Bridging the gap in public health capacity in Africa: Experiences from public health schools without walls (PHSWOW) in Uganda

In 1990 WHO convened a meeting of leading Public Health leaders and educators in Africa and the developed world with experiences in Africa. They concluded that traditional approaches that used classroom based training alone were inadequate to impart the skills needed to address the numerous Public Health challenges in Africa. They recommended the use of practical, field oriented, competency based approaches. The Rockefeller Foundation subsequently provided financial support to develop the Public Health Schools without Walls initiatives in Zimbabwe, Uganda and Ghana with the introduction of Master of Public Health (MPH) programs that had a significant proportion of training time spent in the field. The Makerere University Institute of Public Health (MUIPH) started the Ugandan PHSWOW program in 1994, which became the main graduate level training in Public Health in Uganda. The mission of the MPH program is “to produce practically oriented public health specialists who possess the knowledge, skills and professional attitudes required to assume leadership roles in the public health system,” and “to develop a new model of public health training that emphasizes problem-oriented learning and acquisition of competencies.”

Using a field oriented practice-based curriculum, trainees spend 60% of total time over two years in a field component assigned to one of a network of 11 field practicum sites, under apprenticeship with competent and well experienced Public Health experts who serve as directors of district health departments. Each trainee is required to investigate at least 5 Public Health problems being faced by their host station and write up a professional or scientific report. These studies contribute to acquisition of some of the core competencies in Epidemiology, disease surveillance and control of priority problems (e.g., HIV/AIDS, Malaria, Reproductive Health), health planning and management including program evaluation and communication. From the inception of the program over 600 short studies and 150 dissertations have been produced and recommendations made to improve Public Health in host districts and national programs.

The Program has produced over 150 Public Health leaders at MPH level now serving at district and national program levels, with some in international organizations. Graduates of the program have provided much needed Public Health leaders to manage health care delivery under Uganda's decentralization policy. Continuing shortages are being addressed and MUIPH started a Distance Education based MPH in 2004 so as to scale up the program and cut on time trainees spend away from work.