Medical Education Partnership Initiative Research Articles

Building surgical research capacity in Mozambique.

Background: Surgically treatable conditions are increasingly recognized as important public health problems in low- and middle-income countries.1–3 In Mozambique, the majority of surgery in rural areas is performed by “técnicos de cirurgia”—nonphysician surgeons trained locally. To better define rural surgical needs in Mozambique and to improve surgical care, the Universidade Eduardo Mondlane (UEM) formed a research partnership with the University of California, San Diego (UCSD) in 2010. Funded by a Medical Education Partnership Initiative linked award, the specific aims of the of the project are to identify the best strategies for building emergency and essential surgical capacity in rural areas of Mozambique and to increase capacity for surgical research at UEM and its allied institutions. Intervention: During the first 36 months of the UEM-UCSD surgical partnership, a number of research projects have been initiated. These have focused on defining the unmet need for surgical care in rural communities surrounding hospitals; types of surgical procedures performed by the nonphysician surgeons; clinical epidemiology of pediatric trauma as one of the unmet surgical needs; and risk-adjusted outcomes of surgical patients. These projects have been used as the platform to increase capacity for surgical research among local personnel. Outcomes: A community-based survey of 6,104 people living near three primary referral hospitals in rural Mozambique, conducted June 2012 to June 2013, showed that 36% of the respondents had current or historical surgical disease. Review of inpatient records revealed that about 60% of hospital admissions were for treatment of surgical conditions. Compared with patients admitted for nonsurgical problems, surgical patients had longer hospital stays and a greater number of total hospital days. In the rural hospitals studied, nonphysician surgeons performed more than 95% of the surgical procedures and 52 different types of operations, of which 73% were surgical emergencies. The three most common procedures were cesarean section (62%), herniorrhaphy (9%), and exploratory laparotomy (4%). Ten procedures accounted for 80% of the surgical volume. Seventy percent of the pediatric surgical admissions were for injuries, with falls (44%), burns (23%), and road traffic accidents (18%) being the most common. Calculation of risk-adjusted operative outcomes is currently under way. Comment: Our preliminary findings suggest that surgical conditions, especially injuries and obstetrical problems, are common in rural areas of Mozambique and place a significant burden on the health system. While typical of the surgical epidemiology observed in other low- and middle income countries, it emphasizes the important role surgical care has in treating maternal and child health problems. Given the high prevalence of untreated surgical conditions identified in our community-based survey, there is a critical need to better understand which factors limit delivery of surgical care and how surgery fits into the larger health system. Some of the greatest challenges exist in the supply, training, and distribution of human resources for surgical care. Educating and training surgeons is time consuming and expensive, and once qualified, many are reluctant to serve in rural first-level hospitals where the needs are often the greatest. The técnicos de cirurgia model used in Mozambique can provide important information on how best to address the critical need for surgeons in other countries in Sub-Saharan Africa.

Innovations to enhance the quality of health professions education at the University of Zimbabwe College of Health Sciences--NECTAR program.

The University of Zimbabwe College of Health Sciences (UZCHS) is Zimbabwe's premier health professions training institution. However, several concerns were raised during the past decade over the quality of health education at UZCHS. The number of faculty and students declined markedly until 2010, when there was a medical student intake of 147 while the faculty comprised only 122 (39%) of a possible 314 positions. The economic and political crises that the country experienced from 1999 to 2009 compounded the difficulties faced by the institution by limiting the availability of resources. The Medical Education Partnership Initiative funding opportunity has given UZCHS the stimulus to embark on reforms to improve the quality of health education it offers. UZCHS, in partnership with the University of Colorado School of Medicine, the University of Colorado Denver Evaluation Center, and Stanford University, designed the Novel Education Clinical Trainees and Researchers (NECTAR) program to implement a series of health education innovations to meet this challenge. Between 2010 and 2013, innovations that have positively affected the quality of health professions education at UZCHS include the launch of comprehensive faculty development programs and mentored clinical and research programs for postgraduate students. A competency-based curriculum reform process has been initiated, a health professions department has been established, and the Research Support Center has been strengthened, providing critical resources to institutionalize health education and research implementation at the college. A core group of faculty trained in medical education has been assembled, helping to ensure the sustainability of these NECTAR activities.

A systems approach to implementation of eLearning in medical education: five MEPI schools' journeys.

How should eLearning be implemented in resource-constrained settings? The introduction of eLearning at four African medical schools and one school of pharmacy, all part of the Medical Education Partnership Initiative (MEPI) eLearning Technical Working Group, highlighted the need for five factors essential for successful and sustainable implementation: institutional support; faculty engagement; student engagement; technical expertise; and infrastructure and support systems. All five MEPI schools reported strengthening technical expertise, infrastructure, and support systems; four schools indicated that they were also successful in developing student engagement; and three reported making good progress in building institutional support. Faculty engagement was the one core component that all five schools needed to enhance.

Physician tracking in sub-Saharan Africa: current initiatives and opportunities.

BackgroundPhysician tracking systems are critical for health workforce planning as well as for activities to ensure quality health care - such as physician regulation, education, and emergency response. However, information on current systems for physician tracking in sub-Saharan Africa is limited. The objective of this study is to provide information on the current state of physician tracking systems in the region, highlighting emerging themes and innovative practices.MethodsThis study included a review of the literature, an online search for physician licensing systems, and a document review of publicly available physician registration forms for sub-Saharan African countries. Primary data on physician tracking activities was collected as part of the Medical Education Partnership Initiative (MEPI) - through two rounds over two years of annual surveys to 13 medical schools in 12 sub-Saharan countries. Two innovations were identified during two MEPI school site visits in Uganda and Ghana.ResultsOut of twelve countries, nine had existing frameworks for physician tracking through licensing requirements. Most countries collected basic demographic information: name, address, date of birth, nationality/citizenship, and training institution. Practice information was less frequently collected. The most frequently collected practice fields were specialty/degree and current title/position. Location of employment and name and sector of current employer were less frequently collected. Many medical schools are taking steps to implement graduate tracking systems. We also highlight two innovative practices: mobile technology access to physician registries in Uganda and MDNet, a public-private partnership providing free mobile-to-mobile voice and text messages to all doctors registered with the Ghana Medical Association.ConclusionWhile physician tracking systems vary widely between countries and a number of challenges remain, there appears to be increasing interest in developing these systems and many innovative developments in the area. Opportunities exist to expand these systems in a more coordinated manner that will ultimately lead to better workforce planning, implementation of the workforce, and better health.

Improving medical education in Kenya: an international collaboration.

This paper describes a partnership between the University of Nairobi College of Health Sciences (CHS) Library and the University of Maryland Health Sciences and Human Services Library (HS/HSL). The libraries are collaborating to develop best practices for the CHS Library as it meets the challenge of changing medical education information needs in a digital environment. The collaboration is part of a Medical Education Partnership Initiative. The library project has several components: an assessment of the CHS Library, learning visits in the United States and Kenya, development of recommendations to enhance the CHS Library, and ongoing evaluation of the program's progress. Development of new services and expertise at the CHS Library is critical to the project's success. A productive collaboration between the HS/HSL and CHS Library is ongoing. A successful program to improve the quality of medical education will have a beneficial impact on health outcomes in Kenya.

Management of Rheumatic Heart Disease in Uganda

Management of Rheumatic Heart Disease in Uganda

Advancing Biomedical Research to Improve Health at Home and Abroad

Advancing Biomedical Research to Improve Health at Home and Abroad

Quality Assurance for African Laboratories: How Soon can this be Accomplished?

Quality Assurance for African Laboratories: How Soon can this be Accomplished?

Kenyan medical student and consultant experiences in a pilot decentralized training program at the University of Nairobi.

Over the past decade, the University of Nairobi (UoN) has increased the number of enrolled medical students threefold in response to the growing need for more doctors. This has resulted in a congested clinical training environment and limited opportunities for students to practice clinical skills at the tertiary teaching facility. To enhance the clinical experience, the UoN Medical Education Partnership Initiative Program Undertook training of medical students in non-tertiary hospitals around the country under the mentorship of consultant preceptors at these hospitals. This study focused on the evaluation of the pilot decentralized training rotation. The decentralized training program was piloted in October 2011 with 29 fourth-year medical students at four public hospitals for a 7-week rotation. We evaluated student and consultant experiences using a series of focus group discussions. A three-person team developed the codes for the focus groups and then individually and anonymously coded the transcripts. The team's findings were triangulated to confirm major themes. Before the rotation, the students expressed the motivation to gain more clinical experience as they felt they lacked adequate opportunity to exercise clinical skills at the tertiary referral hospital. By the end of the rotation, the students felt they had been actively involved in patient care, had gained clinical skills and had learned to navigate socio-cultural challenges in patient care. They further expressed their wish to return to those hospitals for future practice. The consultants expressed their motivation to teach and mentor students and acknowledged that the academic interaction had positively impacted on patient care. The decentralized training enhanced students' learning by providing opportunities for clinical and community experiences and has demonstrated how practicing medical consultants can be engaged as preceptors in students learning. This training may also increase students' ability and willingness to work in rural and underserved areas.

Strengthening research capacity through the medical education partnership initiative: the Mozambique experience

BackgroundSince Mozambique’s independence, the major emphasis of its higher educational institutions has been on didactic education. Because of fiscal and human resource constraints, basic and applied research activities have been relatively modest in scope, and priorities have often been set primarily by external collaborators. These factors have compromised the scope and the relevance of locally conducted research and have limited the impact of Mozambique’s universities as major catalysts for national development.Case descriptionWe developed a multi-institutional partnership to undertake a comprehensive analysis of the research environment at Mozambique’s major public universities to identify factors that have served as barriers to the development of a robust research enterprise. Based on this analysis, we developed a multifaceted plan to reduce the impact of these barriers and to enhance research capacity within Mozambique.InterventionsOn the basis of our needs assessment, we have implemented a number of major initiatives within participating institutions to facilitate basic and applied research activities. These have included specialized training programmes, a reorganization of the research administration infrastructure, the development of multiple collaborative research projects that have emphasized local research priorities and a substantial investment in bioinformatics. We have established a research support centre that provides grant development and management services to Mozambique’s public universities and have developed an independent Institutional Review Board for the review of research involving human research subjects. Multiple research projects involving both communicable and non-communicable diseases have been developed and substantial external research support has been obtained to undertake these projects. A sizable investment in biomedical informatics has enhanced both connectivity and access to digital reference material. Active engagement with relevant entities within the Government of Mozambique has aligned institutional development with national priorities.ConclusionsAlthough multiple challenges remain, over the past 3 years significant progress has been made towards establishing conditions within which a broad range of basic, translational and clinical and public health research can be undertaken. Ongoing development of this research enterprise will enhance capacity to address critical locally relevant research questions and will leverage resources to accelerate the development of Mozambique’s national universities.

A needs assessment survey for an innovative health-care business course for graduate doctors

Over the course of medical education, physicians are expected to acquire extensive knowledge of clinical medicine, and to develop competence in business skills indispensable to contemporary medicine. Despite this consensus few colleges have aligned their curricula. Less than a third of physician-leaders feel prepared for their duties. Physicians frequently assume leadership positions, ’accidentally’ or ’coincidental’ without formal training. To be effective leaders, physicians need specific training. University Of Zimbabwe College Of Health Sciences (UZCHS) is implementing education improvements through Novel Education Clinical Trainees and Researchers program (NECTAR) funded by PEPFAR’s Medical Education Partnership Initiative (MEPI). During program reviews, a business skills gap was identified6. A questionnaire survey was conducted in May 2013 to qualify this assertion as well as appraise the skills gaps for guided remediation. Out of 119 registrars 26% responded. Of the 32, 99% were 40 years or younger and 61% were male. They had practiced for at least five years: public sector (73%) and private (27%), before enrolling for specialization. 26 (84%) reported preforming management duties regularly. All participants believed that business skills were important, with 93% rating ’important and very important’. Findings confirmed earlier assertions with 55–90% reporting either none or only basic understanding of human resources, conflict resolution and financial management, among others. Every participant selected multiple skills they wished to acquire, with (83%) selecting at least five. Preferred instructional methods were practicums, hand-outs and online tutorials. They listed improved practice efficiency, leadership, cost control and patient care as anticipated benefits. Registrars delineated their business skills gaps precisely. They aspire to narrow gaps through training, using instructional methods that are compatible with their busy routines. The UZCHS can make an informed choice to introduce business skills training to registrars whose needs are now known. Other medical colleges can benefit from similar endeavours in the interim.

P6.010 Implementation of VIA For Cervical Cancer Screening in a Sexually Transmitted Infection Clinic in Lilongwe, Malawi

BackgroundCervical cancer is the most common female cancer in Malawi with high mortality. Cervical cancer can be averted if pre-cancerous lesions are detected early and treated. Visual Inspection with Acetic...

Proceedings of the 4th Annual Meeting of the Alliance for Surgery and Anesthesia Presence (ASAP): Building Sustainable Surgical Systems

Proceedings of the 4th Annual Meeting of the Alliance for Surgery and Anesthesia Presence (ASAP): Building Sustainable Surgical Systems

Investing in community-based education to improve the quality, quantity, and retention of physicians in three African countries.

The Medical Education Partnership Initiative (MEPI) is a $US 130 million program funded by the United States government supporting 13 African medical schools to increase the quantity, quality, and retention of physicians in underserved areas. This paper examines how community-based education (CBE) is evolving at MEPI schools to achieve these goals. We utilized data from the first two years of site visits and surveys to characterize CBE efforts across the MEPI network and provide detailed descriptions of three models of CBE among the MEPI programs. There is widespread investment in CBE, with considerable diversity in the goals and characteristics of training activities among MEPI schools. Three examples described here show how schools are strengthening and evaluating different models of CBE to achieve MEPI goals. In Nigeria, students are being sent for clinical rotations to community hospitals to offload the tertiary hospital. In Uganda, the consistency and quality of teaching in CBE is being strengthened by adopting a competency-based curriculum and developing criteria for community sites. At Stellenbosch University in South Africa, students are now offered an elective year-long comprehensive rural immersion experience. Despite the diversity in CBE models, all schools are investing in e-learning and faculty development. Extensive evaluations are planned to examine the impact of CBE strategies on the health workforce and health services. The MEPI program is stimulating an evolution in CBE among African medical schools to improve the quality, quantity, and retention of physicians. Identifying the strategies within CBE that are reproducible, scalable and optimize outcomes will be instructive for health professions training programs across the continent.

Human capital contracts for global health

Human capital contracts for global health

The Medical Education Partnership Initiative: PEPFAR’s Effort To Boost Health Worker Education To Strengthen Health Systems

The early success of the President's Emergency Plan for AIDS Relief (PEPFAR) in delivering antiretroviral medications in poor countries unmasked the reality that many lacked sufficient health workers to dispense the drugs effectively. The 2008 reauthorization of PEPFAR embraced this challenge and committed to supporting the education and training of thousands of new health workers. In 2010 the program, with financial support from the US National Institutes of Health and administrative support from the Health Resources and Services Administration, launched the Medical Education Partnership Initiative to fund thirteen African medical schools and a US university. The US university would serve as a coordinating center to improve the quantity, quality, and retention of the schools' graduates. The program was not limited to training in the delivery of services for patients with HIV/AIDS. Rather, it was based on the principle that investment in medical education and retention would lead to health system strengthening overall. Although results are limited at this stage, this article reviews the opportunities and challenges of the first year of this major transnational medical education initiative and considers directions for future efforts and reforms, national governmental roles, and the sustainability of the program over time.

Safety and effectiveness of efavirenz versus nevirapine-based regimens in resource-limited settings

639–641Keywords: efavirenz, effectiveness, modelling, nevirapine, safety,sub-Saharan AfricaCombination antiretroviral therapy (ART) with eitherefavirenz (EFV) or nevirapine (NVP), both nonnucleo-side reverse transcriptase inhibitors (NNRTIs), and twonucleoside reverse transcriptase inhibitors (NRTI) isrecommended by the WHO as first-line therapy inresource-limited countries [1]. Compared with NVP,EFV is easier to monitor, is relatively well tolerated, hasless frequent and less severe rash and hepatic toxicity thanNVP, and can be administered once daily. Whereas NVPandEFVhavegenerallycomparableclinicalandvirologicefficacy [2–5], because of lower drug–drug interactions,EFV-based ART is associated with superior virologicoutcome compared with NVP-based ART in individualswith tuberculosis (TB) receiving anti-TB therapycontaining rifampicin. Therefore, efavirenz is theNNRTI antiretroviral drug of choice of TB-coinfectedindividuals [6–9]. However, there have been concernsregarding potential for central nervous system birthdefects with first-trimester exposure to EFV based onstudiesinpregnantrhesusmacaquesandretrospectivecasereportsinhumansthathavelimitedEFVuseinwomenofchildbearing age. This is a problem in many resource-limitedsettings,wherewomenconstitute50%or moreofHIV-infected individuals and TB is endemic, but there islimited access to contraception or women may wish tobecome pregnant.In this issue, Ouattara and colleagues use a computersimulation model to evaluate the risks and benefits ofusing EFV and NVP in women of childbearing age inresource-limited countries [10]. Using the previouslyvalidated Cost-Effectiveness of Preventing AIDS Com-plications (CEPAC) International model, the authorssimulated the trade-off between potential excess birthdefects and potential long-term clinical benefits forwomen starting EFV-based versus NVP-based ART inCote d’Ivoire. In a ‘hypothetical’ cohort of 100000women starting ARTwith EFV, the authors found that adrug with lower toxicity and requiring less regimenswitching led to approximately 911 more women aliveafter 10 years compared with those starting with NVP, animprovement in survival of approximately 1%. However,over thesameperiod,therewere59morebirthdefectsinwomen initiating EFV-based ART than those startingwith NVP. The authors concluded that in Cote d’Ivoire,initiating ART with EFV instead of NVP is likely to

Establishing and Upgrading Physical Therapist Education in Developing Countries: Four Case Examples of Service by Japan and United States Physical Therapist Programs to Nigeria, Suriname, Mongolia, and Jordan

Background and Purpose. Physical therapist (PT) professional (entry-level) education programs are non-existent in most developing countries. The PT professional education programs that do exist in some developing countries may need to upgrade and strengthen their existing curricula. Many of these programs are in significant need of additional PT faculty and advanced education for their existing PT faculty. Efforts to create or enhance PT education programs in developing countries are frequently limited by inadequate human and material resources. Method/Model Description and Evaluation. This paper describes and discusses 4 models of collaboration and international partnerships in which educators and PT education programs in developed countries with more human and material resources partner with universities in developing countries to help establish or enhance PT education programs. Experiences of PT education programs in the US working with programs in Nigeria, Suriname, and Jordan, and a program in Japan working with a program in Mongolia, are presented. Outcomes. The models of collaboration between service and host countries resulted in provision of online education to practicing physical therapists, consultation on curriculum, short-term teaching/consulting for existing and developing programs, and PhD education of foreign PTs with the intention that they return to their country of origin as faculty members in PT programs. Discussion and Conclusion. These case examples of international collaboration serve as models for other PT programs and educators to form similar international partnerships and to develop new models. Key Words: International, Education, Physical therapy. BACKGROUND AND PURPOSE Developing countries carry over 55% of the global burden of disease, but have less than 15% of global health care work force.1 In contrast, many developed countries carry a lower global burden of disease, but have a relatively higher ratio of the global health care work force. For instance, the United States with 10% of the global burden of disease has 25% of the global health care work force; whereas Africa, which carries 25% the global burden of disease, has less than 4% of the global health care work force.24 The shortage of health care work force in developing countries is exacerbated by migration of health care professionals from resourcepoor to resource-rich countries. This concept of migration is known as brain drain.2,510 Often, health care professionals in developing countries immigrate either for pecuniary reasons, a poor practice environment and infrastructure, or political instability.7,1113 To address this disparity and perennial health care work force shortage, efforts by the World Health Organization (WHO) and governments in developed and developing countries primarily focus on training, retention, and recruitment of health care professionals in medicine, nursing, pharmacy, dentistry, imaging, and medical laboratory sciences.14,15 For instance, education and training specific to medical and nursing health care professionals in sub-Sahara African countries have received a tremendous boost in funding, human and material resources, and partnerships with many US academic institutions.1618 These initiatives, driven by HIV/ AIDS funding, have been funded by the US government through the Medical Education Partnership Initiative (MEPI)19,20 and the Nursing Education Partnership Initiative (NEPI)21,22 programs of the National Institutes of Health (NIH) and the US President's Emergency Plan for AIDS Relief.19,20 Specifically, successful upgrading of nursing education programs through NEPI have been reported for Botswana, Lesotho, Kenya, Malawi, Zambia, Brazil, India, Thailand, and the Philippines.22 The Consortium of Universities for Global Health,23 comprised of over 50 academic institutions in the United States and Canada, and funded by the Bill and Melinda Gates Foundation and the Rockefeller Foundation, currently partner with developing countries and their institutions. …

Health Workforce Development with a Focus on CVD in Zimbabwe : CHRIS Program, a Medical Education Partnership Initiative

The health workforce challenge in sub-Saharan Africa has gained prominence because of the pivotal place that it plays in health care delivery and development in the continent [1–4]. Several workshops and conferences by the WHO and other interested global partners have been held to address this challenge. Unless this serious short fall in the healthcare workforce is addressed, global health disparities between the developed and the developing world will continue to hamper the implementation of plans that are resourced and funded through well-meaning initiatives. The Medical Education Partnership Initiative (MEPI) has been lauded as an intervention that begins to address this challenge [1,2]. Zimbabwe, one of the countries with a serious health workforce shortage, is a beneficiary of this initiative. During the decade from 1999 to 2009, Zimbabwe suffered a serious economic downturn which seriously affected the training of all health professionals including doctors. In 2009, the vacancy rate of doctors in the Ministry of Health institutions was as high as 62% [5]. Similarly, at the University of Zimbabwe College of Health Sciences (UZCHS), the only medical school in the country, the faculty vacancy rate in some departments was as high as 80%. Postgraduate training, the source of future specialists and faculty, fell to insignificant levels, while at the undergraduate level student performance fell dismally with alarming failure rates.