This Gates-funded university has a plan to transform global health education

BUTARO, Rwanda — Arlene Nishime was a newly minted medical doctor in her early twenties when she began interning at a district hospital in her native Rwanda. Such assignments are a standard requirement for those leaving medical school, but her training had left her unprepared for what she saw. “Probably the most high-tech campus I’ve seen in Africa.” --— Rex Wong, director, Institute of Global Health Equity Education Like so many other medical professionals working in the lowest resource settings, Nishime quickly realized her job entailed “more than medicine.” Providing medicine to patients without access to clean water or nutritious food can be frustratingly ineffective. And that’s when the drugs are even available to distribute. Those are the circumstances facing health care workers serving most of humanity. According to the World Health Organization, half of the world’s population lacks access to essential medical care. Yet top quality global health education — from a master’s in public health to medical degrees for physicians to executive education for policymakers and health leaders — remains largely the purview of elite universities in western countries, far from the context where needs are greatest. That may now be changing. The University of Global Health Equity sits on top of a small hill in a rural part of Rwanda, a three-hour drive from the capital Kigali. Its improbable location and modest size — just two dozen students will graduate this spring with a master’s in global health delivery — belies a big ambition. The contemporary campus cost $8 million to build and will ultimately host 250 students, offering multiple master’s programs, a bachelor of medicine, bachelor of surgery, and executive education. Already, Gavi, the Vaccine Alliance has sponsored executive education at the University of Global Health Equity for ministry of health officials from India, Zambia, Liberia, Gambia, and Rwanda. The current cohort of master’s students hail from 13 countries. A new $20 million grant from the Cummings Foundation and the Bill & Melinda Gates Foundation, the principal funders of this Partners in Health initiative with the Rwandan government, will allow the campus to expand further. A second phase of construction is set to begin in the next year. In total, four phases are planned, but that’s not all. This small but growing Rwandan university has big plans. Already, executives here talk of satellite campuses everywhere Partners in Health operates, from Haiti to Liberia. They refer to the current campus as a “proof of concept” that can be scaled and replicated. The local Butaro Hospital is being expanded and utilized as a teaching hospital. And among the leadership of the university is Marshall Thomas, who helped set up Harvard University’s online education programs in health. That online approach has multiple angles. One is using the fiber optic connection the Rwandan government provided to pipe in medical educators from around the world. Another is following a so-called “flipped classroom” model, eschewing lectures in favor of an online curriculum that allows students to study on their own time and utilize classroom time for more interactive discussion. Finally, the university plans to provide online curriculum to medical programs around Africa and the developing world. The tech that will be available on campus, much of which is not yet installed, will include an e-library, online testing center, and automated mannequins in place of human cadavers. Rex Wong, who has set up hospitals and worked in health care in a dozen countries and left Yale University to join this project, tells Devex it is “probably the most high-tech campus I’ve seen in Africa.” Cost is an issue. The published tuition rate is $54,000, which includes literally everything “down to the laundry detergent” according to Wong, and is thus comparatively cheap compared to many U.S. universities. But, due to scholarships, not one student is paying the full amount. And while construction costs in places like Rwanda are low, operating costs can be high and add up, especially when they can’t be offset by significant tuition fees. Another challenge is attracting and retaining world-class educators. The medical program alone requires 17 disciplinary areas of instruction. Butaro is beautiful, nestled in green hills, but it’s a world away from the kinds of rich social life, employment opportunities for spouses, and schools for the children of faculty that university towns in the United States and Europe can offer. Nonetheless, there is a growing recognition that the “last mile first” agenda which has led to a resurgence in interest in community health workers, may also require a new model for health education. This university can meet those needs, and Wong even commented that “we think of [community health workers] as part of our faculty.” Increasingly, people interested in a career in global health want something different from the traditional model. That includes two students in the master’s program — one from Rwanda and one from Sierra Leone — who told Devex they were educated in the United States but decided to come back to rural Africa to prepare for a career in global health. That’s part of what makes this small university so radical and so ambitious. If it can succeed, and sustained philanthropic funding and continued government support will be key, it may offer a new model and even a competitive threat to more traditional global health programs. Why study abroad in an African capital city or take on a months-long student project in rural Rwanda, when you can live and study there for the entirety of your health education? That approach may not be for everyone. Wong, who has been in Rwanda for eight years already, has signed on for another five to help scale the University of Global Health Equity. And Nishime, who could, like so many other African doctors, go abroad for further study and end up staying there, is now a fellow studying medical education under Thomas. She has taken a job to become part of the faculty at the university, training the next generation of Rwandan doctors how to provide top quality medical services in the context in which the majority of people live.