The Medical Education Partnership Initiative (MEPI) was envisioned by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to address the terribly inadequate supply of health and medical personnel required to support health programs in Sub-Saharan Africa, particularly around HIV/AIDS but extending to other medical needs as well. By investing in education in medicine and the allied health sciences, MEPI intended to build human capacity for health in Africa by strengthening the medical education system in an environment that values and nurtures research. Why do we see research as integral to this endeavor?
The answer is that in the 21st century, education and research in leading academic institutions in Africa as in the United States must go hand in hand. In the past few decades, the epidemic of HIV/AIDS in Sub-Saharan Africa has overwhelmed the capacity of the medical community and called out for innovations in the treatment and prevention of HIV/AIDS. For more than 25 years, the National Institutes of Health (NIH) has invested in training African researchers to address this epidemic, which has dramatically shortened life expectancy, increased mortality in all age groups, and decimated a generation of the most productive people in society, leaving millions of orphans in its wake. Research has informed care and treatment so that a diagnosis of HIV/AIDS has been transformed from a death sentence to a manageable chronic illness.
Much of this research has been conducted by African investigators working in African academic institutions at African field sites with African populations, often but not always in collaboration with academic colleagues in the United States. This research has been truly game changing and could not have been conducted as quickly, carefully, or effectively without outstanding local scientific leadership and implementation of solutions. The results have included the development of rapid diagnostics for detecting and monitoring HIV infections, new drugs for treatment, and new strategies for prevention, such as prevention of mother-to-child trans mission, voluntary medical male circum cision, and treatment as prevention. These are examples of success within one field; however, many questions related to the prevention and treatment of HIV, as well as other diseases, remain.
Research, along with health care and training, are key missions of academic health centers today. Students need to be able to access new advances in medicine, evaluate published literature, ask critical questions, and consider ways to better implement interventions that we think will work but remain to be tested. Engaging in research helps academic leadership remain competitive, funded, and knowledgeable of the advances of science, and research grants can help support an institution’s growth. At a time when many African economies are growing rapidly, innovations in the health care sector can be important drivers of this economic boom.
When then-PEPFAR Ambassador Dr. Eric Goosby envisioned MEPI, NIH Director Dr. Francis Collins joined him in order to promote research in this innovative program.1 The Director’s Office as well as five NIH institutes provided funds. The Fogarty International Center was tasked with coordinating this NIH response because of its long history of supporting grants that train researchers and build research infrastructure at institutions in low- and middle-income countries. This strategy previously demonstrated its value in the AIDS International Training and Research Program, a 25-year initiative at Fogarty linking U.S. and foreign institutions to train a generation of researchers in those countries most affected by the epidemic. Graduates of this program have become well-established researchers, educators, and leaders in their universities, countries, and often, internationally in their fields. They are deeply involved in research activities at their home institutions, have received international research funding, and have remained at their universities. They have been involved in training the next generation of researchers as well as clinicians, who, through exposure to research, better understand how to evaluate and integrate new evidence into policy and practice. Many have gone on to provide scientific and political leadership for their respective countries.
Research support in MEPI sites has just begun to influence medical education and practice.2 In each country, many young investigators and physicians/trainees have been offered research opportunities, gained confidence in questioning what they have been taught, and been encouraged to seek new solutions. For example, at Kilimanjaro Christian Medical Center in Tanzania, nearly half of the students engage in research projects during their medical training, focusing on projects of their own choosing. One project to assess the etiology of fever in this malaria-endemic setting found that fewer than 5% of these patients actually had malaria, which prompted a revision to the standing recommendation to blindly treat all fever patients with antimalarial drugs. In Ghana, students and residents examined the causes of trauma and time required to receive emergency care. Their study led to lower waiting times for acute emergencies and a more efficient system for triage. In Zimbabwe, one resident’s research findings on morbidity and mortality of stroke patients led to the establishment of a stroke unit in a teaching hospital in Harare. MEPI has supported many students and young faculty with opportunities to build their research skills (e.g., research design, data analysis, grant writing), conduct their own projects, and collaborate with researchers from other countries.
MEPI has been built on the idea that outstanding academic institutions in the health sciences must be excellent in education, service, and research. Research can play a key role in the education of effective and sustainable leadership in health, the development of knowledge and practice for the delivery of care, and for building academic centers in Sub-Saharan Africa. MEPI will contribute to building stronger health systems by expanding the community of research scientists who can address the most challenging problems in their settings, both in basic research and in the new area of implementation science.
The research perspective provided to students and faculty, the ability to raise and answer questions, and the idea that medical knowledge and practice are continually changing are being supported by MEPI sites and will hopefully endure long after the program ends. Medical education and establishing a research tradition does not occur overnight. It takes decades. Although this program has been built on African centers that were already engaged in some research, the comprehensive impact of this transformative program will take years to evaluate in full. For now, as articles in this Supplement indicate, it is off to a most promising start.
Acknowledgments: The authors thank Dr. Jeanne McDermott and Ann Puderbaugh for their helpful comments.
1. Collins FS, Glass RI, Whitescarver J, Wakefield M, Goosby EP. Developing health workforce capacity in Africa. Science. 2010;330:1324–1325
2. Mullan F, Frehywot S, Omaswa F, et al. The Medical Education Partnership Initiative: PEPFAR’s effort to boost health worker education to strengthen health systems. Health Aff (Millwood). 2012;31:1561–1572