Transformative Education
for Health Professionals

Addressing inequities in public health education, a perspective from Sudan

Addressing inequities in public health education, a perspective from Sudan

 

The Sudan, a country located in North Eastern Africa is one of the largest countries in Africa, ranking the sixteenth in the World. The country suffered from political instability and prolonged conflicts that lead to a failing economy. Discrepancies in development between rural and urban areas manifested in an urbanization that drew residents of all areas to move towards urban settings. The impact of such movements had a toll on the health care system. The health care system of the public sector is made up of three levels that are implemented as a mean of decentralization of health care, however it requires significant health care resources which are in fact not available. The distribution of resources between the levels lacks equilibrium and the localities have insufficient materials and human resources. The majority of health professionals’ work in urban areas, leaving rural areas suffer serious shortage. The Federal Ministry of Health is aware of the situation and has set strategic plans to strengthen the health care system.

 One of the tools of assisting the health care system was through the establishment of the Public Health Institute (PHI) at 2009. The PHI is a multi-disciplinary institute that contributes to health system strengthening through provision of tailored post graduate training, applied health system researches, and conducting consultancies to support the Federal Ministry of Health. The educational programs provided by the institute are designed to train staff, working or intending to work in the health sector throughout Sudan, at postgraduate level to act as leaders in public health by building their knowledge and skills in public health management; health systems and biomedical research. The institute provides mainly four postgraduate programs, Public health (with different tracks), health systems management, disaster management (emphasis on health) and family medicine.

All of these programs (excluding Family medicine) target inter-professional learners from different disciplines in the health sector. The bulk of the array of health professionals include public health workers, medical doctors, nutritionists and other students majoring in social sciences. Within the class it is easy to figure out that the two most powerful polls are medical doctors versus public health workers, sometimes doctors versus all others. The reason I refer to polls here is the occasional tug of war that appears during class discussions, where doctors try to dominate and public health workers strive to prove a point. Public health is a multi-disciplinary profession, yet it hasn’t been recognized in Sudan as such but recently; with several higher academic institutes in the last 5 years establishing master programs in Public health that accommodate inter-professionals and multi-disciplinary participants. The health of the public has been the sole concern of community health physicians aka school of medicine graduates that specialize in community medicine. This has led to the apparent dominance of doctors in the field, with negligence on the importance of other disciplines to improve the role of public health. Thus, even though this turn towards Public health is positive, it comes with all the challenges of change and transition. Here in the PHI we realized that we need to assess the dynamics of Inter-professional education as it goes and determine the strengths and challenges of this experience to enhance learning. Accordingly a study by Awadallah (2013) has been done to evaluate the student’s and faculty’s perception on inter-professional education. On one hand the majority of the students reported that they enjoyed the experience, though were challenged by the dominance of some candidates which mainly disrupted the efficiency of group work. On the other hand the faculty reported being challenged to bridge the knowledge gap between the different professions for they come from different academic backgrounds. This has also been noted in their language competencies; the instructional language is English in the PHI yet certain health professionals e.g. doctors, have better command of the English language than their counterparts.

Inter-professional education has the charm of bringing in the experiences of different health professionals to class. Having such a rich group which already work or intend to work with the ministry of health bring in live experiences from the different perspectives of the health sector whether in public health, disaster management or health system management. We dare to say that this may produce a positive impact on our health system by integrating these different yet equally important groups within the profession, to produce a mindset that works through collaborative efforts rather than isolation and fragmentation.

Challenges are there, and challenges are not solely related to the fact that students represent different backgrounds. Compatibly, we need to consider whether those who teach reflect inter-professionals or are dominated by one profession. The truth is even though we attempt to engage different disciplines in teaching our postgraduate programs of public health, the field is still dominated by doctors, which are ultimately doing most of the teaching in Sudan. In the meanwhile this may appear to be the most feasible or convenient option, yet to enhance the experience, the instruction methods needs to embrace the ideologies of inter-professional education. Time may show an incremental change as more professions graduate with postgraduate degrees in public health, disaster management etc. Training in the meanwhile of educators on inter-professional education may also be of great help.

Dr. Shahd Osman (MBBS, IFME, MS.EPID)

Deputy of the Academic Secretary

Public Health Institute

Khartoum, Sudan