In addition to the cluster groups, quarterly trainer meetings were established to bring all the trainers from the district together and provided all HC trainers an opportunity to meet in person to share experiences, challenges, and opportunities, which was reported by trainers to strengthen inter-professional bonds.
Problems related to workforce development including uneven distribution, rapid turnover and lack of professional development opportunities were also reported by two other studies from Iraq [ 13, 36].
The only difference observed was that public sector physicians reported personal safety as a motivator rather than opportunities for higher qualification, as reported by those in the private sector.
Salient themes identified from the open-ended question inquiring about available physical activity options and opportunities for these children as reported by the children and their mothers were examined.
These issues map onto the barriers of lack of time knowledge, money and PA opportunities that have been consistently reported by children and adults as barriers to PA participation [ 31, 40, 41].
The views expressed by students in this study in regard to the interactions with other members of the health care team as positive experiences and opportunities for reflective practice simulate those reported by Bergh et al.[ 34] and supported by Irvine [ 35] who addressed this very topic as president of the British General Medical Council.
Opportunities for professional development (that is career advancement, opportunity to further nursing education, and access to continuing education) were reported by the respondents as unsatisfactory.
In the study reported by Gorse et al. a unique, educational opportunity was lost.
The pilot study was well accepted with high satisfaction levels reported by participants; 94 % (N = 1136) reported that if given the opportunity they would take part again.
Other important issues reported by COs to constrain their role within the system include the limited career progression opportunities (the glass ceiling), findings also reported from Malawi [ 3].
