Strengthening Health Systems for an AIDS-Free Generation: The MEPI Story

Posted by Eric Goosby
May 21, 2013
A Nurse Tends to a Patient at the Ugandan Cancer Institute

During a World Health Assembly side meeting on May 20, I joined U.S. Secretary of Health and Human Services, Kathleen Sebelius, and leaders from across Africa to highlight the contributions the Medical Education Partnership Initiative (MEPI) is making in meeting the priorities of national ministries of health.

In 2010, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) embarked on this bold new initiative -- MEPI -- to build sustainability through funding commitments, support, and integration with national health efforts including national Human Resources for Health Strategies and Implementation Plans.  There is a critical need for improved human resources for health capacities, both in terms of absolute numbers of those delivering services and the quality of their preparation to do so.  Therefore, in collaboration with partner governments, PEPFAR, the Fogarty International Center at the National Institutes of Health, and the Health Resources Services Administration committed to investing $130 million to strengthen medical educational capacity in sub-Saharan Africa.  Our goal was simple -- as PEPFAR-supported HIV efforts continue to evolve from an emergency response to a more sustainable effort, we needed to help strengthen the in-country expertise and capacity for evidence-based decision making and service delivery.  We saw a shortage of the number and distribution of qualified health workers who are able to respond to the needs of the population.  We strongly believe that building this expertise will empower countries to lead their own health programs and better meet the health needs of their own people.

The acute shortage of health workers in sub-Saharan Africa is one of the most significant constraints to the region's achievement of key health and development goals, including those related to HIV.  Africa has the world's lowest health workforce density of approximately 2.17 per 1,000 people (WHO 2006).  These shortages contribute directly to the region’s poor health outcomes, including the highest rates of maternal, infant, and under-five mortality -- and the lowest life expectancy rate -- in the world. The heavy burden of HIV in sub-Saharan Africa has placed an additional and overwhelming strain on already overstretched health systems throughout the region.

While efforts have been, and will continue to be, harnessed on enhancing the skills of existing personnel, the gap in human resources for health will not be solved without sustained training of additional health care workers.  MEPI, along with the Nursing Education Partnership Initiative (NEPI), help effectively address that need and support a long-term solution to improve the quantity, quality, and relevance of doctors, nurses, and other health care personnel. 

Through a competitive evaluation and award process, 12 countries were awarded five-year MEPI grants allowing them to partner with U.S. universities to strengthen the country’s health system.  This will enable countries to increase the number of quality healthcare workers trained where they are most needed, and invest in regionally relevant research.  These programs are using innovative educational models, including e-learning, to improve quality and increase the numbers of graduates. 

The benefits of MEPI across Africa have been extraordinary.  For example, at the Addis Ababa University’s College of Health Sciences in Ethiopia, MEPI funding provided more than 1,800 critical medical text books to the medical schools of Addis Ababa, Haramaya, and Hawassa Universities.  Additionally, doctoral students across Mozambique are also realizing the benefits of MEPI as a result of revamped curriculum.  Through collaborative efforts with the government and a PEPFAR implementing partner, a new package was recently rolled out that included new syllabi, lesson plans and handouts, rotation guides, and orientation manuals for both the clinical rotations and a rural internship.  The content of these tools are high quality, current, and adapted for the specific context and epidemiology of Mozambique, in addition to being easily understandable by students.  The hard work in development of the curriculum is now paying off—the first three cohorts of clinical students trained with these tools graduated in December 2012. 

The demonstrated success of the MEPI program is an essential ingredient to our shared goal of an AIDS-free generation, but we still have more to accomplish.  Investing time and resources in strengthening health systems will continue to help us make a significant impact on the AIDS epidemic and save even more lives.  As Secretary Kerry has stated, "The great progress we have already made has transformed an AIDS-free generation from a distant dream to an ever closer reality.  With an end on the horizon, now is the time to resolve to push even harder, both at home and abroad, to see the fight to eradicate HIV/AIDS cross the finish line."

About the Author: Eric Goosby serves as the U.S. Global AIDS Coordinator.

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