LETTERS
Accessible public-health education: a potential growth area?
David SandersI; David GuwatuddeII, 1; Lucy AlexanderI
ISchool of Public Health, University of the Western Cape, Cape Town, South Africa
IIDepartment of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda
We were pleased to see that the December 2007 issue of the Bulletin of the World Health Organization featured the important topic of public-health education. In particular, we welcome the attention given to the urgent priority of producing public-health professionals in Africa, a somewhat neglected aspect of the continent's documented health human resource crisis.1
We would like to augment the interesting - if challenging - information presented from the AfriHealth study, which reports on data collected between late 2001 and mid-2003. In particular, we would like to report on subsequent successful developments in distance-learning, which IJsselmuiden et al. note as "... rare, as is on-the-job ... training".1
Since 2000, the School of Public Health (SOPH) at the University of the Western Cape in South Africa has provided three levels of postgraduate public-health training (Table 1) through a combination of home-produced text-led distance learning materials and optional in-class instruction. Similarly, Makerere University's School of Public Health (MUSPH) in Uganda has been providing in-class public-health training at Masters Degree level since 1994, which was later supplemented with a home-produced text-led distance learning option starting in 2004. In addition to an early collaboration between SOPH and Flinders University in southern Australia in developing a distance learning programme, SOPH and MUSHP have more recently developed a collaborative relationship to further develop their distance learning programmes.
SOPH now ofers 22 courses by distance learning, whereas MUSPH ofers 21 courses through the in-class option, as well as through the distance learning option. Te courses ofered at the two schools cover themes such as health research, quantitative and qualitative methods, health systems and information management, health promotion, health human resources, maternal and child health and nutrition, and communicable and non-communicable diseases. Materials are written in an activity-led interactive format and applied to common practical problems frequently encountered by managers and practitioners.
Since commencement of the distance learning option, SOPH's reach into Africa has expanded dramati-cally, with almost 300 students from 15 countries now enrolled and able to undertake studies without having to leave their job or country. Completion rates at SOPH have improved dramati-cally since 2004 as systems problems are ironed out and the experience base grows. Completion for all students who should have completed the training programmes by the end of 2007 stood at 57% (n = 234] for the Postgraduate Certifcate in Public Health (Table 1), 72% (n = 260) for the Postgraduate Diploma in Public Health, and 57% (n = 120) for the Masters in Public Health. Tese completion rates must be viewed in light of the fact that they have been calculated as the proportion of students who had completed the qualifcation by the end of 2007, rela-tive to the number of students expected to have completed the qualifcation by that time. While some of these students who have not yet completed may indeed drop out, our experience is that they constitute a minority.
At MUSPH where the distance learning option started in 2004, the stu-dent body now stands at approximately 170, based primarily within the east African region, but with the potential to reach further into Africa. Te frst cohort of 49 students admitted in 2004 should all have completed by the end of 2007. Seven students (17%) were able to complete on time, and most of the remaining 35 students are currently in their fnal stages of completion. Te rest of the students enrolled after 2004 have not yet reached completion for this 3-year training programme. Te overall dropout rate by end of 2007 stood at 9.3%. Tis is much lower than the expected 40% dropout rate that has been documented through research, as being characteristic of distance learn-ing programmes.2
Key to the success of the distance learning programmes at SOPH and MUSPH is the opportunity for health professionals to study at Masters level while remaining in post. Tis is es-sential to reducing the cost of study for mature working professionals, as well as sustaining the health services. In addition, the programmes ofered at the two schools have remained respon-sive to the students' learning context needs by retaining a text-led mode of distance learning amidst strong pres-sure to switch to web-based learning. Surveys we have conducted indicate that only about 30% of our students are able to access the internet reliably for lengthy periods, making web-led learning at this stage possible for only a minority of African health and allied professionals. Te web, however, remains a valuable support mechanism for our programmes, and its potential is regularly trialled and monitored and will be more fully developed when the context allows. So far SOPH has been able to ofer two electives as CD-based options and one as a web-based course for those who have such access.
Te programmes at the two schools are, we believe, innovative in several ways: the multidisciplinary cur-ricula cater for a wide range of health professionals working at diferent levels of the public-health system; as far as possible, they are open-learning systems, allowing students to proceed at their own pace according to the time they have available. Te development of applied research skills is given high priority, as is public-health professional development involving students in exploring a wide range of transformative strategies to address key problems facing public-health services in a developing country context. Aside from the pressure of combining work and study, students gain considerably from this pedagogical model, which facilitates the immediate application of theoretical concepts and models to their situations in the work arena.3-5
We believe that the only way in which Africa (and indeed other "developing" continents) can successfully address the human resource crisis, especially in public health, is by dramatically expanding access while simultaneously preserving quality service provision. Financially accessible distance learning provision, applied to practical public-health problems, ofers such a possibility. 
References
1. IJsselmuiden CB. Nchinda TC, Duale S, Tumwesigye NM, Serwadda D. Mapping Africa's advanced public health education capacity: the AfriHealth project. Bull World Health Organ 2007;85:914-22. PMID:18278250 doi:10.2471/BLT.07.045526
2. Potashnik M, Capper J. Distance education: growth and diversity. Finance Dev 1998:42-5.
3. Sanders D. Education and training in public health. Cape Town: University of the Western Cape PHP; 2000.
4. Alexander L. Report of an evaluation of Eastern Cape students' experiences of the SOPH postgraduate programme in public health, University of the Western Cape 2000-2003. Cape Town: University of the Western Cape SOPH;2006.
5. Sanders D, Chopra M, Lehmann U, Heywood A. Meeting the challenge of health for all through public health education: some responses from the University of the Western Cape. S Afr Med J 2001;91:823-9. PMID:11732451
1 Correspondence to David Guwatudde (e-mail: dguwatudde@muwrp.org).