Field Epidemiology Training Programmes in Africa - Where are the Graduates?

Alumni data from African FETPs were reviewed in order to establish graduate retention. Retention was defined as a graduate staying and working in their home country for at least 3 years after graduation. African FETPs are located in Burkina Faso, Ethiopia, Ghana, Kenya, Nigeria, Rwanda, South Africa, the United Republic of Tanzania, Uganda and Zimbabwe. However, this paper only includes the Uganda and Zimbabwe FETPs, as all the others are recent programmes.This review shows that enrolment increased over the years, and that there is high graduate retention, with 85.1% (223/261) of graduates working within country of training; most working with Ministries of Health (46.2%; 105/261) and non-governmental organizations (17.5%; 40/261). Retention of graduates with a medical undergraduate degree was higher (Zimbabwe 80% [36/83]; Uganda 90.6% [125/178]) than for those with other undergraduate qualifications (Zimbabwe 71.1% [27/83]; Uganda 87.5% [35/178]).African FETPs have unique features which may explain their high retention of graduates. These include: programme ownership by ministries of health and local universities; well defined career paths; competence-based training coupled with a focus on field practice during training; awarding degrees upon completion; extensive training and research opportunities made available to graduates; and the social capital acquired during training.A key ingredient to achieving improved health outcomes is stronger health systems, including an adequate health workforce [1,2]. There is evidence of a direct and positive causal link between numbers of health workers and health outcomes [3,4]. The World Development Report 2004 [5] states that without improvements to the health workforce, the health-related Millennium Development Goals cannot be achieved. In many countries, the effects of insufficient development of the health workforce are aggravated by migration and a mounting burden of disease [5]. The current shortage of health workers, part