[Public health training in subsaharan Africa: challenges and opportunities]

Public health is a complex domain that covers a vast array of disciplines. Specialization in public health therefore requires a combination of various skills in equally complex fields. The public health training institutions in Africa are thus still unable to meet the huge need for adequate training in this domain. Counting solely on sending Africans to developed countries would neither quantitatively nor qualitatively fulfill the continent's enormous public health needs, either. To meet these needs, some African countries have created their own public health schools and offer local graduate training programs in various public health disciplines. A major advantage of these schools in comparison with the schools in developed countries is that the degrees they offer are immediately recognized by local African administrations. In addition, their training programs specifically focus on the existing public health needs and problems of African countries. Training Africans locally also contributes to reducing their temptation to emigrate after their graduation. However, the lack of adequate resources of African schools and their tendency to encourage premature high level specialization represent serious threats for the school's further development and long-term effectiveness. The lack of adequate management strategy to utilize well the trained cadres is still of great concern. It is along with poor wages and salaries among the key determining factors of the brain-drain. Poor management strategy appears also to be the root causes of the failure of the short term training programs. The effectiveness of these short term training programs is currently questionable because of their unnecessary huge numbers, and the focus on the payment of "perdiems" as their main benefit. Many obstacles to providing adequate local training to African public health providers remain to be overcome. However there are a number of opportunities including use of new information and communication technologies, partnerships between institutions, and use of modern management techniques. These opportunities can greatly improve the situation if they are properly used.