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EDITORIALS: Lola Dare and Eric Buch The future of health care in Africa BMJ 2005; 331: 1-2 [Full text]

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Is there only one agenda?

Ulf R. Dahle   (1 July 2005)

Deans and Vice Chancellors have central role

Thomas C. NCHINDA, NONE   (8 July 2005)

Is there only one agenda? 1 July 2005
Ulf R. Dahle, Senior scientist Norwegian Institute of Public Health, POB 4404 Nydalen, 0403 OSLO, Norway Send response to journal: Re: Is there only one agenda?	Dare and Buch inform about the health care future in Africa and ongoing emigration of African health-care workers(1). Lately, infectious disease control and microbiological research has regained a political interest, since emerging and re-emerging pathogens appear simultaneously with increasing microbial resistance to standard therapeutics in the developed world. Additionally post-September 11th, it has become the interest of rich countries to be patient and make sacrifices to ensure fairer trade, more aid and health care, and more generous debt relief to developing countries. Even President Bush has emphasized (in a speech to Congress) that infectious diseases "make no distinctions among people and recognize no borders". Aided by rapid travel and constant migration, infectious diseases persist as global problems. Drug resistant and more-virulent M. tuberculosis strains has spread to several countries around the world, and new pathogens like sars, the West Nile Virus, aids and others compel rich countries to (finally) approach infectious disease as a global issue. There are however, ample warnings throughout recent history how infectious disease control may fail if it is initiated on behalf of (and not by) local authorities, or enforced contrary to regional culture, habits, customs or beliefs. Challenges like getting African patients into care, consumer education and protection, diagnostic delay, and linking prevention and care are typical aspects to health care that the G8 summit should not solve while meeting in Scotland. It is therfore not suprising that several groups have called on the G8 to invest in Africa's efforts to stem the emigration of native health-care workers and to produce the right multidisciplinary workforce of local health-care systems (1). References. 1. Dare L, Buch E. The future of health care in Africa. BMJ 2005;331:1-2 Competing interests: None declared
Deans and Vice Chancellors have central role 8 July 2005
Thomas C. NCHINDA, Retired WHO Official and Consultant Epidemiologist and Public Health Physician Geneva, Switzerland, NONE Send response to journal: Re: Deans and Vice Chancellors have central role	Lola Dare and Eric Buch, two friends of mine, address the important issue of the crisis of the healthcare workforce in Africa. This is a complex issue with many facets. The article indicates how Africa has risen to the challenge of the healthcare workforce by drawing up guidelines to the health strategy within the New Partnership for Africa's Development(NEPAD). The key actions needed is described by NEPAD as well as its evaluation. This is a laudable step. The article goes on to stress the need for international assistance to fill the funding gap needed to meet this ambitious programme. The paper suggests two possible solutions - what they refer to as "brain-sharing" and the role of technical cooperation in medical education and training. This is the aspect I wish to address. Much of the syllabus for medical training both at undergraduate and postgraduate level in African medical schools accross the language divide is in need of radical reform both in form and spirit. Most medical education in countries accross Africa, particularly at undergraduate level, do provide locally-pertinent training focused on resolving the bulk of locally-relevant health problems most of which have strong community orientation. It is uncertain if ALL of the postgraduate training in the medical specialties have the same degree of pertinence to local problems. For example, many of the specialists hardly have the capability to do locally-relevant clinical research to understand clinical problems. Their training programme is also devoid of competence in research protocol and scientific writing and skills in evaluation and working in a multidisciplinary evironment. In fact most of these specialists are probably trained abroad in UK, France and the US. This is where Deans have a central role - getting ALL of the training done locally. In addition, sufficient vital equipment and supplies should be provided for training including electronic communication equipment and some funds for research. They should develop strong links to in-country research groups doing good and relevant research. The government should back this up by equipping the hospitals adequately including having appropriate disgnostic facilities. This is indispensable for providing quality care and giving first rate specialist training. Finally, there should be appropriate use of training through regional collaboration where students can do some modules and units of their course in another African University with stronger faculty for the particular module. Such regional training (a good example for south-south collaboration accross the continent) is vital in using all competence within the continent. There should be greater use of external examiners, a necessary accompaniment of south-south training. Much of this will be vital for the development of reciprocity of degrees and equivalence in diplomas so much needed in Africa. This point again requires the strong and determined action by Deans of Medical Schools and Vice Chancellors of Universities and supported by Government. Reciprocity and equivalence of undergraduate and in particular, postgraduate qualifications in the medical disciplines should be instituted as a matter of urgency. In this way the need for sending these professionals for long stay abroad (US, UK, France) should no longer be necessary except for short stay much later to learn specific techniques. This, along with other incentives and better service conditions and adequately equipped hospitals and peripheral health establishments with reduce the attractions of migrating abroad. The options for healthcare financing being requested should address the issue of training the much-needed health workforce locally along the lines proposed. All of thus will go a long way to keep the trained nationals working in their home countries. Competing interests: None declared