1. Undergraduate Curriculum in Sub-Saharan Africa Dr S Capey Swansea University Tel 01792 513489 s.capey@swansea.ac.uk

2. Deaths from Preventable Causes WorldMapper.org 2002 These conditions caused 32% of all deaths worldwide in 2002, an average of 2968 deaths per million people. communicable infections, maternal, perinatal and nutritional conditions in one year

3. Health Spending WorldMapper.org 2002 Territory size shows the proportion of worldwide spending on public health services that is spent there. This spending is measured in purchasing power parity.

4. The Extent of the Problem

5. Policy and Service Drivers: International Globalisation of Higher Education – students’ and professionals’ – migration patterns Medical schools expanding into new countries (Malaysia, Cyprus, Gambia, Sudan) – “academic imperialism” Financial drivers – higher fees, international students; higher unemployment, more studying, capping of numbers tied to performance indicators

6. Medical Migration in African Countries Travel opportunities have improved Disparity between developed and developing countries is increasing Need to train faculty and improve curricula to support trainees Lack of higher specialist training NationDoctors / 100,00 No of doctors emigrated No of doctors who remain % emigration Liberia1.7785558.6 Ghana8.87911,84230.0 Zimbabwe5.726673626.5 Tanzania2.327082224.7 Zambia5.816464720.2 South Africa 69.36,99330,74018.5 Ethiopia2.73591,97115.4 Uganda4.31951,17514.2 Nigeria24.04,05330,88511.6 Sudan12.46224,97311.1 Bundred & Gibbs; Medical Teacher 2007

7. Policy and service drivers: HE Shift to initial/basic degree-level professional qualifications Changes in student numbers Links to local/national workforce commissioning International student flow increasing New ways of learning/teaching Changing expectations of students (Gen X, Y, me)

8. ECOWAS Economic Community of West African States (ECOWAS) – Sub-Saharan Africa shoulders 25% of global disease burden and has only 3% of global health personnel Harmonised Curriculum for Undergraduate Medical Training in the ECOWAS Region March 2013 published

9. The ECOWAS curriculum initiative Curricula of undergraduate medical education in the West Africa region are currently largely un-harmonized Medical training varies from one country to another and from one university to another in the same country Doctors are not allowed free travel within the ECOWAS region due to these differences The harmonized General Medical curriculum will allow; – Identical Scientific content for all basic medical training institutions – Acquisition of equivalent skills favouring free circulation of health professionals – Easy mobility of teachers and students

10. Underlying Principles The doctor in relation to himself – Comparable to world class doctors, Global practice The doctor in relation to his team – Health team, Leadership The doctor in relation to his community – Identify individual/commuinty health needs The doctor in relation to his profession – Personal integrity, responsibility, Ethics

11. ECOWAS Curriculum Structure Bachelor of Medicine Degree Three cycles 1.4 semesters 120 credits (pre-clinical years) 2.8 semesters 240 credits (clinical years) 3.4 semesters 120 credits (housemanship) http://www.wahooas.org/IMG/pdf/Curriculum_Harmonise_de_Medecine_Generale_CEDEAO-2.pdf

14. Service shifts Integrated, patient/client-centred services Move to community based services and ‘centres of excellence’ Mobile and personalised technologies Economic constraints and staffing shortages Different regions need different services

15. Medical education and training Align scholarship, commissioning systems and workforce planning Align undergraduate medical education and postgraduate training with workforce planning Curriculum models (e.g. graduate entry) to enable career progression into medicine for other health professionals or for new roles

16. Accreditation Quality assurance process that evaluates educational/training institutions, programs and practices Determines whether applicable (i.e. national and/or international) standards for healthcare professionals’ education are met Different models: national, professional, regional, international

17. Accreditation Educational programs – internal and external review and processes needed, to defined standards/benchmarks – raise quality Shift to HEIs self regulation and external QA of processes Accreditation can facilitate mobility between programs, professions and countries Needs to be linked to health needs and WF planning – standards/outcomes tailored to meet country needs

18. Integration Not just curriculum integration Integration between universities, hospitals and community activities Systems and process integration Content management systems: underpin curriculum assessment and evaluation

19. Balancing act Communities vs individuals Collaboration vs uniqueness Training vs education Workplace vs university Research vs teaching Service needs vs learning needs Art vs science of medicine/healthcare Technology as an enabler and not a driver

20. Any Questions