The need for more medical schools in medically underserved regions in Africa

Africa struggles with the double burden of disease, bearing the highest disease burden in the world and also having the most severe health workforce shortage. Only four countries on the continent meet the WHO-recommended density of 4.45 health workers per 1000 people. This physician shortage has been attributed to a variety of factors including shortfalls in medical education and medical schools' capacities. This commentary aims to reveal the gap and ‘underrated’ problem of inadequate medical schools and poor utilization of existing ones. Recommended solutions calling for the need for urgent improvement in medical education in Africa are highlighted in the paper.

contrast to Asia and Europe, Africa also has an unequal distribution of ites few medical schools. Despite having the fewest schools in the region, Southern Africa's schools per million inhabitants at 0.21 is higher than that of Central Africa and Western Africa (Table 1). Further disparities in distribution exist within these regions. For example, only one medical school can be found in each of the seven West African nations (Guinea, Liberia, Mali, Niger, Sierra Leone, Burkina Faso, and Togo), whereas 45 medical schools are located in Nigeria alone [10,11]. A total of 18 countries in the continent have just one medical school. However, in two of these countries-Seychelles and Namibia-the number of health workers is above the WHO-recommended density owing to the small population. This may imply that they need only one medical school to produce sufficient physicians to cater for the nation. This is not the case for other countries with one or more medical schools, such as Madagascar, Malawi, Togo, Benin, South Sudan, Chad, Central African Republic, and Niger, where the ratio of medical schools per million inhabitants ranges between 0.05 and 0.2. Less than 0.5 health workers per 1000 people are present in these countries [4,10,11].
Addressing the problem of limited and uneven distribution of medical schools in Africa is critical to improving physician supply. The establishment of medical schools in these areas is crucial, but it can be challenging and expensive. To reduce the cost, the existing medical schools should increase their capacities by the creation of annex campuses [12]. To accommodate for the increase in medical students, the government can invest in building more teaching hospitals and upgrading private and non-governmental organizations owned health facilities into teaching hospitals. For instance, the best performing district hospitals in Burkina Faso could be upgraded into teaching hospitals awarding medical degrees. Government can increase these hospitals' capacities and convert them into teaching hospitals where students from branch campuses can receive training. In addition to the quantity and capacity of medical schools, it is essential to consider the quality of education. Therefore, collaboration with foreign medical schools and medical research groups through exchange programs should be considered as well. Such collaboration could be advantageous for both parties as students experience the practices of medicine in different cultures. Furthermore, this allows medical students in Africa access to the latest knowledge and best medicine practices.
Another crucial step is to review the admission criteria into medical schools. The majority of schools in Africa only select students based on their cognitive skills in science subjects [13]. As medicine is as much an art as it is a science, a high degree of cognitive ability in sciences and humanities combined with considerable components of psychosocial competency is required for successful completion of medical school and subsequent transformation into a compassionate healthcare provider. These African institutions should consider a more holistic approach and prioritize non-cognitive factors such as conducting personality tests (like Myers-Briggs Personality Test), interpersonal skills, and leadership potential to choose candidates who can successfully develop into competent well-rounded physicians. Besides, integrating medical students in clinical years into the community through more structured and longer community medicine rotations can reduce the workload on the limited health workforce in local communities while also providing more space in teaching hospitals to accommodate more students. This will sharpen their skills in diagnosing common medical conditions rather than spending more time observing sophisticated procedures in teaching hospitals. Finally, the utilization of cutting-edge technology in medical education, including telemedicine, virtual reality, robotic mannequins, and artificial intelligence, will raise the quality of education and open up opportunities for distance or remote learning.
In conclusion, it is worrisome that despite the shortage of medical doctors in Africa, the continent also suffers from inadequate or underutilized medical schools. This is a call to action for the government, private organizations, non-governmental organizations, and major stakeholders to improve medical education in African nations to produce more qualified doctors in an effort to uplift Africa's healthcare system and reduce health inequalities.

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The authors have no competing interest to declare.

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Author contribution
AOB conceptualized the manuscript. FOB, NME, MSK and PB drafted the manuscript. AOB and FOB reviewed the manuscript. All authors approved the manuscript for submission.

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Declaration of competing interest
Authors declare no conflict of interest.  Regions and the ratio of population to medical schools [10,11].