African medical schools see profound culture change

September / October 2013 | Volume 12, Issue 5

By Cathy Kristiansen

African medical education is evolving quickly as academic institutions harness new technologies and teaching tools, strengthen the breadth and depth of available curricula and ramp up training in rural sites. Many of these changes are being spurred by the Medical Education Partnership Initiative (MEPI), funded by the President's Emergency Plan for AIDS Relief (PEPFAR) and NIH, and co-administered by Fogarty and the Health Resources and Services Administration. MEPI participants gathered recently in Uganda to share lessons learned and review progress.

Dr. Nelson Sewankambo speaks into microphone at podium, slide reads 2,000 doctors leave country in 10 years
Photo by Dr. Roger I. Glass/Fogarty

Dr. Nelson Sewankambo, head of Makerere University
College of Health Sciences, opened the annual Medical
Education Partnership Initiative meeting in Uganda.

"Your commitment and effort have created a sea change in your programs and in the partnerships and collaborations that have provided such a significant catalyst for innovation and collective effort," observed Ambassador Eric Goosby, U.S. Global AIDS Coordinator, who heads PEPFAR. The result, he added, is that the whole is greater than the sum of its parts.

MEPI institutions have reached out to form partnerships with other medical schools in their own countries, as well as with other MEPI grantees, creating a network that now includes some 40 members, a quarter of sub-Saharan Africa's medical schools. Deans, faculty and other policymakers travel frequently among sites to learn about successful programs they might also adopt and to relay their own experiences. Through these collaborations, they are leveraging resources and expertise so all can benefit from the lessons learned.

"There has been a profound culture change" in how African countries are networking with and helping each other in pursuing the common goal of improving health everywhere, said Dr. Joseph Kolars of the University of Michigan, who's collaborating with the MEPI effort in Ghana. "We're seeing an emphasis on and celebration of those academic community partnerships."

Ambassador Eric Goosby speaks at a podium
Photo courtesy of MEPI CC

Ambassador Eric Goosby,
U.S. Global AIDS Coordinator,
spoke at the MEPI symposium.

Another dramatic shift in MEPI institutions has been the adoption of information communication technologies (ICT) to enhance teaching methods and greatly expand students' access to electronic education materials and current journal articles. Some MEPI sites are supplying students and faculty with personal tablet computers loaded with medical books, national health guidelines and other valuable resources. "The tablets have helped address the shortage of text books, improve access to electronic resources and extend the lecture beyond the classroom," said Dr. Miliard Derbew, of the MEPI project in Ethiopia.

MEPI partners are also deploying ICT to bring videotaped lectures, interactive procedure demonstrations and other e-learning materials to rural training sites. Because the need for health care workers is greatest outside urban areas, MEPI schools are posting faculty and students at these remote locations to give them experience in community-based health care and to offer local trainees quality mentorship. Many countries are shoring up living and working conditions at these sites, providing improved housing and Internet connectivity.

"We're delighted to see that MEPI is fundamentally changing the way African institutions are approaching medical education," said Fogarty Director Dr. Roger I. Glass. "Through decentralization, they are training health care workers in the places where they're needed most, engaging local physicians and increasing enthusiasm for rural practice and research."

Before: Stacks of large, bulky, quickly outdated textbooks After: Compact handheld e-reader shows cover page of digital textbook
Photos courtesy of MEPI Ethiopia

Before and after: MEPI funding has helped Africa's
medical schools move from hard copies of
textbooks, which are expensive and quickly
out-of-date, to tablets that provide access to the
latest information.

Another MEPI goal is to expand the subject matter included in curricula beyond infectious disease topics to include emergency medicine, mental health, surgery, cardiology, cancer, and maternal and child health. Developing expertise in these areas is critical to addressing current health challenges as well as the rising tide of chronic illness sweeping the continent.

Brain drain still takes a devastating toll on Africa's medical workforce, so MEPI funds are supporting research grants for faculty as both an enticement for them to remain in-country and also to ensure health care quality continues to improve as science evolves. That investment is already paying dividends. MEPI institutions currently receive support from about 150 NIH grants, double the level three years ago, reflecting their growing research capacity and ability to handle ethical review, manage financial programs and compete in grant writing. "As the MEPI sites mature, their ability to support and compete for additional funding will be key to long-term development efforts," Glass noted.

Five students seated in a classroom, all using tablet computers
Photo courtesy of MEPI Ethiopia

Some MEPI sites are supplying students and faculty with
personal tablet computers loaded with medical books,
national health guidelines and other valuable resources.

Another essential MEPI aim is to nurture the cooperation of national governments and ensure goals are aligned with country priorities, since financial and policy support are critical for maintaining momentum. Many African governments have already boosted their health care funding significantly. "We have started a fire," Kolars said, "but it is going to need to be fueled by more financing, more support." The framework of institutions and collection of teaching tools have been assembled and are ripe for scale up through additional investment, MEPI partners suggested.

The challenge now is how to package this rich experience so it can be shared further within the MEPI network and beyond, said Dr. Francis G. Omaswa, a principal investigator for the MEPI Coordinating Center. "We want to move to a stage when our own African governments are putting our own money into making sure that what has been set in motion by MEPI does not stop when the MEPI program stops."

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