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The current capacity for training in public health nutrition in West AfricaFré Peppinga
a Graduate School of Advanced Studies in Food Technology, Agro-biotechnology, Nutrition & HealthSciences (VLAG), Wageningen University, Wageningen, The Netherlands
Online publication date: 25 November 2010
To cite this Article Pepping, Fré(2010) 'The current capacity for training in public health nutrition in West Africa', GlobalPublic Health, 5: 6, S20 — S41To link to this Article: DOI: 10.1080/17441692.2010.526127URL: http://dx.doi.org/10.1080/17441692.2010.526127
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The current capacity for training in public health nutrition in WestAfrica
Fre Pepping*
Graduate School of Advanced Studies in Food Technology, Agro-biotechnology, Nutrition &Health Sciences (VLAG), Wageningen University, Wageningen, The Netherlands
(Received 22 January 2010; final version received 9 September 2010)
This article is based on a paper prepared for the Workshop on Establishing aRegional Institute for Public Health Nutrition Research and Training in WestAfrica, convened in Dakar, Senegal, 26�28 March, 2009. Information wasgathered mainly prior to this workshop; several responses, however, came in afterthe workshop and these have been included in the current paper. In completion ofthe article use was made of the views and opinions as expressed during thisworkshop.
Objectives were to provide background information on academic programmes(undergraduate and graduate) and research institutions with a focus on humannutrition in West Africa, to describe the importance of foreign nutrition trainingprogrammes for West African students and to detail existing nutrition trainingactivities currently in the region. Data were obtained from a survey of 15UNICEF country offices in the West African region, previously publishedreports, United Nations University/International Union of Nutrition Sciencescapacity development activities 1996�2009, personal communications andwebsites of relevant African institutions. Results indicate that West Africannutrition academic programmes and research institutes do not adequately meetthe demand for nutritionists and technical services in the region. Exceptions seemto be Benin, Ghana and Nigeria. Diploma courses and other short courses havebeen an important means of attracting people from a variety of disciplines tonutrition. A well-equipped regional institute could directly and indirectly bolsternutrition capacity in the region. To meet the regional nutrition research andtraining needs in West Africa, it is not necessary to make a choice betweencreating a new regional institution vs. expanding existing national institutions.Based on solid capacity development principles, both options need action.
Keywords: public health nutrition; nutrition research; nutrition training; nutritioninstitutional capacity; West Africa
Background
The main objectives of this paper are to provide background information for West
Africa on:
- the number and ‘capacity’ of existing undergraduate and graduate (master and
doctoral) academic programmes in human nutrition;
- the number and capacity of research institutions focusing on human nutrition;
*Email: [email protected]
Global Public Health
Vol. 5, No. S1, November 2010, S20�S41
ISSN 1744-1692 print/ISSN 1744-1706 online
# 2010 Taylor & Francis
DOI: 10.1080/17441692.2010.526127
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- the relative importance of foreign training programmes for students from West
Africa; and
- other types of training activities currently available in nutrition.
The information presented in this paper was gathered during a 6-week period from
February to March 2009; therefore, it is by no means a comprehensive inventory of
existing nutrition training capacities or training needs of the West African region.
Nevertheless, the information provides a useful starting place for considering these
issues in greater detail.
The methods used to gather information for the current paper can be summarised
as follows:
- Consultation with the formal government representatives of the countries
present at the ECOWAS Nutrition Forum meetings in 2006 and 2008.
- Analysis of supplementary information from a survey initiated by staff
members of Helen Keller International (HKI) and the regional UNICEF
office for West Africa in Dakar to obtain relevant information from the country
offices that report to the West Africa regional UNICEF office.
- Review of previously published reports (e.g., reports of the United NationsUniversity/International Union of Nutrition Sciences (UNU/IUNS) capacity
development activities) and consultation with the key persons involved.
- Personal communications with, and assessments of curricula vitae of, former
participants of the leadership programmes in Africa (ANLP for English-
speaking participants since 2002 and PLAN for French-speaking participants
since 2007).
- Review of websites of relevant African institutions.
Countries that were considered part of West Africa for this analysis are the 15
member states of the Economic Community of West African States (ECOWAS)1 plus
Cameroon and the Central African Republic.
The approach used was comparable to, but less ambitious than, that of a previous
project that mapped Africa’s advanced educational capacity in public health
(IJsselmuiden et al. 2007). One of the opening sentences in the article states:
Many years of capacity-building have increased the number of senior staff in spite of thecontinuous brain-drain, and globalization of communication has contributed to anincreasing democratisation and accountability of education and politics. Combined withattitudinal changes in donor countries and institutions, there is a stronger awareness ofthe need to phrase answers to problems in terms of local ability rather than foreignassistance interest, although problems in ‘vertical programming’ remain.
It is worth considering whether the same observations may also be true for nutrition.
The aforementioned paper mainly refers to ‘advanced’ levels of capacity
development, whereas the current paper also reports on ‘undergraduate training
programmes’ (B.Sc. or Licence degree). Whether students leave university with a first
degree after 3 or 4 years varies from country to country, with differences between
Francophone and Anglophone areas. M.Sc. and Ph.D. training activities are grouped
together under the heading of postgraduate education. Research institutions that do
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not have a degree-granting capability, but a research mandate, do not appear in the
list of academic institutions, but they are listed separately. Effort was also made to
estimate the numbers of West Africans who obtain a M.Sc. or Ph.D. degree each year
outside the region. In a separate section, some examples are given about stand-alone
diploma/certificate courses and other capacity development activities. Often, such
courses provide the first opportunity for non-nutritionists to enter a nutrition career
path, and they play a complementary role in preparing professionals to upgrade or
broaden their skills in a specific area. It was particularly difficult to collect complete
and reliable information on such training programmes, which, in part, is due to the
fact that such training programmes are less institutionalised.
Capacity development issues in nutrition in Africa received renewed attention
after the UNU/IUNS meetings held in Manila in 1996 (United Nations University
[UNU] and International Union of Nutritional Sciences [IUNS] 1997) and Cape
Town in 1999. An important part of the meeting of the Standing Committee on
Nutrition (SCN) in Nairobi in 2001 was also devoted to the issue of capacity
development. The West Africa regional task force focused on developing an
‘advocacy’ strategy aiming at convincing policy and decision-makers on the role of
nutrition in the development process.
In the Manila document, the Working Group presented the concept of the
national training pyramid (Figure 1), which describes the different levels of job
responsibilities, for which specialised training is needed in nutrition and the range of
career paths for nutrition professionals. The purpose of the national training
pyramid is to provide a quantitative estimate of the needs and the different
categories for advanced training to meet the requirements for human resources. The
Working Group also developed estimates of the numbers of each type of nutrition
professional that are generally required per 5 million persons (Figure 2). Although
the specific estimates can be debated, the proposed numbers of each category of
personnel required provide a useful starting point for assessing the adequacy of the
current regional training capacity. Specifically, an estimate of 100�500 nutrition
professionals are needed in Category I per 5 million persons, 10�50 in Category II
Figure 1. National training pyramid for advanced training, a graphic representation of
functional categories within an integrated system that includes implementers, planners,
researchers, trainers and policy/decision-makers in a given field.
S22 F. Pepping
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and 1�5 in Category III. For the purpose of the Dakar workshop, Category II was
of greatest interest because this is the professional category that includes the
researchers, planners and trainers that would be required to advance public health
nutrition programming in the region. Notably, the former Working Group
concluded that most action was needed in this segment. The concept of the national
training pyramid and the figures used for nutrition as given above have been used
quite extensively in the domain of nutrition and by the UN agencies involved.
Nearly all the observations made by the Working Group are still valid to date as
indicated by their statement that ‘the Working Group recognized that limitations in
available resources and the requirement for a critical mass of professionals make it
imperative that resources be concentrated in a few highly selected academic or
research institutions’.
Three levels of capacity development have been described in the publications of
the United Nations Development Programme (Lopes et al. 2002, Lopes and
Theisohn 2003):
- individual;
- institutional; and
- societal (country and its governance).
In the Dakar workshop, the focus was primarily on individual and institutional
capacity development, such as how to produce more trained nutritionists and bolster
institutional capacity to provide training and support. Regarding institutional
development, Lopes and Theisohn (2003) noted that the critical importance of
institutions for individual development is obvious. In several countries in West Africa
there are simply too few trained nutritionists, and a properly functioning regional
centre could provide such isolated individuals a helping hand in many ways. The
importance of the third level of capacity development was not fully appreciated until
recently. However, it is now more widely recognised that the state’s role in governance
Figure 2. Career paths for professionals and ranges of minimum numbers of professionals
per 5 million population in categories I�III for nutrition; the figures are not intended to be
precise estimates but represent consensus of the Manila Working Group.
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is fundamental to expanding scientific and technical capacities, creating more
professional opportunities and sustaining growth. This is a vital issue when setting
up a regional initiative, which will need the commitment and support of the countries
in the region.Finally, reference is made to some observations made by Besrat in his
background paper for the 1999 Cape Town meeting.2 The UNU focused on a few
key government research institutions, so as to enable the build up of a critical mass of
expert human resources. However, implementation was difficult, primarily due to
uncertainties about which institutions had the potential to assume leadership roles.
Besrat concluded that concentrating activities in government ministries rather than
independent academic institutions was not very successful. He concluded that
‘regional collaboration is needed to establish centres that will serve the high-leveltraining needs of the countries in the region’. Can we still find traces of the UNU
investments in the past or of focused inputs of other donors? Does this lead us to the
best practices?
Results
Bachelor’s programmes
Table 1 lists the universities that provide B.Sc. (or Licence) degrees in nutrition or
food sciences and nutrition. Until recently, 3-year undergraduate (B.Sc.) programmes
were not very common in West Africa. However, the table shows that well-defined
undergraduate programmes are now available in Benin, Ghana and Nigeria. For
most Francophone countries the ‘initial degree’ programmes take longer. For several
countries, including Burkina Faso and the Central African Republic quantitative
data about the number of students were not provided; but it is not very likely that this
would change the overall picture with respect to the limited number of under-graduate programmes.
Master’s programmes and their equivalents
The data assembled in Table 2 suggest that well-established M.Sc. nutrition
programmes exist in Benin, Burkina Faso, Cameroon, Senegal, Ghana and Nigeria.
Quantitative information about the number of students is still pending for severalprogrammes and details about the number of faculty members are lacking.
Fortunately, we see some degree of mobility among Francophone countries and
between Francophone and Anglophone countries. However, several of the pro-
grammes are linked to food science programmes, for which the primary focus is often
not public health or community-oriented.
The annual output of the programmes in Benin, Burkina Faso and Senegal might
be sufficient to supply the minimum requirements for their own countries. However,
in the Francophone countries overall there seems to be a clear shortfall in thetraining capacity of the institutions involved (namely, low numbers and inadequately
trained staff, combined with a limited number of graduates). An important aspect
not included in this overview and perhaps worthwhile to investigate is the type and
quality of the thesis work. Often, this does not involve high-quality laboratory
analysis, sound epidemiological methods or suitable biostatistical analysis, so it
S24 F. Pepping
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Table 1. Undergraduate nutrition programmes in West Africa and numbers of faculty
members and yearly graduates, by country.
Annual
output
Faculty
members Comments
Francophone countries
Benin
Universite d’Abomey-Calavi
� Licence en nutrition
humaine
20 12 Food science/Nutrition combined in
new programme; Nutrition one of
three specialisations
Burkina Faso
Universite de Ouagadougou 10�20 6
Guinea
No undergraduate programme in nutrition exists
Cameroon
Universite de Yaounde I � � No undergraduate programme
Universite de Ngaoundere � �Central African Republic
Universite de Bangui
� Maıtrise en Sciences
Alimentaires et Nutrition
? ? Specialisation in 3rd�4th year, No
additional information found
Ivory Coast
Universite Cocody;
Pharmaceutical Sciences
? ? Specialist of food quality control
Universite d’Abobo Adjame
Maitrise, DEA
12 6 Specialist in food science and
nutrition
Mali
No undergraduate programme in nutrition exists
Niger
UAM Inst. Sante Publique �20 1�2 License level (BAC�3), operating
4�5 years; difficult for graduates to
find employment. ISP also has
epidemiology, nutrition education
and public health study programmes
1�2 faculty members have a M.Sc. in
Nutrition
Senegal
Universite Cheik Anta Diop � � No undergraduate programme
Togo
No undergraduate programme in nutrition exists
Anglophone countries
Gambia
Information not available
Ghana
University of Ghana (Accra) 40 8 Nutrition
University of Development
Studies (Tamale)
100 9 Community nutrition
Liberia
As far as information was obtained no undergraduate programme exists
Nigeria
University of Ibadan �20 ? Human nutrition
Abia State University ? ? Food science and nutrition
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would be important to assess the quality as well as the quantity of these training
programmes.
Doctoral degree programmes
Structured programmes leading to a Ph.D. degree are available in Senegal,
Cameroon, Ghana and Nigeria. Each of these programmes is described briefly, as
follows.
Senegal
A school of doctoral studies was recently established at the Universite Cheikh Anta
Diop (UCAD) in Dakar. A doctoral programme in Nutrition and Human Pathology
with specialisations in Food Science and Human Nutrition and in Public Health
exists. Nine Ph.D. degrees were awarded during the period of 1998�2007, at an
average of one per year.
Cameroon
The University of Yaounde offers Ph.D. degree training in Nutrition and Food
Sciences, and the university website reports that 15 persons are enrolled in Ph.D.
studies. During the past 5 years the combined programmes produced seven Ph.D.
theses. Also, the University of Ngaoundere offers a Ph.D. programme in Food
Science and Nutrition; 11 Ph.D. degrees were awarded during the last 5 years, but
details about the distribution of these in food science vs. nutrition were not available.
Apart from the National School of Agro-industrial Sciences located at the University
of Ngaoundere, no institution awards degrees specifically in Nutrition.
Table 1 (Continued )
Annual
output
Faculty
members Comments
University of Nigeria,
Nsukka
? ?/14 B.Sc. Nutrition and dietetics
University of Agriculture,
Abeokuta
50 B.Sc. Nutrition and Dietetics
8 others in various states ? ? Nutrition and dietetics
Sierra Leone
Njala University �20 ? B.Sc. with honours in nutrition and
food technology, average of 2009 and
2010 was 22.
Lusaphone countries
Cape Verde
No complete picture, incidental training takes place in Portugal
Guinea Bissau
No structure available that provides training in nutrition
S26 F. Pepping
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Table 2. Countries with postgraduate programmes M.Sc./M.Phil. or equivalents.
Annual
output Staffing Comments
Francophone countries
Benin
Universite d’Abomey-Calavi/FSA
DIA (1986) 7�10 12a 2 specialisations, Nutrition/Food
Science
DEA (2004 onwards) 6�8
FSA and Ecole Polytechnique To start Beginning 2011 Master in Human
Nutrition (3 years on top of
Baccalaureat)
Regional Institute of Public
Health, Parakou
20 ? Canada (University of Montreal
and CIDA) and WHO supported,
M.Sc. Public Health Nutrition,
started 2009
Burkina Faso
Universite de Ouagadougou
CNRSBAN � DIA 5�10 ? Mainly Food Science oriented
CNRSBAN � DEA �5 ?
FAST ? ?
Cameroon
Universite de Yaounde I, Department Biochemistry
Lab. Food Science and
Metabolism
�10 35/25 M.Sc. in Biochemistry
Lab. Nutrition and Nutritional
Biochemistry
8 8 persons busy with DEA? See
http://www.Innb.yaoundel.com
Universite de Ngaoundere,
ENSAI
0 15/12 Mainly Food Science oriented
research
M.Sc. in Food Science and
Nutrition
M.Sc. in Applied Nutrition Professional
University of Douala
Lab. Biochemistry and Clinical
Nutrition
�3 ? M.Sc. in Biochemistry
Central African Republic
Universite de Bangui,
Maıtrise en Sciences
Alimentaires et Nutrition
? ? Specialisation in 3rd�4th year, no
additional information found
Guinea
No M.Sc. programme or equivalent exists
Ivory Coast
Polytechnic Institute HB of
Yamoussoukro
? ? Diplome de Technician Agricole/
Diplome d’Ingenieur Agronome
Malib
School of Medicine, Pharmacy,
Odonto-stomatology
0 0 1 M.Sc. and 1 Public Health MD
teaching nutrition, no nutrition
specialisation
Niger
No M.Sc. programme or equivalent exists, initial discussions started about establishing a
DEA in Food Science and Nutrition with Faculty of Agriculture
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Ghana
The University of Ghana offers a Ph.D. programme in Food Sciences and Nutrition,
which graduates approximately one Ph.D. student every other year.
Nigeria
Four universities reportedly award Ph.D. degrees in Human Nutrition or closely
related fields. The University of Ibadan is relatively well-known and connected
internationally. There were a total of 15 Ph.D.s produced during the period from
2002 to 2007. The University of Nigeria in Nsukka, the University of Agriculture in
Abeokuta (reporting five students at Ph.D. level) and Umudike also have Ph.D.
programmes in Nutrition, but little information was available on these programmes.
Table 2 (Continued )
Annual
output Staffing Comments
Senegal
Universite Cheik Anta Diop;
Faculty of Science and Technology
Programme exists for many years
DEA 3�4 3 29 M.Sc.-equivalent degrees
awarded from 1998 to 2007
Togo
No M.Sc. programme or equivalent exists
Anglophone countries
Gambia
No M.Sc. programme or equivalent exists
Ghana
University of Ghana (Accra) 4�6 11/9 Nutrition
Liberia
No M.Sc. programme or equivalent exists
Nigeria
University of Ibadan (M.Sc./
M.Phil.)
12 10/5 Human nutrition (76 graduates
‘02�‘07)
Abia State University ? ? Food science and nutrition
University of Nigeria, Nsukka ? ?/14 M.Sc. in Nutrition
University of Agriculture, Abeokuta 23 20/12 M.Sc. Nutrition and dietetics
20 Postgraduate diploma in nutrition
University of Port Harcourt, Choba,
Rivers State
8 ? M.Sc. Nutritional Biochemistry
with 2/3 project work and 1/3
course work
8 others in various states ? ? Main focus on Nutrition and
Dietetics
Sierra Leone
Njala University 12�14 ? M.Sc. in Nutrition and Dietetics;
2009 and 2010 figures
aTotal staff/academic staff.bIt was estimated that at this moment there are two Ph.D. graduates in nutrition in the country and twoare working on their Ph.D., at M.Sc. level these figures are five and one. The only two Ph.D. Public Healthnutritionists are working abroad.
S28 F. Pepping
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In summary, the focus of most of the Ph.D. programmes seems to be more on
food technology than on human nutrition. Even when there is greater attention to
nutrition, the emphasis tends to be more on clinical nutrition and nutritional
biochemistry than on public health nutrition. Thus, existing programmes might nothave the ideal set-up to work closely with a potential regional institute of public
health nutrition and nutrition intervention programmes.
Training abroad
With Cameroon, Nigeria and potentially Senegal as exceptions, it is clear that the
majority of the nutritionists with a Ph.D. degree in West Africa obtained their degree
abroad. In Table 3, an estimate is given of the number of West Africans who are
enrolled in an M.Sc. or Ph.D. programme in nutrition outside the region as of March
2009. Key universities/training institutions in Europe, North America and Australia
were contacted and alumni were asked to provide information. Although the work that
was completed was by no means comprehensive, it seems reasonable to conclude thatapproximately 80 West Africa students are currently enrolled in M.Sc. programmes
abroad and at least 40 in Ph.D. studies, with more participants from French-speaking
countries than from English-speaking countries. The foreign programmes might have a
larger proportion of public (health) nutrition, with much more emphasis on
epidemiology, biostatistics, than those offered in West Africa.
The idea of selecting regionally important developing country institutions as
done for the UNU-fellowship programme was adopted by Scrimshaw and Uauy for
the programme they initiated focusing on nutrition and infection financed by theEllison Medical Foundation (EMF).3 In West Africa, only Ghana benefited from this
programme (three Ph.D. students). A possible regional nutrition research institute
might be able to attract similar type of focused programmes.
Brain drain
Much has been written about the brain drain and the efforts to address it. The
International Organisation for Migration (IOM) had a Reintegration of Qualified
African Nationals Programme that ran from 1983 to 1999 and managed to relocate
2000 nationals to 11 participating countries (Mutume 2003). More recent initiatives
from the New Partnership for Africa’s Development (NEPAD) show that African
governments, UN agencies and bilateral donors are taking this issue more seriously.McCoy et al. (2008) described the potential benefits of well-planned academic
partnerships in health research between rich and poor countries. Although specific
figures about the nutrition discipline are unavailable, based on discussions with key
personnel from the training institutions involved, there appears to be a trend among
graduates of returning to Africa after graduation. However, a considerable
proportion of graduates begin working for NGOs and UN agencies rather than
academic institutions, as the opportunities of these academic institutions to employ
more staff are restricted. This ‘internal brain drain’ has been discussed duringsubsequent SCN meetings (Pepping, personal observation); however, viable solutions
have not been put forth. In addition, not all graduates are able to find an appropriate
position upon returning, which drives them to seek employment elsewhere (within or
outside the region). The so-called ‘push’ factors that contribute to this phenomenon
Global Public Health S29
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Table 3. Number of West African scholars enrolled in M.Sc. and Ph.D. programmes in
Nutrition at North African, European, North American and other foreign universities as of
March, 2009.
Country/institution Degree No.
Comments (for example countries
of origin of graduates)
Africa
Morocco M.Sc./
Ph.D.
a In CVs of applicants for ANLP/
PLAN we see that M.Sc./Ph.D.
degrees are obtained in these
countries
Algeria M.Sc./
Ph.D.
10
Egypt: Senghor University
Alexandria
Ph.D. 1�2 year The Ph.D. programme at Senghor
University has various sub-
programmes and is given in French
Europe
France: University Montpellier II M.Sc. 2 Benin, Togo
Ph.D. 4 Benin, Burkina Faso (2), Ivory Coast
France: Paris Ph.D. a
Other sites in France M.Sc. a
Ph.D. a
The Netherlands: Wageningen
University
M.Sc.
2 years
3 Ghana (all 3)
Ph.D. 5 Burkina 2, Benin, Mali, Ghana
Belgium: Gent Universityb M.Sc.
2 years
17 Benin 2, Burkina 2, Cameroon 5,
Congo 1, Ghana 3, Nigeria 3, Togo 1
Ph.D. 1 Benin
Portugal: University of Porto M.Sc. 1 Cape Verde (for the Clinical
Nutrition Programme), occasionally
they candidates for their B.Sc.
Nutritional Science from Cape
Verde, Guinea Bissau and Sao Tome
e Principe (around 10 persons last
have 5 years)
UK: London School of Hygiene
and Tropical Medicine (LSHTM)
M.Sc./
Ph.D.
a
UK: University of Glasgow Ph.D. 1 With LSHTM
UK: University of Greenwich M.Sc. 1 Nigeria, 5 students from English-
speaking countries were reported to
have deferred for financial reasons
Ph.D. 2 Nigeria (one via collaboration with
Ibadan)
UK: University of Chester M.Sc. 2 Ghana, Nigeria (public health
nutrition)
UK: other universities M.Sc. 5�10 Programmes with participants from
West Africa were reported within the
universities in Sheffield (M Med Sci),
Kings College London, Westminster
(public health nutrition) and Leeds
but accurate figures are lacking
Norway: Bergen Ph.D. 1 Burkina Faso
S30 F. Pepping
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are: (1) low and eroding salaries; (2) under-utilisation of qualified personnel; (3)
discrimination in appointments and promotions; and (4) lack of research and other
facilities.
Diploma//certificate courses and other short courses
Diploma courses and other short courses have been an important means of
attracting individuals from a variety of disciplines to nutrition, and many of the
region’s nutritionists began their careers in fields other than nutrition. Thus, it is
important to maintain these opportunities for recruiting people into the field. A
possible role for a regional institute could be to offer these types of (short) courses,
and thereby enhance the visibility and credibility of nutrition. A few examples of
existing short courses are as follows.
Table 4. Number of applications to the ANLP from 2006 to 2009 (no course held in 2007).
Countries 2006 2008 2009
Gambia/Ghana/Nigeria 24 27 43
French-speaking countries 8 10 5
Number of applications received in total 76 60 106
Percentage of applications from West Africa (%) 42.1 61.7 45.3
Table 3 (Continued )
Country/institution Degree No.
Comments (for example countries
of origin of graduates)
North America
USA: Cornell University Ph.D. 2 Ghana, Nigeria
USA: Tufts University Ph.D. 2 Funded through EMF, Ghana
USA: University of
Massachusetts
M.Sc./
Ph.D.
2 Ghana, Nigeria
USA: Tulane University M.Sc. a Few years ago programme for Mali
with 5 graduates
USA: University of California,
Davis
Ph.D. 1 Ghana
Canada: University of Montreal M.Sc. 3
Ph.D. 4 Benin, 2 Burkina Faso, Mali
Canada: Laval University,
Quebec
M.Sc. a
Ph.D. a
Australia
University of Queensland,
Brisbane
M.Sc. a M.Sc. Community Nutrition exists
for considerable period of time
University of Western Australia,
Perth
M.Sc. a
aActual numbers not available but information provided that people have been trained/are being trained.bNutrition and rural development (110 in total; 60% takes the nutrition stream, rest is home economicsand tropical agriculture).
Global Public Health S31
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Formation Internationale en Nutrition et Sciences Alimentaires (FINSA)
FINSA; International training programme in food science and nutrition; Universite
d’Abomey � Calavi, Benin: the 18th edition of this course (August 2009) covered
the topic of ‘Food and nutritional security and development: Impact of the HIV/
AIDS epidemic’. This 1-month course has provided the entree into nutrition for
many in West Africa. Regrettably, since 2001 the number of participants has
decreased from 20�30 annually to 8�10 participants. Since 2007, however, the
numbers are beginning to increase, and a fellowship programme is in place from
2009 onwards.
Nutrition Leadership Programmes
Since 2002, seven rounds of the African Nutrition Leadership Programme (ANLP)
have been held in South Africa. In 2007, a French version of this course started in
Morocco. Core elements of these programmes are team building, communication,
social responsibility, leadership styles and some nutrition case studies. The ANLP
statistics on the number of applications show an overwhelming interest for this
programme from English-speaking West Africa (1/3 or more of the total number of
applications). The number of applications for the 2010 edition in South Africa
exceeds 100, and for Morocco the number exceeded 50. The interest in this
programme indicates that sufficient Ph.D. holders see for themselves a career in
nutrition.
Food and Nutrition Security, Wageningen, the Netherlands
The former International Course in Food Science and Nutrition (ICFSN, 5 months)
was re-structured several years ago into a modular 11-week programme, leading to a
diploma at the postgraduate level. Most participants in recent years have been from
NGOs. Increased participation in recent years is due to better use of the fellowship
system.
Training possibilities linked to USAID-funded global, multi-country projects
The BASICS II Project of the USAID West Africa Regional Office (1998�2003) used
to provide technical support to the Regional Food and Nutrition Research
Organisation (ORANA), which covered nine Francophone West African countries
(Benin, Burkina Faso, Ivory Coast, Guinea, Mali, Niger, Senegal, Togo and
Mauritania). ORANA organised training workshops on various subjects including:
formative research methods, such as, Trials in Improved Practices (TIPS) for the
adaptation of feeding recommendations under the Integrated Management of
Childhood Illnesses programme; use of Nutrition Policy Analysis and Advocacy
tool, such as Profiles; and instruction in Community Nutrition Programming.
Currently, the Food and Nutrition Technical Assistance II Project (FANTA-2,
2008�2013) implemented by the Academy for Educational Development, is working
with USAID/Ghana to integrate community-based management of acute malnutrition
(CMAM) into the Ghana Health Service (GHS) and strengthen the capacity of the
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GHS and national training institutions. FANTA-2 is also working with USAID’s Office
of Foreign Disaster Assistance/West Africa to support CMAM training workshops.
The respective USAID-funded projects, such as FANTA-2, BASICS and
PROFILES, continue to offer a wide range of training opportunities for the WestAfrican region and to provide employment for a considerable number of Ph.D.
holders in nutrition for various lengths of time.
Research institutions
Table 5 summarises research institutions that have an exclusive research mandate.
Several of the institutions listed were originally established in cooperation with
institutions in France. The initiatives in Senegal have also benefited from World
Bank support. The summary is far from complete, and the nutrition component of
the work of several of the institutions listed may be limited. In addition, staffing
patterns with regard to nutrition capacity are not always clear. More and more
centres seem to get involved in larger projects with several foreign partners; suchcentres could be the nuclei for cooperation with a regional institute. Not listed are
institutions like the National Nutrition Agency in Gambia and similar organisations
elsewhere as these organisations are not primarily focused on scientific research
albeit they might provide relevant input to national surveys.
Linking education and research and maintaining professionals
Assisting students to achieve a certain level of knowledge and awarding a
corresponding academic degree are one set of tasks. Another challenge is to keep
trained nutritionists involved in their profession, which is a difficult task in some
countries. Two issues are raised here:
- Sometimes people do not fit easily into a national system when returning from
training outside the country. This is an important consideration if a regional
institute is to be established. If the problem is not properly addressed, the
institute could build capacity that will not ultimately serve the region. Thus, it is
worth reiterating the importance of the third level of capacity development
focused at the society level and makes a firm commitment, visible in the
national nutrition plans, of the countries in the region a prerequisite.
- In some cases, students trained abroad can continue to work in collaborationwith their training institutions while based in the West Africa region. For
example, some nutritionists (and food scientists) from Benin and Ghana who
studied at Wageningen University continue to work on challenging research
questions after graduation in collaborative, inter-disciplinary projects funded
by the University4 and/or the European Commission (EC; FONIO and
INSTAPA).5 However, with competitively obtained funding there is no
guarantee that they will be continuously funded. Similar linkages exist between
researchers in the UK and Gambia and between researchers in France andseveral countries in West Africa. Such projects offer possibilities for continuing
development of former students’ expertise, including new areas beyond the
focus of the students’ research conducted during Ph.D. studies and might
neutralise some of the ‘push’ factors.
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Table 5. Other research institutions in West African region not listed in Tables 1�3 because
they do not have a specific training mandate.a,b
Country/institute Characteristics
Burkina Faso
Institut de Recherche en Sciences de
la Sante (IRSS), Ouagadougou
Good international networkc (World Bank, IAEA,
IRD), work reported on vitamin A deficiency, strong
in malaria research, staffing in terms of nutrition?
Centre MURAZ, Bobo-Dioulasso No data available
CNRST No detailed information; food science oriented
Cameroon
Centre for Research in Food and
Nutrition (CRAN) at the IMPM
University students carry out nutrition research in
CRAN facilities under joint supervision; 16 research
staff (5 senior and 11 junior all busy with their
Ph.D.); 4 laboratories on:
- Food technology;
- Quality control;
- Epidemiology;
- Metabolism
Main research lines; nutritional value of infant
foods; and nutritional status of population groups.
Guinee
National Institute of Nutrition and
Child Health
No detailed data available, several nutritionists are
reported to be abroad for further training at M.Sc.
level.
Ivory Coast
Institut National de la Sante
Publique (INSP)
Research institute with nutrition laboratory and
nutrition rehabilitation centre. Scientific centre for
pilot experiments before scaling up any nutritional
strategy or intervention
Centre Suisse de Recherche
Scientifique
Partner for field research in nutrition and food
science,
Provide finance and technical support to Ph.D.
students
Mali
INRSP, Departement de
Sante Communautaire
Has 3 ‘services’ and one research programme
Nutrition:
- Epidemiology;
- Social Sciences; and
- Research programme on health systems.
Staffing details lacking, staff development seen as
lacking.
Senegal
Prime Minster’s Office;
Malnutrition control programme
Headed by Dr Dieng, supported by World Bank
loan
Faculty of Medicine; Research
programme on nutrition/
parasitic diseases
Headed by Prof. Sembene, also World Bank loan
Togo
No government nutrition research or analysis unit exists
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A well-equipped regional institute could directly and indirectly provide incentives to
trained professionals to remain within the nutrition discipline in the region.
Refresher courses could be part of the programme of a regional initiative. However,
setting up the appropriate arrangements for this will need the ‘attitudinal changes in
donor countries and institutions’, as discussed by IJsselmuiden et al. (2007).
Conclusions and discussion
This section is split into two parts; in the first part the pros and cons of the existing
structures are discussed, and in the second part the focus is on the pros and cons of
setting up a new institution.
The existing structures
Are the observations made by IJsselmuiden et al. (2007); (‘many years of capacity-
building have increased the number of senior staff ’ and ‘there is a stronger awareness
of the need to phrase answers to problems in terms of local ability’) also true for
nutrition? Three developments seem to justify that this question is answered with a
firm ‘yes’:
Table 5 (Continued )
Country/institute Characteristics
The Gambia
Human Nutrition research
MRC Keneba
Well-established field station operating for many
years. 6 Gambian Ph.D.s trained by UK, �12
trained up to M.Sc.
Partnering now with Gambian National Nutrition
Agency to contemplate accredited course sand train
two Ph.D.s while these remain in their job.
Ghana
Noguchi MIMR, College of Health
Sciences, University of Ghana
Focus on infectious diseases, Nutrition department
has broad focus, a.o. on community-based
research, micronutrients, 6 research fellows/
assistants with academic degrees, see
http://www.noguchimedres.org
Liberia
No government nutrition research or analysis unit exists
Nigeria
No information available
aNational Statistics Offices and similar institutions are left out of this overview.bOrganisation de la Coordination et de Cooperation pour la lutte contres les Grandes Endemies(OCCGE) attends the ECOWAS Nutrition Forum, not included in this list but OCCGE has an interest innutrition.cIRSS and Regional Institute of Public Health in Benin are involved in an EC-funded project coordinatedby ULB, Brussels and with University of Bordeaux II titled ‘Creation of a curriculum based on the qualityof health care in West Africa’.
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10Defaultprinciplesforcapacitydevelopment
Don’t rushCapacity development is a long-term process.
It eludes delivery pressures, quick fixes and the
search for short-term results.
Respect the value system and foster self-esteemThe imposition of alien values can undermine
confidence. Capacity development builds upon
respect and self-esteem.
Scan locally and globally; reinvent locallyThere are no blueprints. Capacity development
draws upon voluntary learning, with genuine
commitment and interest. Knowledge cannot
be transferred; it needs to be acquired.
Challenge mindsets and power differentialsCapacity development is not power neutral,
and challenging mindsets and vested interests
is difficult. Frank dialogue and a collective cul-
ture of transparency are essential steps.
Think and act in terms of sustainable capacity outcomesCapacity is at the core of development; any
course of action needs to promote this end.
Responsible leaders will inspire their instituti-
ons and societies to work accordingly.
01
02
03
04
05
06
07
08
09
10
Establish positive incentivesMotives and incentives need to be aligned with
the objective of capacity development, inclu-
ding through governance systems that respect
fundamental rights. Public sector employment
is one particular area where distortions throw
up major obstacles.
Integrate external inputs into national priorities, processes and systemsExternal inputs need to correspond to real de-
mand and be flexible enough to respond to
national needs and agendas. Where national
systems are not strong enough, they should be
reformed and strengthened, not bypassed.
Build on existing capacities rather than creating new onesThis implies the primary use of national exper-
tise, resuscitation and strengthening of natio-
nal institutions, as well as protection of social
and cultural equity.
Stay engaged under difficult circumstancesThe weaker the capacity, the greater the need.
Low capacities are not an argument for with-
drawal or for driving external agendas. People
should not be held hostage to irresponsible go-
vernment.
Remain accountable to ultimate beneficiariesAny responsible government is answerable to
its people, and should foster transparency as
the foremost instrument of public accounta-
bility. Where governance is unsatisfactory it is
even more important to anchor development
firmly in stakeholder participation and to main-
tain pressure points for an inclusive accounta-
bility system.
Figure 3. Ten default principles for capacity development.
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(1) In 2004/2005, the African Graduate Students’ Network (AGS-net)6 was
created with enormous enthusiasm. After a successful start, it has proven
difficult to maintain the network. Nevertheless, its continued existence
demonstrates some of the attitudinal changes that have occurred.(2) The Africa Nutrition Leadership Programme based in South Africa is alive
and well, with the completion of the eight sessions in 9 years. The alumni of
this programme stay connected as is demonstrated by their informal meetings
at international events and show commitment to collaborate across borders.
(3) In 2008, a very successful and inspiring third edition of the African
Nutritional Epidemiology Congress (ANEC) was organised by and for
Africans; in 2010 we will have the fourth edition.
These events in themselves will not change the situation with respect to ‘nutrition
capacity’ in Africa, but they provide evidence of ‘attitudinal changes’ and ‘stronger
awareness’ in the region.
Can results of the investments in nutrition training that UNU started in the mid
1970s still be identified? Yes, some of the African champions of this moment in
Ghana and Nigeria were beneficiaries from that programme.
Although it is not the main objective of this paper to draw conclusions in terms
of ‘we are short of x B.Sc. or M.Sc.-programmes in y countries’, it is clear that only in
a few exceptional cases are adequate numbers of nutritionists available in West
Africa. It can be concluded that a more thorough inventory providing more data and
more accurate data, with input from the responsible government agencies, is essential
in moving forward. Three documents/studies might provide insight into some aspects
that can be of relevance for the initial planning process of a regional initiative:
(1) It is important to take into account the 10 default principles for capacity
development as formulated by Lopes and Theisohn (Figure 3). The authors
use the term ‘default’ principles to indicate that the fundamentals of capacity
development are universal and that set of core principles can be identified and
applied. Which of these principles should get most attention during this initial
planning stage?
- There is no need to rush, but 12 years after Manila it is time to act.
- It’s obvious that African institutions need to lead this initiative.- ‘Positive’ incentives need to be selected and implemented with great care
to avoid a brain drain within Africa.
- We started listing the existing capacities and this makes clear on what we
can build.
- ‘Circumstances’ in West Africa will always pose a challenge!(2) A report of the Institute of Development Studies (Sumner et al. 2007) provides
useful insight regarding the attitudes of donors, who in some cases see
nutrition as a supporting investment rather than a foundational one. More-
over, capacity development is grouped under the category of ‘indirect nutrition
interventions’. Thus, nutrition training does not currently receive the highest
priority for these agencies’ development funding. The lack of institutional
champions is also seen as one of the reasons why nutrition does not get the
attention it deserves.
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(3) In a study published by the International Food Policy Research Institute
(IFPRI) published in 2008 (Benson 2008) the author concludes that ‘The
manner in which available human capacity in nutrition is used is certainly as
important as the presence of trained nutritionists’. This statement confirmsthat it is not the first and second level of capacity development that hampers
progress here, but the third level involving the society and government. Large
numbers of nutritionists have been trained in Ghana and Nigeria (two of the
four countries investigated), as contrasted with the situation in Mozambique
and Uganda (the other two countries studied). Nigeria’s human capacity in
nutrition is represented by the Nutrition Society of Nigeria, which estimates
that there are �500 professionally trained nutritionists (masters level or
above) in the country.
Preliminary findings as presented in the Tables 1�5 can be summarised as follows:
- The French-speaking countries Benin, Burkina Faso, Cameroon and Senegal
have programmes that have existed for a considerable period of time and can be
regarded as reasonably sustainable, albeit continuously facing difficulties in
enrolling new cohorts each academic year because of lack of student funding.
Cameroon seems to have adequate programmes in place, but without muchfocus on ‘public nutrition’. With 10�50 level II nutritionists needed per 5
million population (average 30 and simplifying this to M.Sc. level) and taking
Benin (9 million inhabitants) and Senegal (12 million) as examples, this would
mean 54 and 72 M.Sc.-level nutritionists are needed in each country,
respectively. These countries might be able to provide for their own needs
(depending on the continued employment of these individuals and their
professional longevity). It is worthwhile to complete such exercises with more
accurate figures at the country level, as this will enhance awareness of theexisting gaps in nutrition capacities.
- Using similar assessments of the current training capacities in Ghana and
Nigeria, adequate numbers of nutritionists seem to be produced annually in
these countries.
- Many of the smaller countries do not seem to be able to meet their needs for
nutrition professionals. Taking into account Besrat’s remarks about countries
with small populations and small economies without B.Sc. programmes, there is
a clear need to foster people from such countries to send secondary schoolleavers to neighbouring countries/countries in the region to follow a nutrition
programme.
A new institution
What could be recommended for a regional institute to meet, in a step-by-step
approach, research and training needs?
- A firm commitment from countries in the region is essential and should be a
starting point. Some countries have long-standing cooperative linkages with
donor countries in the area of nutrition. A three-way linkage agreement
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between countries from the north and the south and a regional nutrition
institute might seem complicated, but could solve part of the sustainability issue
and overcome donors’ propensities to focus on specific countries at particular
points in time. Such an approach could be the starting point for attractingbroad-based financial support from multiple donors. Given the fact that
nutrition is linked to many sectors, next steps in the planning process might be
best guided by organisations like the UNDP and the World Bank (for example
in the Global Action Plan).
- However, good links to existing programmes should not maintain existing
inequalities of national capacity. It is essential for a start-up phase of a
regional initiative to avoid having the strongest partners dominate the regional
initiative.- The EC included a variety of schemes in their sixth and seventh Framework
Programme to bring qualified people back to Europe. Perhaps the EC could
assist a similar regional nutrition in West Africa by supporting EC projects in
collaboration with West African institutions. Furthermore, the EC launched
mid 2009 a special Africa call including a so-called Coordination and Support
Action to design a research road map for nutrition in Africa. A regional
institute would have been an ideal partner in this project.
- Part-time secondments (and not always at the head office) should beinvestigated to avoid a brain drain within the region.
- A regional institute could embark on an accreditation programme for
nutrition programmes at M.Sc. level and assist the accredited universities
in maintaining a fellowship programme for students from the region. The
thesis/research component of M.Sc. programmes in nutrition could be an
important part of such an accreditation scheme. With relatively small
amounts of earmarked money available to heads of nutrition departments,
the quality of the fieldwork/analyses can be increased considerably. Smallamounts of money can promote big changes, and a regional institute could
be of help in this.
- The institute could play a role in bringing together/harmonising e-learning
modules that are nowadays prepared for distance-learning purposes.7 This is an
exciting and challenging new development, in which the ‘hands-on’ training
requirement is often underestimated.
- To address degree-granting issues (often one of the most challenging issues), it
might be advisable to seek assistance from the UNU. UNU is changing itsposition and now aspires to become a degree-granting organisation.
- At the Ph.D. level a regional initiative can make a difference for existing
doctoral programme by offering assistance in high-quality laboratory analysis,
data-management capacity, etc. The experiences of the Gambia show that a
medium- to long-term commitment is needed for this. During a starting-up
period a regional institute could affiliate with those institutions from the
north that execute their Ph.D. projects for international students on the basis
of a so-called sandwich programme, in which the preparatory period andwriting-up period take place in the north, and the field research is
implemented in the home country. Support for the fieldwork could create a
win�win situation, thereby convincing funding agencies to invest in such a
regional initiative.
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In closing, to meet the regional nutrition research and training needs in West Africa,
it is not necessary to make a choice between creating a new regional institution vs.
expanding existing national institutions. Based on solid capacity development
principles, both options need action 12 years after Manila.
Acknowledgements
There are no conflicts of interest related to this manuscript. We thank the participants andinstitutions represented at the workshop. The advice of Grant J. Aaron, Mohammed AgAyoya, Inge Brouwer and Kenneth H. Brown and the contributions of colleagues whoprovided data regarding their respective institutions are gratefully acknowledged. Funding wasprovided by UNICEF, HarvestPlus, Wageningen University and HKI.
Notes
1. French speaking: Benin, Burkina Faso, Guinea, Ivory Coast, Mali, Niger, Senegal andTogo. English speaking: Gambia, Ghana, Liberia, Nigeria and Sierra Leone. Portuguesespeaking: Guinea Bissau and Cape Verde.
2. Abraham Besrat worked for a long time with UNU (Tokyo) and was involved (a.o. withScrimshaw) in implementing the fellowship programme of UNU. UNU has spent between1975 and 2000 nearly 45% of all its fellowships on food science and nutrition; 27% of thefood and nutrition fellowships came to Africa. The institutions that benefited most were:Federal Institute of Industrial Research, Oshodi; Department of Human Nutrition,University of Ibadan, Nigeria; and Food Research Institute, Ghana.
3. The programme has the title: ‘Targeting advanced fellowships to strengthen selectedregionally important developing country institutions for research on health issues related tonutrition and infection’, the overall budget was US$5,000,000 and many participatinginstitutions from the north waived fees to do more with the same amount of money.
4. Two examples: From natural resources to healthy people (food-based interventions toalleviate micro-nutrient malnutrition; Benin and Burkina Faso) and TELFUN (Tailoringfood sciences to endogenous patterns of local food supply for future nutrition; Ghana andBenin).
5. FONIO � improving the quality of fonio for West Africa and European markets (lead byInstitut de Recherche pour le Developpement, IRD, Montpellier); INSTAPA � improvednutrition through staple foods in Africa (with Wageningen, IRD, London School ofHygiene and Tropical Medicine and ETH-Zurch; 6 million Euro).
6. AGS-net � the Africa Graduate Students network. It was established by Cornell-basedPh.D. students.
7. Several of the large EC-funded programmes under FP6 have included this as one of theirobjectives and modules are (becoming) available on the use of food composition data, onrecommend intakes, etc. There are many more of such stand-alone modules that could beobtained at relatively low costs.
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