Thomas Quinn, M.D., M.Sc.

Director of Global Health, Johns Hopkins University

Associate Director for International Research, NIAID

North South Experiences of Doctoral Training for

Development in Africa: The Impact of Partnerships

• 2006: “Programme of Strategic Cooperation between Irish Aid and Higher Education and Research Institutes 2007-2011”(Aid, 2007-2011) launched. Objectives included:

– Strengthen institutional capacity for development research and teaching in Southern Higher Education Institutes (HEIs) and sustained and flexible collaborative partnerships by 2015

– To support capacity building in HEI and research institutions in key poverty related thematic areas in Ireland and countries benefiting from Irish Aid support by 2013

– Support Irish Aid’s mission in reducing poverty by contributing to the achievement of the Millennium Development Goals

“North-South Experiences of Doctoral Training for Development in Africa”

North-South Experiences of Doctoral Training for Development in Africa

• A study of three models of partnership between Trinity College Dublin and higher education institutes in six African countries, designed to understand the strengths and weaknesses of the three different doctoral training models, capture lessons learnt from the partnerships and make recommendations to others establishing North-South doctoral training programmes.

• The goal of these partnerships is to deliver collaborative doctoral training programmes in global health, natural sciences and economics, to train researchers and build research and teaching capacity in African institutions.

Three Models

• African-led – African Economics Research Consortium (AERC). a public not-for-profit organization, established in 1988 and devoted to advanced policy research and training in economics

• Bilateral – TCD and the Makerere Institute of Environment and Natural Resources (MUIENR) at Makerere University, Uganda. This partnership represents the environment discipline of the programme

• Multilateral: The International Doctorate in Global Health (Indigo) is an innovative programme, launched in 2009 and coordinated by the Centre for Global Health (CGH) at Trinity College Dublin, with partners from Africa, Europe and North America.

•

Keys to Success

North

Universities’ Crucial Role • Research

– Focused on the needs of LMIC’s – Collaborative with colleagues in

LMIC’s

• Education and Training – Preparing U.S. experts in global

health – Faculty exchange – Collaborative education with LMIC’s

• Service and Model Partnerships – Mutually beneficial and durable

A. Build on the inspiration and passion of our students and faculty for global citizenship, especially global health – by giving them the experiences, skills, and innovative problem-solving abilities to make a difference;

B. Develop effective interdisciplinary, sustainable collaborations in education, science, and service (interdigitation);

C. Bridge silos between schools and lower the barriers between the boundaries of “ossified academic bureaucracies;”

D. Promote and evaluate collaborations among universities and professional societies, and other institutions in global health.

How Can Universities Become the Transforming

Force in Global Health?

Health Workforce Crisis

• One billion people have no access to a skilled health worker.

• WHO estimates - four million health workers are needed to improve child and maternal health and treat diseases like HIV/AIDS.

• WHO recommends a minimum of 23 health workers per 10 000 people to provide the most basic health coverage.

• "expanding coverage is often hindered by the severe lack of human resources, especially in rural areas and slums" (UNAIDS, 2011)

• Sub-Saharan Africa requires two times its current HRHA population to be added every year for the next 10 years to achieve universal coverage" (Barninghausen 2007)

Source: WHO, WHR 2006; UNAIDS 2011; Barninghausen et al AIDS Patient Care and STDs, 2007

The human resources for health crisis in Sub-Saharan Africa

11 Source: HHA

Unequal Distribution of Health Workers

Global Misdistribution of Health Workers

Physician Density per 100,000 Population

417

340

280

220 220

13 2

206

164

69 60

530

0

100

200

300

400

500

600

Cub

a

Rus

sia

Franc

eU

.S.

U.K

.

Polan

d

Bra

zil

Chi

na

South

Afr

ica

India

Gha

na

Moz

ambiq

ue

Source: World Health Organization (2006) Working Together for Health. The World Health Report 2006: WHO Press.

Medical and Nursing Education Challenges

• Schools limited in size and number

• Faculty shortages

• Infrastructure weakness

• Limited advanced training

• Distribution challenges

Push Factors from the South

• Lack of Post Graduate Training Opportunities

• Insufficient practice Opportunities

• Poor Remuneration

• Security Concerns

• HIV/AIDS

Pull to the North and West

• Training Opportunities

• Practice Opportunities

• Better Remuneration

• Better Technology

• Family Opportunities

Medical Education Partnership Initiative (MEPI)

• PEPFAR/NIH/HRSA supported

• $130 million investment over five years

• 13 medical schools in 12 countries

• 17 African and 20 American partners

• Coordinating Center – GW Department of Health Policy

Medical Education Partnership Initiative (MEPI) Aims/Themes

• ↑ Numbers and quality of graduates

• ↑ Retention and geographic distribution of graduates

• ↑Regionally relevant research

Sustainability –Trainees Return Home

86%

92%

92%

85%

92%

86%

6 PhD degrees

30 Masters degrees

JHU (18), Alabama (3), Makerere (5) Regional (4)

15 Bachelors degrees,

Makerere

65 Diplomas, Certificate

13 Post doc / Sabbatical

Rakai Health Science Program Trainees

Makerere University-Johns Hopkins University Partnership

• To build capacity of MU-College of Health Sciences (CHS) to fulfill its vision …

“to be a transformative institution, a leader in Africa, that influences individuals, organizations, and society to improve health outcomes in Uganda and East Africa”

What does it mean to be a transformative institution?

• Play leadership role in society

• Discover new knowledge in health sciences through research

• Develop evidence-based practices through research

• Build human capacity through education and training

• Deliver high quality service using collaborative models

• Collaborate with other health & training institutions

• Support policy & programme development and evaluation

This is not “business as usual”

The Makerere University College of Health Partnership With Johns Hopkins University

MakCHS

• School of Bio-medical Sciences

• School of Health Sciences (Nursing, Pharmacy, Dentistry, Allied Professions)

• School of Medicine

• School of Public Health

JHU

• Schools of Medicine, Nursing, and Public Health

MakCHS Institution Building

• Supporting new medical schools (Gulu, Kampala International University) and professional bodies (e.g. nursing council)

• Developing public health training at other locations

• COBES supervision tool builds community problem-solving and clinical services in under-served communities

30

Characteristics of Success • Research is an essential component of service delivery and

training

•Early investments in training and career development of both

North and South scientists pay dividends in long-term capacity-

building in global health

•High rate of return to home country following training occurs

when there is local institutional capacity (and a career path)

•“Second-generation” training occurs, i.e. foreign scientists who

are trained and return home contribute to the training of the next

cohort of health professionals

•North supported global health training produces lasting

collaborations and brings foreign scientists into global community

(important in specific topics such as bioterrorism, and generally

important in health diplomacy