Dear Colleagues,

There are many stories of poorly planned health workforce programs in our countries. There are also many meeting taking place on health professionals education and training. at the same time, there are strikes and reported cases of suicide resulting from failure to get employed after graduation and completion of internship.

Here below are my thoughts on long term solutions. Looking forward to seeing your responses.

There is a lot of renewed activity in Africa and globally on the subject of health professionals’ education and training. A meeting took place at the beginning of February, 2023, in Kigali, Rwanda, of the Governing Council of the African Forum for Research and Education in Health (AFREhealth). In November, 2022, two meetings took place; in Miami, USA and in Accra Ghana on this topic. In May 2022, there was a Forum in Canada; McGill University School of Population and Global Health on “Nurturing Leadership for Health: are Universities Stepping Up?” Another meeting took place last week of February, 2023 in Pretoria, South Africa. So, what is going on? Are we making any progress? Are health professional training institutions contributing to better health globally, regionally and nationally? Are they just about themselves?

The Lancet Commission on the Education of Health Professionals for the 21st Century issued its report ten years ago recommending a new generation of reforms in health professionals’ education. Universities, especially university leaders, are called upon to become the change agents among the people that they serve. These leaders should demonstrate social accountability and teach their students to be societal change agents by exemplary lives; engaging with their ministers of health, cultural, religious and civil society leaders. The purpose of this engagement is to ensure that better population health is visible in practice as a result of teaching and research. Failure to achieve this qualifies universities to be described as ivory towers that are disconnected from their communities.

University leadership, including all Faculty should engage proactively with politicians and the public to ensure that knowledge, research and training are aligned with efforts to improve the performance of health systems and advocate and guide investments in health. This requires reviewing incentives for promotion of university lecturers that are currently skewed towards research and publications with insufficient emphasis on teaching and service. When students see this as a dominant role model, they also aspire to become researchers resulting in a gap in service and teaching.

Dear Colleagues,

The concept and discussion on OUR post-colonial relations are important for population health outcomes and deserve our attention. Here are my thoughts. What are yours?

During the AFREhealth conference held in Harare, Zimbabwe last August 2022 there were some presentations on the topic of decolonization of global health which were followed by vigorous discussions. I have since taken more interest in this subject and have been surprised to find that the subject of globalization is huge with many websites addressing diverse aspects of the subject including a group focusing on decolonizing contraception!
There are a number of highly regarded schools of public health and other institutions that are introducing new programs for students under Schools of Decolonizing Global Health and awarding Masters of Public Health degrees in Decolonizing Global Health.

So, what is decolonization with respect to global health? Decolonization of global health is variously defined as a movement that fights against entrenched systems of dominance and power imbalance in the work to improve the health of populations. This power imbalance may take place between countries, and institutions, in commerce and trade in health commodities and in the policy dialogue arena. Generally, the imbalance and inequity are between previously colonized regions on the one hand and the successors of the colonizer countries and regions on the other hand. It is between the governments and institutions and individuals in the global north and the global south or the so-called rich and poor countries. At the individual level, relics of our colonial history have left behind overt and covert ingrained perceptions and attitudes of superiority that result in behavior that patronizes colleagues and institutions based on which region we originate from. The net result is that a small outsider elite gets to determine what health interventions get implemented in what context, what resources go to whom, and, in short, who lives and who dies.

Dear Colleagues,

Awareness among ordinary people on the threat of climate change is low and I am concerned.

The impact of Climate change in the daily lives of the people round the world has been very visible in the news. We have seen graphic pictures of starving children, and dying animals from drought and food shortage. We have seen wild fires destroy homes and disrupt livelihoods and we have seen pictures of floods destroying homes and disrupting livelihoods of communities and there are reports of rising sea levels threatening to wipe out small island nations.

There are epidemics of malaria and other diseases attributed to climate change and pandemics such as Covid-19 are expected to increase in frequency as a consequence of climate change. Yes, we have been informed about how the Antarctic ice sheet is melting and separating.

At personal level, I have a farm where I grow entirely rain-fed crops. The rains have frequently failed in recent years resulting in food crop failure and I have lost money in the process. Worse still, the local the population are chronically short of food.

My major concern is that while Climate change is the single biggest threat facing humanity, I do not see a matching effort to inform and educate African populations actively about this very serious threat to them. The African people know that the rains are irregular but they do not know why and how to respond.

Dear All,

Lets us discuss the health of women, who are our mothers, sisters, and colleagues.

Women and men are inseparable partners in ensuring the continuity of humanity. Women as mothers have unique roles from conception, pregnancy, and childbirth. They are the pillars of families providing helpless newly-born children with critical nutrition and support. Women also provide men and children with homes where the characters and values of people are shaped and communities are built. It is evident that giving priority to the health of women must take center stage in all societies and health systems.
Reproductive health is defined by WHO as “a responsible, satisfying, and safe sex life with the capability to reproduce and the freedom to decide if, when, and how often to do so”. There are health risks at every stage of the cascade in this definition which call for support from the health system and society. These risks include infections, fistula, infertility, and unwanted pregnancies with related mental health implications that impact women’s wellbeing and power dynamics in society.

Women also have cancers and tumors affecting the uterus and cervix, ovaries, and breast, and aging in women comes with post-menopausal disorders and decalcified fragile bones.

Sub-Saharan Africa (SSA) made significant progress during the MDG period with women’s health indices when maternal mortality (MMR) and morbidity declined by 45%. However, this still leaves Africa far behind other regions of the world. The current MMR figures for SSA average 1000 deaths per 100,000 births compared with 25/100,000 in other regions; is a matter of concern and shame.

Dear Colleagues,

Here is a blog written for us by Dr. Patrick Kadama; Director Health Policy and Strategy at ACHEST.

"building back better for more resilient health systems in Africa and the Global South".

The impact of the COVID-19 Pandemic emerged in different ways across the globe. It directly caused devastation through unprecedented morbidity and mortality in the North but, its effects in the South, were deeply felt largely due, to weak health systems, gaps in social safety nets, scarce resources, and other factors of weak social and economic institutions. This divide distorted the global response to the pandemic. Major gaps exposed include the lack of international solidarity and sharing, including not only reluctance to share pathogen data and epidemiological information, but also resources, technology and tools, such as vaccines. This is contrary to the Nagoya Protocol for example. There has been disregard of the International Health Regulations and the WHO Code, resulting in recruitment of Health Professionals from the South to plug staffing gaps for managing the pandemic in the North. A North-South divergence in the fight against the COVID-19 crisis has emerged.

This has unmasked a fact that at present, “Global Health” practice, perpetuates the very power imbalances it claim to rectify, through colonial and extractive attitudes, and policies and practices that concentrate resources, expertise, data and branding within institutions of the Global North. These colonial attributes of global health, place Africa at a great disadvantage for gainful participation in the governance power dynamics which are shaping health policies and responses. This has brought to the fore, gaps and structural asymmetry underlying the power imbalances in the vertically structured global health practice between the North and the South. A contextualized consideration of the Africa region is required to meet challenges relating to this spill-over of a colonial supremacy mindset, of the vertical North to South Global Health construct.