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It is sobering to realise that sub-Saharan Africa (SSA) needs one million additional health care workers to provide for the minimal health care needs of its people.1 This primarily reflects the huge disjunction between the number of health care workers in the region (2% of the world’s health care workforce) and the burden of disease it carries (24% of global disease).2 In this edition of the journal, Greysen et al.3 provide an overview of the literature addressing health sciences education in SSA, in which they identify three major themes that have been, and continue to be, the focus of authors writing from the region: (i) capacity building for increased doctor training; (ii) innovations in doctor training, and (iii) the retention of doctors once trained.

Sub-Saharan Africa needs one million additional health care workers to provide for the minimal health care needs of its people

The data cited in the paper by Greysen et al.3 indicate that African health sciences educators have made some progress, but have a long way to go. The authors suggest three areas that are largely neglected and need attention: (i) the implementation of solutions for health sciences education challenges; (ii) the evaluation of programme outcomes, and (iii) the development of medical education as a specialised field of inquiry.3

It is entirely reasonable to ask what African health professions educators are doing to address these gaps, both with the assistance of developed nations and from within the continent itself.

Over the past decade, the Foundation for Advancement of International Medical Education and Research (FAIMER), a US-based, not-for-profit organisation, has provided faculty development for health sciences educators working in developing countries.4 The overarching goal of the programme is to strengthen health sciences education locally and to help build a sustainable discipline of health sciences education in resource-constrained settings.5 The 2-year, part-time fellowship programme aims to teach participants educational methods, and research and leadership skills, and to support the development of strong bonds with other health sciences educators around the world. The central component of the fellowship is the design and implementation of an innovatory education project that addresses the health professions education needs of aspirant fellows in their home institutions.6

The overarching goal of the programme is to help build a sustainable discipline of health sciences education in resource-constrained settings

In recognition of the need to expand the reach of the programme, FAIMER has established five regional institutes, of which three are located in India, one in Brazil and one in South Africa.6 To date, FAIMER in Philadelphia and the regional institutes have trained 502 fellows, about 70 of whom come from African countries including Egypt, the Democratic Republic of the Congo, Sudan, Ethiopia, Nigeria, Ghana, Tanzania, Uganda, Kenya, Zambia, Malawi, Mozambique, Botswana and South Africa.6 Most of the faculty members teaching in the regional institutes are FAIMER-trained fellows, which reflects the success of this faculty development initiative. Furthermore, recent data provide evidence that the teaching programme and the education innovation projects make a worthwhile contribution to health sciences education in the home institutions of participants6,7 and contribute to the scholarly output of the universities to which the fellows are affiliated.8

The crucial question to ask of any intervention programme concerns whether it increases the likelihood that African educators will emigrate to the developed world or migrate internally within SSA. The answer to this question is astonishing: to date only one African fellow has moved, and then from a poor SSA country to a poor developing country in the Pacific region (V. Burch, personal communication). If this trend persists, it will be worth exploring the possibility of further expanding the programme by developing regional institutes in West Africa, specifically in Nigeria, and East Africa, specifically in Uganda.

The crucial question to ask of any intervention concerns whether it increases the likelihood that African educators will emigrate to the developed world

The rationale for suggesting Nigeria and Uganda as hubs for further health sciences faculty development programmes in SSA is based on the findings of Greysen et al.3 As of April 2010, 62% of all health sciences education publications in SSA came from only three countries, namely, South Africa, Nigeria and Uganda. These countries should focus on developing centres of health sciences education excellence with the capacity to reach out to neighbouring countries in the region. The operation of such communities of practice, in which training could be provided by local FAIMER fellows, would be considerably cheaper than training East and West African fellows in South Africa. International funding is needed to develop this strategy and donors and governments should play a major role in supporting such faculty development programmes.

The presence of FAIMER fellows in the Medical Education Partnership Initiative (MEPI),9 a large-scale, US-funded research initiative aimed at improving health professions education in SSA, may open doors for the further expansion of faculty development in the region. This is an exciting initiative and, if it can achieve measurable outcomes, will represent a major step in the forging of significant North–South collaboration in the future.

Donors and governments should play a major role in supporting faculty development programmes

Within the continent, a number of South African universities, such as Stellenbosch University,10 are now offering tertiary university qualifications (postgraduate diplomas, masters degrees, PhDs) in health sciences education in programmes similar to those run at the Universities of Maastricht, Dundee and Chicago. In the future, similar programmes may be offered elsewhere in SSA. Such developments will significantly advance the scholarship of health sciences education as a specialty in SSA.

The ‘grey’ literature identified by Greysen et al.3 provides a unique window into health sciences education needs in SSA. This information should be carefully scrutinised to identify potential collaborative research projects that are of national, regional or continental importance. Such a strategy will avoid the imposition of ‘post-colonial syndrome’ in which Northern partners address their own research agendas rather than African needs. Greysen et al.3 did not tackle the issue of South–South collaboration in their paper. Clearly, this is an important avenue to explore because medical educationalists in developing countries have far more in common with colleagues from the South than they do with their peers in the North.

Such a strategy will avoid the imposition of post-colonial syndrome in which Northern partners address their own agendas rather than African needs

The most important need, however, is for a vehicle with which to disseminate the work of SSA health sciences educators that specifically addresses and solves African problems. A number of initiatives address this key need, one of which is the formation of the South African Association of Health Educationalists (SAAHE; http://www.saahe.org.za), an organisation that hosts an annual international conference dedicated solely to the advancement of health professions education as a specialty in the region. The number of participants from other African countries is growing each year and this meeting serves well to disseminate information in SSA. The Network: Towards Unity for Health (TUFH; http://www.the-networktufh.org/home/index.asp), another international, not-for-profit organisation, also holds an annual conference featuring work from SSA and other developing world regions. In addition, TUFH promotes the publication of health sciences education work from developing countries in its journal Education for Health.11

The most important need is for a vehicle to disseminate the work of SSA health sciences educators that specifically addresses African problems

The development of a free, open-access, electronic journal specifically focusing on work conducted by African health educators is another important strategy to advance the scholarship of health professions education in SSA. The African Journal of Health Professions Education (AJHPE),12 the only journal dedicated to the discipline of health sciences education in SSA, made its debut in June 2009, but, although it is mentioned by Greysen et al.,3 was not interrogated to evaluate the progress of this initiative. The journal is published biannually and since its inception has published 20 peer-reviewed, original research manuscripts and 20 peer-reviewed abstracts, largely emanating from the annual national SAAHE conference and the projects completed for the Southern Africa–FAIMER Regional Institute (SAFRI) fellowship programme.

In conclusion, there can be no shying away from the work required in SSA or from the need for Africans to rise to the challenge and place a long overdue ‘African footprint on the map of academic discourse relevant to health sciences education’.12

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