n
e
ss
,
”
Eu
ro
p
e
a
n
J
o
u
rn
a
l
o
f
Hi
g
h
e
r E
d
u
c
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t
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n
,
v
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l
.
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o
.
3
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p
.
2
5
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7
1
,
2
0
1
8
.
[2
6
]
T.
M
o
ra
d
i
,
M
.
A.
M
e
h
ra
b
a
n
.
a
n
d
M.
M
o
e
n
i,
“
Co
m
p
a
riso
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o
f
t
h
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P
e
rc
e
p
ti
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n
s o
f
M
a
n
a
g
e
rs an
d
Nu
rsi
n
g
S
taff t
o
wa
rd
P
e
rfo
rm
a
n
c
e
Ap
p
ra
isa
l
,”
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n
ia
n
J
o
u
rn
a
l
o
f
Nu
rs
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n
g
a
n
d
M
id
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fer
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,
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,
p
p
.
1
2
8
-
1
3
4
,
2
0
1
7
.
[2
7
]
S
.
Warm
a
n
,
“
Ch
a
ll
e
n
g
e
s
a
n
d
issu
e
s
in
t
h
e
e
v
a
lu
a
t
i
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n
o
f
tea
c
h
in
g
q
u
a
li
t
y
:
h
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w
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o
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s
it
a
ffe
c
t
tea
c
h
e
rs'
p
ro
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ss
io
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l
p
ra
c
ti
c
e
?
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e
rsp
e
c
ti
v
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,
”
J
o
u
rn
a
l
o
f
Vete
rin
a
ry
M
e
d
ica
l
E
d
u
c
a
ti
o
n
,
v
o
l.
1
,
n
o
.
1
,
p
p
.
1
-
7
,
2
0
1
5
.
[2
8
]
H.
J.
M
a
c
h
u
m
u
a
n
d
S
.
H.
Kisa
n
g
a
,
“
Qu
a
li
t
y
As
su
ra
n
c
e
P
ra
c
ti
c
e
s
in
Hi
g
h
e
r
Ed
u
c
a
ti
o
n
I
n
stit
u
ti
o
n
s
:
Les
so
n
fr
o
m
Afric
a
,
”
J
o
u
rn
a
l
o
f
Ed
u
c
a
ti
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d
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c
ti
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e
,
v
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l
.
5
,
n
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.
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6
,
p
p
.
1
4
4
-
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5
6
,
2
0
1
4
.
[2
9
]
R.
M
a
h
b
u
b
,
“
Qu
a
li
t
y
As
su
ra
n
c
e
fo
r
Hig
h
e
r
E
d
u
c
a
ti
o
n
:
C
h
a
ll
e
n
g
e
s
in
S
u
sta
in
in
g
Co
n
ti
n
u
o
u
s
Q
u
a
li
t
y
Im
p
r
o
v
e
m
e
n
t
fo
r
M
a
lay
sia
n
Un
iv
e
rsiti
e
s,”
Pro
c
e
e
d
in
g
s
o
f
INT
ED2
0
1
7
Co
n
fer
e
n
c
e
,
Va
len
c
ia,
S
p
a
in
,
2
0
1
7
,
d
o
i:
1
0
.
2
1
1
2
5
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n
ted
.
2
0
1
7
.
1
2
1
4
.
[3
0
]
B.
O.
Ow
o
lab
i
,
“
T
h
e
Eff
e
c
ts
o
f
S
t
u
d
e
n
ts’
Ho
u
sin
g
o
n
Ac
a
d
e
m
ic
P
e
rfo
rm
a
n
c
e
a
t
t
h
e
U
n
iv
e
r
sity
o
f
I
b
a
d
a
n
,
”
In
ter
n
a
t
io
n
a
l
J
o
u
rn
a
l
o
f
S
c
ien
ti
fi
c
&
En
g
i
n
e
e
rin
g
Res
e
a
rc
h
,
v
o
l.
6
,
n
o
.
3
,
p
p
.
1
1
1
8
-
1
1
3
2
,
2
0
1
5
.
Evaluation Warning : The document was created with Spire.PDF for Python.