In 1927, young Kwame—bright-eyed, sharp-witted, and deeply compassionate—stood outside the gates of a colonial hospital in Accra. Despite being one of the top students in his school, he was turned away. “Africans are not permitted to train as doctors,” the colonial officer told him flatly. That moment, though heartbreaking, captured the reality for many Africans under colonial rule. Medical knowledge was locked behind walls of exclusion. But from those denied dreams, seeds of resistance and transformation began to take root.
Colonial Shadows: The Good, The Bad, and the Deeply Unjust
Colonial rule introduced structured medical education systems in several African territories. Institutions like Makerere Medical School in Uganda (founded in 1924) and the University of Ibadan in Nigeria (established in 1948) emerged as important centers for training medical professionals (Chen et al., 2012). These early institutions laid a framework for medical instruction, clinical rotations, and professional licensing.
However, the legacies were far from benevolent. Medical training was primarily designed to meet the health needs of European settlers, not African populations. Indigenous Africans were largely excluded or trained only for subordinate roles such as orderlies or dispensary assistants (Crozier, 2009). The West African Medical Staff, created by British colonial authorities, strictly barred Africans regardless of their qualifications, institutionalizing medical apartheid in education.
Moreover, curricula were heavily Eurocentric—detached from Africa’s pressing health challenges like malaria, maternal mortality, and tropical infections. The result? A medical system alien to the local context, disconnected from the lived realities of African patients.
Post-Colonial Progress: Momentum and Missteps
Following independence, African nations moved to reclaim and transform medical education. By the 1980s, Sub-Saharan Africa had established over 50 medical schools (Chen et al., 2012). National pride and public health urgency fueled expansions in both admissions and institutional infrastructure.
But this momentum faced turbulence. Economic crises, political instability, and civil conflicts between the 1970s and 1990s left universities underfunded and understaffed. Many institutions deteriorated, and graduates often lacked exposure to basic clinical tools and patient-centered care models.
In response to these challenges, some institutions began adopting innovative educational strategies. For instance, the University of Cape Coast School of Medical Sciences in Ghana implemented a problem-based learning (PBL) curriculum in 2007. Despite resource constraints, this approach emphasized student-directed learning and critical thinking, aligning medical training more closely with local health needs (Amoako-Sakyi & Amonoo-Kuofi, 2015).
Similarly, Makerere University in Uganda undertook curriculum reforms to incorporate PBL, aiming to produce graduates better equipped to handle community health challenges. This shift required significant changes in faculty development and assessment methods but was seen as a step toward more contextually relevant medical education (Kiguli-Malwadde et al., 2006).
Today, medical education in Africa remains a landscape of contrasts:
- Faculty shortages plague many institutions, with some schools reporting less than one instructor for every ten students (Mullan et al., 2011).
- Outdated infrastructure and inadequate simulation tools limit hands-on learning and innovation.
- Irrelevant curricula still dominate, with disproportionate focus on diseases common in Europe and North America while local health priorities are underemphasized.
- Brain drain continues to sap talent, with many African-trained doctors seeking better opportunities abroad.
Charting the Way Forward: From Colonial Echoes to African Excellence
To move forward, Africa must embrace a bold, context-driven reimagination of medical education. Governments must invest in faculty development and provide meaningful incentives to retain health professionals. Curricular reform should align with Africa’s epidemiological realities and embed community-oriented care. Emphasis on primary healthcare, preventive medicine, and interdisciplinary training is essential.
In addition, a continental effort to build robust accreditation systems, facilitate inter-university collaboration, and incorporate digital health education platforms will ensure that African medical schools produce competent, confident, and compassionate doctors.
The journey of medical education in Africa has been shaped by struggle, resistance, and resilience. It is now poised for transformation—not by erasing its past, but by learning from it. As we confront the future, the challenge is clear: to build a system that trains healers, not just clinicians; that serves communities, not just institutions; and that reclaims medical education as a tool for equity, dignity, and justice.
References
Amoako-Sakyi, D., & Amonoo-Kuofi, H. (2015). Problem-based learning in resource-poor settings: lessons from a medical school in Ghana. BMC Medical Education, 15, 221. https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-015-0501-4
Chen, C., Buch, E., Wassermann, T., Frehywot, S., Mullan, F., Omaswa, F., & Greysen, S. R. (2012). A survey of Sub-Saharan African medical schools. Human Resources for Health, 10(1), 4. https://human-resources-health.biomedcentral.com/articles/10.1186/1478-4491-10-4
Crozier, A. (2009). An all-white institution: Defending private practice and the formation of the West African Medical Staff. Medical History, 53(1), 1–28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844288/
Kiguli-Malwadde, E., Kijjambu, S., Kiguli, S., Galukande, M., Mwanika, A., & Luboga, S. (2006). Problem-based learning, curriculum development and change process at Faculty of Medicine, Makerere University, Uganda. African Health Sciences, 6(2), 127–130. https://www.ajol.info/index.php/ahs/article/view/6939
Mullan, F., Frehywot, S., Omaswa, F., Buch, E., Chen, C., Greysen, S. R., … & Wassermann, T. (2011). Medical schools in Sub-Saharan Africa. The Lancet, 377(9771), 1113–1121. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61961-7/abstract
Dear Afromedics,
