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The CHEPSAA project

The development of sustained African health policy and systems research and teaching capacity requires the consolidation and strengthening of relevant research and educational programmes as well as the development of stronger engagement between the policy and research communities. The Consortium for Health Policy and Systems Analysis in Africa (CHEPSAA) will address both of these issues over the period 2011 - 2015. CHEPSAA’s goal is to extend sustainable African capacity to produce and use high quality health policy and systems research by harnessing synergies among a Consortium of African and European universities with relevant expertise. This goal will be reached through CHEPSAA’s five work packages:

• assessing the capacity development needs of the African members and national policy networks;
• supporting the development of African researchers and educators;
• strengthening courses of relevance to health policy and systems research and analysis;
• strengthening networking among the health policy and systems education, research and policy communities and strengthening the process of getting research into policy and practice;
• project management and knowledge management.

The CHEPSAA project is led by Lucy Gilson (Professor: University of Cape Town & London School of Hygiene and Tropical Medicine).

PARTNERS

• Health Policy & Systems Programme within the Health Economics Unit, University of Cape Town, South Africa
• School of Public Health, University of the Western Cape, South Africa
• Centre for Health Policy, University of the Witwatersrand, South Africa
• Institute of Development Studies, University of Dar es Salaam, Tanzania
• School of Public Health, University of Ghana, Legon, Ghana
• Tropical Institute of Community Health, Great Lakes University of Kisumu, Kenya
• College of Medicine, University of Nigeria Enugu, Nigeria
• London School of Hygiene & Tropical Medicine, United Kingdom
• Nuffield Centre for International Health and Development, University of Leeds, United Kingdom
• KarolinskaInstitutet, Sweden
• Swiss Tropical and Public Health Institute, University of Basel, Switzerland

CHEPSAA WEBSITE:

Suggested citation

Agyepong, I.A., Frimpong, E., Kwamie, A., Lehmann, U. and Gilson, L. (2015). Report on scoping of potential for developing Doctor of Public Health (DrPH) training for Sub-Saharan Africa (SSA). Accra: Consortium for Health Policy and Systems Analysis in Africa.

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Table of Contents

1. Introduction

1.1 CHEPSAA WP3 and relevance of scoping for PhD/DrPH

1.2 Rationale for focusing on scoping for DrPH in Health Leadership for Africa

2. Methodology

3. Findings

3.1 Existing DrPH programmes

3.2 Core competencies for a DrPH

4. Conclusions and way forward

Annex 1 – Summary of DrPH programmes reviewed

Annex 2 – ASPH Core Competencies for a DrPH

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1. Introduction

1.1 CHEPSAA WP3 and relevance of scoping for PhD/DrPH

Work package 3 of CHEPSAA focused on supporting sustained health policy and systems research and analysis (HPSR+A) capacity development in Africa by strengthening the focus and delivery of existing HPSR+A training programmes offered by African Consortium members. It had four sub-objectives, of which the third was to scope the potential for developing specialist HPS masters and PhD /DrPH training. This paper reports on the scoping for PhD /DrPH training.

The sustainability of African HPSR+A capacity requires the development of relevant African Education programmes. Targeted at researchers and policy makers, managers and policy advocates, these programmes seek to generate a sustained supply of researchers and a sustained demand for their research and analysis.

The CHEPSAA WP 3 coordination team aimed to scope the potential for development of doctoral level HPS related training in Africa - with an initial review of international experience with doctoral level HPS training, considering target audiences as well as the forms and substance of training provided (considering both PHD and DrPH training). The team began from recognition of two key sets of experiences identified through the African partners assets and needs’ assessment (undertaken within WP1) – that all African Consortium partners:

1)already offered some relevant training in HPSR+A at the time CHEPSAA began work, but none offered HPS research masters or HPS related PhD /DrPH training;

2)recognized the need to provide training programmes for those who would in future pursue both research and leadership careers, and to encourage individuals to move between the two career pathways;

Both the Doctor of Philosophy (PhD) in Public Health and the Doctor of Public Health (DrPH) degree programmes are doctoral level programmes. However, PhD training is typically aimed at graduates who focus their research in more defined public health sub-disciplinary specialization tracks such as epidemiology, health economics, health policy and systems, behavioural sciences etc. The PhD is aimed at those who desire advanced research positions in academia or similar settings. The DrPH on the other hand, is more broadly aimed at professional training designed to prepare individuals for evidence based public health leadership, including practice oriented research and field-based roles.

In this document we report on the scoping for a DrPH focused on Health Leadership for Africa.

1.2 Rationale for focusing on scoping for DrPH in Health Leadership for Africa

It is almost thirty years since the 1978 declaration of Alma Ata. Despite notable past and current successes in public health in developing countries such as the eradication of small pox and successful immunization programmes, health systems remain very fragile and many public health targets and challenges remain unattained or unresolved. Recent challenges like the Ebola epidemic in West African highlight this continuing fragility. The reasons are myriad but prominent among these factors are the lack of adequate human resources in terms of appropriate skills and numbers as well as severely under funded health systems. This problem is compounded by inadequate attention given to the strengthening of public health leadership through appropriate selection, training and long term mentoring and development. Indeed, public health leadership is crucial at all levels of the health system and in health research for operational as well as strategic analysis, policy development, program design and planning, monitoring and evaluation and health systems strengthening for effective service delivery. This can only be achieved through the appropriate selection, training and support through mentoring of public health leaders in developing countries.

Following the Alma Alta declaration of 1978, in the area of health systems strengthening much effort in sub Saharan Africa was put into capacity building through International Masters Programmes inPublic health training in the North and in the South. This helped to strengthen public health capacity in many parts of the developing world. A critical mass of public health professionals with MPH training has been built up and each year, more are trained. Over the years, in many countries, such staff have moved through the system from more operational managerial positions into key strategic management and policy positions in the health sector. The unspoken assumption appears to be that the years of service and experience will automatically provide the needed leadership and operational and strategic management skills. The years of service and experience are indeed critical and important. However, many of the skills required at operational and strategic leadership and management positions in public health cannot be assumed to have been automatically acquired by years of experience alone. There needs to be a deliberate and systematic effort to develop the skills through training, mentoring and the chance to apply the skills and theory and learn further by application. Effective leadership like any other skill needs to be built and nurtured in those who are expected to use them. A deliberate and systemized effort needs to be made to build the organizational capacity for effective strategic leadership and management at the middle and top levels of the health system and for research to promote health development across sub-Saharan Africa.

Tichy (1997)[1] suggests that “one of the major differences between winning (performing) organizations and losing (non performing) organizations is that winning organizations deliberately build leaders at all levels of the organizations and deliberately and strategically prepare the leaders of tomorrow today”.

The focus on scoping for a DrPH with a concentration in Health Leadership for Africa was to respond to these observations and needs by exploring the relevance of a formalized public health leadership training program for sub-Saharan Africa that is designed such that experienced and busy mid career professionals can still make the time to acquire the training to add to their experience to increase their leadership and strategic management effectiveness. Persistence through the program would lead finally to the award of a doctoral degree in public health leadership. The ability to eventually acquire a doctoral degree if the training and capacity building process is followed through is important since it will meet self esteem and self actualization needs, which are important in motivation to complete the process and to perform.

2. Methodology

An online search in Google was made to identify academic institutions offering the DrPH degree. When identified, the program website was searched for information on program characteristics such as vision, duration of the program, courses, competencies and entry requirements.

Selection was purposive based on availability of information on a program website. We also tried to make sure that we searched all regions of the world with the aim that if DrPHprogrammeswere available, at least three of the programmes (if there were as many as three and information was available on the internet)were reviewed. If there were less than 3, all were reviewed.

Based on an internet search, schools of Public Health that currently offer the DrPH degree were found located in the United States, the United Kingdom and Malaysia. None were found in sub-Saharan Africa. The United States had the most DrPHprogrammes, followed by Australia. There was one older established program in the University of Malaya Kuala Lumpur; and the Jeffery Cheah School of Medicine and Health Sciences was also starting a new DrPH program.

A non-exhaustivereview of some of the existing DrPHprogrammesworld-wide was done for the schools below.

United States

• University of North Carolina at Chapel Hill School of Public Health ( )
• Jiann-Ping Hsu College of Public Health at Georgia Southern University ( )
• Columbia University Mailman School of Public Health ( )
• Harvard School of Public Health
• Johns Hopkins Bloomberg School of Public Health ( )
• University of California, Berkeley (
• Boston University School of Public Health (

United Kingdom

• London School of Hygiene and Tropical Medicine ( )
• Brunel University, London. (

Malaysia

• University of Malaysia Kuala Lumpur (

Australia

• University of Sydney ( )
• Curtin University of Science and Technology ( )
• La Trobe University (

3. Findings

3.1 Existing DrPH programmes

The Doctor of Public Health (DrPH) is an advanced professional degree for those who intend to pursue or advance a professional practice career in health and for current leaders and future leaders in health systems. They face the particular challenge of understanding and adapting scientific knowledge in order to achieve health gain and results. This degree leads to a career in high-level administration, teaching, research or practice, where advanced analytical and conceptual capabilities are required. The DrPH program develops in its candidates all competencies included in MPH programmes, with increased emphasis on high-level skills in problem-solving and the application of public health concepts. The concept of the DrPH is not new. Currently there are several schools of Public Health that offer the DrPH degree located in the United States, the United Kingdom and some countries in Asia[2]. There are none in Africa. Annex 1 summarizes some of the program information available from the internet search.

Given that DrPH training is for public health professionals in active practice and who are expected to work primarily in public health practice with the training, many programmes – to varying degrees – try to create options for the flexibility to enable professionals to acquire the further training without taking extended periods of time away from professional public health practice. Approaches include using distance learning, having concentrated and therefore shortened periods of residence in the university for theory courses, and allowing part-time study. All programmes require a relevant doctoral research dissertation though in some cases e.g. the John Hopkins program, a specified number of publications in peer-reviewed journals clearly related and linked to a selected dissertation topic can be substituted for the doctoral dissertation. All programmes insist on candidates meeting the required institutional academic quality standards to merit a doctoral degree e.g. credit hours of course work, quality of doctoral dissertation, examinations etc. Mentors and academic supervisors are assigned as for any doctoral dissertation to support the trainees to carry out high quality work since the DrPH is a doctoral degree and must meet the competence levels of any doctoral degree.

Though the fundamental principle of training for the award of a doctoral degree for candidates who intend to use the degree in top-level professional public health practice was common to all the programmes, there was some diversity in the details of how different Schools of Public Health organize their programmes. Almost all the programmes provide information on what they offer on the internet through their websites. Since there is much similarity in principle across programmes, the review is not exhaustive.

Common to all the programmes were:

• The emphasis on professional doctoral level applied training and leadership in practice
• The requirement that candidates are already in or have been in middle and senior level professional public health practice positions and have some practical professional public health working experience before taking the degree
• The efforts to provide the flexibility for professionals who may find it hard to take extended periods of work for doctoral study and thus the use of approaches such as distance learning, crash courses that compress as many credit hours of academic work as possible into limited periods of time
• A doctoral dissertation
• The requirement of an MPH or its equivalent at entry or failing that the need to acquire core MPH credits in the course of the doctoral training

3.2 Core competencies for a DrPH

The Association of Schools of Public Health (ASPH) DrPH Steering Committee, draft Consensus Statement about DrPHprogrammes (ASPH 2009) states:

“There is consensus that ‘the basic public health degree is the master of public health (MPH), while the doctor of public health (DrPH) is offered for advanced training in public health leadership’[i]

ASPH embarked on an extensive and rigorous process between 2007 and 2009 to define core competencies for a DrPH. The working group consulted over 200 academic and practice participants, using a modified Delphi process to generate consensus and agreement on these guidance notes. The competencies were to guide students and educators on the core abilities recommended for doctoral level training in public health. The ASPH document groups the competencies into the domains of:

• Policy analysis, development and advocacy
• Communication
• Community /Cultural Orientation
• Leadership
• Management
• Professionalism and Ethics
• Systems Thinking

A brief description of each domain and details of the competencies under each domain as developed by ASPH can be found in Annex 2.

A study of these competencies confirms the close overlap between the competency areas for a DrPH; and the field of research and practice we refer to as Health Policy and Systems Analysis.

4. Conclusions and way forward

Given the lack of such a programme in Africa and its potential relevance in meeting known needs, we concluded that it was important to continue to explore the possibility of developing a DrPH Health Leadership for Africa.