Michael P. Johnson, MD, is deputy director of the Fogarty International Center at the National Institutes of Health (NIH). He is an expert on HIV/AIDS issues and has worked on both global and domestic projects, including positions as the U.S. Health and Human Services’ liaison to the President’s Emergency Plan for AIDS Relief (PEPFAR); the chief of party for the Centers for Disease Control and Prevention’s Caribbean Regional Office; and chief medical officer and director of the Division of Training and Technical Assistance for the Ryan White CARE Act.
John Donnelly interviewed Johnson Thursday in Bethesda, MD. Johnson had just returned from South Africa, where he took part in the launch of the Medical Education Partnership Initiative(MEPI), a $130 million program funded by PEPFAR and NIH to build research and clinical work at African medical schools. This is the fourth and final part of the “Research Frontlines” series that explores HIV research issues.
How will the Medical Education Partnership Initiative make a difference in research and medical education in Africa?
It’s very important to support African clinicians and researchers directly because they are closest to the problems and they see the problems on the frontlines. If a patient is not responding to a treatment for HIV or TB, they are going to be the first to recognize and be able to study the cause of the problem.
Through this program, African doctors are going to learn from each other and share clinical and research approaches to improving the care of their patients. There is no place on earth that has a greater shortage of doctors than in Africa. This program intends to train more doctors, and to help newly trained doctors have access to the best clinical knowledge. It will also help doctors to conduct applied research that is best suited to improving the care of their patients in ways that fit with local needs and resources.
With this new funding, what change do you think we’ll see – other than simply training more doctors and nurses?
An overall goal of PEPFAR is to train 140,000 new health workers. This MEPI initiative will make some dent in that number, but this is also about developing quality. We’ve already started this project by awarding grants to 13 African medical schools, and we’re already starting to see a change in the dynamics.
For one thing, the grant recipients (Principal Investigators, PIs) are African doctors. The PIs are no longer Americans – that is quite a shift. The African PIs are in the driver’s seat. The project also brings these African medical education leaders together to learn from each other and share ways to train doctors and conduct research in ways that directly respond to local health needs. We believe this will be very powerful.
It is apparent from the SAMSS study, led by Fitzhugh Mullen, Seble Frehywot (both of George Washington University), and Francis Omaswa (of the African Centre for Health Education and Social Transformation), that there is fantastic work already being done in many African medical schools. There are medical schools from Sudan to South Africa recruiting potential medical students from rural, impoverished locations, and conducting much of their training in rural locations. Sometimes they use cell phones for distance learning and patient care. These programs are showing that when medical students are recruited and trained this way, there’s a much higher likelihood of retention in those locations.
The core funding for MEPI comes from PEPFAR, so a focus of the programs is HIV/AIDS. But there is also NIH funding to the projects, and this expands the program past HIV/AIDS into issues such as training in child and maternal health, cancer, heart disease, mental health, and emergency medicine. This makes sense because you don’t go to medical school just to be an AIDS doctor, you go to be a doctor. The NIH funding also supports applied research, and this attracts the interest of many institutes and centers of NIH.
What makes you think this will be more than a spark and will catch on?
The grants are large and the projects are visible, because of this approach of providing the funds directly to the African PIs. In order to receive a grant, the recipients had to show that the most senior health and education officials in their countries are highly committed to its success. At the meeting this week in South Africa, you could see and hear the excitement on the part of the PIs to work together and share ideas in ways that they really haven’t had before.
Why haven’t they had that interaction?
They are isolated. They have not been able to share their successes – or their failures – with each other very often. If that doesn’t happen, they don’t learn from each other. Even methods of interaction that we take for granted, such as broad-band internet access, conference calling, and regular meetings, are limited. They are also doing their work with little in the way of financial resources.
In this project, they will post and receive information from a common website, have regular calls and meetings, and develop other ways to share their ideas and advances. And they will have back-up, input, and other support and training from partner schools in the U.S. We hope that by identifying measures of success, and sharing their results, they will develop a learning environment and a friendly competition by comparing things like the number of students recruited, number of trained doctors retained in-country, number of trained doctors practicing in rural areas, and the number of doctors conducting applied research on local problems. They will also develop and share measures of quality. This will not only be a ‘numbers game.’ We see this as developing a community of practice, driven by communication and networking. We’re really excited about this and believe it might show models of community-based medical training and research that are not only vital for Africa, but also that we could use right here in the U.S.