Developing excellence in biostatistics leadership, training and science in Africa: How the Sub-Saharan Africa Consortium for Advanced Biostatistics (SSACAB) training unites expertise to deliver excellence

The increase in health research in sub-Saharan Africa (SSA) has led to a high demand for biostatisticians to develop study designs, contribute and apply statistical methods in data analyses. Initiatives exist to address the dearth in statistical capacity and lack of local biostatisticians in SSA health projects. The Sub-Saharan African Consortium for Advanced Biostatistics (SSACAB) led by African institutions was initiated to improve biostatistical capacity according to the needs identified by African institutions, through collaborative masters and doctoral training in biostatistics. SACCAB has created a critical mass of biostatisticians and a network of institutions over the last five years and has strengthened biostatistics resources and capacity for health research studies in SSA. SSACAB comprises 11 universities and four research institutions which are supported by four European universities. In 2015, only four universities had established Masters programmes in biostatistics and SSACAB supported the remaining seven to develop Masters programmes. In 2019 the University of the Witwatersrand became the first African institution to gain Royal Statistical Society accreditation for a Biostatistics Masters programme. A total of 150 fellows have been awarded scholarships to date of which 123 are Masters fellowships (41 female) of whom 58 have already graduated. Graduates have been employed in African academic (19) and research (15) institutions and 10 have enrolled for PhD studies. A total of 27 (10 female) PhD fellowships have been awarded; 4 of them are due to graduate by 2020. To date, SSACAB Masters and PhD students have published 17 and 31 peer-reviewed articles, respectively. SSACAB has also facilitated well-attended conferences, face-to-face and online short courses. Pooling of limited biostatistics resources in SSA combined with co-funding from external partners has shown to be an effective strategy for the development and teaching of advanced biostatistics methods, supervision and mentoring of PhD candidates.


Introduction
Biomedical research plays a key role in strengthening health systems, identifying and addressing health needs, and in improving health through building a local evidence base which helps to inform policy and practice (Agnandji et al., 2012;Franzen et al., 2017). The data generation from donor-funded health sciences research initiatives has increased in the past decade, which has been matched by increased governmental funding for healthcare from most African countries (Gezmu et al., 2011). However, in sub-Saharan Africa (SSA) there is a dearth in statistical capacity to analyse the vast amounts of research and routinely collected patient data (Cole et al., 2014;Thomson et al., 2016). Biostatisticians (biomedical methodologists) in the region are required in particular at universities, research institutions, governmental institutions, industrial settings and pharmaceutical companies; hence, there is a great demand for well-trained biostatisticians. However, there has been limited support to enhance the expansion of biostatistics at tertiary institutions. Moreover, the current pool of biostatisticians is too small to sufficiently provide the much needed statistical support and lead statistical research/methodological development in SSA (Gezmu et al., 2011;Machekano et al., 2015).
With the increasing availability of data resources such as routinely collected health data and publicly available data in addition to the increased focus in data science to guide evidence-based policies, an increased mass of biostatisticians is needed to analyse these data (Fegan et al., 2011). Training biostatisticians abroad is expensive, and many biostatisticians who undertake advanced training in foreign countries do not return. However, to date, in SSA the number of institutions offering biostatistics programs to build the critical mass to fill the urgent need for biostatisticians is limited, especially for post-graduate training (Esterhuizen et al., 2019;Machekano et al., 2016;Thomson et al., 2016). Furthermore, the statistics departments offering such training need to be linked to research institutions to ensure students have a practical understanding of the clinical and scientific context of the data they analyse (Turner et al., 2016) and to provide job opportunities and career pathways for their graduates.
As much as the Sub-Saharan Consortium of Advanced Biostatistics (SSACAB) was established to empower biostatisticians in this era of evidence-based health management and policy formulation, the consortium complements other currently existing initiatives that offer training in mathematics, biology, physics, economics, statistics, and epidemiology but in a much more structured and integrated manner. Several initiatives exist in SSA, but most of these initiatives focus on capacity building in disciplines other than biostatistics (Ezeh et al., 2010). Moreover, these initiatives rely on biostatisticians to fully meet their deliverables which shows the importance of biostatisticians in the current times. Some of these initiatives are highlighted in Box 1.

Box 1. Examples of the research capacity initiatives in sub-Saharan Africa
• Mathematics in South Africa (MASAMU) Program at Auburn University (funded by the National Science Foundation (NSF)) (https://www.masamu.auburn.edu/). The MASAMU overall objective is to enhance research in the mathematical sciences within the Southern Africa Mathematical Sciences Association (SAMSA) institutions; • African Institute for Mathematical Sciences (AIMS) with six centres of excellence across Africa, in Ghana, Cameroon, Senegal, Tanzania, and Rwanda, and South Africa (https:// aims.ac.za/); • South African Centre for Epidemiological Modelling and Analysis (SACEMA) (http://www.sacema.org/); • Consortium of Advanced Research Training in Africa (CARTA) (http://cartafrica.org/);

Pooling of limited resources for advanced biostatistics training
North-South collaboration between high-income countries and low-and middle-income countries (LMIC) can help to transfer knowledge and skills to develop biostatistical capacity, retain skilled graduates, and increase research output

Amendments from Version 1
The major differences between this version of the article and the previously published version are that we have rephrased some sentences in the original document to make it clearer. We have corrected several and added sections of the manuscript in response to the reviewers' comments. Particularly, we have added: A section which describes challenges faces by SSACAB in the discussion Added the selection criteria of the 11 SSACAB partner institutions General editing of some statements in the abstract and introduction to make the manuscripts clearer Any further responses from the reviewers can be found at the end of the article REVISED (Franzen et al., 2017;Kellerman et al., 2012;Nachega et al., 2012;Uthman et al., 2015). Since 2010, regional meetings have explored ways to improve South-South collaboration in biostatistics to pool resources and build training capacity (Machekano et al., 2015). The funding of the SSACAB programme by the Wellcome Trust under the Developing Excellence in Leadership, Training and Science in Africa Scheme (DELTAS) provided the opportunity to initiate South-South collaborations in biostatistics training and ensured a well-coordinated advanced training in biostatistics. This was done to build a critical mass for research and biostatistics leadership. The SSACAB programme aims to develop and improve skills among health researchers and academics in Africa as well as grow the biostatistics discipline in the region through Masters and PhD level training. SSACAB aims to create nodes of biostatistical excellence, which train public health researchers with advanced skills and expertise in biostatistics; and to provide a sustainable career path for African statisticians.

The Sub-Saharan Africa Consortium for Advanced Biostatistics programme
SSACAB comprises 11 African universities in nine countries ( Figure 1 top map) with interest in developing biostatistics degrees, four research institutions and four Northern partners.
The SSACAB (see Table 1 for a full list of SSACAB partners) aims to address three major objectives: Development, strengthening and implementation of biostatistics Masters level training Each partner institution developed its curriculum for a Masters programme in biostatistics fitting within the local teaching capacity at each institution, and the regulations for Masters level training in each country. The Northern partners supported the development of specific modules and short courses that would benefit students and academic staff. SSACAB funds included support for administrative work on the program and fellowships for a total of 90 biostatistics students across the 11 institutions. SSACAB leadership reviewed the curriculum at each institution to ensure a basic minimum required for high-quality programmes in the region which could attract highly competent students. Further, to provide comparable standards across the courses, SSACAB aimed to work towards accreditation of the courses from the Royal Statistical Society of the UK. Providing PhD level training to develop expertise, skills, and become research leaders in biostatistics in Africa The objective for building sustainable networks for biostatisticians envisaged close collaboration between academic training courses and the research institutions that undertake medical research. For high-quality cutting edge research questions and application of the advanced biostatistical methodology, co-supervision from members of both institutions was essential. This often starts with students planning a masters research project located within one of the research institutions. Such students can build a pipeline into PhD training, although to date it was mostly possible for fellows to join at the PhD level having trained elsewhere.
Building a sustainable network of biostatisticians and statistically informed researchers within each country through outreach, mentoring and transferring skills, workshops and conferences The third objective look towards the long-term impact of SSACAB based on the pillars illustrated in Figure 2. Integrating SSACAB meetings with national and regional statistical societies meetings allowed for greater synergy to encouraged biostatistics students and staff from SSACAB to take a role in the leadership and management of biostatistics societies. It also encouraged members to participate in meetings to present their work and network with colleagues. Apart from sharing biostatistical knowledge and scientifically sound research output, the networks provide a quality check for programmes, statistical analyses and manuscripts in preparation for submission.

Impact of SSACAB
To allow a smooth flow of the implementation and coordination of the SSACAB programme, one or two representative institutions from a given country based on evidence of biostatistics research and training were selected to join the programme. However, candidates to benefit from the SSACAB could come from any institution and country across the SSA region. Of the 11 African universities partnering in SSACAB, four had developed a Masters level program in Biostatistics before the start of SSACAB in 2015 (Table 2). Within five years of SSACAB's existence, all remaining universities have developed and started teaching Masters in Biostatistics programmes with assistance from SSACAB.   The University of the Witwatersrand gained Royal Statistical Society accreditation in 2019, the first African university to do so. The development of all programmes has involved national accreditation and higher education institutions approval for Masters level training, which requires a commitment from the university for the appointment of lecturers and professors with appropriate biostatistics qualifications and expertise. SSACAB has also enabled external support to the programs in developing Masters level modules like infectious disease modelling, Bayesian modelling and spatial modelling which are universal across all the institutions; and provides assistance to teach these modules. This involved Northern partners from SSACAB as well as from within other SSACAB institutions, who teach alongside the local faculty staff at institutions to build the institutional capacity to develop and deliver new courses and modules.
A total of 150 fellows have been awarded scholarships to date from 14 different countries in SSA ( Figure 3). Since the inception of the SSACAB in 2016, a total of 123 Masters have been awarded a fellowship as of 2019 (Table 3).
The Masters students in the 11 SSACAB partner institutions are taught over a range of modules shown in Table 4 with the teaching models varying by institutions. Most Masters courses have an initial biostatistical foundation course, which is also available to Masters students following other disciplines, including Medical Officers on residency for MMED degrees (Table 4). This facilitates new ways to enhance the basic statistical applications available to medical doctors and other health professionals in their studies. In general, a Masters student takes theoretical modules which are taught in class, conducts a research project as part of a research internship and engages in statistical consultancy before graduating within two years.
The value of the Masters programmes is reflected in the further professional development of the students following graduation and the outputs from their studies (Table 5). Of the 123 Masters students enrolled, 41 students have graduated in 2019, 19 students have been employed in African academic institutions while 15 students are working in African research institutions. Thirteen Masters graduates have been enrolled in PhD programmes. Two of students who have graduated have been employed in the government ministries. Although the number is currently low, the programme is expected to contribute to government institutions with time. To date, 17 Masters students have been able to publish their research in a peer-reviewed journal.
Initially, the SSACAB had planned to award fellowships to 15 PhD students; with support from several co-funders by the end of 2019, a total of 27 (10 of which were female) PhD students have been awarded fellowships (Table 3). The data (SEARCH) project has supported an additional two PhD students at the Kilimanjaro Christian Medical College (KCMUCO) and four at the University of Zambia (UNZA), while a capacity-building grant from Glaxo Smith Kline (GSK) has supported a further six PhD students (two at the University of Witwatersrand (WITS), two at the University of KwaZulu Natal (UKZN), one at Stellenbosch University (SU) and one at the University of Nairobi (UoN). Additional funding has been provided by the German Academic Exchange Service (DAAD) for Masters fellowships in biostatistics. Additionally, other research projects have paid for their University of Malawi (UNIMA ) 10 (4) 15 (3) 10 (3) 10 (3) ----- Stellenbosch University (SU) 13(12) University of Namibia (UNAM) University of Nairobi (UoN) Makerere University (Mak) 23 (20) - PhDs, external examination of courses and research reports as well as sharing curricula, thereby increasing the visibility of the consortium and improving quality of the Masters and PhD programmes. Four of the PhD students are due to graduate by 2020. There are currently 31 peer-reviewed publications from PhD fellows and a further two from staff supported by SSACAB (Table 6).
SSACAB has also partially supported other PhD students enrolled in partner institutions with their manuscript publication fees in peer-reviewed open journals. Furthermore, staff members within SSACAB have also been supported in publishing their research work and in presenting their work at international conferences. This partial support of staff and student research has resulted in approximately 10 publications. Such meetings integration with IBS have been done to support quality education and state of the art biostatistical methodology within SSACAB. Local research institutes within SSACAB have supported students through hosting students during their research period. Masters and PhD students have been supported with data generated by these research institutes for their dissertation and thesis reports. Moreover, the students have also had the opportunity to interact with research experts in other public health fields. Collaboration between academic universities and the local research institutions enable joint supervision of students, providing greater insight into the statistical issues that need to be considered when handling research data.

Discussion
The SSACAB's ultimate goal was to create a research node of excellence (scientific citizenship) through contributions to science, policy and practice; growing the biostatistics discipline and nurture upcoming researchers with advanced skills and expertise (research training). The SSACAB goals are well intertwined within the DELTAS Africa strategic areas in health. The SSACAB programme initiative specifically benefits the African continent in terms of expanding the biostatistical capacity based on the needs identified by African institutions.
The SSACAB initiative came at a time when the global focus has shifted towards novel data analysis concepts, including big data analysis to support evidence-based health sciences. Over time, the SSACAB programme has accommodated these new methods through advanced biostatistics teaching modules addressing big data analysis challenges and by increasing the number of partner institutions that can provide biostatistical training. This is a positive stride towards achieving greater coverage of biostatisticians across Africa and in widening the scope for new biostatisticians working on cutting edge analyses. At the inception of the programme, only four institutions had an established Masters programme in biostatistics. Through the SSACAB, a professional research environment has been provided to institutions to facilitate their biostatistical research and ensure high-quality post-graduate degree training. This SSACAB support has ensured that biostatistics researchers are given adequate resources and mentorship to develop their interests in statistical concepts and methods.
The SSACAB consortium has achieved its research training goals as many Masters and PhD students have been awarded fellowships andthe timely graduation of these students for both Masters and PhD programmes. The research training has allowed the fellows to strengthen their professional development and provides a career pathway through progression to PhD level and postdoctoral training; and employment in leading academic and research institutions. Several of these trained statisticians are now working within various entities in the Ministry of Health, other government agencies and non-governmental organisations (NGOs) in different SSA countries. Such involvement of biostatisticians in government structures supports evidence-based policy and planning. Mentorship and building of biostatistics research leadership are important to consolidate this initial impact further and make a lasting contribution to health research in SSA. The diversity of courses offered, ranging from theoretical statistics to applied epidemiology could be viewed as one of the strengths of the SSACAB consortium since this provides a wide diversity of career options to students to choose from.
Scientific citizenship in the African context has been facilitated in several ways. Firstly, the SSACAB Masters and PhD fellows across all the 11 partner institutions have to date produced 44 peer-reviewed scholarly publications addressing major health issues in SSA. These publications are a measure of how upcoming researchers are nurtured in the biostatistics programme to produce high-quality research to inform policy and practice in the African context and beyond. Secondly, fellows shared these research outputs through other platforms to ensure that the research findings are disseminated to peers and policymakers in Africa. At the same time, public engagement and awareness have been supported through press, social media platforms and community activities to increase the uptake of new health research findings regionally and beyond. In other words, the impact of SSACAB has not been limited to offering awards to post-graduates but has been felt in the generation of high-quality research to inform policy in SSA. There were research presentations at the AAS Conference in Senegal and female genital mutilation (FGM) work presented to the United Nations. Globally, SSACAB work has been presented at the 61st Session of the World Congress of the International Statistical Institute (ISI) in Morocco and the 62nd ISI World Statistics Congress 2019 (ISIWSC 2019) in Malaysia.
Collaborative research supervision through South-South and North-South partnership is an important component of the success and has significantly impacted on the quality of teaching and research supervision. Senior statisticians from well-resourced universities have assisted with teaching courses and supervision of graduate research projects. Research institutions have supported research internship and attachments through the provision of data generated in these research institutions. This has strengthened the research capacity of the students and opens up more opportunities for upcoming biostatisticians as they would interact with senior researchers and experts in various public health fields (Bates et al., 2006). These internships and attachments have also provided an opportunity for fellows to engage with health research studies of direct policy significance. This is an important stride accomplished by SSACAB as a future generation of researchers is being shaped to become professionals who will take part in shaping and driving the locally relevant health research agenda which will contribute to the improvement and development of health in Africa (Thabane et al., 2008).
Another crucial highlight within the SSACAB programme has been the spin-off of academic appointments at collaborating institutions as well as the involvement of staff from various institutions as external examiners for structured modules and research reports in other institutions. Such inter-institutional collaboration and involvement of staff opened a platform of content sharing and networking; hence, strengthening the biostatistics programmes at the same time maintaining the quality of the deliverables. Not only has biostatistics been offered to post-graduate students (Masters and PhD) but there has been a promotion of biostatistics to undergraduate students by seasoned researchers within the consortium through research mentorship and consultations.
Most of the substantial achievement of the SSACAB has been attained with modest financial means. The partner institutions pooled limited resources for joint teaching, which resulted in the development of advanced modules being taught in Masters programmes. Many institutions have also obtained funding from other sources which resulted in additional enrolment of students while maintaining the quality of the students' output at these institutions. These initiatives lay the foundation for the long-term sustainability of the programme to run beyond the official funding phase of SSACAB.

SSACAB challenges
SSACAB challenges included different criteria for Masters students' enrolment and fellowship awards. This approach might have contributed to the delayed graduation of some Masters fellows. The variations in the quality of undergraduate statistics training feeding into the Masters programme could have affected the quality of Masters graduates. This same challenge was also observed in the Masters students enrolled for PhD. In instances where the Masters students lacked fundamental theory, the PhD students were encouraged to take Masters courses offered at their host institutions. The shortage of academic teaching staff has hindered smooth delivery of teaching at some institutions. While visiting staff would relieve the burden and provide new teaching perspectives; however, this is more expensive compared to having permanent academic staff. This is one of the challenges that SSACAB graduates can help to remedy. Timely financial reporting has been a challenge in some institutions, which lack the experienced staff to administer and report funds. To familiarise financial managers with the reporting structures and grant conditions for the Alliance for Accelerating Excellence in Science in Africa (AESA)/Wellcome Trust, SSACAB facilitated a workshop in South Africa in 2017 and Nairobi, Kenya in 2018. This realigned the SSACAB programme to meet the expectations of researchers, partners and funders for future collaborative activities.

Conclusion
In the five years, the SSACAB has made tremendous progress in the growth of biostatistics capacity and resources in the SSA region. Now, more than ever there is great awareness and uptake of local biostatisticians into health progress, in addition to an increase in peer-reviewed publications by biostatisticians in the region. The programme has nurtured upcoming researchers with advanced skills and expertise, and create a research node of excellence. Significant strides have been made for each aspect: the enrolment of fellows has surpassed expectation, the Masters programmes are becoming recognised for their excellence, and professional biostatistical networks are flourishing. These achievements need to be consolidated with a career pathway for biostatisticians and data professionals within the health research community.

Sylvia Kiwuwa-Muyingo
African Population and Health Research Center, Nairobi, Kenya The rationale for the open letter is very clear and addresses a critical need to enhance biostatistical capacity on the African continent. The Sub-Saharan African consortium for advanced biostatistics aim was to develop capacity of masters level training in biostatistics; secondly provide expertise skill to becoming a research leader in biostatistics at PhD level through collaborations between academic and research institutions; and build a network of biostatisticians within each country.

Does the article adequately reference differing views and opinions?
While the article clearly addresses a challenge that is very pertinent to demand for biostatisticians in the region, I think it might benefit from addressing a broader view of the career choices for students that have since transitioned to be employed in academia or research institutions and beyond, say mentorship on what to do when the PhD is finished? It is clear most students would like an academic job, which is not easy in the first few years but preferably in the University where they studied so they might opt for a postdoc/position to consolidate their research but there are few flexible postdoc positions.
In fact the lack of awareness of career pathways for biostatisticians might imply many opt to remain in academia or research institutions. There are a lot more flexible opportunities for the semi-academic route such as service statisticians in public health organisations to provide statistical support to other disciplines. Another is the business route for the growing number in consulting, industry, financial institutions. The downside of these organizations is the lack of independence and bureaucracy. The discussion about other possibilities and the fellows awareness in those areas might be helpful to the reader.
Where applicable, are recommendations and next steps explained clearly for others to follow? Beyond integration of SSACAB within existing statistical organisations is the need to recognize that society operates in a nested system in which individuals exist within communities which then contribute to national and regional entities. This plan could highlight the interaction with different actors at each or high level including social, economic and policy actors to effect policy change or practice beyond integration with existing statistical organisations.
Another key challenge for many researchers especially that might be addressed in future plans for biostatistics is the need for "research communication" -a critical skill for communicating research findings to the public and for seeking funding. While publications are top of the list, a lot more is required to communicate good science. It is not very clear from the article if/how communicationvery essential for fellows -contributes to informing policy and practice .

Does the article adequately reference differing views and opinions? Partly
Are all factual statements correct, and are statements and arguments made adequately supported by citations? Yes

Is the Open Letter written in accessible language? Yes
Where applicable, are recommendations and next steps explained clearly for others to follow? Partly

Does the article adequately reference differing views and opinions? Partly
Are all factual statements correct, and are statements and arguments made adequately supported by citations? Partly

Is the Open Letter written in accessible language? Partly
Where applicable, are recommendations and next steps explained clearly for others to follow? Partly training and subsequently, into Ph.D. training. The success in the development of biostatistics research excellence (at MSc/Ph.D.), in part and largely, depends on a solid foundation at the BSc level. A statement on the quality of undergraduate biostatistics/statistics training at the various participating institutions will be useful in highlighting the successes and/or challenges in attracting talent to the biostatics profession as well as the sustainability of the initiative. Additionally, the authors need to comment on efforts made, if any, to support the development of statistical training curricula at the undergraduate level.
The letter should include a section dedicated to the challenges that have been faced in the initiative to develop and nurture biostatistics. Future initiatives would build on addressing these alongside strengthening the existing successes described in the letter.

Does the article adequately reference differing views and opinions? Partly
Are all factual statements correct, and are statements and arguments made adequately supported by citations? Yes

Is the Open Letter written in accessible language? Yes
Where applicable, are recommendations and next steps explained clearly for others to follow? Partly Thank you very much for having time to review our manuscript. We have revised our manuscript faithfully following your suggestions. Below are some responses to some of the questions raised:

I think there should be a section dedicated to challenges faced as opposed to a paragraph on challenges faced in the discussion.
Thank you for the comment. We have made this a stand-alone section in the discussion as suggested.

Why is the vlirous not in the list of northern partners?There are existing initiatives like the sandwich PhD programme by vlirous. Why doesn't SSACAB partner with VLIROUS while they also have the same goal as SSACAB? How do such initiatives fail or how is SSACAB better?
Thank you for introducing Vlir-ous to us, an organisation supporting partnerships between universities and university colleges, in Flanders (Belgium) and low-and middle-income countries. SSACAB, funded by the Wellcome Trust under the Trust's 'Developing Excellence in Leadership, Training and Science' has a strong focus on the development of Africa-led networks for science research in SSA and the development of South-South partnerships. As such, SSACAB tries as much as possible to have collaborations with similar initiatives based in the SSA region. However, we have several SACCAB scientists working with various universities in Belgium that have students under Vlir-ous., which has resulted in some workshops organised in SACCSAB sponsored meetings and conferences. Moreover, the unique feature about SSACAB is that it is a locally initiated and implemented consortium with northern institutions joining as partners and collaborators. The impact of SSACAB in SSA is that is has a great potential to successfully retain trained MSc, PhD and Post-Doc Biostatisticians within the region which is normally less likely if fellows are trained outside Africa.

Are all these co-authors really needed to review and edit? If so, why do you still need other reviewers (like me)?
Thank you for the comment. Co-authors have all contributed to the development and conduct of the SSACAB programme and the manuscript; peer-review is a very different process to ensure the external (methodological) quality of a paper.

Why only 11? Or mention the selection criteria of the participating universities. EG, why would JKUAT from Kenya not be on the list?
SSACAB is one program to improve biostatistics in sub-Saharan Africa. It is not intended to include all MSc programs or all PhD training in SSA. SSACAB is not a regional network of biostatistical institutions, or biostatisticians. SSACAB is encouraging individuals and institutions to network through the national statistical associations and international institutions such as RSS and IBS. The aim of SSACAB is not to become a network of all institutions but to strengthen institutions to belong to a sustainable network such as IBS or RSS. In other words, SSACAB is highlighting the need to come together and strengthen networks of biostatisticians such as the SUSAN network under the International Biostatistics Society. JKUAT would be welcome to join and work with such national and international networks.
There are a couple of incomplete sentences, or sentences that need rephrasing. Please see the PDF file here for additional comments.
Thank you for the comment. We have addressed all the comments accordingly.

Only 2 graduates are in the govt?!, I am doubting their level and impact of involvement in the policy-making and planning.
Thank you for the comment. Although the number of SSACAB graduates working in government to date is low, we anticipate a significant impact these biostatisticians will have in the government institutions with time.