Capacity building in Obstetrics and Gynaecology through academic partnerships to improve global women's health beyond 2015

Significant progress has been made since Allen Rosenfield termed maternal mortality a neglected tragedy and asked ‘where is the M in MCH?’ Recent data from the World Health Organization demonstrates significant declines in maternal mortality ratios, with a 49% reduction in sub-Saharan Africa (SSA), from 990 in 1990 to 510 per 100 000 live births in 2013. Still, Millennium Development Goal (MDG) targets for maternal mortality in SSA will not be reached. Post 2015 reductions in maternal, perinatal and early neonatal mortality will only be realised when the most severe maternal complications can be comprehensively addressed and obstetric interventions that identify and deliver the at-risk fetus can be provided to all pregnant women. To comprehensively address obstetric care and provide leadership in women’s health, skilled professional obstetricians/gynaecologists will be required as part of the health care team. In SSA countries with a low level of obstetric capacity and leadership, the inherent expertise and teaching gap is filled by nongovernmental organisations and non-local trainers. When gaps are filled by training for one specific task, the chances for the development of integrated and comprehensive ‘in country’ capacity building may be missed. Capacity building in SSA countries has taken many forms. Research capacity strengthening in response to the HIV epidemic has resulted in a significant number of research capacity building partnerships. The literature on medical education in SSA disproportionately describes countries with older medical schools, such as South Africa, Nigeria and Uganda, with recent growth of medical education in SSA reported mostly in the grey literature. The Medical Education Partnership Initiative has joined 40 medical schools with 20 medical schools in the USA to foster communities of practice that create a supporting structure to share resources in education, monitoring and evaluation, and research. A recent comprehensive review identified 168 medical schools operating in sub-Saharan Africa, of which 146 were surveyed. Many ‘countries are prioritising medical education scale-up as part of health system strengthening’. A number of recommendations were made, including launching a campaign to increase the capacity of medical school faculties, investing in medical education infrastructure, improving research infrastructure, and establishing national and regional postgraduate training programmes to promote training, excellence and retention. The National University of Laos, in partnership with the faculty of Case Western Reserve University (Cleveland, Ohio, USA) and Khon Kaen University (Khon Kaen, Thailand) began an internal medicine training programme that admits six participants a year. In the first year evaluation, five of the six graduates had remained in the country and the investigation noted that ‘most graduates of this program will eventually participate in creating government health care policy, either on the local or national level, simply because they will be the best trained medical professionals in the country’. The history of early obstetrics and gynaecology training programmes in SSA, such as the Ibadan programme established by Professor John Lawson, has not been written, nor has a survey been done of current postgraduate obstetrics and gynaecology training in SSA countries. A programme to centralise maternal and neonatal care in Eritrea, which included the establishment of an obstetrics and gynaecology training programme, demonstrated significant reductions in maternal mortality, with the first graduates finishing in 2012. The University of Zambia school of Medicine has produced 1276 doctors since its first graduates in 1973, and