A survey of Sub-Saharan African medical schools

Abstract

Background: Sub-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.

Methods: The 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.

Results: Surveys 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.

Conclusions: The 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.

Figure 1

SAMSS survey plan.

Figure 2

SAMSS survey respondent demographics.

Figure 3

Date of establishment of sub-Saharan African medical schools by ownership.

Figure 4

Sub-Saharan African medical school tuition and sources of income.

Figure 5

Sub-Saharan African medical schools post-graduate medical education and other health care workers training programs.

Figure 6

Sub-Saharan African medical schools first year enrolments and graduates.

Figure 7

Percentage change in first year enrolment over the past five years.

Figure 8

Planned percentage increase in enrolment over the next five years and likelihood of reaching enrolment goals.

Figure 9

Sub-Saharan African medical schools focused on student recruitment and reserved positions.

Figure 10

Sub-Saharan African medical schools use of learning approaches.

Figure 11

Mean Estimated location of sub-Saharan African medical school graduates (%) five years after graduation.

Figure 12

Sub-Saharan Africa compulsory service requirements by country reported by medical schools.

Figure 13

Participation of external organizations in setting sub-Saharan African medical school priorities.

Figure 14

Sub-Saharan African medical schools - international collaborations.

Figure 15

Percentage change in sub-Saharan African medical school's faculty over the past five years.

Figure 16

Sub-Saharan African medical schools reasons for staff loss.

Figure 17

Adequacy of student and teaching resources.

Figure 18

Adequacy of technology resources.

Figure 19

Adequacy of clinical teaching sites.

Figure 20

Barriers to increasing the number of medical school graduates.

Figure 21

Barriers to increasing the quality of medical school graduates.

Figure 22

Barriers to increasing the number of medical doctors in the country.