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      The Medical Education Partnership Initiative: Strengthening Human Resources to End AIDS and Improve Health in Africa

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          Abstract

          Faced with a critical shortage of physicians in Africa, which hampered the efforts of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Medical Education Partnership Initiative (MEPI) was established in 2010 to increase the number of medical graduates, the quality of their education, and their retention in Africa. To summarize the accomplishments of the initiative, lessons learned, and remaining challenges, the authors conducted a narrative review of MEPI—from the perspectives of the U.S. government funding agencies and implementing agencies—by reviewing reports from grantee institutions and conducting a search of scientific publications about MEPI. African institutions received 11 programmatic grants, totaling $100 million in PEPFAR funds, to implement MEPI from 2010 to 2015. The National Institutes of Health (NIH) provided an additional 8 linked and pilot grants, totaling $30 million, to strengthen medical research capacity. The 13 grant recipients (in 12 countries) partnered with dozens of additional government and academic institutions, including many in the United States, forming a robust community of practice in medical education and research. Interventions included increasing the number of medical school enrollees, revising curricula, recruiting new faculty, enhancing faculty development, expanding the use of clinical skills laboratories and community and rural training sites, strengthening computer and telecommunications capacity, and increasing e-learning. Research capacity and productivity increased through training and support. Additional support from NIH for faculty development, and from PEPFAR for health professions education and research, is sustaining and extending MEPI’s transformative effect on medical education in select African sites.

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          Medical schools in sub-Saharan Africa.

          Small numbers of graduates from few medical schools, and emigration of graduates to other countries, contribute to low physician presence in sub-Saharan Africa. The Sub-Saharan African Medical School Study examined the challenges, innovations, and emerging trends in medical education in the region. We identified 168 medical schools; of the 146 surveyed, 105 (72%) responded. Findings from the study showed that countries are prioritising medical education scale-up as part of health-system strengthening, and we identified many innovations in premedical preparation, team-based education, and creative use of scarce research support. The study also drew attention to ubiquitous faculty shortages in basic and clinical sciences, weak physical infrastructure, and little use of external accreditation. Patterns recorded include the growth of private medical schools, community-based education, and international partnerships, and the benefit of research for faculty development. Ten recommendations provide guidance for efforts to strengthen medical education in sub-Saharan Africa. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Transforming health professions’ education through in-country collaboration: examining the consortia among African medical schools catalyzed by the Medical Education Partnership Initiative

            Background African medical schools have historically turned to northern partners for technical assistance and resources to strengthen their education and research programmes. In 2010, this paradigm shifted when the United States Government brought forward unprecedented resources to support African medical schools. The grant, entitled the Medical Education Partnership Initiative (MEPI) triggered a number of south-south collaborations between medical schools in Africa. This paper examines the goals of these partnerships and their impact on medical education and health workforce planning. Methods Semi-structured interviews were conducted with the Principal Investigators of the first four MEPI programmes that formed an in-country consortium. These interviews were recorded, transcribed and coded to identify common themes. Results All of the consortia have prioritized efforts to increase the quality of medical education, support new schools in-country and strengthen relations with government. These in-country partnerships have enabled schools to pool and mobilize limited resources creatively and generate locally-relevant curricula based on best-practices. The established schools are helping new schools by training faculty and using grant funds to purchase learning materials for their students. The consortia have strengthened the dialogue between academia and policy-makers enabling evidence-based health workforce planning. All of the partnerships are expected to last well beyond the MEPI grant as a result of local ownership and institutionalization of collaborative activities. Conclusions The consortia described in this paper demonstrate a paradigm shift in the relationship between medical schools in four African countries. While schools in Africa have historically worked in silos, competing for limited resources, MEPI funding that was leveraged to form in-country partnerships has created a culture of collaboration, overriding the history of competition. The positive impact on the quality and efficiency of health workforce training suggests that future funding for global health education should prioritize such south-south collaborations.
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              Scale-up of HIV treatment through PEPFAR: a historic public health achievement.

              Since its inception in 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) has been an important driving force behind the global scale-up of HIV care and treatment services, particularly in expansion of access to antiretroviral therapy. Despite initial concerns about cost and feasibility, PEPFAR overcame challenges by leveraging and coordinating with other funders, by working in partnership with the most affected countries, by supporting local ownership, by using a public health approach, by supporting task-shifting strategies, and by paying attention to health systems strengthening. As of September 2011, PEPFAR directly supported initiation of antiretroviral therapy for 3.9 million people and provided care and support for nearly 13 million people. Benefits in terms of prevention of morbidity and mortality have been reaped by those receiving the services, with evidence of societal benefits beyond the anticipated clinical benefits. However, much remains to be accomplished to achieve universal access, to enhance the quality of programs, to ensure retention of patients in care, and to continue to strengthen health systems.
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                Author and article information

                Journal
                Acad Med
                Acad Med
                ACM
                Academic Medicine
                Published for the Association of American Medical Colleges by Lippincott Williams & Wilkins
                1040-2446
                1938-808X
                November 2019
                16 October 2018
                : 94
                : 11
                : 1704-1713
                Affiliations
                [1 ] P.H. Kilmarx is deputy director, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, and infectious diseases medical epidemiologist; ORCID: http://orcid.org/0000-0001-6464-3345.
                [2 ] F. Katz is director, Division of International Training and Research, Fogarty International Center, National Institutes of Health, Bethesda, Maryland.
                [3 ] M.H. Razak was program officer, Medical Education Partnership Initiative, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, and is currently director, Division of Global HIV/AIDS Programs, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland.
                [4 ] J. Palen is deputy coordinator for program quality, Office of the U.S. Global AIDS Coordinator, Department of State, Washington, DC.
                [5 ] L.W. Cheever is associate administrator, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland.
                [6 ] R.I. Glass is director, Fogarty International Center, National Institutes of Health, Bethesda, Maryland; ORCID: https://orcid.org/0000-0001-7968-9530.
                Author notes
                Correspondence should be addressed to Peter H. Kilmarx, Fogarty International Center, National Institutes of Health, Department of Health and Human Services, 31 Center Dr., Bethesda, MD 20892; telephone: (301) 496-1415; email: peter.kilmarx@ 123456nih.gov ; Twitter: @PeterKilmarx.
                Article
                00028
                10.1097/ACM.0000000000002489
                6467693
                30334836
                2a03ad6d-25ad-43bb-aeac-2b62e97602b6
                Copyright @ 2019

                Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.

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