Research: Mapping public health education in Africa

Source: Bulletin of the World Health Organization 2007;85:914–922.
CB IJsselmuiden,a TC Nchinda,b S Duale,c NM Tumwesigyed & D Serwaddad
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Introduction

In most African countries, health is in crisis. Staffing and resourcing remain serious problems in all aspects of health care,1 including essential public health functions and research.2 At the same time, there is a new optimism: Africa is definitely not where it was 50 years ago.3 Many years of capacity-building have increased the number of senior staff in spite of the continued “brain drain”, and globalization of communication has contributed to an increasing democratization and accountability of education and politics. Combined with attitudinal changes in donor countries and institutions,4 there is a stronger awareness of the need to phrase answers to problems in terms of local ability rather than of foreign assistance interests, although problems in “vertical programming” remain.5 While it is too early to judge the sustainability of these political realities, it is time to greatly enhance system support to enable nations and regions in Africa to govern and manage their health sectors. In particular, it is high time to enable Africa to educate its own leaders in public health – those needed to execute essential public health functions, improve system performance and form an African voice for public health.

Results
Overall, 29/53 countries (54.7%) offer no postgraduate training in public health, 11/53 countries (20.7%) have one programme and 11/53 countries (20.7%) offer more than one programme. If the analysis is stratified by language group, major differentials appear: anglophone sub-Saharan African countries as well as those in north Africa have more developed postgraduate public health training programmes than francophone, lusophone and the one Hispanic country

It is obvious that the largest gap occurs in lusophone countries (91% of the population lives in countries without graduate public health programmes) followed by francophone Africa (34%; Fig. 1, Table 2).

In total, there are 854 staff members working in institutions offering postgraduate public health programmes, only 493 of whom work full-time. Male staff is in the majority (63%) and this differential increases if having a doctoral degree is taken into consideration (73%). Viewed in another way, 89.2% of male staff have either a master’s or doctoral qualification, in contrast to only 71.6% of female staff (Table 3, Table 4).

The age-distribution of staff skews towards younger age groups: 15% are aged 35 years or younger, 66% are aged between 36 and 50 years, and only 19% is older than 51 years of age. There is therefore a shortfall of senior staff in institutions of public health. This study did not allow an understanding of this dynamic, including whether it relates to migration, illness, internal transfer to better-paying externally funded positions, or to other causes. Finally, there are few foreign staff members working in institutions in Africa: of the 554 staff about whom information was available, 11 (2%) were nationals from other African countries and 40 (7%) were nationals from outside Africa.