Fatusi AO, Tsui AO, Oni G, Agbenyega T, Chimbiri A, Enquselassie F, Ojengbede O, Ojofeitimi EO, Quak

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Strengthening Public Health Education in Pop.
RH in Africa through North-South Partnership
The Gates Partners Experience
Fatusi AO, Tsui AO, Oni G, Agbenyega T, Chimbiri
A, Enquselassie F, Ojengbede O, Ojofeitimi EO,
Quakyi I.
12th World Congress on Public Health, Istanbul,
Turkey, April 2009

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Introduction

• An adequate health workforce is central to
  effective health system
• Health workforce shortage is a major global
  problem over 4 million shortage, with situation
  more critical in developing countries
• Major mismatch exists b/w population needs and
  available workforce
• - WHO, WHR 2006

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Sub-Saharan Africa is the worst hit by the health
workforce crisis

• Severe imbalance b/w health workforce and disease
  burden
• Brain drain to more developed countries
• Mismatch b/w skills needs
• High level of poverty low health spending
• Reproductive ill-health accounts for 40 of the
  total disability-adjusted years lost in
  reproductive age for women

Source WHO, 2006
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• African women risk death to give life and their
  offspring have the smallest survival chances in
  the world. It is the sheer magnitude of this
  death, disease and disability that constitutes
  Africas silent epidemic. - WHO AFRO, 2006

• If we want a noticeable improvement in reducing
  maternal mortality rates and improving child
  health, then we have to have a higher density of
  health workers.
• Leitner K (WHO ADG), 2005

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The Challenge for Sub-Saharan

• Respond to the workforce crisis (with skills in
  Pop RH) thro training of health workers who
  are
• Appropriate in number
• Appropriately skilled
• Appropriately located (in-country)
• Appropriately resourced (training)
• Appropriately supported (to function)

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Past efforts at addressing health workforce in
Africa

• Provision of scholarship for students to study in
  more developed countries
• Issues Highly costly High level of brain
  drain
• Partnership b/w African institutions those of
  more developed countries (North-South
  partnership)
• Issues
• Most institutional partnership focus only on
  research
• Imbalance in program design limited capacity
  devel. benefit to African institution (limited
  input into design by Africans Scientific
  Colonialism Trostle, 1992)
• Most partnerships is bilateral in configuration

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Partnership structure FOCUS

• Gates institute Partners

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Partnership Objective

• To build leading and enduring institutions and
  individuals with skills to respond effectively to
  population welfare and reproductive health needs
  of underserved communities, through
• Establishment of graduate PRH training programs
• Enhanced research skills
• Engagement in policy and program discourse

Gates Institute Mission To strengthen the
capacity of individuals and organizations to lead
program and social change that will improve
population and reproductive health outcomes
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The Partnership

• Partnership started in 2003
• Relationship dynamics
• (i) Gates Institute each university
• (ii) African-African university relationship
• (iii) Intra-university multi-disciplinary units

Gates Institute, JHSPH
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Institutional Partners of the Gates Institute

• Addis Ababa University, Ethiopia
• School of Public Health
• 2. Kwame Nkrumah University of Science and
  Technology, Ghana
• School of Medical Sciences
• 3. Obafemi Awolowo University, Nigeria
• Institute of Public Health,
• Community Health, and Demography
  Social Statistics

• 4. University of Malawi, Malawi
• Division of Community Health
• College of Medicine
• 5. University of Ghana,
• Ghana
• School of Public Health
• 6. University of Ibadan, Nigeria
• College of Medicine

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Current Gates Institute Partners on the African
continent
Assiut University Egypt
-University of Ghana -Kwame Nkrumah University
of Science and Technology
Ghana
Addis Ababa University Ethiopia
Rakai Health Sciences Makarere University Uganda
-Obafemi Awolowo University -University of
Ibadan Nigeria
University of Malawi
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Partnership framework
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Results FrameworkScholarship and Science in
Service of Social Change
Improved human welfare (Reduction of health
inequalities and improved reproductive outcomes)
Goal
Manageable interest at country collaborator level
Mobilizing additional human, financial and other
capital for RH and development
Enabling effective P/FP/RH programs and policies
Strategic Objectives
Collaborative development of evidence-based
models for program and policy
Building individual capacity and leadership
Building institutional capacity and leadership
Intermediate Results
Manageable interest at Gates Institute level
Leadership development/training
Trans-national networks
Policy-relevant community study
Program Innovation transfer
Activity Areas
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Logical Framework for Reproductive Health
Academic Partnerships


PROGRAM OUTCOMES INPUTS
ACTIVITIES OUTPUTS
SHORT-TERM MEDIUM-TERM LONGTERM

• External partner
• Program grants
• Joint instruction
• at partner institution
• Attendance of
• visiting scholars
• Program monitoring

• Defining trg. programs
• Developing RH curriculum
• Strengthening
• Teaching research capacity activities
• Implementing
• research translation
• activities
• Improving
• educational
• infrastructure
• Networking
• b/w academic other stake-holders

• Established RH tracks in MPH
• PhD programs
• Short-term courses
• Strengthened
• teaching
• research capacity
• Increased access to modern teaching facilities
• Application of
• analytical and
• evidence-based
• methods

• New RH
• departments
• and centers
• Growth in
• RH student
• enrolment
• Enhanced
• effectiveness
• of faculty RH teaching
• Faculty and
• student
• research
• publication
• Faculty and
• student
• translation of research
• to program
• and policies

• Growth in
• RH grads.
• Graduates
• employment
• Faculty service
• at sub-national national levels
• Sponsored
• projects to
• faculty
• Recognitn of excellence
• of RH dept. Centers
• RH benefits to community

• Sustained programs
• Evidence-
• based RH
• policies,
• programs
• and services
• Improved
• RH welfare
• of population

• Partner program
• Faculty resour-ces salaries
• Curriculum
• resources
• Classrooms and
• other physical
• infrastructure
• Acad. systems

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Principal Components

• Population Repr. Health capacity building
• Individual researchers and program
• practitioners (e.g., Gates Scholars,
• Summer Institutes)
• Academic institutional programs for
• research and training (Gates Partners)
• Strategic research areas
• Relevance of family planning (e.t.c.)
• Leadership forums organized with partners
• Advocacy initiatives for new RH resource
• commitments

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PROGRAM RESULTS
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771 masters students launched by partners PRH
training programs between 2003-2007
127 graduates to date, compared to 13 in Baltimore
New Executive MPH Program launched in 2007 with
20 of 45 students interested in PRH
3 years of data for U Ghana
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Development of Infrastructure Faculty

• Development of Training Infrastructure

• Develop of Faculty members teaching and research
  skills
• Course auditing at JHSPH
• Co-teaching
• Visiting Scholars Program
• Summer Institute
• Mini-sabbatical

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Establishing Population and Reproductive Health
Graduate Training 2003-2007
(7 JHSPH faculty visits to Malawi to teach)
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Status of Gates Scholars 1999-2008
100 of the 158 MPH Graduates of the African
Univ. work in-country
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Peer-Reviewed Publications (294)
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Leveraged External Funding for PRH by Gates
Institute Expenditures 2003-2006
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Population/RH Institutional Programs Examples

• Obafemi Awolowo University
• MPH (PRH track)
• Executive MPH Prg.
• Addis Ababa University
• MPH (RH curriculum expansion)
• Community Health -gt School of
• Public Health -gt Department of
• Reproductive Health
• University of Ghana
• -gt Department of Population, Family and
  Reproductive Health

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Translation into Policy and Program Action

• Leadership Forum 2003 (Baltimore)
• Developing the Next Generation of FP/RH Service
  Providers
• Joint with JHPIEGO
• Nigeria Reproductive Health Leadership Forum
  (February)
• Organized by FMOH, Packard, UNFPA, MacArthur
• April State Health Commissioner Summit
• May Strategic Leadership Seminar
• Involvement of OAU and Ibadan

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(International) RH Advocacy
1st Leadership Forum Obstetric fistula July
2005
2nd Leadership ForumLinking RH, FP and HIV/AIDS
Programs

• October 9-10, 2006
• UN Conference Center, Addis Ababa, Ethiopia
• 500 attendees from African continent and other
  countries
• Abstract submission and review process

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Youth Deliver the Future Conference, Abuja, 2008
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Mobilizing Commitment for PRH Matters

• Strategic leadership training of Nigerian State
  Commissioners for Health for maternal mortality
  reduction (4/06)
• Time for ActionSave Mothers Conference
  (Malawi, 5/06)
• Delegation to the Africa Union Ministers of
  Health meeting on the Maputo Program of Action
  (9/06)
• AdvocacyNigeria and AdvocacyPakistan
• Joint Ghana-Nigeria Adolescent Health and
  Development workshop (Ghana,
• 2/07)

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Lessons Learned

• Effective North-South partnership is
  cost-effective in addressing health workforce
  challenge in Africa
• Effective partnership
• clear framework, trust, respect and clear
  sustainable agenda with critical input at all
  stages by all partners
• Comprehensive approach to capacity building
  train, retain and sustain
• Incorporates strategies for individual as well as
  institutional development.
• Must focus on real needs

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Lessons Learned

• Visiting scholars and mini-sabbatical programs
  are cost-effective and efficient strategies to
  strengthening capacity of faculties and keep them
  motivated
• Partnership involving many partner institutions
  simultaneously facilitate rich mix of learning
  and both North-South and South-South enrichment
• Collaboration between various stakeholders in the
  different partner countries make programs more
  effective and have greater impact

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With Much Appreciation to the Bill and Melinda
Gates Foundation