A survey of Sub-Saharan African medical schools

Abstract

BackgroundSub-Saharan Africa suffers a disproportionate share of the world's burden of disease while having some of the world's greatest health care workforce shortages. Doctors are an important component of any high functioning health care system. However, efforts to strengthen the doctor workforce in the region have been limited by a small number of medical schools with limited enrolments, international migration of graduates, poor geographic distribution of doctors, and insufficient data on medical schools. The goal of the Sub-Saharan African Medical Schools Study (SAMSS) is to increase the level of understanding and expand the baseline data on medical schools in the region.MethodsThe SAMSS survey is a descriptive survey study of Sub-Saharan African medical schools. The survey instrument included quantitative and qualitative questions focused on institutional characteristics, student profiles, curricula, post-graduate medical education, teaching staff, resources, barriers to capacity expansion, educational innovations, and external relationships with government and non-governmental organizations. Surveys were sent via e-mail to medical school deans or officials designated by the dean. Analysis is both descriptive and multivariable.ResultsSurveys were distributed to 146 medical schools in 40 of 48 Sub-Saharan African countries. One hundred and five responses were received (72% response rate). An additional 23 schools were identified after the close of the survey period. Fifty-eight respondents have been founded since 1990, including 22 private schools. Enrolments for medical schools range from 2 to 1800 and graduates range from 4 to 384. Seventy-three percent of respondents (n = 64) increased first year enrolments in the past five years. On average, 26% of respondents' graduates were reported to migrate out of the country within five years of graduation (n = 68). The most significant reported barriers to increasing the number of graduates, and improving quality, related to infrastructure and faculty limitations, respectively. Significant correlations were seen between schools implementing increased faculty salaries and bonuses, and lower percentage loss of faculty over the previous five years (P = 0.018); strengthened institutional research tools (P = 0.00015) and funded faculty research time (P = 0.045) and greater faculty involvement in research; and country compulsory service requirements (P = 0.039), a moderate number (1-5) of post-graduate medical education programs (P = 0.016) and francophone schools (P = 0.016) and greater rural general practice after graduation.ConclusionsThe results of the SAMSS survey increases the level of data and understanding of medical schools in Sub-Saharan Africa. This data serves as a baseline for future research, policies and investment in the health care workforce in the region which will be necessary for improving health.

Establishing Medical Schools in Limited Resource Settings

“…A few universities admit large numbers of students before numbers are reduce themin the second year. Fifty nine of 84 (70%) responding schools reported that at least 80% of first-year students graduate (16).…”

A peer evaluation of the community-based education programme for medical students at the University of Zimbabwe College of Health Sciences: A southern African Medical Education Partnership Initiative (MEPI) collaboration

“…The process of the review supported peer reviewers to learn from each other and share their experiences, similar to the in-country consortia of medical schools that formed within the MEPI network. [11] Medical schools in the region share common constraints of limited resources and infrastructure [12,13] and many face the challenge of finding funding for objective programme evaluations. The peer-review approach therefore affords a cost-effective mechanism to provide valuable feedback.…”

Establishing a New Medical School

“…7 It is also generally accepted that academic salaries for clinicians are commonly higher than they are for other academic disciplines. Thus, in a bid to attract and help retain clinicians, we negotiated a separate and enhanced salary structure with university management and the Botswana government.…”

“…6 In addition, until 2010, eight Sub-Saharan countries had no medical schools of their own, which necessitated dependence on expatriates and external training. 7 …”