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Ferrinho P, Delgado AP, Mendonca MDLL, Fronteira I, Sidat M, Semedo D, Monteiro FF, Garcia AC, Serrano P, Lapão M, Pires DM, Gómez LF, Castanheira ER, Araújo II. Public health capacity development in Africa: The case of advanced public health education and training in Cabo Verde. J Glob Health 2024; 14:03025. [PMID: 39149817 PMCID: PMC11327893 DOI: 10.7189/jogh.14.03025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024] Open
Affiliation(s)
- Paulo Ferrinho
- Global Health and Tropical Medicine, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal
- Faculty of Sciences and Technology, University of Cabo Verde, Praia, Cabo Verde
| | - António Pedro Delgado
- Global Health and Tropical Medicine, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal
- Faculty of Sciences and Technology, University of Cabo Verde, Praia, Cabo Verde
| | | | - Inês Fronteira
- National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, Nova University of Lisbon, Lisbon, Portugal
| | - Mohsin Sidat
- Global Health and Tropical Medicine, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Moçambique
| | - Deisa Semedo
- Faculty of Sciences and Technology, University of Cabo Verde, Praia, Cabo Verde
| | | | - Ana Cristina Garcia
- Global Health and Tropical Medicine, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal
- Faculty of Sciences and Technology, University of Cabo Verde, Praia, Cabo Verde
| | - Pedro Serrano
- Global Health and Tropical Medicine, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal
| | - Manuel Lapão
- Executive Secretariat of the Community of Portuguese Language Countries, Lisbon, Portugal
| | - Dilma Miranda Pires
- Faculty of Sciences and Technology, University of Cabo Verde, Praia, Cabo Verde
| | - Lara Ferrero Gómez
- Center for Research, Institutional Relations and Advanced Training, Capeverdian Jean Piaget University, Praia, Cabo Verde
| | - Elen Rose Castanheira
- Faculty of Medicine, Paulista State University Julio de Mesquita, Botucatu, Sao Paulo, Brasil
| | - Isabel Inês Araújo
- Global Health and Tropical Medicine, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal
- Faculty of Sciences and Technology, University of Cabo Verde, Praia, Cabo Verde
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Luthuli S, Daniel M, Corbin JH. Power imbalances and equity in the day-to-day functioning of a north plus multi-south higher education institutions partnership: a case study. Int J Equity Health 2024; 23:59. [PMID: 38491440 PMCID: PMC10943907 DOI: 10.1186/s12939-024-02139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/03/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Partnerships between Higher Education Institutions (HEIs) in the global north and south have commonly been used as a vehicle to drive global health research and initiatives. Among these initiatives, include health system strengthening, research capacity building, and human resource training in developing countries. However, the partnership functioning of many global north-south partnerships still carry legacies of colonialism through unrecognized behavior patterns, attitudes, and belief systems in how they function. Even with research literature calling for a shift from equality to equity in the functioning of these partnerships, many still struggle with issues of complex and unspoken power dynamics. To understand the successes and challenges of north-south partnerships, this paper explored partnership development and functioning of a northern and multi-southern HEIs partnership focused on nutrition education and research. METHODS A qualitative research approach was used; data were collected through in-depth interviews (IDIs) with questions developed from the Bergen Model of Collective Functioning (BMCF). Thirteen IDIs were conducted with partners from all institutions including stakeholders. FINDINGS The partnership was built on the foundation of experiences and lessons of a previous partnership. Partners used these experiences and lessons to devise strategies to improve partnership inputs, communication, leadership, roles and structures, and maintenance and communication tasks. However, these strategies had an impact on partnership functioning giving rise to issues of inequitable power dynamics. The northern partner had two roles: one as an equal partner and another as distributor of project funds; this caused a conflict in roles for this partner. The partners distinguished themselves according to partner resources - two partners were named implementing partners and two named supportive partners. Roles and partner resources were the greatest contributors to power imbalances and caused delays in project activities. CONCLUSION Using the BMCF to examine partnership dynamics illuminated that power imbalances caused a hierarchical stance in the partnership with northern partners having overall control and power of decision-making in the partnership. This could impact the effectiveness and sustainability of project in the southern institutions going forward.
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Affiliation(s)
- Silondile Luthuli
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway.
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Marguerite Daniel
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - J Hope Corbin
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
- Department of Health and Community Studies, Western Washington University, Bellingham, WA, USA
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Zackery A, Zolfagharzadeh MM, Hamidi M. Policy Implications of the Concept of Technological Catch-Up for the Management of Healthcare Sector in Developing Countries. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221076964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The concept of technological catch-up can be used as a theoretical platform to design policies for the management of the healthcare sector in developing countries. In this article, initially, the factors affecting a technological catch-up process were collected through a conceptual literature review and prioritised using a fuzzy Delphi survey. The interdependences among important contributory factors were investigated as well. They were then used to create some policy recommendations for the management of the healthcare sector in developing countries through an interdisciplinary integration of the literature of technological catch-up and healthcare. Some exemplary projects/initiatives using these policies were collected too. The quality of human resources, a comprehensive knowledge management system, interactive learning and innovation-encouraging culture were rated as the most important contributing factors to an effectual technological catch-up in the healthcare sector in developing countries. Also, the creation of distributed health social networks, development of systematic knowledge management systems, forming strategic partnerships and designing path-creating technological catch-up processes by focusing on indigenous innovation were the final policy recommendations. All in all, the healthcare sector in developing countries should stop chasing frontiers, should try taking detours and flying a balloon by adopting a strategy of differentiation.
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Affiliation(s)
- Ali Zackery
- Department of Industrial Engineering and Futures Studies, Faculty of Engineering, University of Isfahan, Isfahan, Iran
| | | | - Mahdi Hamidi
- Faculty of Management and Accounting, Allame Tabataba’I University, Tehran, Iran
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Horwood C, Mapumulo S, Haskins L, John V, Luthuli S, Tylleskär T, Mutombo P, Engebretsen IMS, Mapatano MA, Hatløy A. A North-South-South partnership in higher education to develop health research capacity in the Democratic Republic of the Congo: the challenge of finding a common language. Health Res Policy Syst 2021; 19:79. [PMID: 33962628 PMCID: PMC8106225 DOI: 10.1186/s12961-021-00728-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, increasing numbers of higher education institutions (HEIs) in non-English-speaking countries have adopted English as a medium of instruction (EMI), because of the perception that this provides opportunities to attract high-calibre students and academic staff, and engage with the international research community. We report an evaluation of a North-South-South collaboration to develop health research capacity in the Democratic Republic of the Congo (DRC) by establishing a postgraduate programme in nutritional epidemiology at the Kinshasa School of Public Health (KSPH), where EMI was adopted. We report experiences and perceptions of stakeholders, facilitators and students about using EMI. METHODS In-depth qualitative interviews were conducted between October and December 2019 among convenience sampled stakeholders (8), facilitators (11) and students (12) involved in the programme from all three partner institutions (University of Kinshasa; University of KwaZulu-Natal, South Africa; University of Bergen, Norway). Interviews were conducted in participants' language of preference (English or French), audio-recorded, transcribed verbatim and translated into English when required. Analysis employed a thematic approach. RESULTS Most participants viewed EMI positively, reporting that studying in English created opportunities to access relevant literature, improve interactions with the scientific community and advance their careers. As a result of adopting EMI, some students had opportunities to present research findings at international conferences and publish their research in English. English-speaking researchers from partner institutions were able to participate in supervision of students' research. However, inadequate English competency, particularly among students, was challenging, with some students reporting being unable to understand or interact in class, which negatively affected their academic performance. Further, EMI created barriers at KSPH among academic staff who were not proficient in English, leading to poor participation among non-English-speaking staff and lack of integration with other postgraduate programmes. Participants suggested additional English language support for EMI. CONCLUSION Partnerships between HEIs could be a powerful tool to develop research capacity in low-income countries in line with United Nations Sustainable Development Goals. EMI could be a solution to language barriers faced by many such partnerships, but wide-ranging support to develop English proficiency among staff and students is essential to ensure that the challenges do not outweigh the benefits.
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Affiliation(s)
- Christiane Horwood
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Sphindile Mapumulo
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Lyn Haskins
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Vaughn John
- School of Education, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Silondile Luthuli
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Paulin Mutombo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Mala Ali Mapatano
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Anne Hatløy
- Centre for International Health, University of Bergen, Bergen, Norway. .,Fafo Institute for Labour and Social Research, Oslo, Norway.
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Ali MM, Haskins L, John V, Hatløy A, Luthuli S, Mapumulo S, Engebretsen IMS, Tylleskär T, Mutombo P, Horwood C. Establishing a postgraduate programme in nutritional epidemiology to strengthen resource capacity, academic leadership and research in the democratic republic of Congo. BMC MEDICAL EDUCATION 2021; 21:136. [PMID: 33639921 PMCID: PMC7912884 DOI: 10.1186/s12909-021-02557-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/25/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Low- and Middle-income countries (LMIC) face considerable health and nutrition challenges, many of which can be addressed through strong academic leadership and robust research translated into evidence-based practice. A North-South-South partnership between three universities was established to implement a master's programme in nutritional epidemiology at the Kinshasa School of Public Health (KSPH), Democratic Republic of Congo (DRC). The partnership aimed to develop academic leadership and research capacity in the field of nutrition in the DRC. In this article we describe the educational approach and processes used, and discuss successes, challenges, and lessons learned. METHODS Self-administered questionnaires, which included both open and closed questions, were sent to all graduates and students on the master's programme to explore students' experiences and perceptions of all aspects of the educational programme. Quantitative data was analysed using frequencies, and a thematic approach was used to analyse responses to open-ended questions. RESULTS A two-year master's programme in Nutritional Epidemiology was established in 2014, and 40 students had graduated by 2020. Key elements included using principles of authentic learning, deployment of students for an internship at a rural residential research site, and support of selected students with bursaries. Academic staff from all partner universities participated in teaching and research supervision. The curriculum and teaching approach were well received by most students, although a number of challenges were identified. Most students reported benefits from the rural internship experience but were challenged by the isolation of the rural site, and felt unsupported by their supervisors, undermining students' experiences and potentially the quality of the research. Financial barriers were also reported as challenges by students, even among those who received bursaries. CONCLUSION The partnership was successful in establishing a Master Programme in Nutritional Epidemiology increasing the number of nutrition researchers in the DRC. This approach could be used in other LMIC settings to address health and nutrition challenges.
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Affiliation(s)
- Mapatano Mala Ali
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Lyn Haskins
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Vaughn John
- School of Education, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Anne Hatløy
- Centre for International Health, University of Bergen, Bergen, Norway
- Fafo Institute for Labour and Social Research, Oslo, Norway
| | - Silondile Luthuli
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Sphindile Mapumulo
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | | | - Paulin Mutombo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Christiane Horwood
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Craveiro I, Carvalho A, Ferrinho P. "Get us partnerships!" - a qualitative study of Angolan and Mozambican health academics' experiences with North/South partnerships. Global Health 2020; 16:33. [PMID: 32295611 PMCID: PMC7161017 DOI: 10.1186/s12992-020-00562-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 03/27/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Sustainable Development Goal (SDG) 17 focuses on North/South partnerships for sustainable development. Literature on research partnerships and capacity -building often neglects how these processes are carried out in practice, their social impacts and participants' subjective experiences. Recognizing the increasingly global dimensions of Higher Education Institutions, the University Development and Innovation - Africa project (UDI-A) was designed to train lecturers and administrative staff of Angolan and Mozambican Universities through collaborations with European institutions, aiming at strengthening African academic and social landscapes through knowledge translation and dissemination. This paper examines potential outcomes of UDI-A on participants' academic pathways, investigating the conflict between different imaginaries of capacity-building and partnerships, focusing on how Angolan and Mozambican health sciences researchers experience international collaborations. METHODS Semi-structured interviews were conducted with seven health academics, as well as a focus group discussion involving all participants. These were recorded, fully transcribed, anonymized and coded to identify common themes. A consent form was signed by all participants. RESULTS AND DISCUSSION UDI-A was considered innovative, fostering the improvement of pedagogical skills and increasing social entrepreneurship activities. Participants arrived with a specific institutional mandate and believed that the training received should be incorporated into institutional practices to "modernize" these specific Portuguese speaking African Universities and the health sector. The institutional mechanisms put in place to attain this goal, Centres for Academic Development and Innovation ("CADIs"), were considered potential research and development hubs and drivers of academic and societal transformation. Nevertheless, participants shared a sense of asymmetry (infrastructural, financial, in terms of access to information) between them and European trainers. Although this asymmetry was the underlying basis of this capacity-building project, they argued that UDI-A did not fully acknowledge their local contexts, compromising the prospective development of partnerships in the health field. CONCLUSIONS More attention should be devoted to understanding how participants experience capacity building processes, integrating the diversity of their aspirations and perceptions into subsequent phases of the project, requiring the development of methodological innovations to increase the impact of these programs.
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Affiliation(s)
- Isabel Craveiro
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - António Carvalho
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
- Centre for Social Studies, University of Coimbra, Praça Dom Dinis, 3000-104 Coimbra, Portugal
| | - Paulo Ferrinho
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
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Amde WK, Sanders D, Sidat M, Nzayirambaho M, Haile-Mariam D, Lehmann U. The politics and practice of initiating a public health postgraduate programme in three universities in sub-Saharan Africa: the challenges of alignment and coherence. Int J Equity Health 2020; 19:52. [PMID: 32272918 PMCID: PMC7147041 DOI: 10.1186/s12939-020-01163-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 03/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background In-country postgraduate training programme in low and middle income countries are widely considered to strengthen institutional and national capacity. There exists dearth of research about how new training initiatives in public health training institutions come about. This paper examines a south-south collaborative initiative wherein three universities based in Ethiopia, Rwanda and Mozambique set out to develop a local based postgraduate programme on health workforce development/management through partnership with a university in South Africa. Methods We used a qualitative case study design. We conducted semi-structured interviews with 36 key informants, who were purposively recruited based on their association or proximity to the programme, and their involvement in the development, review, approval and implementation of the programme. We gathered supplementary data through document reviews and observation. Thematic analysis was used and themes were generated inductively from the data and deductively from literature on capacity development. Results University A successfully initiated a postgraduate training programme in health workforce development/management. University B and C faced multiple challenges to embed the programme. It was evident that multiple actors underpin programme introduction across institutions, characterized by contestations over issues of programme feasibility, relevance, or need. A daunting challenge in this regard is establishing coherence between health ministries’ expectation to roll out training programmes that meet national health priorities and ensure sustainability, and universities and academics’ expectations for investment or financial incentive. Programme champions, located in the universities, can be key actors in building such coherence, if they are committed and received sustained support. The south-south initiative also suffers from lack of long term and adequate support. Conclusions Against the background of very limited human capacity and competition for this capacity, initiating the postgraduate programme on health workforce development/management proved to be a political as much as a technical undertaking influenced by multiple actors vying for recognition or benefits, and influence over issues of programme feasibility, relevance or need. Critical in the success of the initiative was alignment and coherence among actors, health ministries and universities in particular, and how well programme champions are able to garner support for and ownership of programme locally. The paper argues that coherence and alignment are crucial to embed programmes, yet hard to achieve when capacity and resources are limited and contested.
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Affiliation(s)
| | - David Sanders
- School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Mohsin Sidat
- Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique
| | | | | | - Uta Lehmann
- School of Public Health, University of Western Cape, Cape Town, South Africa
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Amde WK, Marchal B, Sanders D, Lehmann U. Determinants of effective organisational capacity training: lessons from a training programme on health workforce development with participants from three African countries. BMC Public Health 2019; 19:1557. [PMID: 31771556 PMCID: PMC6878696 DOI: 10.1186/s12889-019-7883-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health systems in sub-Saharan Africa face multifaceted capacity challenges to fulfil their mandates of service provision and governance of their resources. Four academic institutions in Africa implemented a World Health Organisation-funded collaborative project encompassing training, curriculum development, and partnership to strengthen national leadership and training capacity for health workforce development. This paper looks into the training component of the project, a blended Masters programme in public health that sought to improve the capacity of personnel involved in teaching or management/development of human resources for health. The paper aims to explore factors influencing contribution of training to organisational capacity development. METHODS We chose a case study design. Semi-structured interviews were held with 18 trainees that were enrolled in the training programme, and who were affiliated to health ministries or public health training institutions. We gathered additional data through document reviews, observation, and interviews with 14 key informants associated with the programme and/or working in the collaborating institutions. The evidence gathered were analysed thematically. RESULTS Thirteen of the 18 training participants stayed in the target institutions and contributed to improved capacity of their institutions in the fields of management, policy, planning, research, training, or curriculum development. Five left for private and international agencies due to dissatisfaction with payment, work conditions, or career prospect. Factors that were associated with the training, trainees, and the institutional and broader context, determine contribution of training to organisational capacity development. These include relevance of newly acquired knowledge and skills set of trainees to the role/position they assume in the organisation; recognition of trainees by employing organisations in terms of promotion or assignment of challenging tasks; and motivation and retention of trained staff. CONCLUSION Training, even if relevant and applicable, makes no more than a 'latent' contribution, one which is activated and realised through alignment of clusters of interacting contextual and relational factors related to the target institutions and trained personnel. While not predictable, implementers need to focus more deliberately on the likely interaction and best possible alignments between training relevance, student selection for potential to contribute, recognition and career advancement potential.
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Affiliation(s)
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Uta Lehmann
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Chege MP. Building consensus on identifying research mentoring gaps and finding ways of addressing the gap in a Kenyan college of health sciences. Afr J Prim Health Care Fam Med 2019; 11:e1-e7. [PMID: 31296015 PMCID: PMC6620544 DOI: 10.4102/phcfm.v11i1.1886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The concept of mentoring in clinical practice has traditionally focused on moving graduates from novice to more respectable positions within the clinical practice hierarchy. With the growing emphasis on evidence-based practice, the role of research in generating evidence for practice cannot be overemphasised. Mentoring in clinical operational research for both students and junior members of academic staff in health professionals' training colleges is as important as mentoring for clinical skills. AIM This study aimed at building consensus on possible ways of enhancing research mentoring for graduate students and members of academic staff in a college of health sciences. SETTING The study was conducted within Moi University College of Health Sciences (MUCHS) in Eldoret, Kenya. METHODS The study population was composed of academic staff members and registered graduate students by the end of 2015. All academic staff and graduate students were eligible to participate. The Delphi technique was used to not only collect individual opinions but also build consensus. During the first iteration, questions were sent for which open-ended responses were needed. Responses from the first round were grouped into patterns and themes that guided the writing of questions for the subsequent rounds. RESULTS The response rate was 78%. There was consensus in appreciating that mentoring was fundamental for career growth in clinical practice and research and needed for improving and developing formal structure for effective mentoring. It was crucial to establish training programmes for mentors and for accrediting them. CONCLUSION Enhancing of current research mentoring in MUCHS was needed and expected by graduate students and academic staff.
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Amde WK, Sanders D, Chilundo B, Rugigana E, Haile Mariam D, Lehmann U. Exploring multiple job holding practices of academics in public health training institutions from three sub-Saharan Africa countries: drivers, impact, and regulation. Glob Health Action 2018; 11:1491119. [PMID: 30067152 PMCID: PMC6084497 DOI: 10.1080/16549716.2018.1491119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The paper examines external multiple job holding practices in public health training institutions based in prominent public universities in three sub-Saharan Africa countries (Rwanda, Ethiopia, Mozambique). OBJECTIVE The study aims to contribute to broadening understanding about multiple job holding (nature and scale, drivers and reasons, impact, and efforts to regulate) in public health training schools in public universities. METHODS A qualitative multiple case study approach was used. Data were collected through document reviews and in-depth interviews with 18 key informants. Data were then triangulated and analyzed thematically. RESULTS External multiple job holding practices among faculty of the three public health training institutions were widely prevalent. Different factors at individual, institutional, and national levels were reported to underlie and mediate the practice. While it evidently contributes to increasing income of academics, which many described as enabling their continuing employment in the public sector, many pointed to the negative effects as well. Similarities were found regarding the nature and drivers of the practice across the institutions, but differences exist with respect to mechanisms for and extent of regulation. Regulatory mechanisms were often not clear or enforced, and academics are often left to self-regulate their engagement. Lack of regulation has been cited as allowing excessive engagement in multiple job holding practice among academics at the expense of their core institutional responsibility. This could further weaken institutional capacity and performance, and quality of training and support to students. CONCLUSION The research describes the complexity of external multiple job holding practice, which is characterized by a cluster of drivers, multiple processes and actors, and lack of consensus about its implication for individual and institutional capacity. In the absence of a strong accountability mechanism, the practice could perpetuate and aggravate the fledgling capacity of public health training institutions.
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Affiliation(s)
| | - David Sanders
- a School of Public Health , University of Western Cape , Cape Town , South Africa
| | - Baltazar Chilundo
- b Department of Community Health , Eduardo Mondlane University , Maputo , Mozambique
| | - Etienne Rugigana
- c School of Public Health , University of Rwanda , Kigali , Rwanda
| | - Damen Haile Mariam
- d School of Public Health , Addis Ababa University , Addis Ababa , Ethiopia
| | - Uta Lehmann
- a School of Public Health , University of Western Cape , Cape Town , South Africa
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Hiatt RA, Engmann NJ, Ahmed M, Amarsi Y, Macharia WM, Macfarlane SB, Ngugi AK, Rabbani F, Walraven G, Armstrong RW. Population Health Science: A Core Element of Health Science Education in Sub-Saharan Africa. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:462-467. [PMID: 27508343 PMCID: PMC5367502 DOI: 10.1097/acm.0000000000001320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Sub-Saharan Africa suffers an inordinate burden of disease and does not have the numbers of suitably trained health care workers to address this challenge. New concepts in health sciences education are needed to offer alternatives to current training approaches.A perspective of integrated training in population health for undergraduate medical and nursing education is advanced, rather than continuing to take separate approaches for clinical and public health education. Population health science educates students in the social and environmental origins of disease, thus complementing disease-specific training and providing opportunities for learners to take the perspective of the community as a critical part of their education.Many of the recent initiatives in health science education in sub-Saharan Africa are reviewed, and two case studies of innovative change in undergraduate medical education are presented that begin to incorporate such population health thinking. The focus is on East Africa, one of the most rapidly growing economies in sub-Saharan Africa where opportunities for change in health science education are opening. The authors conclude that a focus on population health is a timely and effective way for enhancing training of health care professionals to reduce the burden of disease in sub-Saharan Africa.
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Affiliation(s)
- Robert A. Hiatt
- R.A. Hiatt is professor and chair, Department of Epidemiology and Biostatistics, University of California, San Francisco, and director of population sciences and associate director, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Natalie J. Engmann
- N.J. Engmann is a doctoral student, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Mushtaq Ahmed
- M. Ahmed is professor and associate dean of medical education, Aga Khan University, Faculty of Health Sciences–East Africa, Dar es Salaam, Tanzania
| | - Yasmin Amarsi
- Y. Amarsi is professor and dean, School of Nursing and Midwifery, Aga Khan University, Faculty of Health Sciences–East Africa, Nairobi, Kenya
| | - William M. Macharia
- W.M. Macharia is professor and chair, Department of Paediatrics and Child Health, Aga Khan University, Faculty of Health Sciences–East Africa, Nairobi, Kenya
| | - Sarah B. Macfarlane
- S.B. Macfarlane is professor, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, and visiting professor, Aga Khan University, Faculty of Health Sciences–East Africa, Nairobi, Kenya
| | - Anthony K. Ngugi
- A.K. Ngugi is assistant professor, Aga Khan University, Faculty of Health Sciences–East Africa, Nairobi, Kenya
| | - Fauziah Rabbani
- F. Rabbani is professor and chair, Department of Community Health Sciences, Aga Khan University–Karachi, Pakistan
| | - Gijs Walraven
- G. Walraven is honorary professor, Department of Community Health Sciences, Aga Khan University–Karachi, Pakistan, and director for health, Aga Khan Development Network, Geneva, Switzerland
| | - Robert W. Armstrong
- R.W. Armstrong is professor and dean of the medical college, Aga Khan University, Faculty of Health Sciences–East Africa, Nairobi, Kenya
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12
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Yarmoshuk AN, Guantai AN, Mwangu M, Cole DC, Zarowsky C. Mapping International University Partnerships Identified by East African Universities as Strengthening Their Medicine, Nursing, and Public Health Programs. Ann Glob Health 2017; 82:665-677.e2. [PMID: 28283117 DOI: 10.1016/j.aogh.2016.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND International university partnerships are recommended for increasing the capacity of sub-Saharan African universities. Many publications describe individual partnerships and projects, and tools are available for guiding collaborations, but systematic mappings of the basic, common characteristics of partnerships are scarce. OBJECTIVE To document and categorize the international interuniversity partnerships deemed significant to building the capacity of medicine, nursing, and public health programs of 4 East African universities. METHODS Two universities in Kenya and 2 in Tanzania were purposefully selected. Key informant interviews, conducted with 42 senior representatives of the 4 universities, identified partnerships they considered significant for increasing the capacity of their institutions' medicine, nursing, and public health programs in education, research, or service. Interviews were transcribed and analyzed. Partners were classified by country of origin and corresponding international groupings, duration, programs, and academic health science components. FINDINGS One hundred twenty-nine university-to-university partnerships from 23 countries were identified. Each university reported between 25 and 36 international university partners. Seventy-four percent of partnerships were with universities in high-income countries, 15% in low- and middle-income countries, and 11% with consortia. Seventy percent included medicine, 37% nursing, and 45% public health; 15% included all 3 programs. Ninety-two percent included an education component, 47% research, and 24% service; 12% included all 3 components. CONCLUSIONS This study confirms the rapid growth of interuniversity cross-border health partnerships this century. It also finds, however, that there is a pool of established international partnerships from numerous countries at each university. Most partnerships that seek to strengthen universities in East Africa should likely ensure they have a significant education component. Universities should make more systematic information about past and existing partnerships available publicly.
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Affiliation(s)
| | | | - Mughwira Mwangu
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Christina Zarowsky
- University of the Western Cape, Cape Town, South Africa; CR-CHUM/ESPUM, Université de Montréal, Montreal, Québec
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Dlungwane T, Voce A, Searle R, Stevens F. Master of Public Health programmes in South Africa: issues and challenges. Public Health Rev 2017; 38:5. [PMID: 29450077 PMCID: PMC5810082 DOI: 10.1186/s40985-017-0052-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The demand for highly skilled public health personnel in low- and middle-income countries has been recognised globally. In South Africa, the need to train more public health professionals has been acknowledged. The Human Resource for Health (HRH) Strategy for South Africa includes the establishment of public health units at district and provincial levels. Programmes such as Master of Public Health (MPH) programmes are viewed as essential contributors in equipping health practitioners with adequate public health skills to meet the demands of the health care system. All MPH programmes have been instituted independently; there is no systematic information or comparison of programmes and requirements across institutions. This study aims to establish a baseline on MPH programmes in South Africa in terms of programme characteristics, curriculum, teaching workforce and graduate output. METHODS A mixed method design was implemented. A document analysis and cross-sectional descriptive survey, comprising both quantitative and qualitative data collection, by means of questionnaires, of all MPH programmes active in 2014 was conducted. The MPH programme coordinators of the 10 active programmes were invited to participate in the study via email. Numeric data were summarized in frequency distribution tables. Non-numeric data was captured, collated into one file and thematically analysed. RESULTS A total of eight MPH programmes responded to the questionnaire. Most programmes are affiliated to medical schools and provide a wide range of specialisations. The MPH programmes are run by individual universities and tend to have their own quality assurance, validation and assessment procedures with minimal external scrutiny. National core competencies for MPH programmes have not been determined. All programmes are battling to provide an appropriate supply of well-trained public health professionals as a result of drop-out, low throughput and delayed time to completion. CONCLUSION The MPH programmes have consistently graduated MPH candidates, although the numbers differ by institution. The increasing number of enrolments coupled by insufficient teaching personnel and low graduate output are key challenges impacting on the production of public health professionals. Collaboration amongst the MPH programmes, standardization, quality assurance and benchmarking needs considerable attention.
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Affiliation(s)
- Thembelihle Dlungwane
- College of Health Sciences, School of Nursing and Public Health, Howard College Campus, University of KwaZulu-Natal, Glenwood, Durban, South Africa
| | - Anna Voce
- College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Ruth Searle
- College of Humanities, School of Education, University of KwaZulu-Natal, Durban, South Africa
| | - Fred Stevens
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Rabbani F, Shipton L, White F, Nuwayhid I, London L, Ghaffar A, Ha BTT, Tomson G, Rimal R, Islam A, Takian A, Wong S, Zaidi S, Khan K, Karmaliani R, Abbasi IN, Abbas F. Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations? BMC Public Health 2016; 16:941. [PMID: 27604901 PMCID: PMC5015344 DOI: 10.1186/s12889-016-3616-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges. MAIN TEXT The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs). CONCLUSION SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries.
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Affiliation(s)
- Fauziah Rabbani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Leah Shipton
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Franklin White
- Pacific Health & Development Sciences Inc., Victoria, Canada
| | - Iman Nuwayhid
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Leslie London
- Division Public Health Medicine, School of Public Health and Family Medicine University of Cape Town, Cape Town, South Africa
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | - Bui Thi Thu Ha
- Hanoi School of Public Health, Giang Vo, Ba Dinh, Hanoi, Vietnam
| | - Göran Tomson
- Depts LIME & PHS, Karolinska Institutet Stockholm, Stockholm, Sweden
| | - Rajiv Rimal
- Department of Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, USA
| | - Anwar Islam
- School of Health Policy and Management, York University, Toronto, Ontario Canada
| | - Amirhossein Takian
- Department of Global Health & Sustainable Development, School of Public Health-Tehran University of Medical Sciences, Tehran, Iran
| | - Samuel Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Shehla Zaidi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Kausar Khan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rozina Karmaliani
- School of Nursing & Midwifery and Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Imran Naeem Abbasi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Farhat Abbas
- Medical College, Aga Khan University, Karachi, Pakistan
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Understanding collaboration in a multi-national research capacity-building partnership: a qualitative study. Health Res Policy Syst 2016; 14:64. [PMID: 27538447 PMCID: PMC4991081 DOI: 10.1186/s12961-016-0132-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 07/12/2016] [Indexed: 02/06/2023] Open
Abstract
Background Research capacity building and its impact on policy and international research partnership is increasingly seen as important. High income and low- and middle-income countries frequently engage in research collaborations. These can have a positive impact on research capacity building, provided such partnerships are long-term collaborations with a unified aim, but they can also have challenges. What are these challenges, which often result in a short term/ non viable collaboration? Does such collaboration results in capacity building? What are the requirements to make any collaboration sustainable? This study aimed to answer these and other research questions through examining an international collaboration in one multi-country research capacity building project ARCADE RSDH (Asian Regional Capacity Development for Research on Social Determinants of Health). Method A qualitative study was conducted that focused on the reasons for the collaboration, collaboration patterns involved, processes of exchanging information, barriers faced and perceived growth in research capacity. In-depth interviews were conducted with the principal investigators (n = 12), research assistants (n = 2) and a scientific coordinator (n = 1) of the collaborating institutes. Data were analysed using thematic framework analysis. Results The initial contact between institutes was through previous collaborations. The collaboration was affected by the organisational structure of the partner institutes, political influences and the collaboration design. Communication was usually conducted online, which was affected by differences in time and language and inefficient infrastructure. Limited funding resulted in restricted engagement by some partners. Conclusion This study explored work in a large, North-South collaboration project focusing on building research capacity in partner institutes. The project helped strengthen research capacity, though differences in organization types, existing research capacity, culture, time, and language acted as obstacles to the success of the project. Managing these differences requires preplanned strategies to develop functional communication channels among the partners, maintaining transparency, and sharing the rewards and benefits at all stages of collaboration. Electronic supplementary material The online version of this article (doi:10.1186/s12961-016-0132-1) contains supplementary material, which is available to authorized users.
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Ager A, Zarowsky C. Balancing the personal, local, institutional, and global: multiple case study and multidimensional scaling analysis of African experiences in addressing complexity and political economy in health research capacity strengthening. Health Res Policy Syst 2015; 13:5. [PMID: 25595847 PMCID: PMC4325946 DOI: 10.1186/1478-4505-13-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 01/02/2015] [Indexed: 11/10/2022] Open
Abstract
Background Strengthening health research capacity in low- and middle-income countries remains a major policy goal. The Health Research Capacity Strengthening (HRCS) Global Learning (HGL) program of work documented experiences of HRCS across sub-Saharan Africa. Methods We reviewed findings from HGL case studies and reflective papers regarding the dynamics of HRCS. Analysis was structured with respect to common challenges in such work, identified through a multi-dimensional scaling analysis of responses from 37 participants at the concluding symposium of the program of work. Results Symposium participants identified 10 distinct clusters of challenges: engaging researchers, policymakers, and donors; securing trust and cooperation; finding common interest; securing long-term funding; establishing sustainable models of capacity strengthening; ensuring Southern ownership; accommodating local health system priorities and constraints; addressing disincentives for academic engagement; establishing and retaining research teams; and sustaining mentorship and institutional support. Analysis links these challenges to three key and potentially competing drivers of the political economy of health research: an enduring model of independent researchers and research leaders, the globalization of knowledge and the linked mobility of (elite) individuals, and institutionalization of research within universities and research centres and, increasingly, national research and development agendas. Conclusions We identify tensions between efforts to embrace the global ‘Community of Science’ and the promotion and protection of national and institutional agendas in an unequal global health research environment. A nuanced understanding of the dynamics and implications of the uneven global health research landscape is required, along with a willingness to explore pragmatic models that seek to balance these competing drivers.
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Affiliation(s)
| | - Christina Zarowsky
- School of Public Health, University of Western Cape, Robert Sobukwe Road, Bellville, Cape Town 7535, South Africa.
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