Medical education in sub-Saharan Africa is being revitalized through U.S. funded effort

Aug 1 2014

Medical education in sub-Saharan Africa is being revitalized and expanded through a U.S.-funded effort that is dramatically increasing enrollment, broadening curricula, upgrading Internet access and providing cutting-edge skills labs and other technologies.

In the first substantial publication by participants of the $130 million Medical Education Partnership Initiative (MEPI), more than 225 authors detailed progress being made at the African institutions. Their reports are in a supplement being published today by the journal Academic Medicine. Begun in 2010, MEPI is funded by the President's Emergency Plan for AIDS Relief (PEPFAR) and the National Institutes of Health, and is co-administered by NIH's Fogarty International Center and the Health Resources and Services Administration.

"MEPI is a major venture in international educational innovation that has generated new thinking, energy and optimism in the field of medical education in Africa," the program partners write in a foreword article to the supplement.

The collection of 32 articles includes case studies of national strategies to increase numbers of doctors and health professionals trained; educational innovations such as e-learning and regional training sites; research capacity development; and partnerships that leverage advances across the MEPI network.

MEPI participants provided examples of progress, including:
•In Zimbabwe, medical student and postgraduate enrollment have both nearly doubled, from 260 in 2010 to 513 in 2013, and the Ministry of Higher Education has committed additional financial support to sustain the progress.
•A decentralized training network of 14 regional hospitals has been established in Kenya, and has already provided instruction for more than 300 medical, nursing, dental and pharmacy students.
•Additional research support in Nigeria has resulted in increased numbers of grant applications submitted and an "unprecedented" rise in funded research projects.
•Internal medicine (IM) physicians were in short supply in Mozambique so salary supplements, internet access, and notebook computers were offered to encourage recruitment, resulting in an increase in IM residents from 10, before MEPI, to 75 in 2012.
•In South Africa, pharmacists are scarce and in high demand in industry, so an online master's program was developed to make advanced studies more flexible and attractive.
•A virtual microscopy system was introduced in Zambia, containing 4,000 electronic images, which increased student access and is more cost-effective than optical microscopy using glass slides.
•A research administration office was created in Ethiopia to assist faculty in grant writing and management, and 18 faculty members were supported to present their research at international conferences.

According to an article by medical students, MEPI support has spurred "significant improvement" in their training. "It's an understatement to say that information technology has revolutionized our learning," they wrote. "The unprecedented access to new portals of knowledge allows us to take advantage of textbooks that we can read any time. We also have new possibilities of interacting with other students and professionals from around the world."

The journal supplement also includes commentaries from global health experts such as former U.S. Global AIDS Coordinator Dr. Eric Goosby, MEPI principal investigator Dr. Francis G. Omaswa and Fogarty International Center Director Dr. Roger I. Glass.

The critical shortage of physicians, researchers and health care workers across sub-Saharan Africa spurred MEPI's creation. While the region suffers 25 percent of the global burden of disease, it has only 3 percent of the world's health care workers, according to the World Health Organization.

The impact of HIV/AIDS created an urgent need to increase capacity, wrote Goosby and his co-author Deborah von Zinkernagel, former PEPFAR deputy. "Although concerns arose that resources were being diverted from "services," it was evident to PEPFAR leadership that the ongoing and expanding needs of the HIV-infected community could not be successfully sustained without increasing the number of trained health professionals," they added.

MEPI is built around five core themes detailed in the publication's foreword: capacity development through improving medical education; retention of graduates and faculty; regionally relevant research to build capacity; communities of practice to share information around common areas of interest; and sustainability to ensure continued investment in medical education and health care workforce scale-up.

By awarding the grants directly to African institutions, MEPI is cultivating sustainable local leadership, Omaswa maintained. "For Africa to accelerate the speed of the ongoing transformation, it is necessary for Africans to step up and take ownership and responsibility for what happens in their own backyards and to stop blaming others," he said.

Research is embedded in medical school curricula developed through MEPI, to expand local capacity that will drive innovation. African scientists have already contributed to many "game-changing" HIV-related advances such as development of rapid diagnostics for detecting and monitoring HIV infections, new strategies for preventing mother-to-child transmission, and treatment to avoid infection, noted Glass and his Fogarty co-authors. "The research perspective provided to students and faculty, the ability to raise and answer questions and the idea that medical knowledge and practice are continually changing are being supported by MEPI sites and will hopefully endure long after the program ends," they continued.

Initially conceived as a five-year program, MEPI funders and participants are now developing plans for a second phase of investment in Africa's medical education.

"MEPI's ultimate success would be seen in the transformation of the grantee schools at institutional and individual levels into leaders and change agents in their respective countries and in Africa as a whole," Omaswa observed.