The DRC has experienced multiple disease outbreaks, including Ebola, Measles, Yellow Fever, and Marburg. Many of these outbreaks happen in rural areas and congested urban settlements. The 2018-2020 Ebola outbreak in the eastern part of the country and the 2020 COVID-19 pandemic highlight the need for a more comprehensive health system and a skilled One Health workforce to prepare, detect and respond to current and future public health emergencies.
With a low score of 2 out of 5, the Joint External Evaluation (JEE) conducted in 2018 highlighted limited capacity for a One Health workforce and a large disparity between rural and urban areas, with most of the trained and skilled personnel concentrated in populous urban regions. Following this evaluation, the National Workforce Development Plan 2019-2022 (Plan National de Development Sanitaire 2019-2022) highlighted the need for the country to improve the training, retention, and distribution of skilled workforce. In 2019, the country developed a National Action Plan for Health Security (NAPHS), outlining a roadmap to build country capacity to address priority gaps identified in the JEE. The need for a multidisciplinary workforce to tackle health challenges using a One Health approach was one of the key elements considered. It is therefore essential to incorporate One Health core competencies into higher education programs to align with this national plan and address these priorities.
Expanding the public health workforce in DRC: Established in 1987, with the support of USAID and in collaboration with Tulane University, the Kinshasa School of Public Health (KSPH) is the leading institution in training public health professionals in DRC. The school plays a critical role in developing public health leadership and has done this amidst limited resources.
The KSPH Master of Public Health (MPH) program is 15-months long and requires a thesis defense. The MPH program has five areas of focus: 1) Field Epidemiology and Laboratory Training Program (DRC – FELTP), 2) Health Economics (DRC- ECOSANTE), 3) Nutritional Epidemiology (DRC-EPINUT), 4) Health-Environment (DRC-ENVIRONNEMENT), 5) Community Health (DRC-SAPU). To date, KSPH has trained 1,450 MPH students (261 females/1189 males).
Due to challenging socio-economic status of the potential candidates for the program, USAID established an MPH scholarship program that has supported over 300 students as part of its program to strengthen human resources for health in the DRC. In 2020, USAID engaged AFROHUN and the OHW-NG consortium members to assist KSPH, an AFROHUN member institution, with administration of the scholarship program and integration of One Health into the program’s curriculum. This grant enabled the USAID country office to provide 60 scholarships for health professional development in DRC over two academic years, of 30 scholarships each.
The purpose of this paper is to share the success and results achieved to date about through this 2-year USAID support. AFROHUN aims at improving overall school management and integrating the One Health approach in their curricula with a gender-balance focus.
The first component of this work is to strengthen the MPH program administration. This involved establishing a formal partnership between KSPH, AFROHUN and the OHW-NG. A sub-award agreement was developed and is now being implemented. This is meant to pursue the capacity building of the KSPH to independently manage these processes in future with a large autonomy in the long-term.
The second component is the integration of One Health core competencies into the MPH curriculum. This process involved curation and assessment of the existing curriculum. One Health competency gaps essential to the MPH program were identified, and this informed the integration process. This is a major milestone in keeping the program relevant to emerging needs.
“The integration of One Health is the consideration of health in a global and integrated way, considering the interdependence between human, environmental and animal health, as well as the consideration of the community aspect of health problems.
KSPH admits students from various fields. The integration of this approach promotes experience sharing and the strengthening of the capacities of both professors and students. This experience will allow the country to have the human resources to manage public health emergencies in a global and interdisciplinary way,” – Professor Desire Mashinda Kulimba, Dean KSPH.
Outcomes
As a result of the integration of One Health, a standalone One Health module was developed and is now being taught across the KSPH. Students enrolled on the MPH program appreciate the One Health component and the teaching approach which fosters inter-disciplinary learning and sharing.
“Today with health problems we need a multidisciplinary approach, one which brings together many sectors in order to solve the problems efficiently. I think today for the current health problems, they can’t be resolved only by medical interventions. We need approaches which bring together several fields to find solutions. I think the example of the COVID-19 pandemic proved this very clearly,” said Rose Mubindukila – Community Health track and a molecular biologist.
“My predecessors who missed this working with other sectors they did not practice using social solutions or negotiating with several sectors. It makes us a better team lead. And, it is a whole career that is boosted,” Mimbula Mokalo Elie Caleb – community health track, medical doctor with National Program of Nutrition.
Bottom of Form“One Health has helped me to think in a different way, having a holistic view of issues, openly and widely. It has increased our ability to work in a team and when we
have many competences there is more help to solve problems. I think One Health gives us more opportunities. During the period of study, I saw that the concept of One health is very, very useful because it helps us to think differently and to see the world openly and widely also.”, Lobukulu Lolimo Genese, Medical Doctor in the Health Economics tack, and working with the KSPH as faculty.
While the program and the funding are helping build the necessary One Health competencies, it is also expanding capacity in terms of human resources for health numbers, a fact that is acknowledged by both KSPH management and the students.
“This funding has allowed the DRC to have more people trained and able to better understand health in different aspects. Thanks to this funding, we can count on a new generation of experts in Public Health (Epidemiology and Health Economics) with a better vision of global health and the health problems facing the country and the world”, says Professor Desire Mashinda Kulimba, Dean KSPH.
“Human resource is one among the resources that is important in the confronting health problems. I think the problems are there and the solutions are somewhere; when the human resource is available, you can find the competencies to go through the heath problems. Especially during the epidemics and outbreak that we are facing in our country, you know. And I think that’s what’s going on right now”, Lobukulu Lolimo Genese, Medical Doctor in the Health Economics tack, and working with the KSPH as faculty.
“Yes! really, it is going to improve the human resource capacity, but we have to make sure that those who study return to where they came from to put into practice on the ground the knowledge gained”, Mayala Masiala Viviane-medical doctor in the Health Economics track and working with the KSPH Department of Management.
The financial aid through the scholarship program has made it possible for many otherwise financially constrained Congolese professionals, especially in the public sector to access the MPH program. This has been hailed as a game changer in their professional lives.
“It was complicated. I was telling myself that if I get the admission and no scholarship, I would have to wait for another year. I would like to use this opportunity to thank our financial partners because this training was well-funded, we are well fed and accommodated. It helps to focus I managed to get a Distinction this semester. I hope to continue with an average of above 70 %”, Mayala Masiala Viviane-medical doctor in the Home Economics track working with KSPH in the department of Management.
“If I had to pay for myself, I would have needed a lot of personal savings…. I would not be concentrating like now as a residential student. I would have, like my predecessors, taken a bank loan, been non-resident, because that cuts off half the fees. With all the financial risks that come with borrowing in our low-income country”, Mimbula Mokalo Elie Caleb – community health track, medical doctor with National Program of Nutrition.
“We should encourage women to appIy. lt is not easy when one has children and other commitments at home to take on such trainings. But if the woman has the will and determination, it is possible to make it. This opportunity was good because it took good care of us. Me, I am married since 3 years ago and I have a child of 2 years but I have the determination to study. Even when you are in class there are (people at home) calling you. But you have to have the will to continue,” Mayala Masiala Viviane-medical doctor in the Home Economics track working with KSPH in the department of Management.
“Special attention needs to be focused on gender and targeting the stakeholders in the provinces in the hinterland of the country”, Professor Desire Mashinda – Kulimba.
The KSPH has therefore identified gender as an area that requires urgent attention. A gender gap study has been conducted to identify factors that are hindering women professionals to apply for the MPH and subsequently benefit from the scholarship program. A dissemination meeting that will bring together key stakeholders in this area is being planned to share the key findings and discuss viable interventions to address the challenge.
Sustainability of the scholarship gains will require support from the government as Prof. Mashinda points out. He notes that although the number of scholarship beneficiaries is still low in relation to the country’s human resource needs, it is not insignificant. He advocates for increased focus by the government authorities and university leadership in exploring other funding options. KSPH has made its infrastructure and staff resources available to the program. “The Congolese national government should contribute to the training of professionals by supporting the scholarships and administrative costs of KSPH. KSPH is also looking for other potential funding partners for the scholarships.”
It has only been a few years, but efforts put in strengthening the delivery of the MPH program and the management of the scholarship program, are paying off. Successes so far registered need to be sustained by continuous improvement and diversifying funding sources for the scholarship to bring more deserving Congolese on board.