How to tackle Africa’s shortage of public health researchers

AFRICA

Advancing doctoral training, research and practical capacity in the public health domain at higher education institutions across the African continent needs equitable partnerships between universities, research centres and national, regional and global public health institutions.

This will enable the development of workforces that are needed to mitigate national and transnational threats of disease.

This is one of several recommendations in a policy brief titled ‘The future of public health doctoral education in Africa: Transforming higher education institutions to enhance research and practice’, published recently in The Lancet Public Health.

The policy brief was compiled by the public health education team of the Africa Research, Implementation Science, and Education (ARISE) Network in cooperation with 18 researchers based in Uganda, Ethiopia, South Africa, Ghana, Nigeria, Tanzania, Senegal and the United States.

According to the policy brief, higher education and research in public health are vitally important to increase the capacity of public health workers to address the burden of disease in Africa, an essential element to achieve the aspirations of Agenda 2063 of the African Union.

Therefore, the researchers assessed public health doctoral training in 47 schools and programmes of public health in Africa, using a survey that was conducted between August 2021 and October 2022. The survey results were used to develop six interrelated and actionable recommendations for strengthening postgraduate training programmes in Africa.

Public health researchers in Africa

A study, informing the policy brief, indicated that there is a critical shortage of public health researchers. According to estimates, there are 80 researchers per million people in Africa compared with a global average of 1,081 per million people.

But, Africa will need an estimated 12,500 epidemiologists per million people by 2050 to contribute to global health security.

“While most African universities offer medical training and public health masters programmes, more doctoral and postdoctoral-level training programmes are needed to supply highly trained faculty and research and practice leaders that would further strengthen other graduate programmes and serve as inspiration for those completing undergraduate and masters training,” the researchers said.

According to the study, this was emphasised by the COVID-19 pandemic, which underscored the need for more public health professionals in Africa.

Public health doctoral education

The study found a relatively inclusive education environment whereby all students are treated fairly and get equal opportunities without discrimination.

The study also found that most programmes required intermediate or advanced competencies in biostatistics, epidemiology, and social and behavioural sciences, but less so for economics.

“Analytical skills obtained from essential training in epidemiology and biostatistics are foundational to public health research,” the study stressed.

Most programmes, it noted, showed graduates would be proficient or at least knowledgeable in critical analytic skills including skills for the interpretation of quantitative or qualitative data or both.

However, the study pointed out that there was low proficiency in diversity concepts and health behavioural change communication (BCC) and limited attention to the rising tide of health priorities related to non-communicable diseases and climate change.

BCC refers to the strategic use of communications to encourage individuals and communities to adopt healthier and more sustainable practices.

The study found that programmes were relatively strong in community engagement. In addition, it highlighted that the lack of financial resources and funding for research was the most substantial barrier to institutions’ ability to perform or sustain public health research activities. The most common source of funding was foreign public and private funding followed by domestic funding.

The study found that about half of the programmes considered inter-professional education (IPE) competencies as relevant and a scarcity of collaboration with other researchers and organisations the most significant barrier. Adequate time in the curriculum, funding and administrative support were also considered as key challenges for IPE.

IPE means that students and professionals are learning about, from, and with others from different disciplines.

Most institutions reported that the work done was relevant for policymakers and almost all institutions were members of a formal network or had partnerships with other research or training institutions locally or internationally.

However, most institutions reported one or more obstacles to networking, including collaboration in areas that are significant to all involved parties, sharing benefits equitably, and deciding on the use of funds.

“On the basis of these trends, we developed a set of recommendations to improve public health training in Africa,” the study noted.

Recommendations

The study put forward six recommendations that are “intended as a starting point for actionable steps in advancing public health doctoral training to be taken collaboratively towards improved health in Africa”.

These recommendations include introducing and expanding competency-based education and standard accreditation; accelerating information technology infrastructure transformation at universities; increasing financing for capacity-building; promoting IPE; strengthening links between academic, practice, and research partners; and implementing ongoing tracking and monitoring and sharing of best practices and lessons learned.

The study called for grounding public health programmes in core competencies to produce leaders capable of preventing and addressing future health challenges.

“After establishing a competency-based curriculum through university and country-led processes, regular assessment and standard accreditation of these programmes are necessary for quality assurance,” said the researchers.

They called for substantial investments in digital systems and digital content to create and provide access to effective and efficient digital learning.

“Strengthening the information technology workforce and additional training for existing faculty and staff are required, and should include addressing computer and internet access for students, especially those in rural areas,” the study stressed.

According to the study, an increase in the investment in research and training infrastructure from domestic and global financing is necessary to strengthen African higher education and research institutions.

The study emphasised that “financing should be guided by the priorities of each country or region and must be structured to ensure no conflicts of interest exist in financing mechanisms and that funding does not create or reinforce harmful power dynamics”.

It pointed out that IPE is necessary to deal with pressing public health issues, including pandemic preparedness and climate change. Thus, institutions must incorporate IPE into existing curricula and support faculty development in IPE.

Business and policy schools within universities, noted the researchers, can play an important part in public health education through partnerships that strengthen training in leadership, strategy and entrepreneurship to deal with public health challenges.

The study stressed the need for strengthening the links between academic, practice and research partners through public health associations which can be a resource for academic public health network creation and facilitation that can promote local and regional exchanges for cross-learning and knowledge transfer.

Furthermore, the study also stated that universities within a country or region should come together to harness their collective strengths through intentional mentorship pairings between different generations of universities and training programmes.

The study also pointed out that engaging with national public health institutes and research centres sets the stage for public health research to be aligned with national priorities, and links between public health programmes and regional research centres provide valuable training experiences and enhanced capacity.

Ongoing evaluations to facilitate continued improvement around advancing public health research and practice are important.

This could be done by strengthening knowledge dissemination through local and regional conferences, symposia and social media which could ensure evidence generated within the region benefits the countries and context from which it emanates, according to the study.

It pointed out the need for harmonising doctoral programmes between institutions through the alignment of competencies, admission requirements, credit definitions and academic calendars to facilitate participation in elements of programmes beyond one’s own institution.

“This would … facilitate the flow of the workforce between countries in ways that enable a rapid emergency response and contribute to strengthened health and research systems across the continent,” the researchers recommended.