A Yale School of Medicine team was awarded $3.7 million in grant funding by the World Bank and the Health Resources and Services Administration to strengthen medical education and health care infrastructure in Liberia.

The researchers, who will be led by Asghar Rastegar, medical school professor and director of the school’s Office of Global Health, will work to improve preclinical medical education and residency programs and support the development of a certificate program in health management for Liberia. The group hopes that its work will help the nation to recover and rebuild from the Ebola epidemic that ravaged the country three years ago.

“We will undertake efforts to improve the infrastructure, training and retention of people trained within the health system in Liberia,” said Onyema Ogbuagu, a medical school professor involved in Yale’s efforts. “We hope, through our robust approaches, to help Liberia create a resilient and responsive health care system that prepares the country for the next disease strike.”

The nation is still recovering from the Ebola crisis of 2014–15, an epidemic that took the lives of more than 4,000 people in the country. Since the health care workforce disproportionately contracted the disease, Liberia currently has the lowest health-care-provider-to-population ratio in the world, according to Ogbuagu. The last formal count found a ratio of 40 doctors to about four million people, he added.

The $1.2 million in funding from the World Bank — renewable for an additional four years after June 2018 — will be used to hire physicians both from the West African region and from the U.S. to become faculty in Liberia’s sole medical school, A.M. Dogliotti College of Medicine. The five-year, $2.5 million HRSA grant money will support program staff in developing a certificate program in health management and help fund specific programs, such as infectious disease training and HIV treatment programs.

Working with faculty in the Liberia College of Physicians and Surgeons, the Yale team will support the Liberia Healthcare Workforce Program in enhancing medical education both at the level of preclinical medical school training and in residency programs in internal medicine, according to medical school professor Kristina Talbert-Slagle SPH ’07.

In 2014, the government of Liberia and its Ministry of Health developed the Liberia Healthcare Workforce Program, a seven-year plan designed to strengthen Liberia’s medical education system. The program takes a multipronged approach in targeting the nation’s health infrastructure, improving the training of physicians and nurses as well as creating a new government agency for health administration.

“The untold story is that there are tons of Ebola survivors who, beyond having a stigma attached to them in the workplace and in their communities, often deal with long-term complications from infection, including mental health, ophthalmologic, neurological and musculoskeletal issues,” Ogbuagu said. “We hope to shore up the health care workforce, especially in infectious disease, so that the health care system can cater to this group of individuals who are suffering from these complications.”

Yale will be involved in reviewing the quality of education in medical schools and residency programs in Liberia, according to the the University’s press release about the grants.

A major issue that must be addressed is the almost 50 percent dropout rate during early medical training in Liberia, Ogbuagu said. Because this rate results from low numbers of faculty and poor learning environments in medical school, he added, the team will incorporate more robust evaluation tools for both faculty and students and residents, instituting remediation processes when necessary.

“We’ll perform assessments of the training facilities and hospitals in Liberia to figure out the major gaps in the health system, which include availability of specialists and subspecialists — such as mental health services and ophthalmology, availability of lab facilities and missing infrastructure needed to train physicians,” Ogbuagu said.

The team also hopes to introduce novel pedagogical approaches, according to Ogbuagu. For example, they would like to transition from original teaching models of dictated lectures to more engaging lessons, such as small group approaches and flipped classrooms. Talbert-Slagle will head a curriculum review in medical schools to incorporate elements that are not traditionally included, such as more in-depth basic science and research components in the curriculum, according to Ogbuagu.

“We are bringing faculty with expertise in pharmacology, neuroscience and community medicine to teach in Liberia and to mentor Liberian teaching apprentices, who will, with additional graduate training in Africa, eventually be positioned to become preclinical faculty in Liberia, as well,” Talbert-Slagle said. “This program has been designed to develop a sustainable pathway for Liberians to become basic science, preclinical faculty at the medical school.”

Working with doctors from the region offers multiple advantages, Ogbuagu said. In addition to being knowledgeable about local pathology, these local physicians are used to working in resource-negative settings, so they may have more realistic approaches and expectations and can deliver more locally relevant content in their curricula.

Moreover, this method may be cheaper than sending faculty from the U.S. to Liberia, he added. The team has already hired three generalist faculty and six subspecialists from West Africa.

Ogbuagu noted that Yale has been one of the key players involved in efforts to strengthen medical systems in countries throughout Africa, including Rwanda and Ethiopia.

“We want to position ourselves to be a leader in these kinds of efforts,” he said.

More than 10,000 people contracted Ebola in Liberia during the 2014–15 Ebola epidemic.

Amy Xiong | amy.xiong@yale.edu